Tools in Family Assessment
Qualities of an Assessment Tool 1. Easily utilized by the practitioner 2. Not time consuming to use 3.
Provide composite picture of family strength and needs
Family (Unit of Care)
Collecting, Storing, Processing Information Identify actual or potential health problems
Types of Assessment Tools 1. The Family Genogram
Develop plan to improve wellness of the family
Definition: a scheme or graphic chart representation of both the (1) genetic pedigrees of the family and (2) key psychosocial and interaction data using standardized symbols Limited role in assessing family function, but is best used to assess the family structure Essentially contains the ff information Record of names and roles of each member of the family o Extended family and households o Medical problems of each member of the family o Significant date in the family o More subtle information about the family o
Genograms Genograms graphically represents the family’s family tree, functional chart and family illness/history
FAMILY TREE Must consist of 3 or more generations and each generation is o identified by Roman numerals The 1st born of each generation is farthest to the left, with sibling o following to the right in order of birth The family name is placed above each major family unit o Given names and ages are placed below each symbol o One number of the family is of greater medical significance o because of an illness and he is known as the index patient and is identified with an arrow
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Date is indicated when the chart was developed so that ages would be adjusted over time Males should be listed 1 st (left to right) in the genogram o FUNCTIONAL CHART Gives a more dynamic image of the family – of the relationship of o the members Assess the totality of the family unit o Strengths (as in strong bonds b etween husband and wife) Weaknesses (as in presence of marital discord or separation of parents) Ability to withstand future stressful situations (knowing those who are actually living together in the household) FAMILY ILLNESS/HISTORY ILLNESS/HISTORY Denotes the presence of inherited diseases or familial tendencies o indicating potential problems in the family o
2. The Family APGAR
Definition: asses family function or dysfunction using a set o f 5 questions NOTE: Family map also assess family function and dysfunction o NOTE: APGAR is used for adults only o Assess the influence/impact of the illness to the family o Also helps the physician decide which families need more careful o assessment 4 basic situations where information about family relationships are needed 1. The family will be directly involved in caring for the patient E.g. post MI/CVA patients who need rehabilitation therapy E.g. Asthma, terminally ill, CVA 2. When treating a new patient in order to get information to serve as a general view of the family function 3. When treating a patient whose family is in crisis Family therapy for drug adducts 4. When a patient’s behavior makes you suspect a psycho-social problem possibly due to family dysfunction E.g. patients who have high clinic utilization (>9 visits/year) Lower APGAR SCORES (more dysfunctional family
2 Parts of APGAR Part I (APGAR – adaptation, partnership, growth, affection, resolve) Adaptation o Capability of the family to utilize and share inherent intra and extra familial resources E.g. has resources but doesn’t know hoe to use it Partnership o Sharing of decision making Measures the satisfaction attained in solving problems by communicating Growth o Refers to both physical and emotional growth Measures the satisfaction of the available freedom to change E.g. Family with adolescents Affection o How emotions like love, anger and hatred are shared between members Measures the member’s satisfaction with intimacy and emotional interaction that exist in the family Resolve o How time, space and money are shared Measures the member’s satisfaction with commitment made by other members of the family E.g. emotional blackmail of the patients Part II 1. Delineates relationship with other members 2. Identifies persons who can give assistance to the patient 3. Indicates conflict not revealed in part I Scoring 8-10 : highly functional family 4-7 : moderately dysfunctional family 0-3 : severely dysfunctional family
3. The Family Circle
How it is done? Physician grows a large circle and instructs the patient to draw o circles of their significant people in their lives Size of the circle: influence/significance to the patient Circle may be inside the patient’s on circle, touching or outside it Actual assessment occurs when the patient explains the diagram made
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Advantage: Physician can entertain another patient during the time the ot her patient is busy completing the family circle. Disadvantage: difficulty in interpreting the diagram due to lack of standards in this technique
4. FACES (Family Adaptability and Cohesion Evaluation Scale)
Definition: asses the family function using a self reported scale wherein the patient rates his or her family on 30 items on a 1 to 5 scale
5. FES (Family Environment Scale)
90 item questionnaire Separate class of family parameters are included in the results Compare health care results with family variable
6. Clinical Biographies and Life Chart
Definition: Tools used to facilitate to analyze the connection of the patient’s personal life with his health/sickness Life events and clinical events are put side by side according to dates of occurrence, the correlation may be seen Starts at birth o
7. SCREEM (Social,
Cultural, Religious, Economic, Educational,
Medical) Assess FAMILY resources Assess family’s capacity to participate in provision of health care or to cope with crisis Resources Pathology Isolated from extrafamilial SOCIAL Family member have well balanced lines Problem of over commitment of comminuation with extra familial social groups (friends, sports clubs, etc) e.g. chronically ill galit ang lahat, paano hihingi ng favor? Ethnic/cultural inferiority CULTURAL Cultural pride or satisfaction can be identified especially in distinct ethnic groups Rigid dogma/rituals RELIGIOUS Religion offers satisfying spiritual e.g. atheist experiences as well as contacts with extra
familial support group e.g. easy to accept that eventually they die (terminally ill) ECONOMIC Economic stability is sufficient to provide both reasonable satisfactions with financial status and an ability to meet economic demands of normative life events EDUCATION Education of family members is adequate to allow members to solve or comprehend most of the problems that arise within the format of the lifestyle established by the family Capability to understand MEDICAL Medical health care is abailable through channels that are easily established and have previously been experienced in satisfactory manner Curative aspect
Economic deficiency Inappropriate economic plan
Handicapped to comprehend
Not utilizing health care facilities/resources
8. ECOMAP
Assess COMMUNITY’s COMMUNITY’s resources Definition: tool used to graphically depicts the family’s connections with other families, organizations and institutions Genogram + family circle o Bends, tensions and host of OTHER relationship issue presents are o visualized Graphic picture of the family’s resources both emotionally and o financially Significance Designed to identify as many people that can be part of the o patient’s therapeutic support Determine the person most appropriate for the task Can open the way to calling a family network meeting or creating a surrogate support group o Show a person’s place in t he family and the community
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