Section of Supportive Hospice and Palliative Medicine Department of Family and Community Medicine University of the Philippines – Philippine General Hospital Manila
SHPM PROGRAM DOCUMENT (CFAT 012011-3)
COMPENDIUM OF FILIPINO ASSESSMENT TOOLS FOR CLINICAL PRACTICE & RESEARCH
SCREEM FAMILY RESOURCES SURVEY (SCREEM-RES)
AUTHOR/S: Manuel Medina Jr. and the Section of Supportive Hospice and and Palliative Medicine Medicine (SHPM) FILIPINO VERSION: The Filipino and English Versions were developed simultaneously. PURPOSE: To assess general family resources. DESCRIPTION: The SCREEM-RES was developed by M. Medina, Jr. M.D. and the Section of Supportive Hospice and Palliative Medicine, University of the Philippines – Philippine General Hospital (SHPM, UP-PGH). The goal was to develop a valid and reliable Filipino measure of family resources. It is primarily intended for family medicine and palliative medicine physicians. The items used in the construction of the MAPGAR were directly based on a review of relevant international tools and research, and the opinion and experience of the Section of SHPM in the assessment of family function. In particular, the review and evaluation of available materials materials focused on materials related to the SCREEM Method of Analysis of the family’s resources originally developed by Smilkstein (1978) and adapted by the Philippine Academy of Family Physicians, and materials related to family resources in times of crisis. The brief 15 item SCREEM-RES provides a measure of general family resources. It also includes 6 two-item subscales, representing the 6 domains of the original SCREEM Method of Analysis: Social, Cultural, Religious, Economic, Educational and Medical. SCORING: Each item is scored on a 0 to 3 basis using the following key: strongly agree = 3, agree = 2, disagree = 1, strongly disagree = 0. The scores for the all the items in the SCREEM-RES and its subscales are summed resulting in scores for the SCREEM-RES subscales subscales (Social, Cultural, Religious, Economic, Educational and Medical) and a total score for the entire SCREEM-RES. Higher scores reflect more adequate family resources – in general or based on the 6 dimensions measured by the subscales, and better family resource adequacy to adapt in times of crisis; while lower scores reflect more inadequate family resources and poorer family resource adequacy to adapt in times of crisis. The scores range from 0 to 36 for the entire SCREEM-RES (general family resources) and from 0 to 6 for the Social, Cultural, Religious, Economic, Educational and Medical subscales. Simplified Classification System: Many family medicine and palliative medicine clinicians are used to using simplified classification classification systems such as those used in the familiar Family APGAR. To address the requests for a simplified classification system for the SCREEM-RES, the following system is proposed. This proposed scoring system is developed in the same manner as the scoring system of original Family APGAR as proposed by Smilkstein- the scale is divided evenly into classes and the classification system is based solely on what appears to be most appropriate and conceptually conceptually correct; as opposed to an empirically empirically based division of the the scale. The author/s author/s recommends that for intensive clinical assessment and/or research, the actual scale should be used instead of the classification system. The total SCREEM-RES scores are grouped using the following key: Severely Inadequate Family Resources = 0 to 12, Moderately Inadequate Family Resources = 13 to 24, Adequate Family Resources = 25 to 36. For each of the domain subscales, scores can be grouped using the following key: Severely Inadequate Family Resources = 0 to 2, Moderately Inadequate Family Resources = 3 to 4, Adequate Family Resources = 5 to 6. RELIABILITY: The SCREEM-RES (Filipino Version) has excellent internal consistency. Cronbach alpha for the entire scale was 0.80. Subscales for social and religious family resources had modest split half reliability and internal consistency (rs and α between .60 and .63). Subscales for cultural, economic, and educational family resources had good split half reliability and internal consistency (rs and α between .77 and .92). The subscale for medical resources had a lower split half reliability and internal consistency (rs and α between .40 and .42). These initial findings, led to a re-evaluation of the items in the Medical subscale and a minor modification of o ne of its items (see notes below). Further reliability reliability studies are ongoing and/or planned planned by the author/s. VALIDITY: Preliminary evaluation of the SCREEM-RES (Filipino Version) in families of children with cancer shows that it has good correlation with general family function and satisfaction with family function as measured by the Filipino version of the or iginal 5 item Family APGAR. In another study involving the same sample population of families of children with cancer, the SCREEM-RES also correlated well with the quality of life of the patient, the well-being of the caregiver as measured by the WHO Index of Well Being, and the
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psychological reaction to illness of both the patient and the family caregiver. Construct validity was also achieved through the process of tool development and item selection based on expert opinion and the review of relevant international recognized tools and research. Further validation studies are ongoing and planned by the author/s. ADDITIONAL NOTES January 2011a: Initial studies using a sample of families of children with cancer who are being seen at the UP-PGH showed relatively lower reliability in the Medical Resources Subscale. Revaluation of the subscale led the author/s and study investigators to conclude that this problem may be due to some confusion regarding the 2 items of the subscale. It is likely that the first item was viewed referring to the availability and access to medical resources in the community, while the second item was viewed as referring to the help being received from physicians and health care providers in general – including help being received in PGH. Based on this, the following modification was made: the second item of the Medical Resources Subscale will clearly indicate that the item refers to resources in the family’s own hometown or community. “Natutulungan kami ng mga doctor, nars, at health workers” (“We are helped by doctors, nurses and health workers”) was modified to “Natutulungan kami ng mga doctor, nars, at health workers sa aming komunidad” (“We are helped by doctors, nurses and health workers in our community”). January 2011b: Initial studies using a sample of families of children with cancer using the introductory phrase “Simula ng nagkasakit ang isa sa amin sa pamilya” (“Ever since a member of our family became sick”). The author/s of the tool have suggested that this phrase, or the phrase ”Simula ng nagkasakit si ___” (“Ever since ___ became sick”) for similar populations of patients and families. However, the author/s also recommend a more generic phrase “Kapag may nagkakasakit sa aming pamilya” (“When someone in ou r family gets sick”), for a more general population of families. ADMINISTRATION: The tool can be answered by adults and older children (preadolescents and adolescents); patients and/or family caregivers. It can be administered in a number of fo rmats, including traditional “paper and pencil” format (either self-administration or research-staff interview – face to face, telephone, or internet based interview) and electronic formats and Web-based applications. PRIMARY REFERENCES: 1) M Medina and the Section of Supportive Hospice and Palliative Medicine (SHPM). SCREEM Family Resources Survey (SCREEM-RES). SHPM, DFCM, UP-PGH. 2010. 2) M. Medina, A Panganiban-Corales, L Nicodemus, and A Ang. Family Resources Study: Part 2: Development and Evaluation of the SCREEM Family Resources Survey (SCREEM-RES). SHPM Research Document (FAM 012010-2). Section of Sup portive Hospice and Palliative Medicine (SHPM), DFCM, UP-PGH. 2010. In addition to the primary reference, this document can be cited as fo llows: M. Medina and the Section of Supportive Hospice and Palliative Medicine (SHPM). The SCREEM Family Resopurces Survey. SHPM Program Document. Compendium of Filipino Assessment Tools for Clinical Practice & Research (CFAT 012011-3). SHPM, DFCM, UP-PGH. 2011. AVAILABILITY: Permission to use the SCREEM-RES should be obtained from the author/s. The SCREEM-RES is in an early stage of development. In order to maintain an organized program for further development and ensure appropriate use, use of the SCREEM-RES is mainly restricted to programmed studies within the SHPM. However, the authors also recognize the severe lack of easily available Filipino measures to assess family resources. Therefore, the author/s are amenable to the use of the SCREEM-RES in studies outside of SHPM as long as permission is obtained. Requirements include: submission of program / project / research plan or proposal to the author/s, changes or modifications to the plan or proposal as required by the author/s; regular updates; citation of the role of the author/s in the program / project / research, and as co-author; and submission of the final draft of report or paper for suggestions prior to final approval. No fees apply to nonfunded clinical and research programs. No changes or modifications to the content, format, scoring and interpretation of scores of this assessment tool are allowed by the author/s.
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SCREEM FAMILY RESOURCES SURVEY (SCREEM-RES) – FILIPINO
Kapag may nagkakasakit sa aming p amilya …
S1 S2
C1 C2
R1 R2
E1 E2
E’1 E’2
M1 M2
Matinding Sumasangayon
Sumasangayon
Hindi Sumasangayon
Matinding Hindi Sumasangayon
Kami ay nagtutulungan sa isa’t isa sa aming pamilya. Natutulungan kami ng aming mga kaibigan at kasamahan sa komunidad Ang aming kultura ay nagpapatatag ng loob ng aming pamilya Ang kultura ng pagtutulungan at pagmamalasakit sa aming komunidad ay nakatutulong sa aming pamilya Ang aming pananampalataya at relihiyon ay nakatutulong sa aming pamilya Natutulungan kami ng aming mga kasamahan sa simbahan o mga grupong relihiyoso Sapat ang naipong pera ng aming pamilya para sa aming mga pangangailangan Sapat ang kinikita ng aming pamilya para sa aming mga pangangailangan Sapat ang aming kaalaman upang maintindihan ang mga impormasyon tungkol sa sakit. Sapat ang aming kaalaman upang maalagaan ang may sakit. Madaling makakuha ng tulong medikal sa aming komunidad. Natutulungan kami ng mga doktor, nars, at “health workers” sa aming komunidad.
PARA SA DOKTOR S C R E
E’ M TOTAL
Manuel Medina Jr. MD and the Section of Supportive Hospice & Palliative Medicine, University of the Philippines-Philippine General Hospital, Manila. 2010.
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SCREEM FAMILY RESOURCES SURVEY (SCREEM-RES) – ENGLISH
When someone in our family gets sick …
S1
We help each other in our family
S2
Our friends and people in our community are helpful to our family
C1 C2
R1 R2
E1 E2
E’1
E’2
M1 M2
Strongly Ag ree
Ag ree
Dis agr ee
Strongly Disagree
Our culture gives our family strength and courage Our culture of helpfulness, caring and concern in our community is helpful to our family. Our faith and religion are helpful to our family Members of our church and/or religious groups are helpful to our family Our family’s savings are sufficient for our needs Our family’s income is sufficient for our needs Our knowledge and education is sufficient for us to understand the information about the illness Our knowledge and education is sufficient for us to take care of our sick family member Medical help is readily available in our community. Doctors, nurses and/or health workers in our community are helpful to our family
FOR THE DOCTOR S C R E
E’ M TOTAL
Manuel Medina Jr. MD and the Section of Supportive Hospice & Palliative Medicine, University of the Philippines-Philippine General Hospital, Manila. 2010.
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