Title: Primary Health Care

PRIMARY HEALTH CARE

● Addresses the main health problems in the community, providing promotive, preventive,
curative, and rehabilitative services
● In R.A 11223 also includes palliative services
● Includes at the very least education concerning prevailing health problems and methods
of prevention and control, promotion of food supplies and proper nutrition, an adequate
supply of safe water and basic sanitation, maternal and child health care, including
family planning, immunization against the major infectious diseases, prevention and
control of locally endemic diseases, appropriate treatment of common diseases and
injuries, and provision of essential drugs - Another important feature of such primary
care in the community is its continuity over long periods of time; this builds a special
relationship between practitioners, patients, and their families.

PRIMARY CARE PHYSICIAN

● Doctor to whom a patient first turns when ill or when seeking advice on personal health.
● Primary care practitioners who come to know several members of the same family in the
course of their practice are more able to use this knowledge of the family's state of
health, its resources, relationships, and perception of health when members of the family
turn to them, from time to time, for care.
● The doctor's interest often extends to the school and other institutions in the community,
as resources in the care of individual patients.

COMMUNITY MEDICINE
● The provision of health care in the community, i.e., the practice of medicine outside the
hospital, is sometimes equated with community medicine.
● Discipline concerned with the prevention of disease, the determinants of health and
natural history of disease in populations and influence of the environment and of society
on health and disease.
● We use the term “community medicine” with a different connotation to signify health care
focused on population groups rather than on individual patients.
● Community medicine has its roots in the disciplines of public health and medical
administration.
● Community medicine may be distinguished from other forms of personal health care in
the community in that its interest is centered on the community as a whole and on the
groups of which communities are composed.

4 ESSENTIAL ELEMENTS OF COMMUNITY MEDICINE PRACTICE

 1. Community as the unit of analysis and solution
2. Provision of accessible and appropriate health services. Barangay Health Emergency
Response Team (BHERT)
3. Participatory social development.
4. Community-based physicians working collaboratively with professionals and
paraprofessionals to achieve health development.

CARDINAL QUESTIONS FOR PRACTITIONERS OF COMMUNITY MEDICINE

1. What is the state of health of the community?
2. What are the factors responsible for this state of health?
3. What is being done about it by the health service system and by the community itself?
4. What more can be done, what is proposed, and what is the expected outcome?
5. What measures are needed to continue health surveillance of the community and to
evaluate the effects of what is being done?

COMMUNITY DEVELOPMENT CONCEPTS

KEY CONCEPTS TO AFFECT CHANGE

● Empowerment
● Communication
● Issue selection
● Creating social consciousness

PRINCIPLES IN COMMUNITY ORGANIZING

● Principle of Felt need
● Principle of participation
● Principle of Leadership
● Principle of Structure
● Principle of Evaluation

COMMUNITY AS PARTNER

● “The community is NOT a CLASSROOM, for the medical students to fulfill their
academic requirements. The community is NOT a LABORATORY, for the school to
experiment with different approaches; the community is NOT a CHARITY CASE, to
passively receive dole out projects. Rather, the COMMUNITY is an ACTIVE PARTNER
in its social development which include health and access to health care.”

● The “future” pattern (of community medicine) consists of a complex, highly organized
and multidisciplinary system in which the university is used as a social instrument to
achieve social as well as health objectives. In fact, socioeconomic development, in which
health is included, becomes the major objective… and matters such as equity and the
quality of life are major motivating force (Willoughby Lathem, M.D. 1978).
COMMUNITY-ORIENTED PRIMARY CARE (COPC)
● Strategy whereby elements of primary health care and of community medicine are
systemically developed and brought together in a coordinated practice.
● Features of COPC like continuity care, suitable arrangements for consultative services,
specialist care and hospitalization necessitate competencies to navigate the resources,
address barriers and hazards that may affect the care for individuals and families in the
community.
● Unifies two forms of practice: the clinical care of individuals in the community and
aspects of community medicine.
● The clinical care provided by primary care physicians may include promotive, preventive,
curative, and alleviative functions, but the dominant function is care of the ill or disabled
patient who turns to them for treatment.
● The five attributes that are essential to the practice of good primary care, according to a
definition of primary care prepared by the Institute of Medicine of the National Academy
of Sciences of the United States: Accessibility Comprehensiveness Coordination
Continuity Accountability
● Systematic approach to health care based upon principles derived from epidemiology,
primary care, preventive medicine, and health promotion

CARDINAL FEATURES OF COPC

1. The provision of primary clinical care for individuals and families in the community, with
special attention to the continuity of care. Suitable arrangements need to be made for
consultative services, specialist care, and hospitalization.
2. A focus on the community as a whole and on its subgroups when appraising needs,
planning and providing services, and evaluating the effects of care.

FIVE ESSENTIAL FEATURES OF COPC

1. The use of epidemiologic and clinical skills as complementary functions; both the
epidemiologic and the clinical activities should be of as high a standard as possible.
2. Definition of the population for which the service is or feels responsible. This defined
population is the target population for surveillance and care and the denominator
population for the measurement of health status and needs and the evaluation of the
service.
3. Defined programs to deal with the health problems of the community or its subgroups,
within the framework of primary care. These community health programs may involve
health promotion, primary or secondary prevention, curative, alleviative or rehabilitative
care, or any combinations of these activities. The programs are based on the
epidemiologic findings.
 4. Involvement of the community in the promotion of its health. Community involvement
may be seen as a prerequisite for the satisfactory and continued functioning of a COPC
service.
5. Accessibility that is not limited to geographic accessibility (the COPC practice should
ideally be located in the community it serves) but that refers also to the absence of fiscal,
social, cultural, communication, or other barriers.

TRUE COPC IMPLEMENTATION

● A primary care practice providing accessible, comprehensive, coordinated,
continuous-over- time, and accountable health care services
● A defined community for whose health the practice has assumed responsibility
● A process including the following:
○ Defining and characterizing the community
○ Describing community health problems
○ Modifying the health care program to address high-priority health needs (national
to local)
○ Monitoring the effectiveness of program modifications.

COMMUNITY

The “community” in COPC may be any of the following (in order of preference):
● “True” community, in the sociological sense
● Defined neighborhood
● Workers in a defined factory or company, students in a defined school, etc…
● People registered as potential users of a physician’s group practice, health maintenance
organization, neighborhood, or other defined service
● Users of defined service or repeated users of the service
● Community goes beyond geographic definition but may be a population

FOUR GENERAL DOMAINS OF COMMUNITY SERVICE

● Recognition of and intervention in the community’s health problem.
● Awareness of the health beliefs of local cultural groups.
● Coordination of community’s health resources and collaboration with other health
professionals - Assimilation into the community and participation in its organizations.

COMMUNITY-BASED PRIMARY HEALTHCARE

● This definition of an area or population for which the practitioner or team is responsible
makes it possible to go further and to characterize the community in terms of its
demographic and other characteristics—knowledge that is essential for the use of
epidemiologic methods in community diagnosis, in health surveillance, and in the
evaluation of health programs focused on changing the community's state of health.
● Primary care services that are situated in the communities they serve are in the main
concern with the health care of people who live nearby. This proximity is important; it
 makes it easier for people to come for personal health care or to attend group
discussions or community meetings.
● For older or disabled people and for mothers with their babies and toddlers, it is
especially important that the service should be within easy walking distance or within
easy reach by public transport.
● Proximity facilitates home visits by the health team, for home care of the sick, for family
and group health discussions, and as part of preventive and promotive programs. -
These relationships may promote community involvement in accepting responsibility for
important aspects of its own health.
- When a service is located within the community, the area or people for whom a practitioner or
health team is responsible may be relatively easy to define. - A health team that works with a
small defined population may readily come to know the primary groups 4 and health-relevant
social networks of the community.
- If each practitioner or health team has responsibility for a defined population or geographic
area, this may counteract one of the major deficiencies of modern health care.

“Generally no one person or institution accepts the responsibility for the health of a community
or population. It is this acceptance of responsibility that distinguishes COPC from much of the
primary care that is so common today, characterized by the episodic care of those patients who
seek care when sick.”
TOPIC OUTLINE WHAT IS PFC MATRIX

I. PREVENTIVE, COMMUNITY, AND

FAMILY MEDICINE
II. WHAT IS PFC MATRIX
a. Historical Background
b. Uses of Matrix
c. Patient-centered Care
d. Family-Focused Care
e. Community-oriented Primary
Care
III. CONCLUSION -Patient case analysis using the
Patient-centered, Family-focused and
PREVENTIVE, COMMUNITY AND FAMILY Community-oriented (PFC) Matrix
MEDICINE (PFCM)
• novel teaching strategy that was
designed to simplify the learning of process of
integrating the biopsychosocial information
gathered in the medical interview to come up
with holistic management of the patient.

• This cognitive framework aims to

enable learners to develop the competence of
providing comprehensive care for every patient
encounter in different settings, particularly in
primary care.

• The use of the matrix was

implemented in the educational programs of
both undergraduate medical education,
residency training and postgraduate degree of
the University of the Philippines College of
• Health and Wellness is the same concepts in
Medicine and Philippine General Hospital
Preventive Medicine
respectively spearheaded by the Department of
• Preventive medicine is about risk assessment Family and Community Medicine.
and risk stratification.
- Patient-centered - when we look at an
• After identifying these, we promote the individual as patient.
well-being of a person by diet modification.
- Family - focused - family as ally of care.
Both individual and population - based
promotion by health promotive campaign or • Family is not only blood-linked, but
care. also people sharing common goals. (Same sex
union where one act as father or mother for a
common goal is to rear a child)
 • Family is linked to marriage, a contract
- based where they share common goal of
procreation.

• Each family belonging to a community

- Psychosocial - aspects of dealing with families

and patients

-Biopsychosocial (BPS) approach to care is one 2000 Regular -brown-bag"

of the methods to promote case discussions
patient-centeredness. ● conducted
with clinical
• It is a perspective that patient's clerks and
concern cannot be taken in isolation but rather, residents in
both biomedical and psychosocial aspects of training at
patient's predicament may affect the impact of the
the disease and should be considered when Department
planning delivery of care. of Family and
Community
• Direct application of concepts to
Medicine
patient care, improved communication skills,
University of
and critical thinking skills were the positive
the
educational values identified using this method.
Philippines-P
-Biopsychosocial model has been integrated in hilippine
the medical curriculum through variety of General
teaching methods: Hospital
(DFCM
• Lectures UP-PGH)
• Small group discussions ● introduced
an organized
• Clinical encounters method of
• Inter-professional education analyzing
selected
patient cases
seen at the
OPO of the
Department
using a
biopsychosoc
ial lens
● The matrix
followed the
Subjective-O
bjective-Asse
HISTORICAL BACKGROUND ssment-Plan
(SOAP)
 commonly biopsychosocial
used as approach
freestyle-pati
ent charting Significant insights to
method. this experience were:
● These case 1) applicati
discussions on of
enabled concepts
different to actual
types of patient
learners to care
develop a 2) understa
lens for an nding of
integrated family
biopsychosoc case
ial case reports
analysis. as
● This was the method
birth of the of
PFC Matrix teaching
that took the 3) need for
centerstage deeper
of teaching learning
the on social
biopsychosoc contexts
ial approach of
(BPS). patients

2003 The same matrix 2010 First Textbook of

mentioned previously Family Medicine of
was used to analyze a the Philippine
published case study Academy of Family
of a family with a Physicians (PAFP)
member afflicted where the PFC matrix
with HIV. was introduced to
● This was the concretize the
first in many concepts and
papers that principles of family
medicine.
will use the
2016 Family Health Unit
matrix to
(FHU) of DFCM
dissect both
UP-PGH
clinical and
- Where family
family cases. focused care is
2013 PFC matrix was used practiced
in teaching
● The PFC enabling
matrix was factors
the method and/or
used on barriers in
teaching the family
trainees dynamics and
biopsychosoc community
ial resources for
perspectives the delivery
in managing of care.
chronic
management 2017 2017 PFC matrix was
introduced as part of
of geriatric
the faculty
patients with
development topics
knee
of the DFCM UP-PGH
osteoarthritis ● The series of
, adolescents workshops
with learning elicited ideas
and on the
development enhancemen
al disabilities, t of the
psychosocial contents of
support for matrix to
families with account for
deliberating expansion of
and chronic its use in
diseases. teaching and
● Evaluation learning of
tool was family and
developed to community
evaluate the medicine on
ability of the both the
medical undergraduat
students to e courses and
gather residency
biomedical training.
data and
relevant 2018 2018 PFC matrix has
psychosocial been cascaded to the
issues different family and
attendant to community medicine
patient's trainers in Luzon,
medical Visayas and
conditions to Mindanao
include
USES OF MATRIX

To date, the matrix has been used in several

ways:

- Teaching Method

• to enhance understanding of the

biopsychosocial approach in the
undergraduate course

- Framework for biopsychosocial analysis

• of clinical cases in different settings in

residency training

- Curriculum Framework

• for the practice-based family and

community medicine training program.

- Biopsychosocial Patient Chart

• for family health units or family health

care programs

- Community Medicine as a field of

specialization doing medical mission (traditional
way)

- Health education and Surgical mission are

good substitute of medical mission.

- Biopsychosocial analysis — deals with

psychosocial determinants
PATIENT CENTERED whole person to enable physician
tailor-FA disease management.
o • Such approach includes
identification and addressing
misperceptions of patients
about their health through
health education and
counseling.
- Catharsis-Education-Action (CEA)
technique
o • Psycho-educational method
o • Developed based on the
client-centered approach.
- Patient-centeredness is core to family
o • Aims to address identified
practice.
barriers from emotional
- It means having the patient at the
misperception of patients to
center of consultation process by
enable positive behavior and
creating a safe environment in which
action towards personal health
the patient will be able to express
and wellness.
accurately the disease and illness
o There are phases through which
experience. –
we should allow patients to
- Studies have shown that this type of
vent out -> Catharsis
doctor-patient relationship is correlated
o When patients start to diffuse
with good patient outcomes
their energies totally -> you can
- The processes pertaining to
now ready educate person or
patient-centeredness include:
not
o exploring perceptions of
o After active listening skills ->
patients about the illness in the
mindsets begin to change -> Do
history-taking
action
o providing information and
- Other techniques toward health
explanatory statements
promotion: motivational counselling for
regarding the disease by
smoking cessation, dietary and lifestyle
physicians.
lunge.
- Processes includes exploring
o Are interventions without
perceptions of the patients about the
discounting the implementation
illness.
of evidence-based standards of
o This is the first task to legitimize
ca e according the all levels of
patient-centered care
care utilizing clinical practice
- The first question we should talk to the
guidelines to properly
patient "Naiintindihan po ba Ninyo ang
addressing the biomedical
sakit natin?", "Ano po so tingin natin
disease
ang problem po”
- Stages of Change
- Look for quality assurance indices
- The most essential part of PRE-CONTEMPLATIO No intention of
patient-centered care is understanding N changing behavior
and consideration of the patient's
 We cannot change o Individual therapy, couple
the mind or person if therapy, and family therapy to
that person in pre treat a broad range of
contemplative emotional and behavioral
change. problems
CONTEMPLATION Aware that a problem o Focuses on Cognitive Behavioral
exists but with no Therapy (CBT), Dialectical
commitment to Behavior Therapy (DBT), and
action Mindfulness practices
PREPARATION Intent on taking - PhiISPEN (Philippine Society for
action to address the Parenteral and Enteral Nutrition
problem
o improving patient care through
ACTION Active modification
correct and appropriate
of behavior
implementation of nutritional
MAINTENANCE Sustained change,
management to in-patient,
new behavior
out-patient, or
replaces old
intermediate-care patients by
RELAPSE Fall back into old
patterns of behavior using a multidisciplinary
approach to nutrition
management, which includes
- These are all behavioral counselling the correct and appropriate use
techniques of enteral and parenteral
- Exercise Prescription nutrition.
o Based on individual needs, o Recognition and treatment of
goals, interests, and clinical malnutrition
status o Reduction of mechanical and
o This involves behavioral metabolic complications of
modification and exercise enteral and parenteral nutrition
preference o Reduction of morbidity and
o Modification based on mortality
individual response and o Reduction in the cost of
adaptation providing nutrition support by
o Long term compliance is appropriate use of enteral and
ultimate goal parenteral nutrition
- Diet Prescription o Provision for more
o The principle is based on low cost-effective selection of
carbohydrate and high fat products
intake and will be tailored to o Reduction in length of stay and
individual nutritional costs to the hospital
requirements
o Examples are traditional Components Patient-centered
ketogenic diet, modified Data Relevant clinical
ketogenic diets, and dietary fine histories
Physical findings
tuning
Context of
- ASPEN (Behavioral Health)
psychosocial issues
 (individual) such as
emotions attendant
to the health
condition including
bioethical issues
Analysis Salient
clinical features and
psychosocial,
bioethical issues
Analysis Salient clinical
features and
psychosocial,
bioethical issues, etc.
- Heredofamilial diseases: always
Diagnosis/ Medical diagnosis
Conclusion/ Psychosocial included from the time the
Assumptions diagnosis (using ICS V history-taking during physical diagnosis
Codes) is taught.
Management Comprehensive o The introduction of Family
/Interventions medical interventions Medicine residency training in
based on evidence 1974, led to the realization that
and standards of care the family plays a bigger role in
(encompassing all health and disease
levels of care) - In addition to genetics, common
environmental exposures and shared
Individual health behaviors and resources allow
psychosocial the family to contribute to its individual
interventions such as members health.
psycho-educational - How illnesses or diseases impact family.
approach (CEA), - The family plays a bigger role in health
motivational and and disease and is our greatest ally in
behavioral counseling
healthcare.
etc. appropriate to
o A family member is present in
address the identified
the consultation room, in the
issues
wards or hospital room when
admitted, will help carry out
FAMILY FOCUSED CARE plan of management when
patient is sent home.
o For example, lifestyle
modification needs family
cooperation and out of pocket
expense is borne by the family
- Topics that are very important in
enhancing the understanding the
families of patients:
o The family as unit of care
o Family structure and function
 o family psychodynamics - Management of problems which
o family as a system highlight the focus on family shall
o impact of illness in the family include:
- The following tools for family o health education for the
assessment were introduced: members of the family
o family genogram which o primary counseling
included the family tree, o family meeting
heredofamilial diseases, who o family counseling
among the members are living o capacity building for the
together caregiver
o family map which shows
relationship among members Components Patient-centered
o the family Adaptation, Data Assessment of family
psychodynamics
Partnership, Growth, Affection
using family
and Resolve (Family APGAR)
assessment tools,
which measures the level of
family systems
satisfaction of members in 5 assessment
functions of the family (Structure, Flexibility,
o Family circle where the size and Resonance, Ecological
distance of circles can give clue context,
on degree of closeness of Development
members and can be used even -STFRED)
for children Analysis Salient features of
o family Social, Cultural, the family dynamics
Religious, Economic, Education and/or family
and Medical (Family SCREEM) systems assessment
which when described Diagnosis/ Summary statements
positively can be strengths or Conclusion/ of the issues
resources to solve the problems Assumptions identified in the
and when discussed negatively assessments done
can be weaknesses or possible (both enabling and
cause of the problems barriers to care)
- The family to contribute to its individual Management/ Family interventions
members health. Interventions to address both
medical and
- A family member is present in the
psychosocial issues
consultation room, in the wards or
identified.
hospital room when admitted, will help
COMMUNITY ORIENTED PRIMARY CARE
carry out plan of management when
patient is sent home.
- Working with families brings us to a
higher level of issues.
o Close knit family went together
for a check-up of a family
member.
 - A family physician should be able to
provide assessment of the following,
that may affect the patient's condition,
which can be facilitated using SCREEM
and ECOMAP:
o assessment of the general
sociocultural determinants
o living and working conditions
o environment
o Sanitation
- The building blocks of health system
- An integration of clinical science and such as
public health o service delivery
- Systematic approach (in the analysis of o health workforce
individual and population-based care) o health information system
particularly community diagnosis o access to essential medicines
- Based on the principles derived from o financing and
epidemiology, primary care, preventive leadership/governance within
medicine, and health promotion the locality of the patient
- COPC systematically puts together the affecting the existing medical
elements of primary health care and condition
community medicine in a coordinated - are analyzed to provide the bases for
manner. summary statements or conclusions
- Patient and/or families understanding that can be both enabling and/or
of their ecological and political barrier to the provision of care.
environment however limits this - Patient and/or families understanding
component of the PFC matrix. of their ecological and political
- Elements of Primary Health care + environment however limits this
community medicine component of the PFC matrix
- The core of the practice of family - Features of COPC
medicine is at the level of grassroots. o continuity of care
- In the context of the PFC matrix, o suitable arrangements for
community-orientedness borrows from consultative services
principles of the COPC. o specialist care and
o Community-orientedness uses hospitalization necessitate
the social determinants of competencies to navigate the
health (SOH) and the World resources
Health Organization (WHO) o address barriers and hazards
building blocks as lens in the that may affect the care for
analysis of the health system individuals and families in the
relevant to the presented community.
medical and psychosocial issues - Short-term and long-term solutions to
of the individual patient and overcome the barriers or facilitate the
family enabling effects of the identified social
determinants and components of the
 building blocks of health systems are increasing fragmentation of the
dependent on the existing health system is essential in the
programs implemented by the local achievement of universal health
government that can be tapped. care.
- Physicians' knowledge on patient's - The PFC matrix provides trainees from
rights, health laws, patient support the medical clerkship level through
groups and government and residency and eventual clinical practice,
non-government health programs is a simple and practical tool to look at the
also an advantage so s to enable patient's medical problem in the
referral, collaboration context of the Family and community
o This system’s thinking would
Components Patient-centered hopefully pave the way for the
Data Assessment of social generalist physicians and family
determinants of
and community medicine
health and building
practitioners in the frontline to
blocks of a health
better embrace the concept of
system relevant to
the presented linked health care delivery units
medical and in the different tiers of the
psychosocial issues of service delivery network.
the case - In this way, while centering on the
Analysis Salient features of patient's condition and management,
the assessments on they see the bigger context of care for
the social the patient in terms of his/her family
determinants and and community.
building blocks of a - In the Philippines, we need to be
health system realistic with our expectations in the
Diagnosis / Summary statements social determinants to health.
Conclusion / of the issues - A physician using an integrative lens in
Assumptions identified in the the care of a patient by mobilizing the
assessments done family and helping them navigate
(both enabling and necessary community resources can
barriers to care) help in care coordination, lesser
Management/ Interventions (COPC duplication and maximization of
Interventions based) to address the resources.
issues identified
- The matrix contributes to a better
(existing and
realization of UHC through hopefully
proposed).
paving the way for the medical
practitioners to better embrace the
CONCLUSION concept of linked health care delivery
units in the different tiers of the service
- Biopsychosocial approaches play a vital delivery network.
role in the universal health care - It is necessary to document the
achievement. experiences in using the PFC matrix in
o Espousing the biopsychosocial various teaching learning activities such
approach to care in the light of as bedside rounds, clinical
 preceptorships, case discussions and get
mentor and learner feedback of its
effectiveness as a teaching tool.
- It is also imperative to conduct
researches on how using the PFC matrix
can help improve patient outcomes,
family participation in care and optimal
utilization of community resources to
aid the patient on the road to wellness.
Title: COPC Discussion

WHAT DOES COPC MEAN TO YOU?

- A continuous process by which primary health care is provided to a defined community on the basis of
its assessed health needs by the planned integration of public health with primary care

- COPC is a strategy whereby elements of primary health care and of community medicine are
systemically developed and brought together in a coordinated practice. Unifies two forms of practice: the
clinical care of individuals in the community and aspects of community medicine

DOC: So what common words were described? you have the elements of primary care. Can anyone
answer what primary care is? We have one common word no which is the primary care. What are the
elements of primary care based on your reading?

ANSWER: The elements are education, water and sanitation, nutrition, maternal and child health,
immunization, prevention of endemic diseases, treatment and drug availability.

PRIMARY HEALTH CARE

∙ is a whole-of-society approach to health that aims at ensuring the highest possible level of health and
well-being and their equitable distribution by focusing on people’s needs and as early as possible along
the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative
care, and as close as feasible to people’s everyday environment (WHO and UNICEF)

8 ELEMENTS OF PRIMARY HEALTH CARE (PHC)

E Education concerning prevailing health problems and the methods of identifying, preventing,
and controlling them.
L Locally endemic disease prevention and control.
E An expanded program of immunization against major infectious disease
M Maternal and child health care including family planning
E Essential drugs arrangeme
N Nutritional food supplement, an adequate supply of safe and basic nutrition.
T Treatment of communicable and non- communicable diseases and the promotion of mental
health
S Safe water and sanitation

- Extended Elements in the 21st Century:

∙ Expended options of immunizations.
∙ Reproductive health needs.
∙ Provision of essential technologies for health.
∙ Health promotion.
∙ Prevention and control of non-communicable diseases.
∙ Food safety and the provision of selected food supplements.
DOC: what's your source and what do you think is the level of evidence of the expert opinion? You have
had your evidence based right on your basic epidemiology and I’m sure you were taught the levels of
evidence or the hierarchy of evidence of which the highest is the systematic review.

ANSWER: 4

DOC: What are the levels of primary care? So this session is intended for integration for you to have a
refined foundation because COPC is the endpoint of the PFC matrix and if we do not know the basic
concepts, we will not be able to understand what COPC is. Let's look for a higher level of evidence of
what are the elements of primary care

LEVELS OF PRIMARY HEALTHCARE

∙ Health Promotion
∙ Disease and Injury prevention
∙ Diagnosis and Treatment
∙ Rehabilitative Care
∙ Supportive Care

[Make sure class that each time you make ppt and you lift definition, make it a habit to document or
make a citation, use APA style 7th edition at least. More scholarly technique is you go to PubMed. Search
elements of primary health care + developing countries. We need to have a model that would suit the
categorization]

Background: District Health Network (DHN), one of Iran's most successful health reforms, was launched
in 1985 to provide primary health care (PHC), in response to health inequities in Iran. The present study
aims to use interrelated elements of the 3i framework: ideas (e.g., beliefs and values, culture,
knowledge, research evidence and solutions), interests (e.g., civil servants, pressure groups, elected
parties, academians and researchers, and policy entrepreneurs), and institutions (e.g., rules, precedents,
and organizational, government structures, policy network, and policy legacies) to explain retrospectively
how (DHN) policy in Iran, as a developing country, was initiated and formed.

For example, in the Iran model this is very good because you have a district health network. What is the
impact of the district health network in our local setting or in universal health care when we talk of the
SDM (Service Delivery Network). In Iran, probably the parallelism to SDM or HCPN is the district health
network.

In this journal, it talks of a developing country which is Iran about its district health network and they
mention elements of primary care within the context of the 3i framework. In this journal they are talking
about beliefs, values and culture. That's the reason why we have one question that talks about
ethnomedicine or you talk about social science or the social determinants of health. Or going back to the
family health care program that talks about SCREEM and part of SCREEM is culture. So, it hits the button
of your previous learning.

What else? knowledge, the ideas, research evidence and solutions so each time you are confronted with
concerns or issues like health issues what do you usually do? You look for levels of evidence. You
validate.

You now subject yourself to evidence based. Why do doctors in the Philippines have a hard time
accepting sudden changes of knowledge? It is because we are used with what they dictate upon or the
expert opinion.

What is the second “I”? so we have ideas, the interests.

What are some of the interests that this journal is pointing out. Civil servants. So how we define the civil
servants of the civil service those who work in the bureaucracy or sometimes sectoral groups.

What else? Pressure groups, elected parties, political parties, academicians, researchers, policy
entrepreneurs.

What is the last “I”? Institutions. What are the governing institutions and rules? What are some of the
precedents? And what are the government structures? Look into the structure of the government for
you to be able to learn the context.

In the era we are in particularly in the universal health care era, let us not disengage ourselves with the
common principle that health is a political issue. So, you have to know some of these policy legacies.

These are the three “I”’s the Idea, the interest, and institutions can explain how network based policy in
a developing country was initiated and formed and we can learn the best out of it and that’s primary
care in the context of service delivery network or in the network based model by a developing country
known as Iran.
There are clarifications and important information when you read the whole text. So, I can actually do
eyeball technique to look for the best answers. We are now able to answer COPC as a tool by looking at
health assessments among patients within perspectives of primary care.

IS FAMILY PRACTICE THE SAME WITH PRIMARY CARE PRACTICE?

- Family Practice
∙ Provide primary care services for the whole family
∙ Medical professional who specializes in family medicine is trained to meet the basic medical needs of
both children and adults, from newborns to seniors
- Whereas, Primary Care Practice…
∙ Is a patient’s primary source of treatment for medical concerns?
∙ Provide you with comfortable and reliable services when problems do occur when you are looking for
medical

ANSWER: Based on the 4.1 journals, family practice provides primary care services for the whole family
and also medical professionals specializing in family medicine are trained to meet the basic medical
needs of both children and adults from newborns to seniors. Whereas primary care practice is a patient's
primary source of treatment for medical concerns. Until when the patient faces death. Palliative or end
of life care, from womb to tomb.

DOC: So imagine these two words like a balloon (latex balloon) when you blow the balloon, it changes
shape. In analogy, who is the balloon? Family practice? or primary care practice?

ANSWER: Family care is under the primary care. The balloon is the primary care and the water inside is
the primary care.

DOC: Meaning to say, primary care practice is not exclusive for family medicine practice.

WHAT IS HEALTH DEVELOPMENT, SOCIAL DEVELOPMENT, OR COMMUNITY DEVELOPMENT? ARE THEY

INTERTWINED? ARE THEY DIFFERENT FROM ONE ANOTHER? WHERE ARE THE INTERSECTING POINTS?
Or we take it on a higher level, it’s called equity. In the SDG, what is the SDG in gender equality?

1. End discrimination against all women and girls

2. Eliminate violence against all women and girls
3. Eliminate all harmful practices such as child marriage
4. Recognize and value unpaid care and domestic work
5. Ensure women’s participation in leadership and decision making
6. Ensure universal access to sexual and reproductive health and right

How do you differentiate equality from equity?

ANSWER: For equality it is more on providing equal opportunity not necessarily providing the same
outcomes but for equity, providing specific opportunities to reach equal outcomes.

DOC: In short, if we have a pie, regardless of our cravings for that pie, we get equal share, that’s equality.
If we were given then you started asking who wants a share of a pie, some would say no (busog pa),
some would say that’s my favorite and then you start to slice the pie according to their needs in
accordance to their needs and that is equity.

PHILIPPINE HEALTH OBJECTIVES

1. Financial protection for Filipinos especially the poor and protected from high cost of healthcare.
2. Better health outcomes, Filipinos having the best possible health outcomes with no disparity.
3. Responsiveness. Filipinos feel respected, valued and empowered in all their interactions with the
healthcare system.

DOC: our health objectives are the same with health outcomes. These are your national objectives. Each
goal has an indicator. We would want to have a more defined objective.

It is to reach the average life expectancy of 72 years old in 2022 or 90 maternal mortality ratios for 1000
live births. So, your objectives are your indicators. So, the indicators are measures that when you turn
them into objectives. So, there are several objectives in one strategy.

Look at the national target for TB incidence, the target is 427. In 2016, 434 - 427, so about 7% decrease
by 2022.

Under strategic goal number 2, client satisfaction rate, provider responsive score to be determined by
commission study. Now we have that under LGU score cards particularly with the roll out of universal
health care policies.

For strategy number 3, financial risk protection or equitable health financing, so out of pocket
expenditure. How do you define out of pocket?
ANSWER: For example, in Phil health insurance, you are discharged and you have to pay 40,000 Php and
your Phil health coverage is just 30,000 so your out of pocket amount will be the remaining amount
which is 10,000 Php.

National Objectives for Health 2017-2022 Impact Indicators

Strategic Goal 1: Better Health Outcomes
Indicator Data Source Baseline 2022 Target
Indicator 1: Average life PSA 70 (2010- 2015) 72
expectancy (in years)
Indicator 2: Maternal mortality UN Estimates 114 (2015) 90
ratio per 100,00 live births
Indicator 3: Infant mortality rate PSA-NDHS 23 (2013) 151
per 1,00
Indicator 4: Premature PSA-CRVS 118 (2014) 156
mortality attributed to
cardiovascular diseases, cancer,
diabetes, and chronic
respiratory diseases per
100,000 population
Indicator 5: Tuberculosis National TB 434 (2016) 427
incidence per 100,000 Prevalence
population Survey
Indicator 6: Prevalence of FNRI-DOST NNS 33.4 (2015) 21.4
stunting among under-five
children
Strategic Goal 2: Responsive health system
Indicator Data Source Baseline 2022 Target
Indicator 8: Provider TBD
responsiveness score
Strategic Goal 3: Equitable health financing
Indicator Data Source Baseline 2022 Target
Indicator 9: Out- of-pocket PSA Philippine 52.2 (2016) 50
health spending as National Health
percentage of total health Accounts (PNHA)
expenditure
Indicator 10: Percent of TB
population who have spent
less than 10 percent of their
HH income on health

WHAT IS ETHNOMEDICINE?
- Ethnomedicine is a term that refers to a wide range of health systems and structures, practices, beliefs,
and therapeutic techniques that arise from indigenous cultural development
- Ayurvedic medicine (India)
∙ to restore a person’s harmony and balance and cleanse their body
∙ Use of oils
∙ Massage
∙ Laxatives
- Traditional Chinese medicine
∙ Herbal therapy
∙ Acupressure
∙ Acupuncture

ANSWER: Ethnomedicine is a traditional medical practice concerned with cultural interpretation of

health, diseases, and illness that addresses the healthcare process and healing practices. In the
Philippines, ethnomedical knowledge is intrinsic among -ethnic groups and is inherited from their great
ancestors by oral communication. Examples of which are the albularyo, prayer healing, herbalism. Some
medicines approved by the DOH are the lagundi, guava, and garlic.

DOC: In India, there is Ayurveda, it’s actually a traditional form of medicine in India but they are licensed.
What’s good with India is that Ayurveda is a recognized form of medicine and they also have their
license.

When we look at ways in the systems level, there are certain degrees of practices because of culture.
Even if we have the best communicators, if we do not see it through the lens of culture, we will never
achieve a 70% vaccination rate.

If we peek through the lens of culture and we understand the cultural beliefs of vaccine hesitancy. If we
do not dig down into the deeper meaning into the deeper imagination of these beliefs, we will never get
a certain number of people getting their vaccine.

So, these are actually the social sciences that may actually aid understanding health inequities in the
Philippines. We are too rationalistic, and each region has their own regional beliefs.

Is the health system a simple issue or a complex issue?

The future of health in the Philippines is in you but you need to look at the systems level for you to be
able to penetrate some fields of medicine which for some are non-essential but in fact are essential and
are technically needed by the country to achieve improved health.

WHAT IS INTERPROFESSIONAL COLLABORATION?

- According to WHO, collaborative practice happens when multiple health workers from different
professional backgrounds work together with patients, families, careers, and communities to deliver the
highest quality of care across settings.
- Interprofessional collaboration is the practice of approaching patient care from a team-based
perspective.
- Interprofessional collaboration is defined as practice and education where individuals from two or
more professional backgrounds meet, interact, learn together, and practice with the client at the center
of care.
- Interprofessional collaboration is seen as potentially a powerful strategy for achieving optimal health
outcomes
With these learning experiences in the actual field, if you become doctors someday you have to
cooperate because they are part of the healthcare team. So, if you receive a referral even if that referring
facility only has a barangay health worker, talk to them because that’s part of interprofessional practice.

DOC: BEmONC is Basic emergency maternal and neonatal care. This is the standard practice of lower
health care facilities.

- The WHO Millenium Development Goals 4 and 5 aims to reduce by 75% the maternal and neonatal
mortality be having a birthing facility readily available as well as skilled birth attendants.

- administration of IM/IV antibiotics; administration of IV/IM anticonvulsants; administration of IM

oxytocin as part of the active management of third stage of labor; delivery of imminent breech; manual
removal of retained products of conception and blood clots; manual removal of retained placenta;
administration of antenatal steroids in premature and essential newborn care

PARTICIPATORY GOVERNANCE IN HEALTH

- Genuine engagement of citizens and other stakeholders to gauge expectations and opinions on health
related-matters
- policy-making, decision- making and implementations of these policies and decisions that contribute to
responsive and people- centered health systems.
- Entails bringing in the voice of end users of health services as well as the general population -- in
essence, all those affected by health reforms
- Fostered in the health sector through community and patient engagements, public-private
partnerships, and citizen’s charters

In the succeeding meeting, we will be looking at community definition of geographic and population
based so we will now try to look for a community partner.

What are some of the indications of what's the best community for community oriented primary care.
Remember what was the main principle of community medicine that community is not a laboratory but
rather it’s a preferential degree where engagement should be explored.

You are going to walk through on what is community diagnosis. Evaluation is midterm examination.
Introduce practice, demonstrate community diagnosis and we go for action planning, action program,
program evaluation and you will now select a community where you can come up with a community
oriented primary care output. We can visit actual communities where you would want to digest to have
their community diagnosis.

So it’s called a COPC presentation at the end before your final examination. We will also inject public
health and public health programs to cope with the needs and the demands for your board examination.
REFERENCES:

Yazdi-Feyzabadi, V., Bazyar, M., & Ghasemi, S. (2021). District health network policy in Iran: the role of
ideas, interests, and institutions (3i framework) in a nutshell.
Archives of public health = Archives belges de sante publique, 79(1), 212.
https://doi.org/10.1186/s13690- 021-00737-7

Department of Health (2018). National Objectives for 2017-2022, Table 1.3. National Objectives for
Health 2017-2022 Impact Indicators. p30. https://doh.gov.ph/sites/default/files/publications/N
OH-2017-2022-030619-1.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287322/
https://itrmc.doh.gov.ph/index.php/14-programs-and- services/94-bemon
Title: Managing Organizational Support for 1. Be clear about the
Community Engagement population/communities to engaged
and the goals of the effort
Community Engagement a. Now what are the goals of the
population you are dealing with
Process of WORKING COLLABORATIVELY with 2. Know the community, including its
groups of people who are affiliated by economics, demographics, norms,
geographic proximity, special interests, or history, experience with engagement
similar situations with respect to issues affecting efforts, and perception of those
their well-being (CDC, 1997) initiating the engagement activities.
● interpersonal collaboration but the a. Economic activity: the kind of
premium of working collaboratively is market, jobs/livelihood the
when you look at different lenses or people have
angles, look at groups of people with b. Demographics; age sex race etc
geographic proximity and similar c. Norms: do not assume that the
contexts norm of your community are
● end point of this is always about the the same especially that in this
well-being (saving lives, providing care) country we are multi-linguists
which emanates from all levels of care (divided into regions) and so
and prevention therefore there is cultural
differences as well
Objective: Present a review of frameworks to d. Know the community’s history
help organizations determine the capacity they and experiences that shaped
need to support community engagement. their beliefs and culture
e. What are the management
Frameworks: efforts that they have in the
A. Principles of Community Engagement present which explains their
B. Community Coalition Action Theory present behavior
C. Constituency Development f. What are their perceptions in
engagement with cavities. Some
Principles of Community Engagement would see it as a tool or ayuda
● There are 9 guiding principles for or they feel like tehyre bing
organizations to apply when working experimented on→ people
with community partners becomes hesitant in partnering
● Main principle: Give organizational with activities
leaders a framework for shaping their 3. To create community mobilization
own culture, planning engagement, process, build trust and relationships
conducting outreach, and interacting and get commitments from formal and
with communities. Hence, community informal leadership
engagement is totally different from a. How to guide the community to
medical missions/immersions. There join advocacies or how would
maybe overlaps but they are totally we push interests at saving live
different sand building their capacities
 b. Formal leaders: elected ones; ○ Service Delivery. Good service
Informal: “takbuhan ng mga delivery comprises quality,
tao”/ non-elected access, safety and coverage.
4. Remember and accept that community ○ Health Workforce. A
self-determination is the responsibility well-performing workforce
and right of all people who comprise a consists of human resources
community. No external entity should management, skills and policies.
assume it could bestow to a community ○ Health Information System. A
the power to act in its own self-interest. well performing system ensures
a. We dont assume that we know the production, analysis,
better than those people in the dissemination and use of timely
community and reliable information.
5. Partnering with the community is ○ Medical Products. Procurement
necessary to create change and improve and supply programs need to
health. ensure equitable access,
a. We are doctors for community, assured quality and
for social and health cost-effective use.
improvement ○ Financing. A good health
b. Framework of WHO 6 building financing system raises
blocks: adequate funds for health,
● WHO framework that describes health protects people from financial
systems in terms of six core components catastrophe, allocates
or “building blocks”: (i) service delivery, resources, and purchases good
(ii) health workforce, (iii) health and services in ways that
information systems, (iv) access to improve quality, equity, and
essential medicines, (v) financing, and efficiency.
(vi) leadership/governance. ○ Leadership and Governance.
Effective leadership and
governance ensures the
existence of strategic policy
frameworks, effective oversight
and coalition building, provision
of appropriate incentives, and
attention to system design, and
accountability.
● The six building blocks contribute to the
The table is derived from internet:
strengthening of health systems in
different ways. Some cross-cutting
components, such as
leadership/governance and health
information systems, provide the basis
for the overall policy and regulation of
all the other health system blocks.
 dynamic links and interactions that exist
across each component.
● Focusing on these separate components
helps put boundaries around this
complex construct and permits the
identification of indicators and
measurement strategies for monitoring
progress.

Reference:
https://www.who.int/healthinfo/systems/WHO
_MBHSS_2010_full_web.pdf
c. 3 Health
agenda/indices/objectives:
improvement in health for
every barangay should be
aligned in these 3 agenda

● Key input components to the health

system include specifically, financing
and the health workforce. A third group,
namely medical products and
technologies and service delivery,
reflects the immediate outputs of the
health system, i.e. the availability and
distribution of care.
● Inevitably, any type of division of a According to the discussio:
complex construct such as the health Health Indicators
system is fraught with problems. This is agenda
also true for the framework, which
focuses on health sector actions and Better health 1. Average life
underplays the importance of actions in outcomes expectancy
other sectors. It does not take into 2. Maternal mortality
account actions that influence peoples’ ratio per 1000 live
behaviours, both in promoting and births
protecting health and the use of 3. Infant mortality ratio
health-care services. per 1,000 live births
● The framework does not address the 4. Premature mortality
underlying social and economic attributed to
determinants of health, such as gender cardiovascular
inequities or education, and also does diseases, cancer,
not deal with the substantial and diabetes and chronic
 7. Sustainability results from identifying
respiratory diseases
and mobilizing community assets and
per 100,000
from developing capacities and
population
resources.
5. Tuberculosis
a. After certification of those who
incidence per
are deemed to have capacity to
100,000 population
provide health service, what
6. Prevalence of
comes next? What are your
stunting among
sustainability strategies? How
under-five children
do you maintain it?
Responsive 1. Client satisfaction b. Know the technical capacity
health rate (based on performance indices
system 2. Provider or strategic indicators) and
responsiveness score functional capacity (can be
technically high but not
Equitable 1. Out-of-pocket health
functional, example, certified
health spending as
percentage of total provider sila ng BEmONC, may
financing
health expenditure lisensya to operate but is the
2. Percent of population functionality pinapakinabanan
who have spent less ng bayan? lol)
than 10 percent of 8. Be prepared to release control to the
their household community and be flexible enough to
income on health meet the changing needs of the
For further reading: community
https://www.aidsdatahub.org/sites/default/files a. Know when to release the
/resource/philippines-national-objectives-healt community from the program,
h-2017-2022-2019.pdf it has to end.
b. There is no forever ha!There is
6. Recognize and respect the various no forever. :p
cultures of a community and other 9. Community collaboration requires
factors that indicate its diversity in all long-term commitment
aspects of designing and implementing a. Short-term: 0-3 years (e.g. all
community engagement approaches. other offices that don't have
a. You can do survey/ research 6-year term)
based activities to understand b. Midterm: 3-6 years (e.g.
the culture or context of the Medium Term Developmental
community Goals which coincides with the
b. Organizational culture, you can term of a president, 6 years)
look up on documents or reach c. long-term : >6 years (e.g.
out to experts related to Ambisyon 2040 from NEDA,
socio-anthropology, Nat’l Economic and
ethno-medicine Development Agency)
Read on this daw: a. Pag may binitawang promise,
https://2040.neda.gov.ph/about-ambisyon-nati panindigan :P
n-2040/ 6. Coalition formation is more likely when
there is participation from community
Community Coalition Action theory gate-keepers
a. Gate-keepers: e.g. Brgy tanod,
Composed of (23 )practiced-based proportions BSPO
that address processes ranging from formation b. Never dole out so that people
of coalitions through institutionalization of wont think of the coalition as
long-lasting coalitions just source of “ayuda”
7. Coalition formation usually begins by
1. Coalitions develop in specific stages as recruiting a core group of people
new members are recruited, plans are committed to resolving the issue
renewed and/or new issues are added. 8. More effective coalitions result when
a. Coalition is a cycle, sometimes the core group expands to include
you go back to the first stage participants who represent diverse
because you did not solve interest groups
problems there so you cannot a. Intersectoral governance
go to next stage 9. Open, frequent communication creates
2. At each stage, specific factors enhance a positive climate for collaborative
coalition function and progression to synergy
the next stage a. Synergy: 1 +1 = 3; those
a. Risks, good practices, habits and engaging in community
performances are present in engagement should have
every stage exponential motivation to keep
3. All stages of coalition development are doing their work
heavily influenced by community 10. Shared and formalized decision making
context helps make collaborative synergy more
a. Look at culture, norms and likely through member engagement and
demography for the context pooling of resources
4. Coalitions form in response to a. Pooling of resources: bayanihan
opportunity, threat, or mandate 11. Conflict management helps create
a. Example yung ganap nung positive organizational climate, ensures
world war 2 at ngayong that benefits outweigh the costs and
elections achieve pooling of resources and
b. Coalitions are formed in member engagement
response to a situation, 12. Strong leadership improves coalition
develops factions function and makes collaborative
5. Coalitions are more likely to form when synergy more likely
the convening group provides 13. Paid staff with interpersonal and
technical/material/networking organizational skills can facilitate the
assistance and credibility collaborative process
 a. A genuine community respects ● Community capacity: e.g. look for the
the expertise of a provider capacity of local government to provide
hence, not volunteer! Paid yarn! for a certain facility (if there is enough
14. Formalized, rules roles and structures resources, there is high capacity to build
and procedures make collaborative the facility :p aka no corruption)
synergy more likely
15. Satisfied and committed members will C. CONSTITUENCY DEVELOPMENT
participate more fully in the work of the ▪ Process of developing relationships with
coalition community members who benefit from or have
16. Synergistic pooling of resources influence over community public health actions
promotes effective assessment, ▪ Provides set of tasks that must be undertaken
planning and implementation for community engagement
17. Comprehensive assessment and
planning aid successful implementation STRUCTURAL CAPACITIES NEEDED
of effective strategies
18. Coalitions that direct interventions at 5 KINDS OF RESOURCES
multiple levels are more likely to create 1. Human (BHERT, MHO, PHO)
change in community policies, practices 2. Informational (Data information system)
and environments 3. Organizational (DOH)
4. Physical (Facility enhancement, structures)
5. Fiscal (Budget)

1. Human resources
● Competencies
- Leadership
- Management
- Community health
- Intervention design
Comments on the diagram:
- Disciplinary sciences
● Ang hugot lagingang community (ano
ang context)
● You have to know the structure for 2. Information resources
collaborative work ● Data and scientific knowledge
● Pool resources: clerks, medical students - Demographic and socioeconomic data
● Risk assessment (management) and - Data on health risks and health status
planning - Behavioral data
● How to implement the strategies: what - Data on infrastructure and services
are the strategies for the 3 health - Knowledge-based information such as
agenda those found in intervention and
○ Example: Better health disciplinary sciences used to guide
outcome strategies: High-five health and community action (data
push, push for primary care analytics/data science)
 o Technical assistance and
3. Organizational resources assessment of training needs
- Organizational units and missions for organizational formation,
- Administrative, management structures, and planning and implementation
of initiatives, communication
service-delivery structures (Province wide
and networking, and other
health care provider network)
engagement process.
- Communication channels and networks o Situational analysis and
- Regulatory or policy guidance identifying opportunities for
- Organizational and professional practices and reciprocity within the
processes community.
o Situational analysis the best
4. Physical resources form of leadership (situational
- Work spaces and places leadership)
- Hardware, supplies, materials, and tools used
2. Information/Data on:
to conduct business
o Community demographics
o Socioeconomic status
5. Fiscal resources o Cultural beliefs, attitudes and
- Money behaviors regarding health and
- Real and perceived economic values other contextual aspects of
accumulated from the outputs of an enterprise community life.
o Community civic, faith,
PRACTICE ELEMENTS OF CONSTITUENCY business, philanthropic,
DEVELOPMENT governmental and other special
interest entities – their
A. KNOW THE COMMUNITY missions/purpose, assets, and
● History and experience, Constituents, opinion leaders.
Capabilities o Physical attributes of the
● Intelligence-gathering behind planning, community
decision-making, and leveraging
resources to collaboratively achieve 3. Organizational Structures to:
anticipated or agreed-upon outcomes o Organizational mission or
with community partners values statement that supports
● Risk assessment and stakeholder a culture of long-term
analysis engagement with community
● Structural Capacity Needed:
partners.
1. People Skilled In: o Recognition and reward
o Outreach, relationship building, systems for personnel who
data collection and analysis and effectively per- form duties of
information development and community information
presentation development.
o Outreach is not only conducting
o Information systems to manage
medical missions but also
immersion and understanding collection, storage, analysis,
the culture and reporting of data on the
 capabilities of community o Information and policy analysis,
partners; technical assistance strategic planning and strategy
and training needs for partners development, and initiative
to undertake the formation of planning and implementation.
engagements, planning of o Collaborative methods to work
initiatives, and implementation; with diverse populations and
develop- ment and build community capacity to
maintenance of communication analyze and apply information
channels and networks; and in decision making.
opportunities to take part in o Affiliation and network linkage
other engagement processes. development, organizational
o Policies and procedures formation, collaborative
regarding collection, storage, leadership, facilitation, and
release, or publication of participatory governance.
information, along with privacy o Resource identification and
and security safeguards leveraged resource
o Policies and guidelines in case management.
managements, administrative o Communications development
orders and delivery.

4. Fiscal and Physical Support for: 2. Information/Data on:

o Personnel, contract, or budget o Information/Data on:
for providing information Populations potentially affected
services. by positions under
o Budget for development and consideration and influencing
distribution of information factors of socioeconomic,
materials. cultural, and other situational/
o Office space for staff engaged in contextual data.
information services. o Population response
o Computer hardware, anticipated based on beliefs,
communication devices, and attitudes, past behaviors, and
other office equipment. readiness to act and
participate.
B. ESTABLISH POSITIONS AND STRATEGIES o Opportunities to engage
● To guide interactions, communications opinion leaders in position and
development strategy determination.
● Invest in communications relations, o Symbols, physical location,
media relations, informations relations
institutions , and events likely
● Structural Capacity Needed :
to improve engagement.
1. People Skilled in: o Sign languages
3. Organizational Structures to:
 o Establish information systems equipment to support position
to obtain formative information and strategy development
on issues for which community activities.
engagement is needed. o
o Analyze the range of solutions B. BUILDING AND SUSTAINING NETWORKS
or actions, unintended
consequences, and the ● To maintain relationships,
communications, and leveraging of
opportunities to successfully
resources
address the issue(s) where ● Structural capacity needed:
community engagement is
intended. 1. People Skilled in:
o Project resource needs and o Network analysis and affiliation
potential ways to attract, processes, engagement
leverage, and manage processes that respect diverse
resources. populations and viewpoints,
o Determine organizational collaborative leadership,
position and strategies to network formation and ethical
intiate community duialogue on management of asymmetrical
perceived issues. power relationships, resource
o Present positions and negotiate identification and leveraged
consensus on community resource management, and
actions or what outcomes to communications development
achieve. and delivery.
o Recognize and reward
personnel that effectively 2. Information/Data on:
perform community o Network demographics and
engagement and strategy socioeconomic status.
development duties. o Network cultural beliefs,
o attitudes, and behaviors
4. Fiscal and Physical Support for: regarding health and other
o Personnel budget for strategic aspects of community life.
and program planning. o Network structures and opinion
o Personnel budget for facilitating leaders within these structures.
development of community o Network “boundary-spanners”
capacity to act. who provide linkage across
o Budget for strategic and population and system
program planning. segments of the community.
o Office space for staff engaged in
strategic and program planning. C. MOBILIZING CONSTITUENCIES
o Communication and computer ● For decision making and social action
hardware and other office ● Structural capacity needed:
 o Establish information systems
1. People Skilled in: to manage and maintain
o Mobilization and engagement trusted two-way network
processes, execution of communication.
mobilization strategies, o Establish information systems
initiative planning and to support affiliations and
implementation, collaborative mobilization process of
organizational formation and engagement initiatives,
participatory governance, contingency planning to adapt
listening, appreciating diverse implementation of collaborative
populations and viewpoints, interventions, and feedback on
collaborative leadership to use and management of
ethically manage asymmetric network resources.
power relationships, resource o Deliver technical assistance and
identification, And leveraged training.
resource management, and o Establish information systems
communications development to provide feedback loops to
and delivery. evaluate impacts of
o Technical assistance and engagement and intervention
training to build partner mobilization efforts.
capacity to participate in o Track personnel affiliated with
community actions. formal and informal
organizations and groups across
2. Information/Data on: the community.
o Emerging or new competitive o Leverage affiliation points to
viewpoints and cultural beliefs, support the organization’s
attitudes and behaviors network and mobilization
regarding health and other activities (communication,
aspects of community life. power/influence, resource flow,
o Shifts in community structures and collaborative
and opinions of leaders within interventions). (Doc just
these structures. repeated this and emphasized
o Impacts of engagement and it)
mobilization efforts o Oversee communications and
polcy0related activities network
3. Organizational Structures to: and mobilization activities.
o Collectively govern the o Manage resource exchange
collaborative process and needed to accomplish
communicate effectively with coordinated community
community partners. collaborative work.
 o Recognize and reward
personnel that effectively
perform community
engagement and social
mobilization duties.

4. Fiscal and Physical Support for:

o Personnel budget for managing
and evaluating mobilization
activities that address active
communication, power
relationships, resource flow and
use, and other collaborative
processes.
o Personnel budget to support
and reward personnel
performance in managing and
evaluating mobilization
activities.
o Office space for staff engaged in
managing and evaluating
mobilization activities.
o Communication and computer
hardware and other office
equipment to support
mobilization activities.
 COMMUNITY-CONSOLIDATED near areas of mining operations are therefore
comparable and similar.
I. INTRODUCTION
● In the process of community diagnosis, various
● ITRMC-FEUNRMF Community Based Health community issues had been identified by these
Program (CBHP) has been established in Brgy. multisectoral groups. Various gaps had been
Quirino, Bacnotan, La Union on May 2015 in the identified as manifested in the results and data
continued effort to deliver community gathered.
development in the area aligned both in terms ● To bridge these gaps for discussion, an objective
of Residency Training and Health Service Problem Tree Analysis was used over other
Delivery. methods
o This is to provide community ● Problem Tree Analysis provides the blueprint of
competence towards community both community folks observation in the
development where the entry point is furtherance of identifying the root causes of
the community clinic which will these perceivable problems.
promote wellness, manage health ● Another model utilized is the community-based
needs and assist the partner community primary health care (PHC) model or “health with
in achieving health development. the people” which aims to determine priority
health concerns and possibly to trace and treat
● At par with the Department of Community and underlying causes
Family Medicine’s mission to initiate ● Active discussion, planning and
interprofessional and interagency collaboration, decision-making through a shared responsibility
the Community Based Health Program (CBHP) is among the CBHP stakeholders towards the
tasked to achieve community development in attainment of community development as
three years. partners in health care was also employed.

● Strategic implementation will run in three main

phases:
o Community Profiling Phase: subdivided
into three phases which is expected to
last for a total of six months
▪ Identifying the partner
community
▪ Conducting a community
diagnosis
▪ Designing an action plan

o Implementation Phase: expected to last

for two years II. REVIEW OF RELATED LITERATURE
o Evaluation Phase: expected to last for
six months
● Although there are different techniques to
● Common concerns of foreign population groups
analyze a problem, the problem tree is far
residing near areas with ongoing mining
superior over the other types of analysis in
projects include sudden increases in population
diagnosis a community.
density leading to problems on sanitation and
● The problem tree analysis was used to come up
waste disposal, adverse effects on water supply,
with a community diagnosis
alterations in the quality of life as well as the
● The identified core problem is increased
physical, mental, and social well-being of local
incidence of respiratory conditions, and this was
communities.
attributed to poor air quality in the context of
the community, Quirino Bacnotan which houses
● Health and environmental concerns of both
HOLCIM, a well-established manufacturer of
foreign and local population groups residing
cement.
● In as much as the health of an individual is
defined as the state of complete physical,
mental and social well-being, a community’s
state of health is also multisectoral, occurring as
a result of interplay of a multitude of factors.
● A factor considered was the educational status
of the residents where majority of them are
high school graduates and the number of health
workers are limited.
● Compliance of the residents to health services
was a determinant considered as well.
o Some residents of the barangay cannot
afford to have consultation at the
barangay health station due to lack of
transportation, distance from sitios, lack
of information dissemination regarding ● Data Gathering Instrument
health services offered by BHW, no o A Focused Group Discussion was
permanent doctor/health worker, and conducted and participants perceived
lack of accessibility to health services. responses were used to come up with a
● Since human activities are key sources for proper community diagnosis in
dispersal in airborne activities, improper barangay Quirino, Bacnotan, La Union.
etiquette on speaking, coughing, sneezing, using Direct interview and question and
tap water, and flushing can influence the answer method were employed in data
distribution of airborne particles. gathering:
FGD
III. METHODOLOGY ↓
● Population Problem Tree Analysis
o Quasi nomination and random selection ↓
were utilized in choosing the Community Diagnosis
respondents. Selection of the
respondents was based on multisectoral
grouping as follows:
▪ Barangay folks from different
sitio
▪ Fishermen
▪ Barangay officials
▪ Barangay Health Workers
▪ Parents Teachers Association of
Day Care Center A. Identification of respondents
● The multisectoral groups were identified
using review of records among the
registered sectoral organization and group
in the community. The following were
chosen:
o Parents and teachers association of
day care
o Barangay folks from different sitios
o Fishermen
o Barangay officials
o BHW

B. Focus group Discussion Proper

 ● The sectoral group of fishermen, BHW, and
other barangay officials were retained as
organization while residents were selected
and regrouped according to their
geographical and political jurisdiction.
● Focus Group Discussion was held to identify
the perceived health needs or problems of
the community.
● Seven groups consist of 8-10 members each
participated in the discussion. Each group
represents either an organization or juridical
boundary.
● Each participant was given 3 small pieces of
paper for them to write their identified 3
major health problems of their community.
● The top 3 health problems of the ● As seen in figure 2.0, the total number of
community were prioritized based on lawak, respondents who participated in the FGD in
bigat, agap, kakayahang masolusyonan, at Barangay Bacnotan, Quirino, La Union is 210,
interes ng tao sa barangay. A problem tree respondents were stratified into:
was constructed based on the most priority o Sitio 1 (n=20)
health problem for each group. o Sitio 2 (n=22)
o Sitio 3 (n=28)
C. Problem Tree Analysis o Sitio 4 (n=21)
● Constructed based on the most priority o BHW (n=25)
health problem for each group o Fisherfolks (n=36)
● Core problem was identified → participants o Barangay officials (n=58)
were asked about the direct causes and
effects of the problem ● The top 3 problems perceived are as follows:
● Immediate causes placed below the core o Respiratory problems – common in
problem → Immediate effects placed above barangay officials and BHWs
the core problem → Subsequent effects o Environmental problems – common to
placed above the immediate effects barangay officials and BHWs
● Each perceived problem tree of the groups o Garbage problems – common to
was combined to make one problem tree barangay officials, fisherfolks, Sitio 3
analysis group and Sitio 1

D. Community Diagnosis ● Respiratory problems

o Increased factory emissions of carbon
Analysis of the health status and coal, and subsequent increases in
↓ outdoor air pollutants in the locality,
Evaluating health resources bringing about a higher risk to poor air
↓ quality which serves as a contributory
Assessing attitudes toward health services and factor to the high incidence of
issues respiratory conditions.
↓ o Continued expansion/exploration of
Identifying health priorities through focus group cement plant/raw materials geared
discussion towards infra development of
↓ barangays’ thrust which provided low
Problem tree analysis expansion plans in the health delivery
↓ system, which continually led to lacking
COMMUNITY DIAGNOSIS of knowledge of the community folks
about modes of transmissions of
IV. RESULTS AND FINDINGS
 droplet related infection that is poor ● In the above tree, it is imperative therefore to
cough etiquette to add on. note that the point of convergence to presume
that the diagnosed community problem is the
● Environmental problems increased incidence of respiratory conditions.
o Cement plant operations led to
increased factory emissions of carbon References
and coal, and subsequent increases in ● Galvez-Tan, Jaime J., Health in the Hands of the
outdoor air pollutants in the locality, Filipino People: Framework and Action, 2013
bringing about a higher risk to poor air ● Leopando, Zorayda E. et al., Textbook of Family
quality which serves as a contributory Medicine: Principles, Concepts, Practice and
factor to the high incidence of Context, Volume I, pp. 121
respiratory conditions. ● Guidebook for Evaluating Mining Project
Environmental Impact Assessment, Chapter I:
● Garbage problems Overview of Mining and Its Impacts,
o Factors that contributed to the Environmental Law Alliance Worldwide (ELAW),
increased presence of garbage in the Eugene OR 97403, pp. 15-17
area that contributed to outdoor air ● Doyle, Cathal, Wicks, Clive, Nally, Frank. Mining
pollution: in the Philippines, Concerns and Conflicts: Fact
▪ Dumping of garbage from other Finding Mission to the Philippines Report,
barangays Society of St. Columban, Widney Manor Rd.,
▪ People’s non-compliance to Knowle, Solihull B93 9AB, West Midlands,
scheduled garbage collection UK2007
▪ Throwing of garbage into bodies
of water
● Air pollution
o Low income among residents is the
increased tendency towards the use of
more economical household products.
Among these is the use of the dalikan or
dirty kitchen in place of gas stove. Just
like the use of katol, this also
contributed to an increase in indoor air
pollution.
o Increase in indoor smoking activities
which could be an indirect result of
unemployment
o Smoke emitted from burning of garbage
along with the smoke emitted by
vehicles
● The increased incidence of respiratory
conditions can lead to increased incidence of
coughs and colds, increased perception of
having pneumonia and asthma in the
community.
● On the other aspect, there will be increase in
hospitalization in the community, increased
health expenditures, increased seeking
behaviours to social system support (access to
health care), leading to an increase in the
tendency to depend on available exogenous
financial support system such as politically
inclined support.
TOPIC OUTLINE ● Enhances ability to achieve goals
I. Project management and objectives
A. Definition
B. Benefits of Project c. The Project Management Triad
Management
C. The project Management
Triad
II. 3 Agenda of Project Management
A. Project Phases or Project
Life Cycle
1. Project Management
processes
B. The Enabling Management
Processes to the Project
Phases II. 3 Agenda of Project Management
C. The Facilitating Management
Processes to the Project 1. The Project Phases or Project Life
Phases Cycle
III. 10 Commonly Used Tools and 2. The Enabling Management
Techniques Processes to the Project Phases
3. The Facilitating Management
Processes to the Project Phases
I. Project Management
a. Definition A. Project Phases or Project Life
● Project management is the Cycle
application of knowledge, skills,
tools, and techniques to project ● Project Initiation
activities in order to meet or exceed ● Project Planning
stakeholder needs and expectations ● Project Execution
from a project ○ Implementation
○ Monitoring
b. Benefits of Project Management ○ Adaptation
● Enables completion of projects in the ● Project Close Out
shortest time possible while
balancing cost and quality Project Management Processes
● Enhances staffing flexibility and can 1. Scope Management
help accomplish more work with 2. Schedule Management
fewer resources 3. Budget Management
● Provides timely information to 4. Quality Management
multiple levels of the organization in 5. Human Resources/Team
consistent formats Management
● Enhances decision making based on 6. Stakeholder Management
facts and project information 7. Information/Communications
Management Risk Management
 8. Contract/Procurement Management
9. Project Management Processes

● overlapping activities that occur at

varying levels of intensity throughout
each phase of the project.
● A process is defined as a set of
activities that must be performed to
achieve a goal, in this case, the
project goal.
*larger pic at last page

***the following tables are compiled in the

last pages
Scope Management:
PM stage Scope
Management
Functions

Project initiation Scope Definition

Project Planning Scope Verification

Scope
Management Plan

Project execution Scope Monitoring

PM Fundamentals
Scope
● Project phases: Change/Change
Initiate→ Plan→ Implement → Monitor → Control
Adapt → Closure
Schedule Management:
B. The Enabling Processes:
○ Scope management PM stage Schedule
○ Schedule management Management
Functions
○ Budget management
○ Quality management Project initiation Duration of the
Project

Project Planning Detailed work plan

Milestones
(Activities)

Procurement of
goods and services

Delivery of Outputs
 Schedule Project Planning Quality assurance
management plan planning

Project execution Periodic Progress Quality

Monitoring management plan

Change Control Project execution Quality monitoring

Quality inspection
Budget Management:
PM stage Budget Quality control
Management
Functions Project Close-out Quality
management or
Project initiation Total Project Cost variance report

Budget allocation C. The Facilitating Processes:

among components
○ Contract management
Project Planning Budget/financial ○ Team management
management plan ○ Stakeholder management
○ Information management
Budget scheduling ○ Risk management
per activity or
milestone

Scheduling of
procurement of
goods and
services
Fund replenishment

Project execution Periodic financial

status reporting
(the

burn rate of the HR/Team Management

project)

Project Close-out Project financial PM Stages HR/Team

audit Management
Functions

Quality Management Project Initiation Skills Identification

Roles and tasks
PM stage Quality definition
Management Functional
Functions relationship
definition
Project initiation Quality criteria Hiring
definition
Project Planning HR/Team Project Close-out Recognition and
Management appreciation Project
Planning gains and success
Work delegation stories Knowledge
Manual of operation products
(Office policies)

Project execution Team building Stakeholders Management

Individual PM stage Stakeholders
performance
Management
evaluation
Awards (benefits) Functions
and incentives
Sanctions Report Project initiation Identification of
on staff movements stakeholders
Stakeholders
Project Close-out Post-project Needs and
benefits Expectations
Project staff Analysis
clearance
Project staff Project Planning Stakeholders
post-project kit Management
Planning

Project execution Execution and

Communication Management Monitoring of
Stakeholders
PM stage Communication Management Plan
Management Periodic reporting
Functions about and to
stakeholders
Project initiation Beneficiaries and
stakeholders’ Project Close-out Recognition and
expectations setting appreciation Project
and clarification turn-over
Project champions
and Sponsors Information Management
Social Marketing
Plan PM stage Information
Management
Project Planning Schedule of reports Functions
for submission
Communication Project initiation
flow (internal and
external) Project Planning Archiving system
(coding, sorting and
Project execution Preparation of disposal) – for soft
reports Vertical and and hard copies of
horizontal documents and
communication information
 Information services scheduling
Management Plan
Project execution Execution and
Project execution Execution and monitoring of
monitoring of contract/
information procurement
management plan management plan
Sorting and Periodic reporting
disposal of services and
goods procured
Project Close-out Information Change control
disposal plan
Disposal of all Project Close-out Closure of
documents and contracts (for goods
and services)
Risk Management
III. 10 Commonly Used Tools and
PM stage Risk Management
Techniques
Functions
1. Scope statement
○ defines the project scope
(project boundaries)
Project Planning Risk Identification, 2. Work Breakdown Structure (WBS)
Assessment,
○ to “break” the project into
Analysis and
Mitigation Risk deliverables, activities and
Management Plan sub- activities if require\
3. Work packages
Project execution Execution and ○ determines what skills are
monitoring of risk required
management plan
4. Project charter
Change control
Risk reporting ○ authorizes the project. A
document signed by role
Project Close-out Assessment of players stating what
impacts of risks commitments they will make
towards the project’s success
Contract/Procurement Management 5. Contracts
○ legally binding agreements
PM stage Contract/Procure
Management between the project manager
Functions and external service
providers to the project –
Project initiation Approaches in could be contractors,
service or activity sub-contractors, suppliers or
delivery any other external role
Project Planning Contract/procureme player(s)
nt management 6. Network diagram
plan Goods and ○ shows the sequence of
activities during the project
 and the interrelationship
between activities (activities
taking place simultaneously)
7. Critical path
○ shows the longest time
duration of the project
8. Gantt chart
○ presenting the project’s
schedule, clearly indicating
the start and finish dates of
individual activities
9. Cost estimating
○ estimate the costs of
resources needed to
complete project activities
10. Budget
○ total of all the direct and
indirect costs involved during
the project. The project has
to be completed within the
budget parameters
Project Management Processes
 B. The Enabling Processes

PM stage Scope Management Schedule Management Budget Management Scope Management

Functions Functions Functions Functions

Project Scope Definition Duration of the Project Total Project Cost Quality criteria definition
initiation
Budget allocation among
components

Project Scope Verification Detailed work plan Budget/financial management Quality assurance
Planning Scope Management Milestones (Activities) plan planning
Plan
Procurement of goods Budget scheduling per activity Quality management plan
and services or
milestone
Delivery of Outputs
Scheduling of procurement of
Schedule management goods and services
plan
Fund replenishment

Project Scope Monitoring Periodic Progress Periodic financial status Quality monitoring
execution Scope Change/Change Monitoring reporting (the burn rate of the
Control project) Quality inspection
Change Control
Quality control

Project Project financial audit Quality management or

Close-out variance report
 C. The Facilitating Processes

PM stages HR/Team Communication Stakeholders Information Risk Contract/Procur

Management Management Management Management Management e Management
Functions Functions Functions Functions Functions Functions

Project Skills Beneficiaries and Identification of Approaches in

initiation Identification stakeholders’ stakeholders service or activity
expectations delivery
Roles and tasks setting and Stakeholders
definition clarification Needs and
Expectations
Functional Project champions Analysis
relationship and Sponsors
definition
Social Marketing
Hiring Plan

Project HR/Team Schedule of Stakeholders Archiving system Risk Contract/procure

Planning reports for Management (coding, sorting Identification, ment
Management submission and disposal) – Assessment, management
Planning Planning for soft and hard Analysis and plan
Communication copies of Mitigation Risk
 Work delegation flow (internal and documents and Management Goods and
external) information Plan services
Manual of scheduling
operation (Office Information
policies) Management
Plan

Project Team building Preparation of Execution and Execution and Execution and Execution and
execution reports Monitoring of monitoring of monitoring of monitoring of
Individual Stakeholders information risk contract/
performance Vertical and Management management management procurement
evaluation horizontal plan plan management
communication Plan Periodic plan
Awards (benefits) reporting about Sorting and Change control
and incentives and to disposal Risk reporting Periodic reporting
stakeholders of services and
Sanctions Report goods procured
on staff Change control
movements

Project Post-project Recognition and Recognition Information Assessment of Closure of

Close-out benefits appreciation and disposal plan impacts of risks contracts (for
appreciation goods and
Project staff Project gains and Disposal of all services)
clearance success stories Project documents and
turn-over
Project staff Knowledge
post-project kit products
First Stage: PROJECT INITIATION Second Stage: PROJECT PLANNING

Initiating the Project Why Projects Don’t Live up to Expectations

1. Establishing the project initiation team.
This involves organizing team members ● Failure to reach agreement on
to assist in carrying out the project requirements
initiation activities. Establishing a ● Political battles, unresolved conflicts
relationship with the customer or ● Skill set mismatch
stakeholders. The understanding of your ● Plan was not doable
customer's or stakeholder’s ● Plan was not followed
organization will foster a stronger
● Ineffective communication
relationship between the two of you.
● Lack of leadership
● Lack of project management skills
2. Establishing the project initiation plan.
Defines the activities required to
Describing and validating project scope,
organize the team while working to
alternatives, and feasibility. The understanding
define the goals and scope of the
of the content and complexity of the project.
project
Some relevant questions that should be
3. Establishing management procedures.
answered include:
Concerned with developing team
● What problem/opportunity does the
communication and reporting
project address?
procedures, job assignments and roles,
● What results are to be achieved?
project change procedure, and how
● What needs to be done?
project funding and billing will be
● How will success be measured?
handled. Establishing the project ● How will we know when we are
management environment and finished?
workbook. Focuses on the collection
and organization of the tools that you 1. Divide the project into tasks. This
will use while managing the project. technique is also known as the work
breakdown structure. This step is done
Input requirement for this stage to ensure an easy progression between
tasks.
The Project Charter 2. Estimating resources and creating a
resource plan. This helps to gather and
■ Project charter – authorizes the project. A arrange resources in the most effective
document signed by role players stating manner.
what commitments they will make towards 3. Developing a preliminary schedule. In
the project’s success this step, you are to assign time
estimates to each activity in the work
breakdown structure. From here, you
 will be able to create the target start
technically • 9 subsidiary tools
and end dates for the project.
it is referred management • Work
4. Developing a communication plan. The
to as project plans breakdown
idea here is to outline the
implementati • Monitoring structure
communication procedures between
on planning) and (WBS)
management, team members, and the
Evaluation • Gantt
customer.
Plan Chart
5. Determining project standards and
• Milestones
procedures. The specification of how
• PERT-CPM
various deliverables are produced and
• Network
tested by the project team. Identifying
Diagram
and assessing risk. The goal here is to
• Etc.
identify potential sources of risk and the
consequences of those risks.
6. Creating a preliminary budget. The *at the last page for larger pic
budget should summarize the planned Planning Processes
expenses and revenues related to the ● There are several planning processes
project. Developing a statement of Planning is an ongoing effort
work. This document will list the work throughout the life of the project
to be done and the expected outcome
of the project.
7. Setting a baseline project plan. This
should provide an estimate of the
project's tasks and resource
requirements.

Bottomline of Project Planning

Steps and Outputs/ Tools/Techniq

Processes Documents ues Planning Phase Deliverables
Integrated project management plan
Translation of Detailed Various
● Project definition (approved project)
Project Design Engineering assessment
to Detailed and Design ● Project structure
and planning
Engineering Detailed work ● Subsidiary management plans
tools and
and Design plan
templates
Subsidiary Management Plans
Work and ● Communications/Stakeholders
• Integrated • Various
Financial ● Information
Management assessment
Planning ● Risk
Plan and planning
(more ● Procurement/Contract
 ● Cost
● Quality
● Human Resources
● Scope
● Time

Scope Management Plan

Spells out the process involved for making

changes to the scope
Defines who has the authority to approve
Planning for Project Implementation changes
● Verify scope of the project
● Break the project down into activities Change Control Process
● Determine optimum schedule and ● Can be different from project to project
budget for project implementation Simple projects – simple solution
● Establish quality standards for inputs, ○ PM and/or Sponsor signs off on
processes or activities and outputs any changes
● Determine project staff needs and
definition or delineation of tasks and ● Complex projects –
responsibilities ○ May have different levels of
● Establish communication protocols and change
requirements; prepare communication ○ May have a Change Control
plan Board in place to approve more
● Conduct a risk assessment and prepare detailed or complex changes
a risk management plan
● Prepare a procurement and/or contract Risk Management Plan
management plan ● Identify the potential RISK EVENT
Rate the risk for:
Scope Management
● Define the focus of the project, ● Degree of impact
i.e,scope,coverage, boundaries, limits ● Probability of occurrence
○ Will you place the risk on the
Scope Management Template watch list?
○ Assign a risk owner to watch for
the triggers
 M Moderate risk
● Action plan is required by the
Risk Management Template Area/Department Manager.
L Low risk
● Managed by routine procedures and
employees under supervision.
T Trivial risk
● Unlikely to need specific application of
resources.

Risk Assessment Matrix 3x3

Risk Assessment Matrix – 5x5

Red area
● always “yes” which means develop a
risk management plan.

Yellow area
● iffy, answer on a case-by- case basis.

Green area
● always “no”, don’t develop a risk
management plan. Just hope it doesn’t
Risk Assessment (EHMLT) happen and if it does deal with it then.
E Extreme risk
● Immediate action required; this level of
Project Communication Plan
risk needs detailed research and
planning by senior management.
● Identify key project stakeholders
H High risk ● Determine the information needs
● Action plan is required as soon as ○ Upwards communication
practicable by senior management. ○ Lateral communication
 ○ Downward communication
⮚ Must be a NOUN or a result
● Document what, when, why and how
statement
information will be distributed
● Break each deliverable down into
● Develop documentation standards activities and tasks
⮚ These require action
Communications Plan
prepared during project planning to solicit ⮚ Starts with a VERB or a result
support during implementation statement
● Break each activity or task down as
far as necessary

Work Breakdown Structure

Reports to Stakeholders
prepared during project planning to inform re
progress/status of project during
implementation

Creating the Work

Breakdown Structure
● Deliverable-oriented, tree-like
structure or in bullet form
● Graphically defines all the work in the
project

Defining the Work

● Identify your deliverables (work
buckets)
⮚ Usually a single word, if
applicable
 What is missing here is the numbering…

The activities and tasks should be

properly stated

Creating the Project Schedule

This presents only 1 component. All ● Tasks and activities
items belong to a major group “1 ” ● Start and finish dates
● Resources
 ● Dependencies ● Determine the critical path
● Update the PERT chart as the project
Sequencing the Work
progresses
● Document interactivity dependencies
● Ensure a realistic schedule
● Identify constraints
Identifying Dependency Relationships
● Mandatory
⮚ Inherent in the work itself

⮚ Physical limitations
● Discretionary
⮚ Based on best practices

⮚ Specific sequence desired

Estimating the Time Required

● Estimate the time needed to complete
each activity
● Consider each resources’ availability
Scheduling-Sequencing-Defining
Dependencies
The Network Diagram

Constructing a Network Diagram

● Identify the specific activities and
milestones
● Determine the proper sequence of
activities
● Construct a network diagram
● Estimate the time required for each
activity
Roles and Responsibilities
● Start with the WBS
 ● Identify project roles, responsibilities, SLIDES 62-89
and reporting relationships Estimating Cost Template
● Document primary and support
responsibilities
Selecting Resources
● Work with functional managers
● Ensure right skill sets are available
when needed
● Create your own resource pool

Scheduling with Budget Template

The Gantt chart

Estimating the Project Cost

Base estimate: Budget Summary
● Start with the WBS
● Select an estimating method
● Estimate expected cost of project by
cost category
● Estimate contingency (management)
reserve for:
⮚ Cost mitigation

⮚ Scope changes
Planning for Quality Project
⮚ Unexpected risk events
● Identify areas where to observe
quality during implementation and
operation of the project
 ● Letter of Intent
● Request for Proposal
● Procurement Modalities
● Tender and Bid

Integration Management Plan

● Document spelling out how each of
the individual plans will work
together

THIRD STAGE: PROJECT EXECUTION

Executing the Project

● Executing the baseline project plan.
The job of the project manager is to
initiate the execution of project
activities, acquire and assign
resources, orient and train new team
members, keep the project on
schedule, and assure the quality of
project deliverables.
● Monitoring project progress against
the baseline project plan. Using
Gantt and PERT charts can assist
the project manager in doing this.
● Managing changes to the baseline
Procurement or Contract Management project plan.
● Start with the WBS ● Maintaining the project workbook.
● Identify and list down goods and Maintaining complete records of all
services to be procured project events is necessary. The
project workbook is the primary
Procurement Planning template source of information for producing
all project reports.
● Communicating the project status.
This means that the entire project
plan should be shared with the entire
project team and any revisions to the
plan should be communicated to all
interested parties so that everyone
understands how the plan is
Some Concepts in Procurement evolving.
Management
● Terms of Reference
● Scope of Work
 ● Are unauthorized changes being
allowed?
● Is the team working together
productively?

Monitoring the Schedule

● Update the project schedule on a
weekly basis
● Compare actual to plan
● Report and address variances
Murphy’s Law quickly Hold the
● When things are going well, ● team accountable for delivering on
something will go wrong time
● When things just can’t get any ● Replan as necessary
worse, they will
● When things appear to be going
better, you have obviously Monitoring the Use of Gantt Chart
overlooked something

Bottomline of Project Evaluation

Ongoing Questions During Execution

● Are we on schedule?
● Are we on budget?
● Has the business need changed?
● What new issues do we have to
address?
● Are any risk events materializing?
● Where are we in danger of not
meeting our goal?
● Are we delivering a quality product?
● Are our vendors delivering as
promised?
● Do we have enough resources?
 Use of Variance Analysis
Monitoring the Budget
● Review financial information no less
than monthly
● Compare actual to plan
● Report and address variances
quickly
● Hold the team accountable for cost
containment SLIDES 90-118
● Re-project expenses as necessary Use of Percent Expenditure

Monitoring Budget and Expenditure

Use of Graph

The S-Curve

Monitoring Scope
● Compare work results to the plan
daily
● Ensure results meet the need
● Ensure formal acceptance is received
Reflect
● Approved changes in the project
plan
 ● Usually thought to be minor
● Enforce the change management
process
Change Log

Monitoring Issues
● Use an “action items list” to
document issues
● Ensure ownership is clear
Use of Graph ● Assign a due date
● Review progress at the weekly status
meeting
Monitoring Risk
● Review the risk management plan
regularly
● Monitor triggers and the watch list
● Implement mitigation plans
● Invoke contingency plans as
necessary
Change Management
● Repeat the “identify, assess,
● Any modification to the benefits,
respond” cycle as changes occur
scope, time or cost
● Need an organized process for
Monitoring Quality
change
● Review work products to ensure
● Follow the process for change as
quality standards are met
outlined in the change management
● Use an independent reviewer
plan
● Implement process improvements as
● Source of changes:
necessary to eliminate
○ Sponsor
unsatisfactory performance
○ Regulatory
○ External
Monitoring Procurements
○ Internal
● Review the service providers’
● Keep a record!
performance regularly
● Ensure performance meets the
Scope Creep
requirements as documented in the
● Changes through the “back door”
contract
 ● Insist on formal progress reports ● Steering committee, or senior
management
Monitoring Human Resources ○ Summary level information
● Will the resources be available as (monthly)
originally planned? ● Project sponsor
● Are resources being utilized ○ As agreed upon (varies)
effectively? ● Project manager
● Are resources working together? ○ Mid-level information
(weekly)
● Team members
○ Detailed information
Team Building (weekly)
● Develop a personal rapport
● Be supportive of the team FOURTH STAGE: PROJECT CLOSE-OUT
● Be clear on expectations
● Take a personal interest A. Closing Down the Project
● Celebrate special occasions ● Closing down the project. In this
● Be accessible stage, it is important to notify all
interested parties of the completion
Performance Reporting of the project. Also, all project
● Provide project information to key documentation and records should
stakeholders in a timely manner and be finalized so that the final review
method of the project can be conducted.
● Execute the communications
management plan ● Conducting post project reviews.
● Report progress and trends on ALL This is done to determine the
ASPECTS of the project strengths and weaknesses of project
deliverables, the processes used to
Progress Reports create them, and the project
● Project progress management process.
● Accomplishments this reporting
period ● Closing the customer contract. The
● Plans for the next reporting period final activity is to ensure that all
● Comments (yellow flags) contractual terms of the project
● Issues or concerns (red flags) have been met.

Performance Reporting Guidelines B. Entry into the Closeout Phase

● Project was completed successfully
● Project was put on hold ● Conduct project close-out meetings,
● Project was terminated or canceled both internal and external.
● Write the final project report.
C.Closeout Activities ● Document and share lessons
● Recognition learned.
● Closure
● Performance improvements G. Celebrate!!
● Final approvals ● Show appreciation!
● Contract closure ● Recognize key individuals!
● Transfer responsibilities ● Reinforce positive behavior!
● Release resources
● Documentation (Terminal report,
knowledge products)
● Close out project accounting (time
and budget)

D. Special Challenges
● Uncertainty
● Post-project depression

E. Project Review Document

● Introduction
● Performance Criteria
● Lessons learned and best practices
● Open issues or action items
● Acknowledgements
● Chronology of major events
● Appendix

F. Project Manager’s Role During

Project Close-Out

● Ensure that all project deliverables

have been completed and formally
accepted by the customer.
● Determine if the measurable success
indicators were achieved.
 PFCM 3A | What is Family Medicine?
Tutor: Dr. JD Velasco | Lecture Date: Sept 9, 2021 | 1st SEMESTER

TOPIC OUTLINE
I. INTRODUCTION DEHESA (via translator): The diseases that we see more often in
II. HISTORY AND EVOLUTION OF FAMILY MEDICINE our population are high blood pressure, diabetes, heart disease,
III. WONCA asthma, and chronic obstructive pulmonary diseases. But our
IV. DEFINITION OF TERMS population is of an advanced age. They have lived for a long
V. IS FAMILY MEDICINE A SPECIALTY?
time. There’s an elderly population between 80-90 years old and
1. Distinguishable Body of Knowledge
2. Unique Field of Action even older. I have been in this office for 25 years, so I have been
3. Active Area of Research able to enjoy what the evolution has been of all my population
4. Intellectually Vigorous Training since they’re born until they’ve lived to old age.
VI. FAMILY MEDICINE: CHARACTERISTICS OF CARE
VII. PRINCIPLES OF PATIENT CARE IN FAMILY GUPTA: In the morning Dr. Dehesa sees patients in the clinic.
PRACTICE Then in the afternoon she heads out to make house calls. We are
1. Patient-centered
going to be tagging along with her visiting patients in their own
2. Comprehensive care
3. Continuity of care
homes. To understand why that is important here, let's first take
4. Context of care a step back.
VIII. 5-STAR DOCTOR
1. 5-star Doctor Attributes A pivotal moment in Cuba's history came on January 1st, 1959,
IX. FAMILY AND COMMUNITY MEDICINE IN THE when Fidel Castro overthrows U.S.-backed President Batista, the
PHILIPPINES culmination of the Cuban revolution ending one dictatorship and
1. Program Learning Outcomes starting another. Two years later, January, 1961, Cuba and the
2. Core Values
X. DOMAIN OF FAMILY PRACTICE
United States end diplomatic relations. Cuba turns to the Soviet
XI. DOCTORS OF THE FUTURE Union for economic support but sees its economy crash with the
XII. SAMPLEX Soviet Union collapses in the early 1990s. With the U.S. embargo
still in place and the centralized Soviet-style economy, Cuba
I. INTRODUCTION struggles. And for its free government-run health care system,
that means a need to keep costs low.
VITAL SIGNS WITH DR. SANJAY GUPTA (Transcript)
Episode: Cuba's Health Care System Examined, aired on Preventing disease, as I said, is cheaper that treating it, so Cuba
November 26, 2016
focuses intensely on preventive care. The U.S. trade embargo
“DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: also means limited access to resources, even medications. In this
Cuba is roughly 90 miles off the coast of Florida, but it feels a clinic, you can see how bare it is, just the essentials here -- an old
world away. The old cars, the architecture, the music, it's the Chinese made scale, cabinet with medication organized into
sights and sounds of Havana. This is "Vital Signs." I'm Dr. Sanjay plastic cups, a single bed.
Gupta.
Sometimes you hear that it is difficult to get medications. Is that
Despite being one of the poorest countries, Cuba has a relatively true? Have you found that?
strong health system. As you might guess, a lot of the focus is on
prevention. That's because it's easier to prevent disease and DEHESA (via translator): Well, you know, we're a country which
cheaper than to treat them. So there are screening program has been located, and the number of medications we can import
starting at a young age for vision and for hearing. There's also a are not as many as needed. But we do have those that are
very robust vaccination program. essential in the local offices. Remember, this is a primary health
assistance office. Here we focus on health prevention and
But keeping track of 11 million on the Caribbean's largest island promotion. If the patient needs other kinds of medications and
often requires a personal touch. assistance, they'll go to the secondary institutions, which are the
hospitals, where they can find other drugs that are needed by
This is a family doctor's clinic in Havana. They are known as the patients at the time.
polyclinics and they are the primary facilities of Cuban health
care. Dr. Marta Beatriz Diaz Dehesa runs this clinic and is GUPTA: Time for house calls. The first patient is a baby boy. To
responsible for the surrounding neighborhood. our surprise, we take a left out of the clinic and then straight up
the stairwell.
How many patients do you care for here? How many patients
come to this clinic? So literally next door to where the office is, is the first patient of
the afternoon. A little baby is what we're hearing.
DR. MARTA BEATRIZ DIAN DEHESA, FAMILY PHYSICIAN (via
translator): We have a total population of 1,143 inhabitants. UNIDENTIFIED FEMALE: Please come in.
Programs usually cover 1,100 to 1,500 people.
GUPTA: Are you worried about anything or just a routine visit?
GUPTA: What is the most common types of things that you see
here?

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DEHESA (via translator): No, no. We plan field visits. We see Along with a focus on preventive care, Cuba also places a heavy
them once a month in the office and once a month in the field. If emphasis on prenatal care for babies and their mothers,
the child is ill, we come more often until we discharge them. boasting one of the lowest infant mortality rates in the region.
Now keep in mind, these numbers are coming from the Cuban
GUPTA: Dr. Dehesa talked with Nolan's mother about everything government and we can't independently confirm them. But the
from his diet to his teeth and his motor skills. World Health Organization validated the Cuban health system a
few years ago, calling it, quote, "A model for the world."
DEHESA (via translator): This is the height and the weight curve
that we record on each visit. And this measures the baby Making the rounds, you can tell this is a personal doctor- patient
evolution as a percentile. relationship. Dr. Dehesa knows her patients and this
neighborhood, providing consistency as well as care. It's a
And here we have the foods with information to the families and unique system that does seem to be working here.
what has to be eaten month by month. Here are the vaccines
that reflects follow-up of the child's development. For Cuba, a country cut off from the United States for so many
years, finding these unique solutions has led to some impressive
GUPTA: So healthy, baby is healthy? innovations. So next, we're headed to a research center
developing Cuba's own vaccines, including one for lung cancer.”
DEHESA: Very, very healthy. Transcript obtained from:
https://transcripts.cnn.com/show/vssg/date/2016-11-26/segment/01
GUPTA: A clean bill of health and it's time for the next patient.
• Cuba has a very very good health care system
So this is a bit of an unusual sight, but you see a doctor and a
• Their statistics are comparable to the US, their infant
nurse just walking down the sidewalk making house calls in this
mortality rate is very very low compared to the US or
neighborhood.
other developed countries
A few minutes later we arrive at the home of a woman suffering • Cuba is a third world country but infant mortality rate
from Alzheimer's dementia. wise, they have low IMR because of the emphasis on
the preventive care
Does she have a caretaker, somebody that lives here with her? • The video shows emphasis on prevention and
primary care
DEHESA: She is her caretaker, and she is here eight hours until • We can’t do this in the Philippines because our ratio
her daughter comes home from work.
is 1 city or 1 municipality per 1 doctor. Unlike for
GUPTA: How often do you see her?
them the ratio is 1:1,000 doctor-patient ratio. That’s
why they usually just walk around.
DEHESA: I see her almost every day. • Unlike us, we only have 1 doctor per municipality and
that’s a big municipality. But if it’s a mountainous
GUPTA: On average Cubans have a long lifespan, nearly 80 municipality, and by geographic distribution it is
years. The focus on preventive health care has contributed to difficult to reach also the far-flung areas
that. It also means a growing aging population. Diseases like • For them, it made it easier because they have a lot of
Alzheimer's are becoming more common here. tiers for their health care system.
o Their tier 1 is the primary care center. They are
Our third and final visit today is to visit a pregnant woman
usually visited, or they can visit the primary
DEHESA: (via translator) She’s 21 years old. She has no health care clinic which is manned by a nurse
pathologies. No history. This would be the first house call right and a doctor plus social services. If they want
after she found out about it. secondary care, they have lots of polyclinics also
around. The polyclinics in Cuba usually have
GUPTA: Does the patient find this intrusive at all? They don’t pediatrics, Ob-Gyn, psychiatrists, geriatrics, what
seem to show it. She just let us right into her house. have you.
o But if they need hospital care, that is actually tier
Cuba does have Zika virus circulating here. So Dr. Dehesa 2, yung pang long-term care. They could be
recommends her young pregnant patient take certain
tertiary there.
precautions.
o Tier 3 is specialty and research center just like
DEHESA: (via translator) At this stage, it is very important for our lung center, our heart center, NKTI, that’s
you to protect yourself. To use insect repellant, or that you sleep their specialty centers
with long pants even If it’s hot. But you have to protect yourself • Iba yung kanilang organization, if you have noticed
from mosquito bites. Is that ok? from the start of the Duterte administration, they
want to follow the Cuban health care system.
GUPTA: Dr. Dehesa’s patient tells me she’s gonna receive weekly Unfortunately, the first secretary of health Dr. Ubial
check-ups here in her home throughout her entire pregnancy. was replaced so naiba nanaman siya. We have a

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 different set up again because we changed the SOH. • Willard Report
Depending on the administration as well. That is • Recommend residency training
another problem for us here because that depends programs for family medicine and
on the administration’s priority. Hopefully in the next specified the establishment of a board to
administration health would become again a priority oversee certification
especially now with the setting of COVID. • Even in the Philippines, we started not as
• This is how a family physician would look like a residency training program but we have
supposedly. The old family physicians before they the modular type before, but it was
usually go to the homes of their patients, they have stopped now it was shifted to practice-
their doctor’s bag with them, and they’ll be the one based
to go and see the patients at home or if they want to 1969 • Establishment of the American Board of
be visited in the clinic they can just come. Right now Family Medicine
it’s difficult how to practice because of the limitations
of the Covid even us we cannot even do home care III. WONCA
now. If we do, we really have to have a PPE, because • World Organization of National Colleges, Academies
of this situation. and Academic Associations of General Practitioners /
• If you look at their health care system (Cuba), this has Family Physicians
been years na and yet they have a very good • World Organization of Family Doctors
statistics. Especially on the preventable diseases • Founded in 1972 by member organizations in 18
because this is their health care system, they countries
emphasize on prevention and health promotion. • Currently, 118 member organizations in 131
That’s very very important. Kasi even if they treat, if countries and territories
we don’t advise our patients well, if we don’t educate
• Acts as advocate for its constituent members at an
our patients well, it’s really useless.
international level
• Remember treatment is not only pharmacological, • May 19: World Family Doctor Day
we also have a non-pharmacological aspect. That’s
where prevention, health education, and health WONCA’s Mission
promotion will actually sit.
• Improve the quality of life of the peoples of the world
through defining and promoting its values, including
II. HISTORY AND EVOLUTION OF FAMILY MEDICINE
respect for universal human rights kasi they always
say health is a right and including gender equity and by
1900s • Majority of graduates chose a career in fostering high standards of care in general practice/
general practice family medicine by:
• Grew in popularity after WWII o Promoting personal, comprehensive and
1962 • WHO Expert Committee on Professional continuing care for the individual and the family
and Technical Education and Medical in the context of the community and society;
Auxiliary Personnel meet in Geneva o Promoting equity through the equitable
• Need to train family doctors as first treatment, inclusion and meaningful
contact physicians advancement of all groups of people,
• Every medical student’s training should particularly women and girls (vulnerable group),
include exposure to family practice in the context of all healthcare and other
• Folsom Committee Report societal initiatives;
• “Every individual should have a personal o Encouraging and supporting the development of
physician to ensure the integration and academic organizations of general practitioners/
continuity of all medical services” family physicians;
• Battle cry in the society: Every Filipino o Providing a forum for exchange of knowledge
family should have a family physician for and information between Member
them. Hopefully we will achieve through Organizations and between general
Universal Health Care especially nakapasa practitioners/ family physicians; and
naman na o Representing the policies and the educational,
1966 • Millis Commission Report research and service provision activities of
• Focused on graduate medical education general practitioners/ family physicians to other
and determined that family medicine world organizations and forums concerned with
needed to be a board-certified specialty health and medical care
that’s why they already have the
American Academy of Family Physicians

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Core Competencies and Characteristics o It’s a biopsychosocial approach. It’s not only
the biomedical side, but we have to know
also what is causing the anxiety of the
patient. Aside from the chief complaint, is
there any anxiety? We really have to
understand where the patients are coming
from, so that’s the context.
o We will encounter patients later on to have a
headache. Pero kasi headache remember can
be an emergency or not. So maybe to you if
you do your hx and PE, their headache is
benign, but for the patient it’s actually
another thing. That’s why you really have to
know the patient’s understanding of their
chief complaint.
• Domain of Family Practice
o Academic discipline that both serves and
leads the specialty of family practice
Longitudinal continuity
o Organizes curiosity, systematizes observation,
Promotes patient empowerment
advances understanding, communicates
Person- Centered on patient and context, knowledge and challenges convention
centered care kailangan mong intindihin yung context o We do it in a systematic manner, and then
Emphasis on Doctor-patient you have to communicate. One of the center
relationship for us family physician is the role of
Responsible for health of the communication in our family practice.
Community
community, not only the patient and • FAMILY PHYSICIAN
orientation
the family
• American Academy of Family Physicians (AAFP)
Early undifferentiated stages o Physician who is educated and trained in
Decision-making based on incidence family practice
Specific and prevalence. We really have to know • PAFP Proceedings of the Orientation Course in
problem- the community as well. What are the Family Medicine
solving skills prevalent diseases, what are the top o Physician who is educated and trained in the
ten causes of mortality and morbidity in discipline of family medicine
the community o Generalist who accepts everyone seeking
Comprehensive Acute and chronic health problems care other health providers
approach Promotes health and well-being • Domain of Family Practice
Care coordination and advocacy o Physician generalist who takes professional
Primary care
First contact, open access, all health responsibility for the comprehensive care of
management
problems unselected patients with undifferentiated
Physical, psychologic, social, cultural problems, committed to the person
and existential. regardless of age, gender, illness, organ
Holistic
• Biomedical vs Biopsychosocial system affected, or methods used
modelling
approach – we are more on the o This is a very general approach. We are
biopsychosocial approach to care approaching a patient not in a panel type.
• All of the Clinical tasks, Communication with We go lateral actually. Hindi kami parang
patients, Management of the practice are founded subspecialty type. We usually do lateral
on the attitude, science and context because we have to explore.
o Undifferentiated - for example abdominal
IV. DEFINITION OF TERMS pain, there are a lots of causes of abdominal
• FAMILY MEDICINE pain. Headache, there are lots of causes of
• PAFP Proceedings of the Orientation Course in headache. We really have to be keen in your
Family Medicine differential diagnosis because you really have
o Medical specialty that provides continuing to be skilled to recognize ano ba talaga yung
and comprehensive health care for the sakit ng patient. [Undifferentated to be
individual and family differentiated.]
o Specialty that integrates biologic, clinical and o Emphasis on comprehensive care kasi we are
behavioral sciences more on the holistic type of care. Kahit na

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 fever lang yung complaint ng patient we have psychological medicine, social & cultural
to know the systemic effects of the fever to factors in health care and delivery system.
the patient. Hindi lang because of the • Attention to the person/ patient is of
constellation of symptoms but we do more of profound importance
the holistic type.
• FAMILY DOCTOR 2. UNIQUE FIELD OF ACTION
• Sometimes they interchange. Depending on the • Family-oriented care
country we may call it family physician, family • Encompasses all ages, sexes, organ systems,
doctor disease entities & wellness. As much as possible,
• Primarily responsible for providing comprehensive wala tayong discrimination. We cater to all.
health care to every individual seeking medical • Cases are undifferentiated and not categorized.
care and arranging for other health personnel to Kagaya ng abdominal pain. It’s very vague. It’s a
provide services when necessary (WONCA). We very very big pain symptom. So you really have
coordinate, we navigate care. But if this patient the skills to differentiate the abdominal pain.
needs subspecialty care so lahat sa amin, kami ang
gumagawa no’n 3. ACTIVE AREA OF RESEARCH
• FAMILY PRACTICE Clinical • Epidemiology of common diseases
• Art of how the body knowledge is dispersed in the Problems • Natural history of diseases
community • Screening
• Professional discipline that trains and sustains the • Disease prevention & health
doctors who practice the evolving arts and sciences promotion
of family medicine • Management of common health
• Patient-centered, evidence-based, family-focused problems
and problem-oriented. In the Philippines, we have, Health Care • Provider of characteristics
or in our residency training the PFC (Patient- Delivery • Utilization of health services
centered, Family-focused, we also added • Outcomes of health care alternatives
Community-oriented) Remember if you know the • Cost-effectiveness of care
basic structure, Personal-Family-Community dapat The Family • Family epidemiology
ganun siya, so yun ang sinusundan namin. We do
• Impact of illness on the family
the Patient-centered, Family-focused, Community-
• Effect of family on illness
oriented care.
• Family stress and life event
V. IS FAMILY MEDICINE A SPECIALTY? • Family resource utilization
• Criteria for considering FM as a Specialty by Family • Anticipatory guidance
Professor Ian R. McWhinney: Practice • Decision analysis
1. Distinguishable body of knowledge Approach • Family therapy
2. Unique field of action • Patient education
3. Active area of research • Family medicine education
4. Training which is intellectually vigorous • Lahat ‘to, a family physician can do all this. We have
• This specialty is anything under the sun. We these tools also on how we can interview the family,
are not trained in a very specific subspecialty. how we can intervene, how can we help the patient
Malawak ang scope ng family medicine [as through the allies that we see during our interview.
read in the article that was given] Lahat ‘to we are very very active on this.

1. DISTINGUISHABLE BODY OF KNOWLEDGE 4. INTELLECTUALLY VIGOROUS TRAINING

• Integration of biological, clinical & behavioral • Strong emphasis on continuity and family care
sciences experience. It’s not only the patient experience
• Interdisciplinary curricular framework. Hindi but the family experience in general.
lang kami solo, as much as possible [what] we • Behavioral science
involve, multidisciplinary or interdisciplinary. • Community medicine
• Emphasis on prevention, modern • Inter-departmental operation. If there are
epidemiology, kasi statistics is kailangan, we approaches interdisciplinary or multifactorial or
have to know the data especially if you’re multidisciplinary, hindi lang kami isang
practicing in a community. You have to know department lang
also your data kasi this is where you will make • Commitment to lifelong continuing medical
your health promotion or health education, education. It’s not only in family medicine,

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 actually medicine naman in general is a Coordinates different
continuous process of learning. It doesn’t mean disciplines in medicine
that when you finish medicine you’ll stop learning, & health and non-
no. Sa buhay nga diba we still have to continue to health agencies. We
learn and in everyday that we live, we actually Interdiscipli- are the coordinators of
continue easily learning as well. nary care in the different
disciplines that your
Family Medicine is a three-dimensional specialty patient needs, not only
1. Knowledge in health but also in
2. Skill non-health agencies.
3. Process Involvement of family
in care; doctor-patient
• Patient-physician relationship is viewed in the context relationship. Laging
of the family. We’re not only concentrating on the kasama si family,
patient and physician (dyad), but we also have to actually kasama nga si
Interpersonal
involve the family (triad). From dyad, we also move community eh. If it’s
to the triad kasi we have to include the family of the possible that you can
patient. Not necessarily family, but the significant also have an impact in
others of the patient. Because this is where we get the community, that’s
allies especially if your patient needs help, if you’re also better.
not there personally to supervise the patient. You We don’t know also the patient lang, but
really need the help of the family. we also have to know the Ecological
• Relationship is valued, developed, nurtured and factors: social, cultural, economic,
maintained. This is a very very important aspect in COMPREHEN- educational. As we go along, you will see
family practice. SIVE the other aspects because we have tools
for this to identify the problems or the
VI. FAMILY MEDICINE: CHARACTERISTICS OF CARE pathologic problems of patients when it
comes to these areas.
First contact of care at ambulatory, All levels of prevention
PRIMARY
emergency room, home with emphasis in health
“Womb to tomb”; education. Either from
“cradle to grave”. primordial, primary,
Prevention
Sometimes we see secondary, and the
patients like binubuntis tertiary care. ‘Yun yung
Chronological palang sila ng mom nila lagi nating sinasama in
hanggang sa pagtanda educating our patients.
or hanggang sa Symptom relief;
mamatay. May mga emphasis on early
ganon na practice. diagnosis and
Home, clinic, hospital. treatment, before pa
Usually, home and lumala yung sakit, for
Curative
clinic. But now, since example. We have to
ASPECTS OF
we are promoting be trained here again.
CARE
CONTINUING training also in family This is learned by
medicine specialists, experience, hindi lang
you can see us now on the first glance.
also in tertiary Assist patient to go
hospitals. Sometimes back to society. You
Geographical
you are questioning have to integrate your
why is a family patients as well. It
medicine who usually doesn’t mean that
handles primary and Rehabilitative when your patients get
secondary care present sick, for example your
in a tertiary care patient had stroke, we
hospital, for example? also have to help our
Eto kasi yung role patients go back to the
namin, natin. society and they have

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 to be integrated into future practice, you’ll experience or you will
the society so that they encounter such patients.
will not isolate • Consider not only what the family physician can
themselves naman din. do to the patient but also look for resources and
services that are available in the community that
VII. PRINCIPLES OF PATIENT CARE IN FAMILY PRACTICE will meet the patient’s needs. As family
• Patient-centered physicians, if we want to do comprehensive care,
• Comprehensive care kilalanin natin yung community. What are the
• Continuity of care available resources there, where can your
• Context of care patients get the diagnostics if you have a clinic
• Coordination of care with no diagnostics or if you cannot offer
diagnostics. So you should know where your
PATIENT-CENTERED patients can also avail of those diagnostic tests
• Biopsychosocial model of care ganun siya. You should know your surroundings or
• Approach patients with sensitivity and your environment.
responsiveness to culture, age, gender and
disabilities. As much as possible we minimize the CONTINUITY OF CARE
bias, also being judgmental type of a doctor. • Continuous healing relationships. As family
That’s how we should approach our patients. physicians, we don’t stop when we meet our
• Ability to collect and incorporate psychosocial, patients there. Sometimes we try to follow up din,
cultural and family data into patient-centered kumusta na sila. Kung hindi man, there are times
management plans na as much as possible you should not give your
• Patient-physician relationship that is highly personal numbers. The practice is usually you
satisfying and humanizing to the patients as well should give your secretary’s number. But for
as the physician. Sometimes we have patients na patients that really needs to be monitored pwede
parang ang tingin sa isang doctor is they look at it naman siguro. Usually those are some of our
as if there’s a God. We also try to humanize roles.
ourselves, that we are also humans. It’s not • Maintaining ongoing responsibility for the health
shameful to accept or tell our patients that can care of the patients and families
we read on this, especially if your patients will tell • Facilitated transitions between the primary
you new information that you did not read about. provider, referral agencies and consultants. If ever
Pwede nyo naman sabihin, “can I read more on that your patient needs further care, we should
that,” “can I get back to you”, “can I read this first, also facilitate their transition. [For example], I will
because it’s my first time to encounter”. It’s a refer this patient to an OB-Gyn perhaps, pwede
very humbling experience to do that. As doctors naman, we should be the ones to facilitate all this.
we should not pretend that we know everything. Hindi lang tayo refer nang refer. Sometimes
‘Yun yung humanizing medicine. It doesn’t mean letters does not suffice. Sometimes you have to
that you’re a doctor ikaw na ‘yun. You should also make house calls also or you can call the physician
involve, engage your patient. If you really don’t as well whom will you refer. If you are referring
know, you can honestly say that you don’t know. your patients for example from your clinic to a
Huwag pilitin na kaya natin or alam natin ang higher center [for example] a tertiary care
sagot kung hindi natin alam talaga. hospital, ikaw din dapat iyon. You should also
facilitate that transition. Even if your patient
COMPREHENSIVE CARE needs specialty care than you can offer, as family
• Whole person care physicians we tend to also guide our patients,
• The family physician act as chief consultant or navigate our patients, coordinate our patients.
advisor for each patient’s health care. Sometimes
kasi patients would come to you not necessarily CONTEXT OF CARE
that they want to be prescribed with medicines. • Evidence-based practice
Maybe some of your patients would come to you o If we talk about evidence-based, we have to
because they just want to talk to you, they just look also at the available resources that they
want to see you. [Actually] patient is like that have, not only thinking o baka may makita
gusto lang nila makita ka, gusto ka lang nilang kayong article na ganito, but syempre what if
kausapin okay na sila. They don’t need the ito lang yung available na resources so huwag
medications, they just want you to spend your naman ipilit na ganon.
time to them. May mga patients na ganon. In your o Produce high-quality outcomes that enhance
functional outcome and quality of life in a

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 culturally responsive manner. What if your enhancing he care he or she provides. Dapat you
patient is a Jehovah’s Witness for example? have very good decision-making skills.
Tapos here he comes anemic? Alam nyo • Communicator, who is able to promote healthy
naman ang Jehovah’s Witness they actually lifestyles by effective explanation and advocacy,
don’t believe in blood transfusion. Huwag thereby empowering individuals and groups to
nyong ipilit. There are actually alternatives. enhance and protect their health.
Even as doctors we have to be aware of all • Community leader, who, having won the trust of
this, that there are alternatives to blood the people among whom he or she works, can
transfusion. Hindi lang blood yung pwedeng reconcile individual and community health
ibigay. requirements and initiate action on behalf of the
• Development of patient- and family-centered community. For example, if you have seen that
management plans not only for the patient but hypertension is very very rampant in the
for the whole family as well community, then you may want to advocate more
[for] start ka muna sa diet not necessarily
COORDINATION OF CARE treatment agad. Maybe you can give more
• Complexity of care. Depending on the case, is it solutions on how we can conservatively manage
simple ba? Or complex ba? the hypertension in the community.
• Integrator of complex care collaborates as a • Manager, who can work harmoniously with
health care team member in disease individuals and organizations inside and outside
management, health promotion and patient the health system to meet the needs of patients
education especially for multidisciplinary, and communities, making appropriate use of
interdisciplinary management available health data. We are depending on
• The more that your patient will feel that your statistics kasi dito. How can you manage your
approach is personal. As you’ve seen in the video, community if you don’t know the data? Sayang
it’s the doctors who go to these places. Huwag naman kasi yung budget, the resources if this is
nang antayin na si patient ang pumunta sa clinic. not what your community needs or this is not
[But] if you’ve deemed necessary that your what your patients need in that community.
patient needs this then you go to your patient
IX. FAMILY AND COMMUNITY MEDICINE IN THE
VIII. 5-STAR DOCTOR PHILIPPINES

• Through time nagbago din ang mga ito. But this is

the original. I will be presenting you another one
which is the current set-up of the society.

5-STAR DOCTOR ATTRIBUTES

• Care provider, who considers the patient
holistically as an individual and as an integral part
of a family and the community, and provides high- • The Philippine Academy of Family Physicians
quality, comprehensive, continuous and launched this one last year, yung tinatawag naming
personalized care within a long-term relationship diamond.
based on trust. Medyo mahirap din ito intially but • The diamond-shape here signifies that after rigorous
through time, you will learn to give personalized and pressures of training, the trainers are considered
care to your patients. as valuable assets in the improvement of primary
• Decision maker, who chooses which technologies care delivery. We regard diamond as the hardest of
to apply ethically and cost-effectively while

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 stones, through training, that these trainees will continuity and safety of the patient at
shine and be able to deliver these 6 roles necessary the different levels of the health care
to support our universal health care provider network including patient and
• The three-ring magnifying glass, signifies that we are community groups to improve health
not only seeing the patients but we are also seeing care delivery. Kasi ‘yun yung level ng
their families, we are also seeing their communities. different health care provider. We have
It’s going outwards from patient, to family, to the barangay health stations, we have
community the rural health units, or the municipal
• There is emphasis also on the four stages of primary health offices, we have the district
care like first contact, comprehensive, coordinated, hospitals, we have the community-
and continuing care. Ganun din kasi si diamond, based hospitals, then we also have the
meron siya clarity, the cut, the color, and the carat. apex hospitals and the specialty
But most important kasi is the context, you always centers. Dapat ‘yon well-coordinated
should know the context of your patients, para mas lahat.
maintindihan nyo yung patients nyo rin. They might Facilitate the effective, efficient access
have a different mindset. Intindihin nyo yung gusto to health-related programs, social
nila, you should understand what they want. Huwag services and other resources and
niyo ipipilit yung gusto niyo, you have to always stakeholders for the patient, family and
involve your patient, and their families or their community to achieve health equity
NAVIGATOR
significant others, or their allies. and continuity of care. Paano ba ‘pag
sinabing navigate, i-guide mo sila dapat.
PROGRAM LEARNING OUTCOMES Kung ano kailangan nilang resources,
ano kailangan ng patiemt mo na kung
Cope with demands of being a skilled saan siya pwedeng magpatulong.
generalist and family medicine expert
for various population groups, settings CORE VALUES IN FAMILY AND COMMUNITY MEDICINE
within health care provider network PRACTICE
(there should be a system from the • Emphasis on Patient, Family, Community
apex hospital to the district hospital to
HEALTH CARE the RHU hanggang sa pinakamababa na COMPASSIONATE • Demonstrate sincerity and
PROVIDER Barangay Health Stations) while CARE humility in providing responsive
upholding the highest ethical standards service and treating patient with
of the profession and engaging in dignity, respect and empathy
research and quality assurance COLLABORATION • Foster healthy working
activities to improve care delivery. ‘Yun relationship where colleagues,
yung gusto namin sana through allied health professionals and key
Universal Health Care we can achieve personnel within the community
Generate and utilize relevant research learn with, from and about each
RESEARCHER
to support quality primary care practice other
Demonstrate participatory leadership COMMITMENT TO • Foster diligence, and commitment
and systems development skills and EXCELLENCE towards lifelong learning and
LEADER
engage patients, family and community improvement to achieve quality
within the health care provider network outcomes for patient, family and
Contribute to the creation, application community
and translation of shared knowledge INTEGRITY • Conform to highest degree of
and practice with multidisciplinary and ethical and moral standards in the
interprofessional health care teams, practice of profession
patient and community groups and • Values confidentiality, objectivity,
other stakeholders in order to improve honesty, transparency
EDUCATOR
quality and outcomes of health care. accountability and stewardship
We don’t work as sole family health PROFESSIONALISM • Demonstrate ethical demeanor
physicians, we have to engage other that inspires trust and confidence
specialties, other departments. We while being responsive and open
want to deliver a very holistic care to for feedback and criticism
our patients. • Comply to legal and statutory
Coordinate with multidisciplinary and standards relevant to practice
COORDINATOR
interprofessional teams to ensure
Trans 1| FRIGILLANA | GARDINGAN | MEJOS | P a g e 9 | 10
RESPECT • Shows genuine respect, courtesy SAMPLEX
and sensitivity to one’s belief,
preference, gender, culture and Identification:
diversity _________________ 1. Primarily responsible for providing
comprehensive health care to every individual seeking medical
• These will be discussed as we go along. care and arranging for other health personnel to provide
services when necessary
X. DOMAIN OF FAMILY PRACTICE _________________ 2. Professional discipline that trains and
• PATIENT CENTERED sustains the doctors who practice the evolving arts and sciences
• FAMILY FOCUSED of family medicine
• COMMUNITY ORIENTED _________________ 3. A 5-star attribute who is able to
promote healthy lifestyles by effective explanation and
XI. DOCTORS OF THE FUTURE advocacy, thereby empowering individuals and groups to
enhance and protect their health.
_________________ 4. A core value in family and community
medicine that demonstrate ethical demeanor that inspires trust
and confidence while being responsive and open for feedback
and criticism
_________________ 5. A criteria in considering Family Medicine
as a specialty where cases are undifferentiated and not
recognized.
_________________ 6. An event that is celebrated every May
19th

Enumeration:
7-12. Program Learning Outcomes of Family and Community
Medicine in the Philippines
As doctors of the future, we should know the difference 13-15. What are the three-dimensional specialties of Family
between: Medicine?
Individual health vs community health
Curative care vs preventive care
Appropriate technology to provide cost effective care

*** 2007 Documentary “Sicko” by Michael Moore can be

accessed here https://vimeo.com/76646445

***Further reading: Phillips, W. & Haynes, D. (2001) “The

Domain of Family Practice: Scope, Role, and Function.” The
Keystone Papers: Formal Discussion Papers From Keystone III
Vol 33, No. 4, pp273-277

15. Process
14. Skill
13. Knowledge
12. Navigator
11. Coordinator
10. Educator
9. Leader
8. Researcher
7. Health Care Provider
6. World Family Doctor Day
5. Unique Field of Action
4. Professionalism
3. Communicator
2. Family Practice
1. Family Doctor
Answer key:

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 PFCM 3A | WHO Definition of a Family and Family as a Unit of Care
Tutor: Dr. JD Velasco | Lecture Date: Sept 16, 2021 | 1st SEMESTER

TOPIC OUTLINE Health and Family

I. FAMILY AS UNIT OF CARE • Family has assumed a key role as the basic socio-
a. Engel’s Hierarchy of Systems
biological institution. We all know that family is the
b. Health and Family
II. FAMILY AS CENTER FOR HEALTH DEVELOPMENT basic unit of the society.
III. 1987 PHILIPPINE CONSTITUTION • Family is the most important as well as the earliest
IV. DEFINITIONS OF FAMILY – VIEW POINTS social grouping to which man belongs especially
V. FAMILY AS A SPECIAL UNIT
the parents to children even if the parents are
VI. FAMILY STRENGTHS
VII. DIFFERENT CONCEPTS OF FAMILY separated.
VIII. UNDERSTANDING FAMILY AS A UNIT CARE • Family has displayed a remarkable resilience and
IX. SAMPLEX ability to adjust. Resiliency defines as the capability
I. FAMILY AS A UNIT OF CARE of coping very important during this time, the CoVID
time especially to the family afflicted by this CoVID
Engel’s Hierarchy of systems or the pandemic, either the CoVID by itself or the
indirect effects of it. It has a greater impact on the
family. Family plays a big role in person’s
development.
• Family affects the well-being of an individual
including the physical and organic part of the
human being. Aside from the physical, we are also
talking about the psychological and psychosocial
impact of a family to the individual.

Two Principles to look into when trying to understand the

family as a unit of care:
1. Whatever illness may beset the patient, particularly if
it’s potentially seious, complicated, or life-threatening,
will affect the entire family in varying degrees.
- the family is seen as a system, wherein one part
necessarily affects another. The family members
have to make a number of adjustments to cope
with the demands of this new way of life and to
stabilize equilibrium in the family
- “Role reorganization” is a healthy process that a
family undergoes in response to the illness or feath
of one of its members (Black, 2005). The family
George Engel was a psychiatrist and he formed the system is thrown into disequilibrium. Using each
biopsychosocial approach to patient care. He explained that family’s values, beliefs, and ways of coping, they
in the medical or scientific level, from subatomic, to atoms, must re-evaluate and re-establish the rules,
to molecules, to organelles, to cells (basic unit of our human communication patterns, family expectations, and
body) which make up the tissues, to organs, and to systems, behavior patterns that will keep the family stable.
and in these different systems, we make up a person, that 2. The health care provider should realize that the
person will marry or have a partner (we call it “partner” not transaction is not just between the doctor and the
the usual husband and wife because it does not only patient.
involved the male or the female but we need to include the - It should be seen as a therapeutic triad. A triangular
lgbtq community) then they will become diad (the relationship exists and involves the doctor, the
relationship between the partners) then once they have patient, and his/her family, all providing inputs and
children, that will form a family then next to your family is interaction that can be used in managing and
the community. Community is influenced by culture and addressing the issues pertinent to the case. Thus,
subculture, society and nation, and of course the whole for optimal treatment to be achieved, the doctor
universe that’s actually the biosphere (it is the biggest). leans heavily on the family and employs its
Arrowheads mean that they can go back from subatomic to members as therapeutic allies.
biosphere or biosphere to subatomic, it’s not unidirectional - This kind of approach that repsects families as
but bidirectional. integral and co-equal parts of the health care team

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 expectedly improves the quality and safety of a them. Our right to help is also correlated to
patient’s care by promoting communication the family.
between families and health professionals. • Article XIII Section 2
Moreover, by considering their inputs and o The state shall adopt an integrated and
concerns, the patients and their families get to feel comprehensive approach to health
more comfortable and cooperative with medical development, shich shall endevor tp make
interventions and the overall plan of care. essential goods, health and other social
services available to all the people with
II. FAMILY AS CENTER FOR HEALTH DEVELOPMENT affordable cost
• Family is the fundamental institution of • Article XV Section 1
organization in society o The state recognizes the Filipino family (has
• Families provide the milieu where individuals are close family ties) as the foundation of the
born, nurtured, learn to socialize and where an nation. Accordingly, it shall strenghten its
individual’s behavior and views take shape. solidarity and actively promote its total
Whatever we are now, we actually owe it our development
family, our past experiences, how our family guided
us. Everyone who helped you along the way, not IV. DEFINITIONS OF FAMILY – VIEW POINTS
just only your family or partner, they are considered • Sociologic
as family. o Enduring social form in which a person is
• Family play a pivotal role in nurtutring and incorporated
socializing children and influencing the • Biologic
development of adolescent (very important in o Genetic transmission unit. We share the
psychiatry – Erickson’s psychosocial theory, etc), genes in the family
serving as a support structure for family members, • Psychologic
influencing health impacting behaviors – positive or o Matrix of personality development
negative and providing opportunities and role o Most intimate emotional unit of society
models for healthy living • 1955
• Family can be a source of inequality, control and o Parsons & Bales
oppression (bad side of the family) - i.e. age and o Social unit whose primary tasks are
gender-based discrimination on distribution of socialization of children and the
family resources stabilization of adult personalities It
• Influence of in-laws within families in traditional emphasizes more on the socialization of the
societies is hard to ignore especially for us Filipinos family.
because we are not living with just our nuclear • 1960
family. In-laws are part of our families, so we have o Burgess & Locke
to consider their opinions or suggestions. o Group of persons united by ties of
• Protective function of family is diminished or even marriage, blood or adoption; consisting of
completely lost when family dynamics are single household; interacting and
characterized by conflict, tension and various stress. communicating with each other in their
You can stress the whole family if you llike, respective social roles and maintaining a
sometimes we have problems that are not really common culture. It is more of a genetic ties
personal alone but a family problem. It depends on • 1965
the values you have in your families. o George Peter Murdock
o Social group meaning even your neighbors
III. 1987 PHILIPPINE CONSTITUTION can be your family.
• Article II Characterized by common residence,
o Section 12: The state recognizes the economic cooperation and reproduction
sanctity of family life and shall protect and • 1973
strenghten the family as a basic o Semi -closed system (because sometimes
autonomous social institution. we allow other people to go in or out of our
Autonomous meaning independent, it has family, example, for now we consider them
the capacity to decide, to make their own as family members but they can be evicted
rules, etc. from your house or they can return) of
o Section 15: The state shall protect and actors occupying inter-related positions
promote the right to health of the people defined by society of which the family
and instill health consciousness among system with respect to the role content of

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 the positions and to the ideas of kinship VI. FAMILY STRENGTHS
relatedness. Sometimes, we have what we You need to idenitify the strength of the familly because
call kin network especially for family living you can define some opportunities to grow and some
in compounds, for example, you have 3 opportunities to help people
children then you built a house for each in 1. Ability to provide for the family’s needs
your land, so that’s already a network. • Physical – space management (houses);
• 1999 nutritionally balanced meals family’s general health
o Carter &McGoldrick status
o Families compromise people who have • Emotional – recognizing help; capacity
shared history and shared future development (help each other to improve)
• United nations • Spiritual – sharing of basic beliefs
o Group of people related by blood, • Cultural – sharing of cultural values
marriages or adoption, which live together 2. Child rearing practicesand discipline
in one household • Capability of both parents to respect each other’s
• You can have you rown definition of family. If you views and descicions
have someone whom you consider a family, then • Single parents – consistency and effectiveness in
he/she is your family. raising the children
3. Communication
V. FAMILY AS A SPECIAL UNIT • Ability to communicate and espress a wide range of
emotions and feelings both verbally and non-
verbally
Lifelong
4. Support, security and encouragement
Involvement
• Capacity of the family to provide its members with
feelings of security and encouragement
• Balance in the pattern of family activities
Endurance of Shared
5. Growth – Producing Relationships
Problems Attributes
• Family’s ability to maintain and build friendships
and relationships in the neighborhood
Family as a 6. Responsible Community Relationships
• Capacity of family members to assume
Special Unit
responsibility through participation in social,
cultural and community activities
7. Self -help and Accepting help
Built-in Sense of
• Family’s ability to seek and accept help when they
Problems Belonging
think they need it. Making us to accept help is not a
bad thing, we need to be humble
8. Flexibility of family functions and roles
Social • Family member’s ability to fill-in for one another
Expectations
during times of illness or when needed. “Makuha ka
sa tingin”, we will be talking about this in the next
• Lifelong involvement -walang iwanan
topics
• Shared attributes – it is genetic, either physical,
9. Crisis as a means of growth
psychological, or developmental (they share a
• Family members’ ability to unite and become
home, a social activities, or a lifestyle)
supportive during crisis or traumatic experience
• Sense of belonging – either based on security or
10. Family unity, loyalty and Intra-family Cooperation
defense against potential hostile environment, it is
• Family members’ ability to recognize and use family
a companionship
traditions and rituals that promotes unity and pride
• Social expectations – the sense of responsibility
towards the members/others or the basic affection
or care that you feel
• Built-in Problems – if there’s generation gap,
emotional variability
• Endurance of problems – they talk here about the
resources meaning to say whatever resources you
have, you share it to your family

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 VII. DIFFERENT CONCEPTS OF FAMILY

Western Rural Filipino Urban Filipino Muslims

Complete Equality
Paternal dominance with maternal decision making
between husband and Paternal dominance
income areas
wife
Family if the property
holder and source of labor Family is important in
Minor economic role
because in rural areas, property but less effective Family is the property
except as a unit of
family would like to decide in labor unit. It talked more holder and source of labor
consumption
who will take care of their on businesses
farm lands, etc.
Equality in parent-child
relationship. So don’t be Combination of discipline
Moderate strong discipline Strong and discipline to
surprised if a child calls her and indulgence of
to children children
dad/mom on their first treatment of children
name
Romantic love is very Romantic love exalted
Individual marital choice
important; minor parental subordinate to paternal Family choice of mate
with paternal approval
role approval
No free association with
Little or no chaperonage Chaperonage giving way of
Chaperone or group dating opposite sex except in
and no taboos dating
college
Single standard for both Double standard of Double standard of
Double standard of
sexes for fewer taboos or morality with queridas morality. They can marry
morality
both; prostitution prone being challenged by wives more than two.
Divorce is obtainable on
many grounds subject to No divorce but with No divorce but with
legal restrictions and annulment and legal annulment and legal Divorce is simple for
financial burden. Divorce is separation with right of separation without right of husband; available for
very rampant, who filed for marriage; consensual marriage; Prostitution is “cause” for wife
divorce should provide marriage is common available
alimony
Small family includes only Strong extended family ties
Extended family ties not Extended family often live
2 generations and not with usually separate
that strong together; high birth rate
collateral relatives dwellings; high birth rate

The Philippine Experience o Within the neighborhood, it is the entire

• The Filipino perceives the family unit as the most family unit that decides on the resolution of
basic element of his/her kinship system. important matters
o He/she first learns his/her values and • Tracing one’s roots instantly establishes rapport
where the norms of society and his/her between two outright strangers
outlook in life come together o Finding a common relative, a common
• Bilateral extended structure place of origin, or ethnicity never fails to
o Filipinos are fond of living in compounds or buid a relationship
living next door to close relatives • In the spousal relationship, the husband-
o Support mechanisms are easily put in place breadwinner and wife-homemaker roles can be
• Readiness to accommodate an aged member or extended into “partners-in-work” role
an orpahned relative into its fold o Each supports the other in providing the
o An ailing member has to be taken care of in family’s keep, doing complementary tasks
the same way and with a good deal of in whichever occupation they are
sacrifice • Parent-children role is characterized by both
• In other facets of daily life, the family is still at the affection and discipline
center of events o There has to be a balance to maintain
relationship at a functional level

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 PFCM 3A | WHO Definition of a Family and Family as a Unit of Care
Tutor: Dr. JD Velasco | Lecture Date: Sept 16, 2021 | 1st SEMESTER

VIII. UNDERSTANDING FAMILY AS A UNIT CARE IX. SAMPLEX

Resource Matching Type:

utilization/
source of Part 1: The Constitution, Definitions of Family, Family
Health behavior support Health and Strengths
requirements in illness ____ 1. The state recognizes the Filipino family as the
the unit definitions foundation of the nation.
____ 2. Group of people related by blood, marriages or
adoption, which live together in one household
Health
Transmission 1. Family as ____ 3. Social unit whose primary tasks are socialization
desicions /
of Infectious/ the social of children and the stabilization of adult personalities
approaches
communicable context for ____ 4. Ability to communicate and espress a wide range
and
diseases health care of emotions and feelings both verbally and non-verbally
strategies
____ 5. Family member’s ability to fill-in for one another
during times of illness or when needed
2. The patient’s problem is the Family’s problem
• Important ways in which the family plays a role in A. Flexibility as family strength
the health of its members (Doherty & McCubbin, B. United Nations’ definition of family
C. Communication as family strength
1985)
D. 1955 Parsons & Bales’ definition of family
• Health promotion/ maintenance and illness/ injury E. Article II of the 1987 Philippine Constitution
prevention
• Coping with stressful life events
• Family – based health and illness appraisal for Part 2: Different Concepts of Family
example, both of your grandparents died of a ___ 6. Divorce is obtainable on many grounds subject to
stroke, the other one was hemorrhagic and the legal restrictions and financial burden
other one was malignant infarct, so looking at your ___ 7. Family choice of mate
___ 8. Extended family ties not that strong
family history, you have high risk for stroke or other
___ 9 . Divorce is simple for husband; available for “cause”
cardiovascular diseases. So if you want to maintain for wife
your health, you should do it together as a family ___ 10. Strong extended family ties with usually separate
• Family interaction and level of functioning in dwellings
response to specific illness
• Help seeking or deciding on the issues of seeking F. Muslims
medical support G. Western
• Family adaptation / coping with illness including H. Rural Filipino
care giving, strict adherence to prescribe treatment I. Urban Filipino
and lifestyle modification

3. The family is the greatest ally in the patient’s treatment

• 90% of cases are ambulatory/ out -patient References:
consultations with home confinement / • Dr. JD Velasco’s PPT Sept 16, 2021
prescriptions. Studies showed that families actually • Leopando, Z. (2016) Textbook of Family Medicine
help in the healing process of the members who are Volume 1.
sick. • Further reading on Engel’s Hierarchy of Systems
can be accessed here:
4. Presence of the family in the interview/consulation http://citeseerx.ist.psu.edu/viewdoc/download?do
• Family’s influence on the patient’s personality, i=10.1.1.921.5890&rep=rep1&type=pdf
values, beliefs and experiences
• Family’s influence on the physician’s personality,
values, beliefs and experiences. 5) A 10) H
4) C 9) F
3) D 8) I
2) B 7) F
1) E 6) G
Part 1: Part 2:
Answer key:

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 PFCM 3A | Family-Focused Healthcare
Tutor: Dr. JD Velasco | Lecture Date: Sept 23, 2021 | 1st SEMESTER

TOPIC OUTLINE • Thinking about a symptom or problem in the context

I. INTRODUCTION of the whole person and the person’s significant
II. FAMILY-FOCUSED/ FAMILY-ORIENTED/ FAMILY-
others
CENTERED CARE
III. BASIC PREMISES OF FAMILY-FOCUSED HEALTH CARE • May or may not include other important persons in
1. Family-oriented healthcare is based on a the assessment and treatment processes. Again,
Biopsychosocial Systems Approach there is an emphasis on the importance of family, not
2. The primary focus of healthcare is the patient in
necessarily family by blood (because in the next
the context of the family
3. The patient, family and clinician are partners in succeeding lectures we will be discussing the
healthcare different stages life cycle of family, as well)
4. The family-oriented clinician reflects on how he • In this book, Family oriented Family care 2nd edition
or she is part of the treatment system
IV. Levels of Family Intervention
by McDaniel, Campbell, Hepworth and Lorenz, they
• Level 1: Minimal Involvement actually highlighted the importance of family in
• Level 2: Ongoing medical information & advice healthcare
• Level 3: Provision of emotional support • We define family as any group of people related
• Level 4: Systematic assessment & planned
intervention
either biologically, emotionally, or legally. That is, the
• Level 5: Family Therapy group of people that the patient defines as significant
V. EVIDENCES OF FAMILY-FOCUSED CARE for his or her well-being.
VI. SAMPLEX • The family-oriented practitioner gathers information
about these family relationships, patterns of health
I. INTRODUCTION and illness across generations, emotional connections
“There is tendency for all living things to join up, establish with deceased and geographically removed
linkages, live inside each other, return to earlier members, and life-cycle transitions, in order to
arrangements, get along whenever possible. This is the understand the patient within his or her larger
way of the world.” context.
- Lewis Thomas, The Lives of a Cell, 1974 • In other words, the familyoriented clinician mobilizes
So even our cells, they are also like families because the patient’s natural support system to enhance
actually what we learn in physiology – the cell is the basic health and well-being
unit of our organ system. So when the cells coalesce they
form tissues, when tissues again coalesce they form the MORE DEFINITIONS OF FFC/ FOC/ FCC
organs until these organs again organize. We can equate Mutually beneficial partnerships
Institute for
family just like the cell. Of course, when the time comes between health care providers
Patient- and
there will be joining of families. For Filipinos, for some (HCPs), patients and families in health
Family-Centered
especially Asian families, we as much as possible try to care planning, delivery and
Care (IPFCC)
maintain the close knit as family setting. So when it comes evaluation
to family dynamics the more members we have, the more Organized system of healthcare,
harmonious the family is, tendency is that we help each education and social services offered
other. So yun yung mga advantage din ng having a very to families that permits coordinated
close knit family (That is the advantage of having a very care across systems. Again, if you
close knit family) recall our lectures on The
Perrin and
Characteristics of Family Physicians as
Colleagues
“Each day, clinicians manage and treat the illness of well, we can be coordinator, we can
patients who are joined to, linked with, and live within a be navigators, it’s all here because as
larger context – the family.” family physicians we also give
- McDaniels, 2005 importance to the family of the
patient.
II. FAMILY-FOCUSED/ FAMILY-ORIENTED/ FAMILY- Seamless continuity in addressing
CENTERED CARE patients, family, and community
• An approach or way of thinking that a clinician can needs related to terminal conditions
bring to any patient encounter, with or without Gilmer through interdisciplinary
accompanying family members but still we look at collaboration. We implore not only
the patients that have their family members with the patient but also in healthcare we
them. implore not only ourselves, we care

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 for the patient but we encourage the 1. Family-oriented healthcare is based on a
interdisciplinary collaboration. So Biopsychosocial Systems Approach
meaning to say, we usually refer to
other departments that are actually
needed by the patient in order for us
to render holistic care to our patient
and the families as well

III. BASIC PREMISES OF FAMILY-FOCUSED HEALTH CARE

• Family-oriented healthcare is based on a
Biopsychosocial Systems Approach.
o An exclusively biomedical model, based on
molecular biology, assumes that disease can be
reduced to “measurable biological variables”
• The primary focus of healthcare is the patient in the
context of the family. We should remember that a
patient is a member of the family whether that is the
family by blood or etc.
• The patient, family and clinician are partners in
healthcare. Again we really have to think of the
family of the patient, that the patient - family -
physician are partners in healthcare it’s not a diad
but a triad: the patient, the family and the clinician or
healthcare provider. We are shying out from the
Figure 1. Schematic representation of the hierarchy and
patient and healthcare provider, especially in HIV continuum of natural systems as applicable to Engel’s
AIDS because once a patient is actually diagnosed definition of the biopsychosocial model – adapted from
with HIV AIDS we are mandated as much as possible “The clinical application of the biopsychosocial model”
to inform the family or if not the family, then the
immediate partner of the patient, because they really • 1980: George Engel, MD
have to be screened- this is the importance! But of o To understand illness, the clinician must attend
course you cannot disclose it na ‘barabara’ lang, as to the biological contributors as well as the
much as possible ask permission to the patient if the person, the clinician-patient interaction, the
patient want to disclose it to the family or you’ll be family, the social setting, and how these factors
the one to help the patient disclose the situation to may be connected in the creation of symptoms.
the family. There are arts of actually disclosing If you look at from molecules, organelles, cells,
diseases to the patient or family members or to the tissues etc until Biosphere going out of that system, there
immediate partner. is actually a double arrow so meaning to say it can
• The family-oriented clinician reflects on how he or actually go back start from the biosphere and then the
she is part of the treatment system. Hindi pwedeng reversibility of it, it can always go back.
out siya doon, whatever the patient is actually If we talk of people even if they want to get out of
experiencing dapat kasama niya palagi si patient. that family system, we are still opening our doors for that
person who went out of the system will come back any
time soon.
Sometimes kasi basing on the clinical presentation
that patient. In order for you to understand, you also have
to ask, for example your patient complains of pain, aside
from yung PQRST we must add the ‘U’ – How does this
patient UNDERSTAND the pain? How does this patient
perceive the pain? These are two different things,
sometimes you have to equate the perception and the
reality of what is happening to the patient, as clinician
that’s an art. Aside from knowing about the symptoms of
the patient you have to know also how this patient
understand his or her symptoms in order for you to
actually get better grasp of what is happening to your
patient. There’s also letter ‘V’ – VALUE, what is the value
of that symptom to the patient. You have to look not only

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what’s at the tip of the iceberg but also what’s verbal and non-verbal cues when you interview your
underneath it. patients.
• The significance of the family’s influence on illness
and health
• A balance must be achieved between the goals of
agency for the individual, and communion for the
group
o Agency - a sense that one can make personal
choices in dealing with illness and the healthcare
system.
o Communion - refers to strengthening emotional
and spiritual bonds that can be frayed by illness,
disability, and contact with the healthcare
system.
• Consider the need for communication, connection
and choice aside from high-quality biotechnical
medicine in the delivery of healthcare. Hindi lang
yung bigay ka ng bigay ng gamot. In giving medicine
you must try to explain what the medicines are for,
the side effects of these medicines, how long should
the patient expect for the effect of the medicine. As
doctors we don’t only give medications but as much
as possible we must try to explain.
• Explore family issues to see how they may influence
or be a resource in a crisis:
o The family is the primary source of health
beliefs and behaviors
▪ The initial appraisal of physical symptoms is
usually made within the family and is based
upon family beliefs about health.
▪ Many health behaviors and risk factors are
shared by members of a family. For
example, children are more likely to smoke
if their parents smoke
o The stress of family development transitions
may manifest in physical symptoms
▪ The family-oriented clinician is sensitive to
the impact of life cycle changes on the
• Continuous and reciprocal feedback health of family members
• Each level responds and adjusts to changes in other ▪ Marriage, birth of the first child,
levels adolescence, leaving home, midlife,
divorce, remarriage, loss of a job, death of a
parent, and retirement are all
• Stability is maintained through a process of change developmental transitions that may occur
Although some of us does not like change unfortunately, in the life of a family.
change is very constant. o Somatic symptoms can serve an adaptive
function within the family and be maintained by
2. The primary focus of healthcare is the patient in the family patterns
context of the family ▪ In a sense, the symptoms were both a
• We have chosen to think of the patient in the context problem and a solution.
of the family as the “focus” rather than the “unit” of o Families are a valuable resource and source of
medical care. support for the management of illness
• The person/ patient as a biological and emotional ▪ Physicians and nurse practitioners
entity. Your patient has feelings, whether your recommend treatment that is usually carried
patient might show it or not, your patient has out in the home by the patient and family
feelings. That is why you really have to look for the members. To ignore the family is to invite
sabotage and “noncompliance.”

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 o Clarifying responsibilities. This
3. The patient, family and clinician are partners in responsibilities, in any illness, in any disease
healthcare lahat tayo may talk as members of the family.
That’s why we really have to define,
especially when we engage the family to help
in the management of our patients. We have
to help the families identify the roles, in
order for them to help this patient get better.

4. The family-oriented clinician reflects on how he or she

is part of the treatment system
• How am I part of what is happening? “did I
contribute to the patient’s symptoms?” “Did I
contribute to my brother or sister’s predicament or
illness?”
o In that sense they understand themselves as
part of an interactional process in which their
behavior contributes to what transpires.
• Interaction with the patient and family system may
unwittingly support rather than relieve the problem
• When treatment falters, a change in our own
behavior may help facilitate change throughout the
system. What happens to the family when one gets
sick? What is the dynamics of the family?
• Multiple vehicles exist to help clinicians attend to our
own issues in patient care.
o These include regular discussion with trusted
colleagues, consultation with behavioral health
consultants, personal awareness groups, Balint
groups that examine problematic clinician–
patient encounters, and readings about the
emotional experience of facing illness, whether
as a patient, a family member, or clinician.

IV. LEVELS OF FAMILY INTERVENTION

Doherty & Baird
• Level 1: Minimal Involvement
• Level 2: Ongoing medical information & advice
• Level 3: Provision of emotional support
• Level 4: Systematic assessment & planned
intervention
• Level 5: Family Therapy

Level 1: Minimal Involvement

• Doctor hardly sees the family
• Individual patient is the focus of the treatment
We are shifting from diad, the patient and the doctor, to • Family involvement is limited to medico-legal issues
triad, the patient, physician and family. So this is now the • Families are dealt with for practical or legal reasons.
therapeutic triangle. • One-way communication prevails.
• Family is a natural partner in healthcare • Example: Consent. This is when asking patient
• Patient and family are allies and a resource in consent for a treatment
negotiating a treatment plan that all can support
o Defining what needs to be done ELEMENTS OF INFORMED CONSENT
o Identifying symptoms • Disclosure
o Establishing a treatment plan • Understanding
• Voluntary

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 • Competency • Normalize feelings and emotional reactions to illness.
• Consent • In addition to health education, the physician:
o Probes deeper into the emotional impact of
Level 2: Ongoing medical information & advice illness.
• Doctor involves the family by providing them with o Offers emotional support to the family
information about patient’s illness. This is where members
you start involving the family.
• Communicate information clearly to patients and Level 4: Systematic assessment and Planned intervention
families. • Physician makes systematic assessment of the
• Elicit questions and areas of concern, and generate family dynamics and how it is interacting with
mutually agreed-upon action plans. illness. This is where you get the genogram, the
• Focus: Health education on both patient & family dynamics of the family, you try to get the
o Primarily cognitive in nature timeline, you try to understand the crisis – “How
o Biomedical issues did this family combat past crisis that they had?”
• Minimal emotional support – in order for you to understand how will this
• Example: breaking the bad news of disclosure family cope up with this situation.
• Assess the relationship between the illness
S.P.I.K.E.S PROTOCOL problem and the family dynamics.
• Step 1: Get the SETTING right o If the problem is not complex or long-
• Step 2: Find out what the patient already knows standing, work with the family to achieve
(PRECEPTION CHECK). For example, when the patient change.
receives the biopsy result, for example for breast o If the problem is entrenched or family
cancer there is intraductal carcinoma, so you ask the counseling is not effective, make a
patient what they understand from what they’ve referral and educate the family and
read (results). What does your patient understand therapist about what to expect. Continue
when he or she has read the result. to collaborate.
• Step 3: Find out what the patient wants to know • Plans and carries out intervention to change
(INVITATION from patient to give information) try structures in the family so that health problem of
asking the patient what they know about the illness. the patient can be better dealt with
Invite them. • Examples: Rogerian counseling; Cognitive
• Step 4: Give the information (KNOWLEDGE) once Behavioral Therapy
you’ve point out what your patient wants to know,
you try to impart the knowledge you know also. If Level 5: Family Therapy
your patients want to ask something out of the • Optional for physicians
ordinary, it’s also humbling to say na “I’m sorry I do • Requires additional specialty training.
not know that, can I read it for you then I’ll get back • Average family physicians will likely refer to
on you on your next follow up.” Wag po kayong professionals when confronted with family
magpakagaling, don’t play god in front of your dysfunctions requiring intervention
patient. Your patient will understand especially if • Medical family therapy is intensive specialty care
you’ve developed rapport already, your patient can delivered by professionals with advanced
understand that there are things that you cannot psychotherapy training.
explain. • Primary care clinicians should collaborate closely
• Step 5: Respond to patient’s reactions (EXPLORE on those patients with whom they have active
EMOTIONS AND EMPATHIZE) we also have to involvement.
understand why they are feeling that way, because
there will be times, without us knowing we will V. EVIDENCES OF FAMILY-FOCUSED CARE
experience this din. • “The Family Contribution to Health Status: A
• Step 6: Closing (STRATEGIZE & SUMMARIZE) Population-Level Estimate” by Ferrer et al (2005)
whatever you have talked about, whatever your o Conclusions: At a population level, the family
plans would be so you try to strategize and contribution to individual health status is
summarize. measurable and substantial. The shared
characteristics of income and health insurance
Level 3: Provision of emotional support account for only a modes portion of the effect.
• Demonstrate empathic listening and elicit Health policy and interventions should place more
expressions of feelings and concerns from patients emphasis on the family’s role in health.
and families.

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• “Family-Centered Theory: Origins, Development, o Building up the strengths of client & family
Barriers, and Supports to Implementation in and promoting partnership between them;
Rehabilitation Medicine” by Bamm & Rosenbaum o Viewing client and family members as
(2008) individuals and as members of a family and a
Appendix 1: Main Aspects of Family-Centered community;
Care in Clients’ and Health Professionals’ o Regarding family as a key source of
Perspectives information about their relatives’ and their
Clients’ Perception Professionals’ Perception own needs;
Availability and o Tailoring the services to fit family needs and
Education and counseling preferences- We are trying to shy away from
accessibility
Communication Information the authoritative way of treating our patients
Partnership Policies and we should also ensure that the services
Information (timely that we provide to these families are
Emotional support appropriate - and ensuring that services are
and situation-specific)
Advocacy and appropriate for a family’s culture and
Common goal setting traditions. For example, for those who are
coordination
Education and seventh day Adventist, what are their
Coordination preferences when it comes to food? What are
counseling
your preferences when it comes to health
care? For Jehovah’s witnesses for example,
• “Family-Centered Care: Current Applications and
they don’t want blood transfusion that’s why
Future Directions in Pediatric Health Care” by Kuo,
we try to also provide for an alternative for
et al (2012)
blood transfusion. As physicians we always
Information • Open, objective, unbiased and
must give them options, to choose, whatever
sharing not to be judgemental
they choose you also try to advocate, you also
Respect and • Respect for diversity, cultural &
try to help them understand the option they
honoring linguistic traditions, and care
have chosen.
difference preferences
• Medically appropriate decisions • “Family-Centered Care: An Evolutionary Concept
Partnership
that best fit the needs, Analysis” by Moradian (2018)
and
strengths, values and abilities of o Family-Centered Care Dimensions:
collaborative
all involved ▪ Families are experts about what helps them
• Desired outcomes of medical and what damages them;
Negotiation care plans flexible and not ▪ Families are valuable partners for
necessarily absolute policymakers who [hand] can help them;
• Direct medical care & decision- ▪ Families are not dependent upon
making reflect the child within treatment, but they are contributing and
the context of the family, home, empowering it;
school, quality of life within the ▪ Family-centered policies & practices
community. This is an emphasis promote family- and community-based
Care in the
on pediatrics kasi pediatric systems and provide bipartite support
context of
patients are minors, they cannot (support of the family and community);
family and
decide for themselves. That’s ▪ Principles of democracy and gender
community
why it’s very important here equality should be respected. Especially
that the family would be with those LGBT communities and
supported in order for them to families, it is very important that you also
understand what is happening practice gender sensitivity and equality.
in their pediatric patients. o Key Concepts Family-Centered Care
(Mackean)
• “Family Centered Approach in Primary Health Care: ▪ Family as the central element and the
Experience from an Urban Area of Mangalore, main source of strength and support;
India” by Shivalli et al (2004) ▪ Heed the uniqueness and diversity of
o Treating clients and their families with dignity families and children;
and respect; ▪ Parents are professional care providers;
o Opening communication channels with clients wag natin ismolin, we also must try to
and families; empower these family members who will
take care of our patients.

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 ▪ Family-based care is an enhancement of References:
capabilities NOT weakness • Dr. JD Velasco’s PPT September 23, 2021
• McDaniel, S. et al (2005) Family-Oriented Primary Care. 2nd
▪ Encourage partnership between the edition
family and the treatment team
▪ Create a supportive network within Further reading:
families • Ferrer, R. L., Palmer, R., & Burge, S. (2005). The family
contribution to health status: a population-level estimate. Annals
of family medicine, 3(2), 102–108. Retrieved from
• “Towards a universal model of family https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466857/
centered care: a scoping review” by Kokorelias • Bamm EL, Rosenbaum P. Family-centered theory: origins,
et al (2019) development, barriers, and supports to implementation in
o Collaboration between family rehabilitation medicine. Arch Phys Med Rehabil. 2008
members and HCPs within the family Aug;89(8):1618-24. Retrieved from https://www.archives-
pmr.org/article/S0003-9993(08)00308-0/fulltext
context • Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J.
o Flexible policies and procedures; M., & Neff, J. M. (2012). Family-centered care: current
o Illness-specific patient and family applications and future directions in pediatric health
education care. Maternal and child health journal, 16(2), 297–305.
Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262132/
Considera- • Shivalli, S., Majra, J. P., Akshaya, K. M., & Qadiri, G. J. (2015).
tion of Family centered approach in primary health care: experience
Family from an urban area of Mangalore,
Contexts India. TheScientificWorldJournal, 2015, 419192. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322852/
• Moradian, Seyed (2018) Family-Centered Care: An Evolutionary
Concept Analysis. Int J Med Rev 2018 June;5(2):82-86. Retrieved
from
Overarching https://www.researchgate.net/publication/330835182_Family-
Patient, Goal: Centered_Care_An_Evolutionary_Concept_Analysis
Family and Family-Centred • Kokorelias, K. M., Gignac, M., Naglie, G., & Cameron, J. I. (2019).
Dedicated Towards a universal model of family centered care: a scoping
Care Care Plan Policies and review. BMC health services research, 19(1), 564. Retrieved from
Provider Development Procedures https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693264/
Collabora- and
tion Implementa-
tion
VI. SAMPLEX
Matching Type:
___ 1. Doctor involves the family by providing them with information
about patient’s illness
Ilness
___ 2. Individual patient is the focus of the treatment
Specific
___ 3. Probes deeper into the emotional impact of illness
Education
___ 4. Requires additional specialty training.
___ 5. Physician makes systematic assessment of the family dynamics
and how it is interacting with illness
Fig 2. Universal Model of Family-Centered Care
A. Level 1: Minimal Involvement
• Terry McGeeny, MD B. Level 2: Ongoing medical information & advice
C. Level 3: Provision of emotional support
o “The lack of patient engagement is the Achilles’ D. Level 4: Systematic assessment & planned intervention
Heel of the health care delivery” E. Level 5: Family Therapy
o “The problem is not so much that patients are
unengaged… but rather that providers are not True or False:
_____ 1. Family-focused care may or may not include other important
always very engaging”
persons in the assessment and treatment processes
As healthcare providers, we try to engage our _____ 2. The patient and clinician are the only partners in healthcare.
patients. We should not stop when the family stops, as _____ 3. The family-oriented clinician reflects on how he or she is part
health care providers we try to provide options to the of the treatment system.
family members in order for them that they may help the _____ 4. The primary focus of healthcare is patient in the context of
the family
patient and get better especially for our patients who are _____ 5. The family is a secondary source of health beliefs and
vulnerable, part of the vulnerable group, the pediatric behaviors
patients who are minor. 5. False (primary) 5. D
4. True 4. E
3. True 3. C
2. False (patient, family, physician) 2. A
1. True 1. B
True or False Matching Type
Answer key:

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 PFCM 3A | Family Classification, Structure, and Function
Tutor: Dr. JD Velasco | Lecture Date: Sept 30, 2021 | 1st SEMESTER

TOPIC OUTLINE
I. RECAP A. Task orientation
II. INTRODUCTION  Focus on whether certain tasks for family life are
A. Task Orientation
B. Transactional Process
performed (Wambldt & Reiss, 1989) All family
C. Role of Family members have their own tasks. Who’s the
III. FAMILY CLASSIFICATION breadwinner, the “ilaw ng tahanan” for the
A. Basis of Descent / Lineage mother, who usually does the groceries, who is
B. Basis of Authority / Headship
usually your decision-maker, who usually budgets
C. Pattern of Residence
D. Amount of Mates the finances that you have.
E. Social Class Pattern  Families are described as a group working towards
F. Family Set-Up mutual need fulfillment. What does your family
IV. FAMILY STRUCTURE need? What are the goals of your family? What do
A. Nuclear Families
B. Extended Families
you want to achieve as a family?
a. Conjugal Family  Family as working together towards the
b. Consanguineal family socialization and nurturance of children (Lerner &
C. Single Parent Family Spanier, 1978) In the famous line in the bible “Go
D. Blended Family
and multiply” pero hindi dapat siya multiply nang
E. Communal / Corporate Family
F. Influences on Family Structure multiply, you also have to subdue it. It doesn’t stop
a. Industrialization there that you have to multiply your generation or
b. Divorce your race, but you also have to do something about
c. Class them.
d. State Benefits
V. FAMILY FUNCTION  Role and motto of family and its members
A. Basic Areas of Family Function
B. Attributes of a Well-Functioning Family B. Transactional Process
C. Family Characteristics as a Social System  This places a very strong emphasis on
D. Family Position
VI. Q&A
communication as a major vehicle through which
VII. SAMPLEX the ties of identity and loyalty are forged. It’s very
important also that there should be a good
I. RECAP harmonious communication in the family
What is a family?  Family as a group of intimates who generate a
 "Definitions of the word family generally fall into group identity (Wambldt & Reiss, 1989) What’s
three categories: Family structure, Task your identity as your family?
orientation, Transactional process definitions”  In some close-knit families, unfortunately they give
Who is your family? more emphasis on their reputation as a family. I’m
 We have answered this on the last 2 lectures. I sure some of you have felt that, they try to do
hope you have defined in yourself who is your everything they can just to uphold the reputation
actual family. that the family has, especially if you belong to the
political family or to the elite or to the family na
II. INTRODUCTION [sinasabing] “may sinasabi”. These are very
FAMILY STRUCTURE important also in the family. It’s not a bad thing
 Organizational roles within the family naman that you have your own reputation, meron
 Reflects relationships at the juncture of biological naman kasi talaga iyon. I think values are very
relatedness, marital and partnership status and important also that it has [values] to be
living arrangements emphasized in the family. [I don’t know if you
 This structure includes "Roles” and "Subsystems". realize also that] Sometimes, what our attitude or
The family is already a system, but within that how do we show our attitude or how do we behave
system, there are subsystems because that outside of the family reflects back to our families.
depends on the type of family that you have. I hope Laging sinasabi, especially Filipinos “ah ganyan ka
that after all these lectures this 1st semester pala pinalaki ng family mo”. But of course, you
you’re going to integrate them and correlate them really have to explore deeper din. Sana, but
so that you’ll understand really what the family is sometimes kasi we are stuck, it’s actually I think
all about. human nature that we are stuck on what we see
especially on the first impression. We forget that

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 all of us had gone through something, had gone o Generally, we Filipinos are monogamous. But of
through a lot before we have reached what our course our Muslim brothers practice
stage is or our situation right now. polygamous because it is allowed in their
 Families have strong ties of loyalty and experience culture
a history and future together. Sometimes it’s the  Social class
past and the present that connects us as a family.  Set-up
As much as possible we try to know members of
our families no matter how distant they are. A. Basis of Descent / Lineage
 Concentrates towards various relations and their  Patrilineal Family
communication with each other. o When property and title inheritance passes
down through the father's side
C. Role of Family o Filipino families are dominantly paternal.
 Goal-directed o Sometimes the dowry is usually given by the
o If ever when we have our families, we also have female to the male, although they live in
goals. Ano ba yung goals niyo as a family? What where the male is. But the dowry comes from
do you want to achieve? What are your the females although there is also a part from
objectives as families? the males. Usually, dapat yan whoever is more
 Self-correcting privileged supposedly have more dowry than
o Meaning to say, tayo-tayo lang ang nakaka-ano. the one na hindi. If you have watched some of
So whatever happens in the family, tayo-tayo the old types of families before especially the
lang din naman yung nakakacorrect no’n. As very traditional families, as much as possible,
much as possible we try, as members of the they want to maintain na dapat si guy has the
family, try to fix things. authority also.
 Dynamic  Matrilineal Family
o It’s ever-changing. [Sabi nga] If there’s anything o When property and title inheritance passes
that is constant, it’s change. For example, down through the mother's side
COVID. What happens to the family if this family o Sometimes nagkakaroon ng conflict dito
is affected by COVID? It actually shakes your because we have ego here. It’s usually the
family dynamics. Especially if nobody in the males ang may ego diyan. Kaya minsan
family knows about COVID or nobody in the nagkakaroon ng conflict to the couple because
family knows something about COVID, nagkakasapawan doon sa how much the other
magpapanic lahat. It is very important that even is earning, or on the position, boss ba or
if at your level you should be educated of what something.
COVID is. Kasi, number one, if you have COVID,  Bilateral
you should not panic. o The relatives on the mother's side and father's
o It’s also a crisis that we have to go through. But side are equally important for emotional ties
it’s a balance, magtulungan din [teamwork]. or for transfer of property or wealth
 Interconnected systems that affect and affected o [I’m not sure in your family how you ano
by their environment and by qualities within the naman by the lineage] the wealth or
family itself inheritance ba is it both? Or majority father
o All of us has something to do with how we side? Depending on your family circle.
balance the family. Depending sometimes on
your role in the family, what is your order in the B. Basis of Authority / Headship
family? Are you the eldest, middle, bunso, kasi  Patriarchal
may effect lahat ‘yon. o Father is considered the head
o Usually the eldest is the one given much or  Matriarchal
more responsibilities than the middle or the o Authority is held by the mother
bunso. In general, yung bunso is the favorite,  Equalitarian
especially those menopausal babies, lalo kung o Where the husband and wife exercise an
solo na lalaki or solo na babae. That depends on equal amount of authority
your family.  Matricentric
o Where the absence of the father who may be
III. FAMILY CLASSIFICATION working gives the mother a dominant position
 Basis of Descent/ Lineage in the family.
 Basis of Authority/ Headship o May substitute because if the head of the
 Pattern of Residence family is not around, so the mother takes over.
 Amount of Mates But of course, pagbalik ni father magshishift

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 siya sa patriarchal pa rin. Usually this happens  One woman is married to several
if OFW, usually it’s the father who goes to men simultaneously
work outside, so nagiging matricentric siya.  Sa polyandry, may fraternal tsaka
non-fraternal. Kasi dito pwedeng
C. Pattern of Residence fraternal, magkapatid yung
 Patrilocal husbands. Pwede ring non-fraternal,
o Married couple lives with or near the the husbands here are not related
husband’s family  For both [pala] polyandry and
 Matrilocal polygyny, these women are related
o Married couple lives with or near the wife’s or not or pwedeng sisters [parang
family ganon] may blood relationship
 Neo-local  Group Marriage
o Married couple sets up a home separate from  Family with multiple wives and
either side of their families husbands
o Kasi usually kapag patrilocal or matrilocal
pwedeng it’s a compound, magkakalapit lang E. Social Class Pattern
siya or pwedeng kin network.  UPPER CLASS
 Bilocal o Closely-knit
o Provides newlywed couple the freedom to o They have emphasis on Name and prestige
select where to reside i.e. near the groom’s or  MIDDLE CLASS
the bride’s parents o Believes in hard work, initiative,
o Either near the groom or near the bride, independence, responsibility, economic
parehas. security and self-improvement through
 Avunlocal education
o Prescribes the newlywed couple resides with  LOWER CLASS
or near the maternal uncle of the groom o They are exposed to poverty
o Although in the Philippines, usually the place o Life as continuous struggle for survival
of residence is inference with the close ties o Resigned to a life of frustration and defeat,
prevailing among the family members, also on but I think we are seeing articles now na kahit
the economic dependence of children on their na sila ay basurero or basurera, if given the
parents, and ownership of property, or chance they can some get scholarship grants
parents’ decision. Kasi sometimes those who o Middle class naman those who are working,
can afford, [because] once you are married naging working student sila, sila pa yung
already, some of the parents can give gifts summa cum laude, magna cum laude or after
such as house and lot to their newly married how many years of studying they pass, they
children. Depende kung sino ang nagbigay, is became topnotchers of boards. It depends on
it the mother or father side so that depends the social class pattern.
also.
D. Amount of Mates F. Family Set-Up
 Monogamy  Authoritarian and Democratic are the most
o Marriage to one person at a time common, although there are others also
 Polygamy  AUTHORITARIAN
o Marriage between one person and two or o Authority is usually with the parents, you need
more spouses to obey
o Types: o Unquestioned obedience conformity to
 Polygyny parental guidance
 One man is married to several o Punishments vs. Praise
women simultaneously o Low self-reliance
 I’m not sure if we still have this pero o Stand poorly in stressful situations
polygyny I think usually sa old  Meron silang taga-sangga ng stress. If
Chinese people and some of the you actually have sheltered your family
Korean, uso yung mga concubine or members kasi ikaw na lagi as parents
mistresses na legal. It’s part of their ang usually the one who steps up, some
culture, especially if the legal wife or of the members of your family [would
first wife did not bear them a son. really] are not exposed to what is really
Kasi importante ang son sa kanila. reality
 Polyandry o Hostile with pain and discomfort

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  DEMOCRATIC
o Respect for children's decision & ideas B. Extended Families
o Understanding and permissiveness prevail  Sa ating mga Pilipino, uso ‘yan
 Again, that depends on you as families kung ano  Unilaterally extended
ang gusto niyo. It’s how your dynamics should work o This is your family, your nuclear, but maybe
also. some of the members of your paternal side [or
your father side] came to live with you
IV. FAMILY STRUCTURE  Bilaterally extended
A. Nuclear Families o Both from paternal and maternal came to live
 Consisting married couple either of married (or a with you
divorced or a widowed parent) with unmarried  Number of nuclear families linked together by
children or of a married couple without children. virtue of the kinship bond between parents and
 Consist of parents and their still dependent children or between siblings
children o Pwedeng mother and father, tapos nag-marry
 Occupy a separate dwelling not shared with yung isang anak for example, of course they
members of the family of origin / orientation of cannot live yet alone, so they can stay muna
either spouse sa inyo.
o Naka bukod sila, they are separate from o Nuclear sana itong nag-asawa, parang
both maternal and paternal families. They extended niya yung parents niya, kasi they are
live alone. living with the fatherside parang ganon.
 Household is economically independent because  Usually includes three generations
they can live on their own  Family-centered
 Subsistence is from the occupational earnings of  Families of orientation are merged with families of
either of the couple procreation
Parsons & Bales, 1955 o Pwedeng dun sa family na ‘yon kahit na nag-
asawa lahat yung anak, nandun pa rin sila sa
 Family of Orientation / Origin bahay na iyon
o Children perspective
o Locate children socially a. Conjugal Family
 Family of Procreation  Considers the spouses and their children as of
o Parents perspective prime importance
o Produce and socialize children  Has fringe of comparatively unimportant relatives

b. Consanguineal Family
 Considers the nucleus of blood relatives as more
Father Spouse important than the spouses
Mother Son o Blood is thicker than water. Ang mahirap dito
Siblings Daughter if there is conflict between in-laws, and for
example if there’s a conflict between my
husband and one of my siblings, so sino ang
kakampihan ko, of course blood is thicker than
 Sometimes the father becomes the spouse, or water, are you gong to trust your husband or
father can be son or daughter, the mother ganun your siblings. So magulo din siya. You choose
din your relatives over your husband or your wife.
 If we use the family of orientation or origin, sa mga
father, mother, and siblings, pwedeng nuclear pa C. Single Parent Family
rin yan kasi sila-sila lang, they are not married.  Separate pwedeng due to annulment, legal
 But when it comes to family of procreation, they separation, or pwede ring single parent kasi yung
have the spouse, the son and the daughter nag-OFW [matricentric]
(pertaining to the above figure). So depende for  Lone parent family
example, here comes the mother and father, wala
 Consist of children <17 years of age living in a
sa mga anak niya ang nag-asawa, so nobody
family unit with a single parent, another relative or
married, nobody lived outside of their family
a non-relative
home, pwede pa rin iyon
 May result from:
 Pag nuclear, pwede rin naman na the mother and
o Loss of spouse by death, divorce,
father with the children, parang ganon, pwede pa
separation, desertion
rin ‘yon.
o Out-of-wedlock birth of a child

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 o Adoption  If partners decide to divorce then from being
o One parent is working outside the nuclear nagiging single parent or if somebody
Philippines (OFWs) remarries edi nagiging blended family
 Divorce became socially acceptable
D. Blended Family  Government (even in the Philippines), began
 Includes step-parents and step-children providing financial assistance to single parents as
 Caused by: long as you register, meron ding privileges kasi that
o Divorce they can [have]
o Annulment with remarriage and
separation (or even death na nag re-marry c. Class
one of the parties, tapos nagsama na)  Depending on the cultures that you have
o If you are marrying to somebody who has  Highly influences the family structure as those with
previous children low incomes tend to have a higher divorce rate
due to financial conflicts
E. Communal / Corporate Family  Lower class
 Grouping of individuals which are formed for o Usually matrifocal or single parents
specific ideological or societal purposes (church) o Contribute to the social instability of the
 Considered as an alternative lifestyle for people society
who feel alienated from predominantly  Middle class
economically oriented society o Tend to have less kids than the lower class
 Vary within social context kasi they know the hardships of having lots
o Highly formalized structures: Amish of kids
community in Lancaster County in  Higher class
Pennsylvania o Tend to have an average of one to two
o Loosely knit groups: Sta. Cruz mountains children
(American-Indians ‘yung iba dito) near
Boulder Creek on California d. State Benefits
 Nagkakaroon dito ng conflict especially if you are
F. Lineal Families too sensitive on the earnings of each other. This
 Consisting of two or more generations with each could make or break the family.
generation composed of one married couple (or a  Government as economic support provider
divorced person, widow or widowers) o Marked emergence of single parent
families, they have more benefits than
G. Joint Families those married
 Consisting of two or more married couples (or o Less people are encouraged to get married
divorced persons, widows or widowers) of the
same generation. V. FAMILY FUNCTION
"The key function of family is to preserve, protect and
H. Influences on Family Structure promote its generation year after year"
a. Industrialization
 For example, both of you are working however you Six essential functions of families as listed by Zimmerman
assume that your finances are not enough, (Schleisinger, 1988):
especially if you want to build your own house, you a. Physical maintenance and care of family members.
want to have your own cars. Because of Within healthy families, children, adults, and
industrialization, one of you would actually would seniors all receive the care and support they need.
go out or go abroad to earn. So instead of having a b. Addition of new members through procreation or
nuclear family, pwedeng mag single parent family adoption and their relinquishment when they have
siya matured. Society renews itself through families.
 From agrarian to mechanized society c. Socialization of children for adult roles. Families
 Increased geographical and social mobility prepare their children for life
resulting in the breakdown of the extended family d. Social control of members is the maintenance of
to the privatized nuclear family kasi nga they want order within the family and groups external to it.
to earn e. Maintenance of family morale and motivation to
ensure task performance both within the family
b. Divorce and in other groups. In this regard, families
provide the glue that holds society together keeps
it functioning.

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 f. Production and consumption of goods and their children in the next, on how they
services. Families provide for their own by would face the future na with or without
producing goods and services. As they strive to us. It’s very important to note, [you have]
fulfill the needs of their members, they play a vital to equate the perception versus reality.
role in the national economy. o For millennial learners, you want to be
mentally prepared, ayaw niyo ng surprises.
A. Basic Areas of Family Function Kasi that would actually disrupt your
 Biologic routines. As much as possible she [anak ni
o Reproduction doc] wants to know kung pwede sana ‘no,
o Child rearing / caring ayaw niyang surprise, she doesn’t want to
o Nutrition be caught off-guard. Who wants it anyway
o Health maintenance ‘pag ganun. Kung surprise siguro na
o Recreation maganda siya, but what if surprise na siya
 Economic in a bad way pangit kasi.
o Financial resources o We really have to be prepared always lalo
o Resources allocation na ngayong COVID. A lot have died already.
o Financial security o Life is really short, and we have to accept
 Educational that death is part of life. You have to
o Attitudes accept that the end of our life is death.
o Skills Death is also a process, aging is also a
o Some of us would say na we don’t have process. We will all age, tatanda din kayo,
inheritance to give you but of course we tatanda tayong lahat, we will all grow old.
want that you’ll be educated kasi that’s the
only inheritance that we can give you Attributes of a Well-Functioning Family (Schlesinger,
o Families provide for their own by 1998)
producing goods and services, and within  Kasi if our family is not well-functioning, you will
families also individuals learn positive not have an equilibrium. You will always have
values and behavior and receive criticism disequilibrium, you’ll always have conflicts, which
for negative ones. will stress you out in your family. Supposedly, your
o May kanya-kanya tayong values in the family will be your source of comfort. But if your
family family is in disequilibrium and disarray, you will not
 Psychologic / Affection achieve such.
o This is usually a maintenance of family  Clear role distinctions with distinct boundary
morale and motivation to ensure task are between integral family members and extended
performed both or within family and other family.
groups o Medyo mahirap ito sa umpisa but since if
o Natural development of personalities you are the owner of the house then you
o Psychological protection really have to set the rules, you have to set
o Interrelationships is very important with the boundaries
people not only in the family circle but also o The husband and wife plays in a two-
outside parent family plays a dual role; in the
 Socio-cultural marriage relationship as husband and wife
o Socialization of children for adult roles, and as parents planning on executive or
kailangan mexpose din ang mga bata so managerial role in the nurturance, control,
that they know their roles in the future and later the guidance of their children.
o Promotion of status and legitimacy  High degree of individuality and differentiation
o Families need to prepare their children for o You have a space to grow, you have a
life space to express your own self
o We don’t know what will happen to our individually. No persons are the same,
children but we really have to teach them even twins pa yan, ke identical or fraternal
values, attitudes that would make them twins, ke magkapatid pa yan.
resilient in the future. Resilient, meaning o This leads to a continual tug and pull
to say, how are they going to cope with all between separateness and mutuality.
the struggles that they are experiencing. Conflict arises only if the family views
o We can’t say the future of our children individual expression as a threat.
even if they choose this or that. It’s really
hard as a mom or as parent to prepare

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  Clear and reasonable rules Family Characteristics as a Social System (Philadelphia
o Changes as children mature. The University, 2003)
punishment for breaking the rules is  Interdependence
humane and on a scale commensurate o Each member’s actions affect the others
with the “crime” o It’s like a domino effect
 Good communication  Maintenance of boundaries
o All family members speak for themselves o Ego as well as generational boundaries
 Clear authority or power with implied agreement o There should be clear boundaries. Kaya
of all family members nga sa iba diyan makuha ka sa tingin, or
o For example, who is your decision-maker there are some parents na when their
when somebody gets sick? Who will children make sutil or something, there
decide to what hospital are you going to should be ano din, may sign language
admit this patient? Importante yon, kasi minsan sa mata eh. Importante din, you
once these are not addressed, these can need to take note of that when you have
be a source of conflict later on. your own patients later on.
 Acceptable and appropriate display of full range of  Exchange of energy with the environment
emotions o Input-output relationship
o Kasi you can express yourselves freely and o Changing in response to internal &
diplomatically. There should be diplomatic external forces
relationship among the family members. o You have to take note of the factors that
o Imposing taboos on expressing certain may influence, that may make-or-break
feelings leads to incongruity between your family.
emotions and behavior.  Adaptive
 Highly constructive and satisfying approaches to o Learn how to embrace new roles,
solving problems additions, and relationships
o If your problem entails the whole family to o We should adapt in case there will be
answer it then go ahead. additions in relationships later on.
 Clear understanding of tasks and chores that are o Thinking ahead
shared by family members o We also should accept new additions in
o Like who is going to do the laundry on the family, and those relationships that are
these days? Who is going to wash the to be formed.
dishes on these days? Morning? Bahala Family Position
kayo, may shifting yan. Who is going to  Your position in the family affects your personality,
clean the house on these days? behavior, and view of the world
 Respected individual differences in energy levels,  Birth order is one of the most powerful influence
time perception and space requirements on personality, along with genetics, gender,
o It’s very important that you should know temperament, and parenting styles
your own [in]differences, your own  First-borns tend to be:
idiosyncrasies, nobody’s perfect. So you o High achievers
should also acknowledge yung bad o Perfectionists
attitudes mo rin, your good qualities din. o Responsible
There should be check and balance.  Sibling rivalry, if your siblings are
 Natural development of high esteem within family playing and then later on they quarrel.
members As the eldest, even if I was not part of
o Esteem should be boosted, should be their quarrels, I’m the one who was
lifted up para once you go out of your being scolded kasi I did not discipline
family, you are confident enough to deal them
with everything that you can deal. o Goal-setters
o The well-functioning family is not o Determined
necessarily quiet, well-ordered, and  This is usually true especially if you
rational all the time. Amid the affection want to uplift your family situation on
and companionship, children squabble, finances-wise. As the panganay, you are
compete, and get in each other’s hair as determined to uplift your family para
they learn how to get along with people. gumanda yung buhay
o Rule keepers
 Seryoso si ate or kuya na panganay
o Detail people

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  Seconds and middles tend to be: A: Usually kasi sa Muslim, meron talaga silang
o Peacemakers legal. Kung sino yung first wife, siya rin yung
 Referee merong authority. Usually naman ang mga ito they
o Diplomatic don’t marry na ganun-ganun lang. They also ask
o Flexible permission from the first wife if they can marry
o Free spirits another. Hindi naman siya basta-basta. I think we
o Generous have several Muslims naman na patients, usually,
o Competitive kung sino na yung nandun, kasi legal sa kanila lahat
 Meron din sa first-borns to e. Legal wives nila lahat to, ikakasal pa rin naman
 Youngest children tend to be: nila yan. Usually naman sa medical management
o Charmers wala ring masyadong problems sa kanila. Kung sino
 Kung nag away-away kayo and your yung legal, siya yung magsa-sign. Sa Muslim all of
parents angry, sino ang isusubo niyo? them are their legal wife. Wala naman hindi legal
Usually it’s the bunso diba, sila yung kasi that’s their culture already, dapat ireregister
favorite pa rin nila yan.
o Risk-takers
 Depends on the personality of the *Further info on Amish communities can be watched here:
https://www.youtube.com/watch?v=LpjpE0h2Xjw&list=PL9cJRl8EYnLcr
bunso SOlJdmVvw7DjPgZTezfl
o Outgoing
o Persistent Reference:
o Ideas people • Dr. JD Velasco’s PPT Sept 30, 2021
o Creative • Leopando, Z. (2016) Textbook of Family Medicine
o Challenge authority Volume 1.
 Kasi favorite siya
 Hindi ko naman sinasabing lahat, not all of these,
but these are general. There’s always exception to
the rule

VI. Q&A
1. Q: Just like any relationship, does relationship with
the family ends for the likes when you move out or
when you have your own family na?
A: No, it does not. That’s a good thing with family.
[Even if maybe you have] hindi ka pwede kasing
itakwil ng family mo. Kadugo ka nila e. Unless
maybe you have a very stringent family that
anything that you did and siguro kalabisan na, well
maybe may ganon. Pero those are isolated cases
lang eh. Pero Filipino families? They don’t do that.
Whatever happens to you, your family will always
be there for you. Especially for parents a, kasi
especially for moms, they carried you for 9 months,
they labored for you to go out and see the world
and yet here you are. But still they will love you.
Kasi this is blood, we are talking of blood here. Pag
husband and wife kasi it’s different kasi hindi
naman sila blood-related eh. Pero for families kasi
there’s a blood relationship here. There’s
emotions, they’re poured out already. It does not
end unless you’ll be the one to go out and tell your
family we’ll end it here. May mga ganon naman but
supposedly it does not end. Yun yung hindi dapat
nag-e-end
2. Q: If Muslims, if the husband is unable, who will
sign the consent sa hospital? Any of the legal wives
ba?

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 VII. SAMPLEX
Matching type
A.
1. Father is considered the head
2. Authority is held by the mother
3. Where the husband and wife exercise an equal
amount of authority
4. Where the absence of the father who may be
working gives the mother a dominant position in
the family.

A. Patriarchal
B. Matriarchal
C. Equalitarian
D. Matricentric

B.
1. One man is married to several women A.
B.
3.
2.
simultaneously C. 1.
2. One woman is married to several men B.
simultaneously D 4.
3. Family with multiple wives and husbands C 3.
B 2.
A 1.
A. Group Marriage
A.
B. Polyandry
C. Polygyny
Matching Type
Answers:

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 PFCM 3A | Family Psychodynamics
Tutor: Dr. JD Velasco | Lecture Date: October 14, 2021 | 1st SEMESTER

TOPIC OUTLINE Preliminary questions

I. INTRODUCTION • What is a system?
A. Family is a System
o An entity composed of discrete parts
B. Family Systems Theory
C. Terms used in Family Function which are connected in such a way that a
D. Family Systems Therapy Approaches change in ONE part results In changes in
II.INTERLOCKING CONCEPTS OF FAMILY SYSTEMS ALL parts para siyang domino effect, if
THEORY
you touch one, it actually affects the rest.
A. Differentiation of Self
B. Emotional Triangle Parang ganon ang family, if one family
C. Family Projection Process member suffers or have illness especially
D. Multigenerational Process chronically ill family member, all of us are
E. Emotional Cutoff
actually affected unless they don’t want
F. Sibling Position
G. Societal Position to be bothered or maybe umalis na sila sa
H. Societal Emotional Process family or they are not already part of the
I. Nuclear Family Emotional Process family but even though they are not part
III. NOTIONS IN MINUCHIN’S THEORY OF FAMILY
of the family, of course we are affected at
PSYCHODYNAMICS
A. Adaptation some point depending on the level of
B. Transactional patterns affectation, how close knit the family is.
C. Subsystems o Organized unit made up of
D. Boundaries
interdependent parts they could actually
IV. FAMILY PROCESSES
A. Enmeshment depend on each other because they are
B. Disengagement part of the system, so what happens to
C. Triangulation the other, happens to the other one.
D. Coalition
V. FAMILY SYSTEMS THEORY APPLICATION
• Is Family a system?
VI. Q&A
VII. SAMPLEX A. FAMILY is a SYSTEM
• Each member has a significant influence on all
I. INTRODUCTION other members
Psychodynamics • Has parts or members that are connected to each
• An approach to psychology (psycho, psychic) that other through birth, affiliation especially Filipino
emphasizes systemic study of the psychological family because most of us are part of extended
forces that underline human behavior, feelings families, bibihira kasi yung nuclear family such
and emotions and how they might relate to early that change in one member cause change in ALL
experience of others as well
• If you look back at your psychology subject, it is • Criteria for MEMBERSHIP
the Interplay between the id, ego and super-ego o Emotional significance can be affiliation,
o If we say id, it is the biologically driven least and most favorite children
self, it is the part of us that wants o Enduring ties because you gave birth to
immediate gratification. Gusto natin these children even if you don’t want it
andyan na kaagad. since they are part of your blood, they are
o Ego on the other hand, is the part that part of your generation then you really
develops as we learn that there are limits have you endure that they are part of
on what is acceptable. your family
o And your superego is the part that • ELEMENTS in the system
develops as we learn the rules, standards, o Rules
and values of the society guided by our o Roles
morality. o Boundaries
o These three (3) are different, you really o Resonance
have to differentiate them, if you are • CIRCULATORY
going into psychiatry later on, you might o Cascading series of changes in the family
want to explore more of these. o Paikot-ikot lang siya. For example, how
o All of us have these in different levels per did CoViD affect the family? Were there
individual or also in the family. rules that has been change? Did your
roles change also in the family especially

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 when you are medically in debt because which the family is embedded (W.H Watson,
CoViD-19 is a medical disease. Encyclopedia of Human behavior) we are talking
• HOMEOSTASIS about context, ano yung context niya sa family.
o Tendency to try to go back to its previous How do you face crisis/stressful events in the
functioning – in a sense to resist change family?
o We try to balance the function, as much • Based on Murray Bowen (most common):
as possible we don’t want disturbance of “individuals are inseparable from their network of
the family. relationships” even if one individual wants to
• EQUILIBRIUM disengage or separate himself, it’s impossible
o Orderliness in the behavior of family unless the parents are somewhat punong-puno
systems na or nasagad but deep down they don’t want to
o Discerned through repetitive patterns in disengage other members of the family.
the way members behave • Goal: educate people about the importance of
o What are the usual norms that we do, family emotional systems emotions here are not
what are the traditions that we usually merely feelings
do? • Inform family units about the way which families
• As much as possible, we want to maintain these in are structured to work that’s why we really have
a family kaya we have our own system in the to study families depending on the culture/race
family. As a parent, we want to pass on the like Asian families are different from Caucasians
tradition, the cultures that we have especially family. Indigenous people have their own culture/
when it comes to social gatherings or mga beliefs not only in health but also in different
pamahiin during weddings ganyan traditions like ancestral religion or tinatawag na
paganism but in actuality it’s not really paganism
we still worship the same God that most of us,
Christians, worships but just in different names.
We have different context, traditions, and
cultures and we have to respect those.
• As health workers, we are paternalistic, we
respect the patient’s/ family’s autonomy. We
guide and give them options not forcing our
thoughts to them. That’s why it is very important
to have informed consent.
• Theory of human behavior that views the family
as emotional unit
• Uses systems thinking to describe the complex
interactions in the unit
o It is the nature of the family that its
members are intensely connected
emotionally
o Emotional interdependence involved to
promote cohesiveness and cooperation
families require to protect, shelter and
This is how a family function. Of course, it’s like a bed of
feed their members. Our purpose as a
roses, we still have the thorns, we also suffer some crisis,
family member is to protect, shelter, and
some stressful events in our lives. Family is related
feed our family members. Go and multiply
through feedback loops.
but make sure that you know when to
subdue it, not just multiply and multiply
B. FAMILY SYSTEMS THEORY
then pabayaan mo na.
• How would these family systems affect our
approach to the families when we cater to the
C. TERMS USED IN FAMILY FUNCTION
patients? We are emphasizing on therapeutic
• EQUILIBRIUM
triads, you don’t only engage the patients but also
o State of family homeostasis in which
the family members or significant others or those
member interaction results in emotional
the patient considers as family
and physical nurturement if a family is
• An approach to understand human functioning
nurtured, highly functional yung family,
that focuses on interactions between people in a
family between the family and the context in
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 promoting growth of family members and o Even if there’s equilibrium, it’s still
the family unit pathologic kasi they are functioning as if
• DISEQUILIBRIUM they’re normal but actually they’re not so
o State of impaired functioning, nurturing problems keep piling up
or role complementarity in which a family o Families may have members who are
for the time being can neither escape nor isolated from other members where they
solve problems with their customary can’t receive help so independent
problem – solving resources pwedeng function is paralyzed
Malala na yung crisis that we also have to
implore the help of others as well D. FAMILY SYSTEMS THERAPY APPROACHES
• STRESSFUL LIFE EVENTS • STRUCTURAL
o Life experience requiring the family’s use o Designed/coined by Salvador Minuchin
of resources for coping or adapting not o Looks at Family relationships behaviors
usually required by the family members and patterns as they are exhibited within
for the management of daily activities the therapy session in order to evaluate
o Still manageable the structure of the family.
• CRISIS • STRATEGIC
o State of family disequilibrium resulting o Developed by Jay Hayley, Milton Erickson
from failure to identify resources & Cloe Madanes
adequate to allow family members to o Examines Family processes and
cope with stressful life event functions, such as communication or
o Stressful life events if not solved could problem-solving patterns
lead into crisis • INTERGENERATIONAL
• RESOURCES o What we commonly using
o Assets that serve the process of family o Developed/ introduced by Murray Bowen
nurturing and fall in the general context o Acknowledges generational influences on
of familial finances and extrafamilial family and individual behavior.
social, cultural, religious, economic,
educational, environmental and medical II. INTERLOCKING CONCEPTS OF FAMILY SYSTEMS
support systems THEORY (BOWENIAN APPROACH)
o Not just funds but also resources of
people that’s why we have human This was introduced by Murray Bowen. It explores the
resources significance of family in emotional development. When
• ADAPTATION we talk about emotions, it’s not just merely feelings but
o Process by which family members utilize intense reactivities especially experiencing crisis at very
their resources to effect a resolution of a young age. Example, Doc’s family experienced a massive
stressful life event and return to nurturing change in life because of the 1990 earthquake. Although
family function or equilibrium Doc was young, she was 9yo, Grade 4, at that time, the
o If we cant adapt, iba na yung mangyayari, impact was great. They still remember those family
we’ll talk about it later on. members who died, some of their relatives were buried in
• MALADAPTATION the garden because they were already there and sudden
o Process by which a family in crisis or yung earthquake and some of the bodies were not
disequilibrium chooses abnormal defense recovered. This changed their family even the behavior,
mechanisms to achieve some measure of because of that earthquake, they built more sturdier
equilibrium in family function homes. Emotions are highly complex behavior patterns,
o If they have subdue all the resources they and we need these emotions because we want to survive
have, they now resort to maladaptation, and hoping it’s the correct emotions. That’s why if we
even they achieved the equilibrium, there have unresolved issues in childhood/adolescence or even
are still certain point of disequilibrium now, it’s kind of difficult to decide to move forward
• PATHOLOGIC EQUILIBRIUM because of these emotions that we feel. I hope after this
o State of impaired interaction or nurturing lecture, you would want to study/ appreciate your family
within a family that follows the utilization in order for you to cope, to be resilient at this time.
of abnormal defense mechanisms to • Differentiation of Self
escape from anxiety of unresolved family • Emotional Triangle
crisis. • Family Projection Process
• Multigenerational Process

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 • Emotional Cutoff parents, we need to give our child
• Sibling Position some space so they can think, know
• Societal Position or describe their feelings
• Societal Emotional Process • WELL DIFFERENTIATED SELF
• Nuclear Family Emotional Process o Recognizes the realistic dependence
• on others. No man is an island. We
A. Differentiation of Self need to depend on others, not only in
• Families and other social groups greatly affect family but also in work or school
how people think, feel and act. As person, we o Calm and clear-headed in the face of
have separate thought, feelings, response to conflict, criticism and rejection to
anxieties, and cope to life while pursuing our distinguish thinking rooted in careful
own personal goals. assessment on the facts from thinking
• Individuals with high level of differentiation clouded emotionally
maintain individually while still maintaining o Thoughtfully acquired principles help
emotional contact with the group. Members guide decision-making about
of healthy family can differentiate between important family and social issues
own thoughts and feelings of other members. o If you have well-differentiated self,
This is where the family would allow you grow you will survive whatever life throws
either personal or professional growth. at you. It’s up to you on how you will
• The basic building blocks of “self” are inborn turn negativity to positivity.
can be influence by our family, our
relationship in the family, but an individual’s B. Emotional Triangle
family relationships during childhood and • Triangle – the patient, the family, pwedeng other
adolescence primarily determine how much person but in health, it is the family, the patient,
“self” he develops maraming pwedeng and the doctor
magbago because we have peers or if it was • Building block or “molecule” of larger emotional
not your family who took care of you, what systems
are the influences of the relatives who raised • It is the smallest stable relationship system
you especially those who were raised by their because we shy away from dyad, we want to
grandparents just like Doc’s daughter who involve the family. Stable siya kasi may base,
was raised by her grandparents for 4 years. nakakatayo siya mag-isa.
o Once established, the level of “self” • Two members experience stress, and bring in
rarely changes unless a person makes another family member to relieve the tension para
a structured and long-term effort to siyang arbiter/referee
change it. • Spreading the tension can stabilize the system,
o Fusion is the opposite of self- but nothing gets resolved
differentiation. In the family, if there’s • Stable than a dyad
no self-differentiation and there’s • Creates an odd man out try to engage people who
only fusion, the poorer the are not bias.
functioning because you don’t • Patterns change with increasing tension during
appreciate and contribute to solving intense stress, the triangle gets bigger so if the
family problems, you always depend smaller triangle can’t solve the issue, they can
on other member of the family. You connect to other triangles in order for them to
have to have your own thoughts and solve the problem.
feeling. Greater fusion in the family = • There are times when anxiety hits a family, they
poorer functioning can disperse, we don’t want this.
• POORLY DIFFERENTIATED SELF
o Heavily depends on acceptance and
approval of others. No self-
esteem/self-confidence
o Quickly adjust what they think, say
and do to please others
o Proclaim what others should be like
and pressure to conform. People who
are swayed by peer pressure, there’s
always a risky behavior for it, so as

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 D. Multigenerational Process
Depicts the way individuals seek out partners with the
same level of differentiation leading to behaviors passed
through generations.
Transmission of anxiety from generation to generation

Dysfunctional processes and roles transmitted from

generation to generation

More anxiety focused on children, LESSER

differentiation

Child most fused with anxious parent has lowest

differentiation
When Person 1 and 2 have problem, we g et on
another person, Person 3, unfortunately kasi one- It’s difficult for children with parents who does not want
sided lang sila ni Person 1, if you look at the image to let them grow because that child would be dependent
above, there’s no relationship between Person 3 and on his parents in decision making, hindi na siya
Person 2, so hindi pwedeng si Person 3 would only makakatayo sa sarili niyang mga paa.
talk to Person 1 kasi there’s 2 side of the story. We
want that the third person you bring in the system E. Emotional Cut-off
would look at the situation in different perspectives, The greater the fusion, the greater the cut-off
not just for kampihan because nothing will be
resolved.
An attempt to reduce tension and stress
C. Family Projection Process
Unfortunately, this one is where the parents’ anxiety, Physical and emotional distancing
relationship difficulties, emotional concerns are
transmitted to their children within emotional triangle ESCAPE
which contributes to the emotional issues of these
children and other concerns as well. So, in turn, as child, Usually because of this, the person decides to manage his
he wants to resolve the issues of his parents, he would try own emotional difficulties or other concerns by
to fix this issue/concern. Example, marital problems of emotionally distancing kasi ayaw niyang makisawsaw.
parents that can’t be resolved, when he grows up, he is There’s an immediate relief that the tension would be
afraid into going in a relationship because of what reduced here but in reality, there would be more anxiety
happened to his parents and tension kasi nga as a family we try to solve certain
• Scanning issues as a family, we want the opinion of all not just only
o Parent focuses on the child out of fear few people.
that something is wrong with the child Because of this emotional escape, the person would seek
• Diagnosing help from others, it could be a family member, or it could
o Parent interprets the child’s behavior as be an extended family member, now because of this
confirming the fear extended family member know what is happening, they
o As parents, they don’t want to admit to will now add to the tension because they want to solve
their children that there’s a problem, the the conflict of the one who was emotionally cut-off.
ego is talking here.
• Treating F. Sibling Position
o Parent treats the child as if something is • Tendency of children to assume specific roles
wrong with the child within the family due to differences in
As parents, we don’t like to try to diagnose or treat, we expectation, parental discipline, and other factors
have to really talk to the children. Spend time to talk to • People who are in the same sibling position tend
them. Try to explain to them especially if you have crisis to have common characteristics (Walter Toman)
because these kids can really understand what’s • Sibling position and the associated personality
happening, you can’t hide the truth from them. Better to traits can impact family relations, especially
be truthful and genuine to them marital relationships kaya sabi nila bawal mag-
asawa yung both panganay because no one would
Scanning Diagnosing Treating give up

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 G. Societal Emotional Process

Coping More Highly How families

strategies for differentiated deal with social
life are passed people cope expectations
down through better with are passed
generations life's stresses down

Emotional system of a family affects the emotional system

of a society/community where you belong or your overall
generation

H. Nuclear Family Emotional Process

The following are the 4 common na pinag-aawayan in a
family
• Marital Conflict
o As family tension increases, spouses A. Adaptation
externalize their anxieties into marital • Ability to adapt to changes in the environment
relationship • Grows in order to progress from one stage to
o Nilalabas nila yung problem sa padrino or another in the family life cycle we’ll be talking
kumara nila. They get opinions of other about this on Family Life Cycle next topic
on how to solve their conflicts. • We have to remember that adaptation has 2
• Dysfunction of one spouse order changes
o One spouse pressures the other to think • FIRST ORDER CHANGE
and act in certain ways, exerting control o “Need to DO”
over their partner o Mastery and adaptation
• Impairment of one or more children o NO alteration of family structure, identity,
o The spouses focus their anxieties on one roles
or more of their children o Example, nag-graduate ka from
o Children with special needs, we care more elementary to high-school another classic
for them, but we need to explain it to example is kapag nag-migrate ka from
other children why we do that. one place to another
o This may limit the child’s individuality • SECOND ORDER CHANGE
• Emotional Distance o “Need to BE”
o People distance from each other to o Transformation of an individual’s status
reduce the relationship intensity, but risk and meaning
becoming isolated o CHANGE in family’s structure, identity,
roles
III. NOTIONS IN MINUCHIN’S THEORY OF FAMILY o Classic example is if the husband becomes
PSYCHODYNAMICS a father or if the wife becomes a mother,
• Adaptation another example is if you are the first
• Transactional patterns child then you marry someone then you
• Subsystems when children get married, their own will be moving out of your family system
families are subsystems because you are going to form a family of
• Boundaries your own.

B. Transactional patterns
• Repeating sequence of family interaction – in who
relates to whom, when and how

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 • Depends on the family RULES Roles of members of the subsystems
o Agreed ways of dealing with each other, • Role
with situations and external environment o Function assigned to a family
o Overt member
▪ Clearly and verbally stated o Plays part in maintaining stability and
▪ Eg. Curfews, no BF/GF before ensuring the survival of the family
college system
o Covert o Common examples: Breadwinner
▪ NOT stated but which everyone (father); Decision-maker
agrees to conform to anyway (grandparents); Second parents
▪ Eg. Seating arrangement in dining (eldest sibling)
table, makuha ka sa tingin o Other example: Symptom carrier
• Hierarchy (child gets sick whenever the parents
o How power or authority is distributed in fight – detouring of conflict)
the family
• Role selection Exploring roles
o Unconscious assignment of roles in the "When someone gets sick
family in the family, who do you
• Alliance usually go to first?"
o Positive relationship between any 2 Example, when one of the
members of a system children gets sick, they
usually tell to either the
• Boundaries mother or father but
o Rules defining who participates in the usually it's the mother
subsystem

Exploring structures: Series questions When that person does not

know what to do, who does
he consult? They would ask
"When situation A happens, their friends or neighbors,
what happens to member 1?" seldom na pupunta sa doctor
immediately

"When this happens to number When the patient must be

1, what happens to member 2?" admitted to the hospital,
who's permission must be
obtained? usually it's the
father unless the father pass
"When member 2 behaves in the financing to the mother
that way what happens to
member 3?" and so on and so
forth, until you asked all the Who says
members of the family.
This is where you look how they would react when one of What
the members of the family suffers
Through which
C. Subsystems channel
• Subgroups or smaller units in the family (married
couples, siblings) To whom
• Often separated from each other by a significant
period (grandparental, parental, sibling
Whit what effect
subsystem)
• Ways by which family system differentiates and
carries out its function of mutual support, D. Boundaries
nurturance, regulation, and socialization of its • Rules that govern the interactions between
members subsystem in the family

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 • Ideally, should be clear enough to prevent to differentiate, you have to allow them
interferences but flexible enough to allow to make mistakes and experience mistake
contact across subsystems for them to realize the mistake.
• Types: 2. Disengagement
o Clear (_/_)
▪ (--------) o Boundaries are too rigid, as when
▪ With clarity and negotiable mother-child subsystem excludes the
▪ Example, curfew is 10PM but father’s involvement in parenting
this is negotiable, if you could o Explore whether family members are
talk to your parents na isolated from each other or have little
malalate kasi ksi ganyan emotional response from each other
ganyan, so pwede iyon. o Eg. Husband is not concerned with the
o Rigid prenatal check-up of his wife
▪ (_____)
▪ NOT open to negotiations Explore: Emotional closeness & distance: “closer-farther”
▪ Kapag sinabing 10PM that’s it, questions
walang negotiations, your These are the things we usually ask in family therapy or
parents will not listen to you family sessions
kasi rigid nga. Who is closest to his
o Diffuse Who is the person who
patient? feels farthest away
▪ (…….)
emotionally form the
▪ Lack of clarity After that, who is next patient?
▪ Intrusions by one subsystem closes?
into another
▪ Kapag sinabi mong 10PM ang Then who is next
And then next closes after farthest?
curfew but there are times in that?
the past na hindi naman
nangyayari/nasusunod 3. Triangulation
especially if you said different
curfews sa iba’t ibang anak o When a third person is drawn into a two-
mo, well diffuse siya. That’s pair system to diffuse anxiety or conflict
very important if you said a or negotiate a relationship
rule dapat isang rule lang o Explore whether family members talk
there should be no other directly to each other about personal
variations kasi magkakaroon matters
ng gulo. o Eg. A couple with marital problem argues
about the management of bronchial
IV. FAMILY PROCESSES asthma of their child rather than personal
1. Enmeshment (three lines) concerns there are times kasi na parents
__________ don’t want to talk the issue, their focus
__________ shifts to the problem of the child, they try
__________ to diagnose the child when in fact, it’s
o When boundaries are diffuse i.e. parents their problem that is the problem of the
have no privacy from their children that’s child kumbaga the child is concern to the
why as parents it is important to walk the parents, nagkakaroon ng triangulations
talk kasi if we disregard our own rules kasi there is shifting of focus, so the
that we made then unfortunately the conflict will not be resolved, mag-aaway
children would do the same. at mag-aaway ang mag-asawa, mag-
o Explore whether family members seldom aasthma at mag-aasthma ang anak and
act independently or get involved with the cycle continues
each other 4. Coalition
o Eg. Mother insist to accompany her 20- { }
year-old son to his pre-employment o Informal groupings within the family of
physical examination we must let go of people who usually side with each other,
our child because this is over-involvement often, regardless of the issue involved
already because in order for our children o Opposing coalitions within the family

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 o Maybe divided according to generations had used abnormal defense mechanism there would be
but usually intergenerational maladaptation (9) resulting in a pathological equilibrium
o Eg. A child sides with the mother (10) which would lead to terminal disequilibrium (12)
regarding their problem with the father. meaning the family would be in disarray because nothing
They accuse their father of having another has been resolved but even if you are in a crisis (7) but if
woman dahil nga nagkakampihan yung you have identified extra familial resources (8) and these
family, the more the tension/conflict extra familial resources become adequate (4) of course
would be there. Almost all of families will this would go back to your functional equilibrium (1) but if
experience some kinds of this, not just these extra familial resources still inadequate (6) the cycle
being a womanizer but a lot of conflicts would go to pathological equilibrium (10). If your family is
like that one. in pathological equilibrium (10) then another stressful life
event (11) happens chances are it would lead to terminal
Eliciting Coalition disequilibrium (12). This is actually sums up the family
• Who is the person that the patient usually functioning or the family psychodynamics.
disagrees with the family?
• Who in the family usually agrees with the other Behavioral symptoms Seen in PATHOLOGICAL
person? Dito yung naghahanap ka ng kakampi EQUILIBRIUM
• In case of disagreement with that persons, who in Anger Depression Postponing
the family agrees with the patient? Arguing Distorting Running away
Badgering Evading Refusing
V. FAMILY SYSTEMS THEORY - APPLICATION Coercing Holding grudges Scape-goating
Complaining Isolating School failure
Defying Lying Silence
Demanding Non-participation Withholding
Delinquency Ordering

Psychological defense mechanism utilized by family

members when resources are inadequate or
inappropriate to manage a family crisis
Avoidance Postponing
Conversion Projection
Denial Rationalization
Displacement Repression
Identification Somatization
Introjection Transference
Masking

Adaptive or Coping behavior in Functional/ Nurturing

Families with adequate Resources
Pooled resources
Shared points of views
Accepted individual growths and changes
Shared affection
Shared time, space and money
Employed listening skills
If a family is in functional equilibrium (1) meaning Individual family member activities are adjusted,
maganda ang relationship within the family, if there’s a postponed or modified to meet family needs
stressful life event (2), this would lead to family Accepted role changes
disequilibrium (3) so syempre magugulo yung family but if Nurturing family rituals experiences are utilized as a
you have adequate resources (4) so your adaptation (5) supportive and cohesive force
would be okay and you would be back to family Humor is used appropriately as a tension relieving
equilibrium (1), you would bring back the functionality of instrument
your family, but if your family is in family disequilibrium
(3) and you have inadequate resources (6) it would be
expounded to be a crisis (7), unfortunately because you

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 KEY POINTS you interpret what you read, lalo kasi nakalagay
• Knowing the psychodynamics of the family of our “invasive ductal carcinoma”, do you know the
patients allows us to intervene in the system in meaning of carcinoma [sinasabi ko sa patients].
order to help them Minsan kasi yung mga hindi nakakaalam, yung
• A small change towards health in one member hindi nag-go-google, they will not know na
can result in similar changes in all members carcinoma is already cancer, so some patients
• Family is a system with “parts” or members would say I don’t know. So again you have to ask
• As family, we share rules, roles and boundaries again from the beginning lalo na if I catch them
which can undergo changes kasi it’s my first time kasi it was referred to me.
• ILLNESS causes changes that reverberate Unfortunately for some surgeons, they would just
(resonate) through the system tell the patients please go to the clinic of the
• Changes are circular, and not linear Department of Community and Family Medicine
we will refer you to them. Then when these
patients come to me I will ask them, did the
Roles •Who-does-what-when? surgery people explain to you your condition
that’s why you are being referred to me? Did they
Rules/ structures •Series Questions tell you the reason why did they refer you to
my/our clinic? Most of them would answer “no,
Relationships •Close-farther Questions they just told me to come here”, which is actually
wrong. So ilalagay mo doon stage 3a breast
•Who disagrees with cancer, tapos dadalhin ng patient yung blotter to
Coalitions
whom? me na hindi man lang inexplain dun sa patient na
“may cancer po kayo”. So sa akin iiyak yung
VI. Q&A pasyente ngayon. Parang ako pa ngayon yung
1. Q: Do we have most common defense mechanism maghihirap pa na magdisclose na ito yun, so
in the Filipino families? instead of me doing talagang enrolling this
A: I’m not sure pero siguro ang common sa atin is patient, hindi na. I will have to take time
denial. Nakikita ko lang a. Because sometimes disclosing the diagnosis to the patient because
napapansin kasi natin yun e, not only in Filipino the primary service did not disclose the diagnosis
families but any family who would receive bad to the patient. So yun yung mahirap, so ang sabi
news, like if you say that [a] member of your ko sana as doctors you would learn how to
family has cancer or chronically debilitating communicate well to your patients. Kami kasi sa
illness, they would try to deny. Unfortunately, if FM kami ang pinakamadaldal, we usually know
we try to deny, and then if your patients could not what’s happening to the patient. We usually know
accept that they have this kind of illness, the family hx of these patients even the personal
nagkakaroon na ng anger, bargaining, we try also and social hx of these patients. I just hope na mga
to be depressed kasi that’s the pattern of grief eh. future surgeons dito I just hope na you will also
Usually yan ang common sa atin is denial because spend time trying to tell your patients what’s
it’s not easy for us to accept and not all doctors wrong with them or any member of the family
are trained to break the bad news or say the you have to spend time telling them that. Don’t
diagnosis in a nice way. Kasi siyempre how would assume, don’t presume. Always ask what does the
you expect the patient to react when you just say patient know with regards to his or her condition,
“may cancer ka” period especially if the biopsy is meron na mga yan lalo na with the digital world.
obtained by the patient and hindi tayo. I’ve Most people are tech savvy already so they
encountered in my breast cancer patients kasi usually google or search in the internet kung ano
those who underwent biopsy. Philhealth has a man ang ibig sabihin no’n. So you have to be
program on early cancer care, may Z-package kasi prepared as doctors and if you don’t know then
for that, meaning to say the Philheath is allotting just tell the patient “I’m sorry I don’t know this”,
Php100k for early cancer diagnosis. Usually these “may I read on it”, “can I read on it and I’ll get
patients yung may bukol [have tumors] will back to you”. Hindi naman masamang umamin.
undergo incision biopsy then this will be 2. Q: Question on pathologic disequilibrium
submitted to the laboratory. Usually, these A: Yes, kasi sometimes usually if you have
patients are the ones who will get the results. problems at home, some of the members of the
Then you would ask them have your read the family would seek diversion. Yung mga iinom,
results of the biopsy, then they would say yes. magsusugal, or bisyo, this could be coping
Ako I usually ask what did you read, how would mechanisms to them ah, pero eto are masamang

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 coping mechanism kaya nga nagiging abnormal VII. SAMPLEX
defense mechanism sila. Kasi you are now
creating another problem kasi you are already Matching Type
harming yourself [self-harm na yun eh]. Instead of 1. ___ State of family homeostasis in which member
you looking for good answers or better coping interaction results in emotional and physical nurturement
mechanism to this problems, ayun uminom ka na 2. ___ Process by which family members utilize their
resources to effect a resolution of a stressful life event and
or nagyosi ka na or nagbisyo ka na. So these are
return to nurturing family function or equilibrium
actually considered abnormal defense 3. ___ Building block or “molecule” of larger emotional
mechanism. They are thinking kasi na if you systems
drown yourself in alcohol, you will feel numb, and 4. ___ Examines Family processes and functions, such as
you will not think about anything. But what communication or problem-solving patterns
happens when you wake up the next day, you’re 5. ___ Explore whether family members are isolated from
still the same. Walang nagbago, you still have that each other or have little emotional response from each
same problem. Yes, those are abnormal. These other
are mga binabantayan din na family members, 6. ___ “Need to do”
binabantayan din natin ang mga ‘to. 7. ___ Parent interprets the child’s behavior as confirming the
fear
8. ___ Family rules that are NOT stated but which everyone
Some naman [about the topic] you can relate agrees to conform to anyway
actually. Before you knew this, you don’t know 9. ___ Boundaries that are not open to negotiations
yet the terms, but know we are giving you terms 10. ___ Heavily depends on acceptance and approval of others
on how you would describe your family
psychodynamics. All of us naman have our own A. Disengagement [Family Processes]
functioning psychodynamics. It’s up to us on how B. Equilibrium [Terms used in Family Function]
we could cope up, we could relate to our family C. Adaptation [Terms used in Family Function]
problems and help in resolving conflicts or the D. First order of change [Adaptation, Minuchin’s]
stress that the family suffers. Kaya important din E. Strategic [Family Systems Therapy Approach]
F. Rigid [Boundaries, Minuchin’s]
na we have to know the dynamics really of our
G. Covert [Transactional Patters, Minuchin’s]
patients kasi this is where we can help in order for H. Emotional Triangle [Bowenian Approach]
us to find allies for our patients as well. I. Poorly Differentiated Self [Differentiation of Self,
Bowenian Approach]
Reference: J. Diagnosing [Family Projection Process, Bowenian
• Dr. JD Velasco’s PPT October 14, 2021 Approach]

Enumeration
11-15. at least 5 behavioral symptoms seen in Pathological
Equilibrium
16-20. at least 5 psychological mechanisms when resources are
inadequate or inappropriate to manage a family crisis

Masking
Transference Introjection
Somatization Identification
Repression Displacement
Rationalization Denial
Projection Conversion
Postponing Avoidance
16-20.
Ordering Delinquency
Withholding Non-participation Demanding
Silence Lying Defying
School failure Isolating Complaining
Scape-goating Holding grudges Coercing
Refusing Evading Badgering
Running away Distorting Arguing
Postponing Depression Anger
11-15.
Enumeration:

1. B; 2. C; 3. H; 4. E; 5. A; 6. D; 7. J; 8. G; 9. F; 10. I
Identification:

Answer Key:

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 PFCM 3A | Family Life Cycle Stages
Tutor: Dr. JD Velasco | Lecture Date: October 28, 2021 | 1st SEMESTER

TOPIC OUTLINE • TRANSITION

I. FAMILY DEVELOPMENT THEORY o Shift from one family stage to another
II. TERMS TO KNOW
III. Why study Family Life Cycle
IV. MODELS
III. Why study Family Life Cycle?
V. RECAP: Levels of Magnitude of Change • Provides a predictable, chronologically oriented
VI. SIX-STAGE FAMILY LIFE CYCLE sequence of events in family life with which
• Unattached Young Adult – Leaving Home physicians and other health professionals are
• Newly Married Couple – The Joining of
already familiar
Families through Marriage
1. Stage of Marriage • Involves a sequence of stressful changes that
• Family with Young Children – Becoming required compensating or reciprocal
Parents and Families with Children readjustments by the family to maintain viability
• Family with Adolescents
• Events can be related to clinical events and
1. Changes during Midlife
• Launching Family health maintenance of the family
• The Family in Later Life • Family members need to adapt to family changes
VII. What can Disrupt the cycle? to ensure family survival
VIII. What can Improve the cycle?
• Challenges cause you to build/ gain new skills in
IX. KEY POINTS
X. Q&A each stage
XI. SAMPLEX • Not everyone passes through the stages
smoothly. It depends on the culture of the family,
I. FAMILY DEVELOPMENT THEORY anong pinagdadaanan, what is the crisis that’s
• An approach to studying families dated back in the been going on in the family.
1930s • Successful transitioning may also help prevent
• Two (2) concepts diseases and emotional or stress-related disorders
o Life Cycle • Experiences through the different stages will
▪ Emotional and intellectual stages from affect who you are and who you become.
childhood to retirement as a member of the Whatever it is that you go through in each stage
family may make or break you.
o Developmental task
• Thoroughly understand the health and illness
▪ Growth responsibilities that arise at certain
responses of patients and their families. We have
stages in the life of the family
to involve the family because remember we have
▪ In every stage ng life cycle there is a
to make them our allies in order for us to help our
corresponding developmental task
patients.
• Family projects various identities and roles, once
II. TERMS TO KNOW
fulfilled, ensured advancement to the next or
• FAMILY LIFE CYCLE
higher level
o Set of predictable steps or patterns and
• Process: transitions; extensions; overlapping
developmental tasks families experience over
• Length of time/ stage: variable. The duration
time
when are you gonna be on that stage is up you.
▪ Individual development changes
IV. MODELS
▪ Evolution of the marital relationship
▪ Cyclic development of the evolving family • Evelyn Duvall (1957)
NINE-STAGE
unit • Based on “distinctive role complex”
o Its concept facilitates studying the family from • Barnhill & Longo (1978), Carter and
beginning to end EIGHT-STAGE McGoldrick (1999) & Carr (2006)
o It delineates various developmental stages in • Experiences with the Family of Origin
the status of families and describes the manner • Goldenberg & Goldenberg (2002);
in which a family is functioning. In each stage, a Lauer & Lauer (2004)
family projects various identities and roles, the SIX-STAGE • Based on developmental tasks;
fulfillment of which would ensure advancement patterns of behavior; process of
to the next or higher level. transition
• FAMILY STAGE • Various authors
o Time period in the life of a family from FIVE-STAGE • Analysis of family, its needs, and its
beginning to end that has unique structure coping strategies

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 SECOND • NEED TO BE something new
V. RECAP: Levels of Magnitude of Change ORDER • Transformation of individual status
FIRST • NEED TO DO something new
ORDER • Mastery and adaptation
Table 2. Relationship of Individual and Family Life Cycle to Age*
Age** Individual Life Cycle Tasks Family Life Cycle
Infancy
0-1 Oral Basic trust vs Mistrust
Childhood
2-3 Early: anal Autonomy vs doubt and shame
4-5 Middle: preschool Initiative vs guilt
6-11 Late: latency Industry vs inferiority
Adolescence
12-17 Early Identity vs role confusion Courting
Middle Going steady
18-21 Late: pulling up roots Marriage: associated couple
Pregnancy
Adulthood
22-27 Eary: leaving family transition Intimacy vs Isolation
28-39 : the “30” transition First child
: “settling down” Multiple children
Generativity vs stagnation Frist child leaves home
First grandchild
40-59 Middle: midlife Ego integrity vs despair
: the “50” transition Last child leaves home
Multiple grandchildren
60-69 Late Couple again: empty nest
Widowhood
Old Age
70+ Adjustment to death Termination
*A composite picture based on Freud, Erikson, Levinson, Lidz, Duvall, Gould, Glick, Hill, and others.
**Age groups are approximate as the life cycle stages show a great deal of variation and overlap
*It says here pagdating sa infancy, this is the basic trust vs mistrust kaya it’s important in this stage, we really have to
establish the trust, the bond of the parent and the child or sibling and the infant.

VI. SIX-STAGE FAMILY LIFE CYCLE

A. Unattached Young Adult – Leaving Home
Ito yung start ng family cycle, kasi magisa mo palang. So as long as you are able to get married, you can actually
leave home. Sa states nga actually pag 18 years old you already are independent. As an unattached young adult we
usually come in terms with the family of origin, we also formulate our own roles in developing as an individual
including our plans to already form a family especially when we already have a partner.
For the unattached young adult, we leave home. Pero kasi for Filipinos it’s not in our culture, we usually stay
palang at home.
Changes in Family Problems Encountered
Emotional Process of Status required to
Transition proceed MEDICAL EMOTIONAL SOCIAL
Developmentally
Accepting financial and Differentiation of the
emotional self in relation to the Psychosomatic
responsibility for family. There is a Sexually Transmitted problems secondary Peer group pressure
oneself. transition from having Infections to new job, role and on acquiring vices
your nuclear family to peer group
moving out of it.
Development of Unwanted Depression secondary Fiancée pressure for
intimate peer Pregnancies to adjustment to life marriage and

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 relationships. away from home; premarital sex
Establishment of the Pre-employment difficulty finding
self in relation to physical employment and / or
work and financial examinations. In the suitable life partner
independence. If you government, in order
want to leave home, to not use this a
you are ready to live reason for
by yourself. You know discriminating the
how to pay bills and applicant or not hiring
budget. the applicant, this pre
employment physical
examination is done
after the person is
hired. As much as
possible we don’t
want to use any
comorbidities or
illness not to hire
them, unless the
position which was
advertised or is
applied will need a
very very technical
person.

B. Newly Married Couple – The Joining of Families through Marriage

In the Philippines it’s usually a bilaterally extended family. There will be transition from individuals to life as a
couple.
Changes in Family Problems Encountered
Emotional Process of Status required to
Transition proceed MEDICAL EMOTIONAL SOCIAL
Developmentally
Commitment to the Sexually Transmitted Depression due to forced early marriage and
new system. Formation of the Infections unwanted pregnancy
marital system Jealousy to job, friends, previous fiancée.
Early Pregnancy
Inferiority complex
Realignment of Job-related physical Emotional problems relating to new role as
relationships with examination spouse
extended families and Gynecologic problem Problems relating to in-laws, friends, peers and
friends to include the money
spouse. If you are Infertility Demands of new role
starting a family but Problems of adjustments to office and work
don’t have yet
enough finances to
rent or stay in a
separate area then
you should adjust
with your in laws/
extended families.
This will entail a lot of
sacrifice and this can
also produce conflicts.
This is one of the
most emotional kasi
you are still starting
palang.

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STAGE OF MARRIAGE
STAGES EMOTIONAL ISSUES STAGE CRITICAL TASKS
1. Honeymoon Stage Commitment to the marriage • Differentiation from family of origin. Especially if
0-2 years you are the one who was uprooted from your
family.
• Making room for spouse with family and friends
• Adjusting career demands
2. Early Marriage Stage Maturing of Relationship • Keeping romance in the marriage. How would you
2-10 years keep your commitment.
• Balancing separateness and togetherness
• Renewing marriage commitment
3. Middle Marriage Stage Post-Care Review • Adjusting to mid-life changes.
10-25 years • Renegotiation relationship
• Renewing marriage commitment
4. Long Term Marriage Stage Farewells and Planning. • Maintaining couple functioning
25 + years Planning for retirements, • Closing or adapting family home.
where you want to go? Etc. • Coping with death of spouse.

C. Family with Young Children – Becoming Parents and Families with Children
This starts from the pregnancy of the first child to the immergence of adolescence. The coming of children defines
a new family status, ito yung second order change niyo; where the wife becomes a mother and the husband
becomes the father. And ditto rin, the children starts to go to school as well.
Changes in Family Problems Encountered
Emotional Process of Status required to PARENTS
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Accepting new Adjusting the marital Episodic medical
Peer pressure
members into the system to make space problems
system – children. for children.
What if the couple Remember that not
OB-Gyne problems Sexual inadequacies
cannot bear children everyone wants to
accept if you want to have children
adopt. Joining in child- Family planning Spouse abuse. Domestic violence.
rearing and financial
and household tasks.
As a mom, multi-
tasking: you do the Annual physical
chores, you take care Job-related problems
examination
of the children and
you have work

Child-rearing problems

Realignment of Problems with in-laws.

relationships with the Financial difficulties. Kasi kung dati sarili lang
extend family to Sexually Transmitted binabudgetan mo ngayon meron na si asawa
include parenting and Infections mo tapos pati sa bata magbabudget ka. And
grandparenting roles the most challenging will be the first few
months kasi there will problems with the
clothing, diaper, the milk if you are not breast
feeding, etc.

C. Family with Young Children – Becoming Parents and Families with Children
Emotional Process of Changes in Family Problems Encountered

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 Transition Status required to CHILDREN
proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Episodic medical Learning deficiencies
problems
Child abuse and neglect
Accidents

Mental retardation
Growth monitoring;
oral rehydration
therapy;
breastfeeding and
immunization (GOBI)
problems
Poisoning

C. Family with Young Children – Becoming Parents and Families with Children
Changes in Family Problems Encountered
Emotional Process of Status required to GRANDPARENTS
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Episodic medical Psychosomatic problems related to illness and
problems loneliness
Financial difficulties
Degenerative diseases

Chronic debilitating
disease

D. Family with Adolescents

Changes in Family Problems Encountered
Emotional Process of Status required to PARENTS
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Increasing flexibility of Shifting of parent- Common medical
family boundaries to child relationships to Midlife crisis
problems
include children’s permit adolescents to
independence and move in and out of OB-Gyne problems Male Climacteric
grandparent’s frailties. system
Focus on midlife Pre-menopausal
Extra-marital affairs
marital and career symptoms
issues Alcoholism and other
Insecurities secondary to changing appearance
vices

CHANGES DURING MIDLIFE

INCREASE Sensitivity to drugs
• Sleep
• Sexual Activity
DECREASE • Physical Activity
• Visual Acuity
• Hearing Acuity

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 D. Family with Adolescents
Changes in Family Problems Encountered
Emotional Process of Status required to ADOLESCENT
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Drug and other Sexual experimentation leading to teenage
substance abuse pregnancy. So for us doctors we should
disorders educate our kids, let them face the reality.
Sexually Transmitted
Homosexuality
Infections
Conflict with parents. This is the stage of
Ance, bad odor
identity crisis
Gynecologic problems Juvenile delinquency
Depression secondary to peer pressure;
Allergies and other
identity crisis
skin diseases
Child prostitution
Circumcision
Suicidal tendencies

E. Launching Family
This starts when the first child leaves home and the last child leaves home (that is if they leave). Remember
here in the Philippines, this is a prolonged stage because the unmarried children stay with the parents and
usually once you have launched/ allow your child to go out of your family, you are allowing them din to form
their own family.
Changes in Family Problems Encountered
Emotional Process of Status required to PARENTS
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Accepting multitude of Beginning shift Episodic medical
Career stagnation
exits from and entries toward joint caring problems
into the system. for the older “Empty Nest syndrome” you don’t have kids
Meron gusting umalis generation OB-Gyne problems anymore. Because you’ve already launched
meron ding gusting Renegotiation of your children.
bumalik marital system as a Degenerative diseases
Over-dependent married children. Even if they
dyad. Balik dalawa ulit
already are married staying in or out of the
sila, because they will
house they will ask you still for financial help or
launch their kids
in other aspects.
Development of
adult-to-adult
relationships Early retirement, financial problem
Realignment of
relationships to Extra-marital problems
include in-laws and
grandchildren Taking care of sick parents or in-laws
Dealing with the
disabilities and death Adjustment of new member of the family
of grandparents through marriage

E. Launching Family
Changes in Family Problems Encountered
Emotional Process of Status required to CHILDREN
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Episodic medical
Independence and dependency problems
problems

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 OB-Gyne problems Juvenile delinquency
Medical problems of Peer group pressure on vices
adolescence Problems of old relatives
Conflict with parents
Problems on adjustment to married life

F. The Family in Later Life

This starts from the departure of your last child (pag nalaunch mon a last child) and continues to retirement
and ends when both are dead.
Changes in Family Problems Encountered
Emotional Process of Status required to PARENTS & GRANDPARENTS
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Accepting the shifting Maintaining own Episodic medical Depression due to death of spouse and
of generational roles and/or couple problems sickness
functioning and Psychosomatic problems secondary to children
Gynecologic problems
interests in the face leaving the home
of physiological
decline; exploration
of new familial and Loneliness
social role options Degenerative diseases
Support for a more
central role of middle Financial adjustment
generation
Making room in the Urologic problems
system for the
wisdom and
experience of the
elderly and
supporting the older
generation
Dealing with the loss
of spouse, siblings,
and peers;
preparation for one’s
own death
Life review and
integration

F. The Family in Later Life

Changes in Family Problems Encountered
Emotional Process of Status required to CHILDREN
Transition proceed
MEDICAL EMOTIONAL SOCIAL
Developmentally
Episodic medical
problems
OB-Gynecologic
problems
Menopausal
problems

VII. WHAT CAN DISRUPT THE CYCLE? • Ongoing stress or a crisis can delay the transition
• The stress of daily living, coping with a chronic to the next phase of life; unresolved issues in each
medical condition, or other life crises can disrupt stages may not let you proceed to the next stage.
the normal life cycle;

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 • May move on without the skills that you need to X. SAMPLEX
easily adapt and transition to the next phase of Enumeration
life. 4 Models of Family Life Cycle Stages
4 Stages of Marriage
6 Stages of the Six-Stage Cycle of Family Life Cycle Stages

The Family in Later Life •

Launching Family •
Family with Adolescents •
Parents and Families with Children
Family with Young Children – Becoming •
Families through Marriage
Newly Married Couple – The Joining of •
Unattached Young Adult – Leaving Home •
6 Stages of the Six-Cycle
Long Term Marriage Stage •
Middle Marriage Stage •
Early Marriage Stage •
Again you have to follow this cycle family function. It is Honeymoon Stage •
important that even if we are exposed to stressful life
4 Stages of Marriage
event we have to maintain the Family equilibrium or if the
family is in disequilibrium, we have to make sure that this • Five-Stage
resources or adaptation and coping will already be in • Six-Stage
place in order for you to bring back the family equilibrium. • Eight-Stage
But if they will not be able to go back to equilibrium • Nine-Stage
4 Models of Family Life Cycle Stages
because inadequate ang resources, the child cannot yet
adapt, so magkakaroon talaga tayo ng problema, Enumeration
magkakaroon ng crisis, tuloy tuloy na masisira – there will Answers:
be dysfunction.

VIII. WHAT CAN IMPROVE THE CYCLE?

• Can learn missed skills and improve your and your
family's quality of life at any stage; we have to
process everything, why did this happen? If
there’s a need to do a family meeting then do a
family meeting to lay out all your facts or issues
on the table.
• Self-examination, education, and counselling are
ways to improve yourself and your family life

IX. KEY POINTS

• Changes over time. We have to keep up with the
change!
• Each stage has a beginning and an end
• Allows family development in each stage
• Phase-specific developmental tasks
• Has normal transitions and unexpected crises
• Transmission consists of biologic, behavioral and
social processes

References:
• Dr. JD Velasco’s PPT October 28, 2021
• Leopando, Z. (2016) Textbook of family medicine
Volume 1.

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Comparison of Family Life Cycle Stages
Nine-Stage Cycle Eight-Stage Cycle Six-Stage Cycle Five-Stage Cycle

Stage I: Experiences with Stage I: The Young unattached Stage I: Independence

Family Origin Adult
Stage II: Leaving Home

Stage III: Pre-marriage

Stage I: Establishment (Newly- Stage IV: Childless Couple Stage II: Newly married Couple Stage II: Coupling or marriage
married couple)
Stage II: New Parents (Infant Stage V: Family with Young Stage III: The Family with Stage III: Parenting-babies
to 3 years old) Children Young Children through adolescence
Stage III: With Pre-school
Children
Stage IV: With School-age
Children
Stage V: Family with Early Stage VI: Family with Stage IV: The Family at Midlife
Adolescents Adolescents with Adolescents
Stage VI: Family with Young
Adults
Stage VII: Launching Family Stage VII: Launching Family Stage V: The Last Stage of Stage IV: Launching Adult with
Launching Children
Stage VIII: Middle-aged Stage VIII: Family in Later Stage VI: Family in Later Life Stage V: Retirement or Senior
Parents Years Years
Stage IX: Aging Family

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 PFCM 3A | Impact of Illness to the Family
Tutor: Dr. JD Velasco | Lecture Date: October 28, 2021 | 1st SEMESTER

TOPIC OUTLINE •Examine the clinical and laboratory evidences of

I. INTRODUCTION biologic and pyscho-physiologic dysfunction
II. FAMILY SYSTEMS ILLNESS ILLNESS
III. ROLLAND’S PYSCHOSOCIAL TYPOLOGY OF
ILLNESS • Explore the meaning of illness to the patient and
A. Onset family/ significant others. Ex. This patient is
B. Course complaining of headache, but what is the meaning
C. Outcome of this headache for them? Baka naman based on
D. Disability
their family history, may stroke pala sa family, or
E. Level of Uncertainty
IV. TIME PHASES OF ILLNESS there was immediate death from headache alone,
V. IMPACT OF ILLNESS ON THE FAMILY kaya you have to investig8ate din. Baka kasi this
VI. THE FAMILY ILLNESS TRAJECTORY would cause anxiety to the patient, so you really
A. ONSET of Illness have to dig up the meaning of the illness to the
B. REACTION TO DIAGNOSIS – Impact Phase
C. MAJOR THERAPEUTIC EFFORTS
patient. Asking what’s the patient’s understanding
D. EARLY ADJUSTMENT TO OUTCOME – of the chief complaint.
RECOVERY PHASE You really have to ask, because we have different
E. ADJUSTMENT TO THE PERMANENCY OF THE interpretation of our feelings. How do they
OUTCOME
understand what they are feeling because from
VI. SAMPLEX
there you can guide the patient -reach your goal
sa patient.
I. INTRODUCTION
• Families’ experience of illness and disability are II. FAMILY SYSTEMS ILLNESS (FSI) MODEL
enormously influenced by the dominant culture FSI
and the health systems embedded in it • Grounded in systems theory
• Lack of access to adequate basic health care has • Formulated by JS Rolland in the 1980s
serious implications on the incidence of illness, • comprehensive way of organizing our thinking
disease course, survival, quality of life and varied about the multiple interactions involving a
forms of suffering caused by discrimination patient, his or her family, and health care
• The impact of illness on the family is very much professionals while dealing with a chronic
felt among Filipinos because of their strong family condition
ties.
FSI Core Concepts & Components
Disease vs Illness vs Sickness We all need these in order to understand the family
system illness.
DISEASE •
Something is wrong with a bodily
function
• Primarily biologic & pyscho-physiologic
disorder (Organic)
• Refers to psychological abnormalities
taking place in a patient’s body.
ILLNESS • Experience of a person with the disease
• Subjective or psychological state of a
person
• Encompasses the person's perceptions,
emotions, and experiences of the disease,
as well as the suffering and changes the
patient and the family have to undergo in
the presence of that disease
SICKNESS • Role that an individual assumes when ill
• Social dysfunction

HOW DO YOU INVESTIGATE?

DISEASE

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 Need to be able to tolerate highly charged emotional
situations
Flexibly exchange roles
Solve problems efficiently
Utilize outside resources effectively

B. COURSE

PROGRESSIVE • Family is faced with a perpetually

(ex. COPD) symptomatic member whose
disability worsens in a stepwise or
gradual way
• Families need to be prepared for
continual adaptation & role changes
• Family needs to keep reforming its
system to keep pace with changing
picture of the illness
III. ROLLAND’S PSYCHOSOCIAL TYPOLOGY OF • MINIMAL periods of relief from the
ILLNESS demands of the illness
This is usually the constructed map in order for us to CONSTANT • Occurrence of an initial event is
understand the typology. This defines the categories and (ex. Spinal followed by a stable biological
the demands for each categories and also the prognosis cord injury, course
and characteristics of these disease and illness STI, • Recurrences can occur any time
PSYCHOSOCIAL ILLNESS TYPES Myocardial • Potential for family and patient
infarction) exhaustion but with less strain.
RELAPSING/ • Requires less continuous caretaking
EPISODIC or role changes. Because you are
(ex. Asthma, waiting for the attacks, the best you
Multiple can do is to remove the trigger.
sclerosis) • Families are strained in between
critical & noncritical transitions
• Ongoing uncertainty of when a
recurrence will occur
• Family is always on call to cope with
crises and handle exacerbations of
A. ONSET the illness

ACUTE GRADUAL C. OUTCOME

Emotional and practical More protracted period of • The extent to which a chronic illness is a likely
changes are compressed in adjustment cause of death or shortens one’s life expectancy
a short time has profound social impact
More rapid mobilization of • Most crucial factor: Initial expectation
family crisis management • Major differences between the outcomes:
skills. Unfortunately for o Degree to which family experiences
acute kasi there is anticipatory loss
immediate strain for the o Pervasive effects on family life
family lalo na if there is • Clinicians need to assess the following:
already involvement of o Family perceptions about outcome
laws and death o Family’s preparedness to face downhill
Greater immediate strain Generate more anxiety as course
to prevent further loss and establishment of accurated.
death There is anxiety because
you wait. Habang inaantay
mo yung confirmed
diagnosis, pwede ring
recurrent yung disease

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 D. DISABILITY

Depends
Family on the
expectatio following:
The > How the
extent, ns must
Social be type of
stigma is kind and diability
timing of explored interacts with
an the premorbid
important disability role of the
cause in involve affected
family
many sharp member
disorders difference > Family belief
s in the system
degree of > Flexibility
family > Emotional &
stress financial
resources

E. LEVEL OF UNCERTAINTY
• The more uncertain the course and outcome, the
more a family must make decisions with flexible
contingencies built into their planning
• Normally complicated life decisions are always
layered with a myriad of illness-related
ambiguities
• Clinicians need to achieve a balance between IV. TIME PHASES OF ILLNESS
overloading a family with information about Timeline and Phases of Illness,
possible future crises and allaying anxieties by Rolland 1984
providing useful information concerning
uncertainties

• During the initial crisis this is where the diagnosis

is being done. In here we have the pre diagnostics
with symptom and then after doing all the
necessary works laboratory and diagnostic works
this should have an initial adjustments period.
After a month, this is the chronic one now and
unfortunately it can lead to death. Classic example
is cancer, if you catch them early then there is a
better prognosis but if you’ve catch them late
then bad prognosis.
• Give time for families to grieve.
• Clinicians and families need to think longitudinally
and to understand chronic illness as an ongoing
process with normative landmarks, transitions,
and changing demands
• Each phase of a chronic disorder poses its own
psychosocial challenges and developmental tasks
that may require significantly different
capabilities, attitudes, or changes in order for
families to adapt

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 V. IMPACT OF ILLNESS ON THE FAMILY family members supposed to
HOW ILLNESS AFFECT FAMILY FUNCTIONING are concentrating launch members
FAMILY RELATIONS • Produces physical impact not within the family. outside the
only on the patient but also to There may be a system
the entire family problem if the
• Decreased physical well-being stages are
and increased utilization of supposed to
medical services launch members
SOCIAL • Other members of the family because
FUNCTIONING may feel socially isolated with mababawasan na
the need to care for ailing ang resources
family members and in mo.
performing other tasks Degree of Family Functional Dysfunctional
FINANCIAL • Burden is greater among Functionality families that are: families
families in the Lower socio- - Flexible in
economic bracket (Rolland, adapting to
1999) changing roles
• Inadequate economic - Healthy
resources is a marked communication
hindrance and contributes to lines
the strain of dealing with - Provide good
illness (Panganiban- Corales & emotional
Medina, 2011) support
PSYCHOEMOTIONAL • Apparent among family Typology of Acute and self- Acute and life-
members who witness the Illness limiting, non- threatening,
sufferings of loved ones fatal diseases chronic,
• Common: depression and with NO debilitating,
sleep problems incapacitation rapidly
progressing and
Enablers and Barriers to the Family in Coping with Illness terminal illness
(Atwood & Weinstein) Stigma Diseases that do Highly
The ability to cope with the onslaught of illness depends associated with not carry social communicable
both on the internal integrity and resources of the family the disease stigma diseases that
and the external burden of the disease [Flanagan, 2003] carry with it a
• Intrafamilial factors social stigma
o Family resources isolating patients
o Family life cycle stages and families
o Degree of family functionality
• External Factors VI. THE FAMILY ILLNESS TRAJECTORY
o Typology of illness • Passage thru sufferings
o Stigma associated with the disease • Normal course of the psychosocial aspects of
diseases for the patient and the family
• Allows physicians to predict, anticipate and deal
Depending on this (table below) description of the with a family’s response to illness
components, the family could be able or unable to cope • Indicates normal and pathologic responses thus
with the demands of the disease enabling the physicians to formulate special
therapeutic plan
COMPONENTS ENABLERS BARRIERS
• Family Illness Trajectory
Family Resources Adequate Limited financial
• Onset of illness to diagnosis
financial resources Lack of
resources Good social support • Impact phase - Reaction to diagnosis
social support group Lack of • Major therapeutic efforts
system Strong access to • Recovery phase - Adjustment to outcome
spirituality community • Adjustment to the Permanency of the
Community resources outcome
resources • Four Stages of that the family undergoes in coping
Family life cycle Stages wherein Stages that are with illness (Trajectory of Illness in Leopando)

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 • Stage 1: Onset of symptoms/illness
• Stage 2: Impact phase - reaction to NATURE OF NATURE CHARACTERI IMPACT ON
diagnosis ILLNESS OF STIC OF FAMILY
• Stage 3: Major therapeutic efforts ONSET EXPERIENCE
• Stage 4: Recovery phase - adjustment to ACUTE Rapid Little time Caught up in
outcome - Rapid Clear for physical suddenness
illness and
- Accidents psychologica
l adjustment
Short period Deal with
between immediate
onset, decision
diagnosis
and
management
Little time to Little support
remain in from within
state of and outside the
uncertainty family unit
Can be
dramatic but
less crisis if less
threatening
A. ONSET of Illness CHRONIC Gradual Suffer from Vague
• Stage experienced prior to contact with medical - Debilita- state of apprehension
care providers. It means the patient have ting uncertainty and anxiety
symptoms already pero prior to consultation pa. over Fearful
• Influenced by medical beliefs and previous meaning fantasies over
experiences and denial of
• Nature of onset may play an important role on symptom seriousness of
impact of illness on a family symptoms and
• In the Filipino setting, possible
o Acute, self-limiting, and non- implications
incapacitating illness that the family has
previously dealt with is oftentimes PHYSICIANS’ ROLES
treated using self-medication and rarely • Explore routinely the explanatory model and fear
brought to the attention of physicians. that patients bring to the clinic
▪ One study on dealing with • Acknowledge and explore conflict the patient may
children with acute illnesses be experiencing
found that "majority of childhood • Explore several aspects of pre-diagnostic phase of
illnesses are treated without patients and families
consulting a doctor" • Should be able to elicit the patient's explanatory
o Chronic, non-progressive illness poses a models of illness.
burden in terms of having to furnish
resources for the long haul, but since the B. REACTION TO DIAGNOSIS – Impact Phase
disease is stable, it is not marked by many • Disease and appropriate treatment can be
crisis situations. described according to the patient’s level of
o Chronic, debilitating, and terminal comprehension and understanding
illnesses cause great degrees of anxiety • As a physician you need to explain it In layman’s
because they drain resources and leave term, you need to explain it properly and
the family uncertain as to the potential appropriately to your patient so that they can
outcome of the treatment understand kasi this will depend on their level of
comprehension and understanding.
• The physician disclosing the diagnosis is
responsible for making a clinical judgement about

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 the amount of information the patient can absorb o Works in harmony with the wishes of the
at the state of anxiety and shock patient and the family
• Give small doses of information over time if the o Coordinate all aspects of the therapy
diagnosis is particularly traumatic and the patient which involve specialist and others
and the family may be unable to receive so much. o Offer the family options that are effective
You need to put the patient and family at ease, at a cost they can afford and are
that is why you need to have constant acceptable to the patient and the family's
communication with them belief systems.
• This is where initial contact with the physician is
usually established. Critical Issues in Choosing Therapeutic Plans
• During this time, it is important for the physician • Psychological state and preparedness of the
to explore first what the patient and his/her patient and family. Constant communication is a
family already know and ask what they still want must because if the family does not understand
to know. then they will constantly question and ask you for
• A good dictum to follow here comes from a quote your help.
from Fetherstonhaugh (1997): • Assumption of responsibility for care very early in
o “Diagnostic information regarding one's the treatment plan
body and life belongs to the person to • Economy of therapeutic plan
whom it refers, not to family or • Lifestyle and cultural characteristics of the family
physicians. Therefore, a patient's wish to • Effects of hospitalization, surgery and other major
know or not to know the truth is the most therapeutic procedures. (Sa parents) There will be
important determining factor.” feelings of helplessness, frustration and guilt, pag
geriatric naman there is vulnerability to feel death
PHYSICIAN’S ROLES and rejection. Those na may high risk
• Provide support and continuity of care nagkakaroon ng family dysfunction, nagkakroon
• Interpret findings which are misunderstood ng emotional problems in the family. Pag children
• Offer advice and encouragement naman ang affected, they might feel hostile,
• Clarify meaning of specialist’s message and abandoned. and sometimes depending on the
outcome of illness and operation. roles of the family members.
• Anticipate number of problems and help families
to cope and adapt more through family PHYSICIAN’S ROLES
conferences. The feeling of guilt Is a natural • Remain open to the family and provide them
response to grief and loss, you need to help them. information
• Help family assess the: • Consider all factors in planning a treatment
o Effect of the illness on the family regimen
o Predict problems likely to arise • Anticipate pathologic response
o Develop plans for realistically coping with
them D. EARLY ADJUSTMENT TO OUTCOME – RECOVERY
o Family’s capabilities to deal with such PHASE
stress • Return from hospital or major therapy initiates a
• Offer alternative interpretation of proposed period of gradual movement from the role of
therapeutics, bolster family’s denial and inability being sick to some form of recovery or
to accept reality adaptation, with corresponding adjustments of
relationship within the family
C. MAJOR THERAPEUTIC EFFORTS • Experience of recovery or adjustment to the
• Start of management illness outcome is an important phase for patients
• Management represents one of the most and families
challenging and rewarding part of medical o Type of outcome anticipated:
practice ▪ Return to full health
• This is the period of great mobilization when the ▪ Partial recovery
family pursues avenues for treatment or ▪ Permanent disability
palliation. • This phase is usually marked by the disappearance
of symptoms for acute, self-limiting illnesses or
• Physicians should: returning to the home environment and some
o Deal with multiple variables degree of functionality for chronic illnesses.

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PHYSICIAN’S ROLES • Encourage ventilation of feelings
• Deal with immediate effects of trauma • Give reassurance and reinforcement for care
• Alleviate anxiety
• Provision of psychological support through TERMINAL ILLNESS
understanding and repeated assurance. This could • Highly emotional & potentially devastating
be when we conduct family meeting already, call • moment of diagnosis of a major debilitating or
the other family members for support and find if terminal disease is often remembered by patient
other members have similar problems, to know in their families as the single most difficult time of
how we can help. the entire illness experience
• Explore level of understanding of patient and
family • Functional Family
• Prepare the family for the potential outcomes of a o members will be drawn close together to
disease so that they may learn to deal with them provide care & support to the patient &
and prepare a realistic plan. to each other

E. ADJUSTMENT TO THE PERMANENCY OF THE • Dysfunctional Family

OUTCOME o can be the seed for future family discord
• “second crisis” and breakdown
• Family’s adjustment to the effect of the illness
• Occurs as family realizes that they must accept • Physician can
and adjust to a permanent disability o Assist the patient and the family in
• Family must accept that life must go forward relating to health care system;
• Pattern believed to be temporary must be o Aid the patient & the family in efficient &
accepted as permanent functional readjustment;
• Coping mechanism is developed during earlier o Provide quality care:
stage of family adjustment. ▪ Home care is the best & most
o Person who is sick continued to be accepted & the last demanding,
treated as sick & he is treated as patient thus it should be facilitated
& not reintegrated into the family
o Treat patient as recovered, full, FAMILY’S REACTION TO DEATH
responsible person • after prolonged severe illness and adaptation and
reaction are already accomplished
ACUTE ILLNESS o Death comes swiftly & physician must
• Potential for crisis especially when family routines assist family to cope
are suspended o If prolonged
• Emotions are high & can lead to anger especially if ▪ premorbid pattern of abnormal
the family perceives that the care given by the behavior
doctor is not satisfactory.
• Suddenness of illness will render the family
difficult to face the stress

• physician can facilitate healthy response or

acceptance of diagnosis & recognize danger
signals such as delayed or prolonged reaction

CHRONIC ILLNESS
• Higher incidence of illness in other members of
the family
• Chronic illness may bring about additional burden
& sometimes feeling of guilt especially if the sick
member was previously neglected, then as a
result of this feeling, the family becomes over-
indulgent toward the sick member & this will later
result into feeling of overwork In any of these stage we need to support the family and
• Anger & resentment toward sick member sets in we need to know what are the appropriate interventions
leading back to feeling of guilt later. we need to give (IAC, Emotional Support, Guidance and

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Direction). Remember that this is not time bound, you
need to process their grieving.

References:
• Dr. JD Velasco’s PPT October 28, 2021
• Leopando, Z. (2016) Textbook of family medicine
Volume 1.

VII. SAMPLEX
Matching Type
1. Primarily biologic & pyscho-physiologic disorder
2. Subjective or psychological state of a person
3. Role that an individual assumes when ill Acceptance •
A. Disease Depression •
B. Illness Bargaining •
C. Sickness Anger •
Denial •
True or False 5 Stages of Kubler-Ross Grief Cycle
1. Most crucial factor in outcome is the initial outcome
expectation Adjustment to the Permanency of the •
2. Normally complicated life decisions are always outcome
Recovery phase - Adjustment to •
layered with a myriad of illness-related Major therapeutic efforts •
ambiguities Impact phase - Reaction to diagnosis •
3. Onset of illness is influenced by medical beliefs Onset of illness to diagnosis •
and previous experiences 5 Stages of Family Illness Trajectory
4. Management represents one of the most Enumeration
challenging and rewarding part of medical 4. True
practice
3. True
Enumeration 2. True
5 Stages of Family Illness Trajectory 1. True
5 Stages of Kubler-Ross Grief Cycle
T/F
3. C
2. B
1. A
Matching Type:
Answers:

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 PFCM 3A | Navigation of Family Assessment Tools
Tutor: Dr. JD Velasco | Lecture Date: Nov. 11, 2021 | 1st SEMESTER

TOPIC OUTLINE o Depicts the comprehensive

I. Learning Outcome understanding of the multigenerational
II. Recap: Family Assesment Tools family systems
III. Activity 1: Case Scenario
IV. Case scenario: “Impact of HIV/Aids on an OFW
III. ACTIVITY 1: CASE SCENARIO
and his family” Patricia Manalastas, a 68-year-old retired high
school teacher, from Candon City, Ilocos Sur, was
experiencing intermittent left sided chest discomfort,
I. LEARNING OUTCOME pressing in character with note of occasional shortness of
Upon completed of this assisted medical education breath. She attributed the symptoms to her very significant
activity, you will be able to: weight gain in the past two years. The chest pain usually
• Draw a complete and correct genogram of occurred after doing strenuous chores at home, but lately,
o Patient presenting with chest discomfort it had apparently been becoming more frequent and more
o Own family genogram severe, according to her 69-year-old husband, Victor,
• Analyze and interpret the family genogram and whom she married in 1978.
correlate with the biopsychosocial concerns of the On physical examination, there were stable vital
patient signs and essentially normal systemic findings. However,
• To analyze a case of a chronic debilitating illness the treadmill exercise test revealed ischemic heart disease.
and its impact on the patient and family using Patricia was prescribed with maintenance medications
appropriate family assessment tools (i.e., ASA, ISMN, and statin). She was also advised regular
* For your patients to help themselves is you have to let aerobic exercise, weight reduction, and proper diet, as she
them understand what they are going through, what is was usually sedentary and was fond of salty and fatty food.
happening in their bodies, because it’s their body. It’s them So if we look here ang daming niyang psychosocial
who are actually suffering it’s not us Doctors. We as concerns yung index patient, si Maam Patricia no? Sa Chest
doctors are only instruments, we can help them when it pain niya and that’s the chief complaint. Pasadahan lang
comes to all these. natin yung mga biomedical problems niya – intermittent
II. RECAP: FAMILY ASSESSMENT TOOLS left sided chest discomfort, may shortness of breath, and
then nagkaroon siya ng significant weight gain.
Anatomy Family Genogram And then you also have to ask them their diet. If
Development Family Life Cycle you ask this kasi, this is also where you have to intervene.
Function Family APGAR Kasi nga may ischemic heart disease na nga siya. Yung
Family Lifeline biopsychosocial concern niya is ito – she doesn’t want to
Resources SCREEM die of a potential acute Myocardial infarction, because
SCREEM-RES that’s what happened sa mother niya. She was actually,
Family map noit really forced, pero meron tayong (as I’ve said) in
Ecomap communication. If you remember in your second year,
sometimes yung how we also relate to our patients is
Family Genogram because of what their past experience is, that’s why we
• Graphic representation of the following: really have to ask it.
o Inheritance patterns Patricia did not receive the diagnosis well and was
o Family illnesses apprehensive regarding being on maintenance
o Family members medications. When you probed about this, she suddenly
o Family structures broke down and lamented how she could not be sick and
o Emotional patterns could not possibly die of potential acute myocardial
• Useful strategy in encouraging family members infarction, like her own mother.
who may have been reluctant to get involved in So eto nga yung kanyang biopsychosocial
discussions on family matters to participate. concerns, you correct some of the misperceptions if your
• Compulsory part of the patient’s chart since it patient has misperceptions. Especially (in this case) high
provides the following: risk pala ang ating patient, her own mom died of
o Quick overview of the family members myocardial infarction so there’s a possibility. Sa amin
and relationships during our counselling we usually equate the perception
o Visual illustration of the biomedical and and reality. So for this patient kasi for example, after follow
psychosocial information up then your patient despite your counselling, despite yung
mga bilin mo for this patient to adhere to the medications,

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to adhere to the diet, etc. and then she still did not do it relationship has also been rocky, as the parents of Paige
you can actually elevate, increase the anxiety of the patient have explicitly disapproved of Piper and their same sex
specially with this history na her mo0m died of MI. But if lesbian relationship.
your patient has been doing well although the risk is still Ito rin sa lesbian na anak niya, kaya they are trying
there, you can equate to reality that as long as the patient to raise awareness. Hindi ko alam sa inyo, pero sa school
continue to adhere sa medication, the dietary and exercise, kasi yung gender and development. As much as possible
restrictions then it could actually lower the risk of MI. you we try not to create policies that are gender responsive to
can also appreciate them that they are good. create environment in our school or in our offices to be
She cried about how Victor’s diabetes mellitus and gender responsive. Lalo na ngayon yung theme kasi ng
hypertension were already eating up a large chunk of their gov(?) is safe space, you have a safe space act na kasi. We
pension as retired teachers. She further argued that she are trying to create environment for our students na when
could not die yet, as her children and her husband still we suffer sa bullying they suffer from, especially during the
needed her. You learned that her three children were all identity crisis they have spaces in the schools where the
employed adults, but they were all still emotionally students can go even with teachers. Di lang naman
dependent on their mother and father, given their present students ang nabubully, teachers din nabubully even
issues. administrators. Even in the virtual space. We really have to
Another Biopsychosocial concern is the budget/ know how to create environment, virtual man or physical
finance, kasi sabi nga niya the diabetes and hypertension is that would actually ease the burden of the student.
eating up their pension. Kung medyo mahal ang gamot, we
look for alternatives. Yun lang since alternatives sila Family Genogram: Manalastas family
sometimes it will not give you the result that you actually *Please refer to the image below (Figure 1.)
expect. So you should also adjust din and hopefully with So actually this is the genogram, di ko na sinama
the diet pwedeng istrengthen yung sa diet and sa exercise kung may close or something even with yung relationship
para mabawasan din yung gamot. So pwede niyong ni Patricia with Penelope. Eto kasi kasi if you look at this,
balansehin lahat yun. eto yung genogram.
Phoebe, the youngest daughter at 33 years old, So if you look at it, here it the family name tapos I
separated from her husband, Cole, 37 years old five (5) also placed the date. Tapos (with) Victor they are married,
months ago. She took her two young children --- Wyatt, eto yung date na 1978. And of course these are my legends
male (9 years old) and Chris, male (4 years old) --- to live (refer to those in the blue box) – for ischemic heart disease,
back with her parents. Diabetes, hypertension and of course the arrow, that’s my
And of course yung dynamics din in the family as index patient.
much as possible we would want to track, to mend things And then eto nga yung first child niya, si Prue,
as well. Pero kung stress ka na wag na lang kasi medyo tapos si Piper, and then si Phoebe. So eto nga
matanda na din naman mga anak mo (Maam Patricia). Kaya magkakasama sa household diba (those within the red
lang siyempre you have to get din the thoughts of the border) hindi na kasama si Cole kasi nga they already
children, especially kung separated parents nila. separated. So sila magkakasama sa bahay. And then of
The eldest is Prue, 41 years old, and she is married course yun nga yun sign din ( ) diba yung gender nila is
to her 45-year-old husband, Andy in 2004. Prue expressed they are lesbian, eto din kasama doon. Si Andy naman at si
their concern and apprehension, since their only daughter Prue tapos may anak sila si Penelope. Eto lang kapag
Penelope, 15 years old, was becoming belligerent and gagawan niya kasi siya ng Family map, si Penelope at si
rebellious. And this hurt Patricia too, as her granddaughter Patricia, strain na din yung relationship,so pwedeng hindi
used to be very close to her but had slowly become aloof na din functional yung relationship nila. You can draw a
and distant. single line between them. (Going back kay Piper and Paige)
Ito rin yung nagkaroon sila ng tension even with eto naman broken line kasi di naman sila married pero
the mom and si lola. Another pandagdag din yan sa stress nagsasama sila. (Going back to Phoebe and Cole) kapag
In addition, the middle child, Piper, was a 36-year- may slash yan ibig sabihin niyan separated.
old lesbian, and she moved in with her partner of three
years, 34-year-old Paige. Their domestic and romantic

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Figure 1. Family Genogram: Manalastas Family

IV. CASE SCENARIO: Impact of HIV/AIDS on an OFW

and his family
Brief medical background

• General data: Family Genogram

o JD
*Please refer to the image below (Figure 2)
o 42 -year-old
o Male So if you look at this family genogram, makikita
o Married mo na maganda naman yung relationship ( JD and ND)
o Cavite kaya may double arrow diyan diba. Functional naman
• Chief Complaint yung relationship despite what happened between JD and
o Dyspnea yung karelasyion niya. If you look at this kasi (pertaining to
• PTB 2001 the son daughter) 20 years old, tapos si Heidi 21 years old,
• OFW so this (yung relationship niya with the other women) is
• Screened POSITIVE for HIV antibody between nun (current relationship with wife ND).
Unfortunately lang JD did not disclose this kaagad sa wife
Family Assessment tools (used for this case) niya parang years din with the disclosure. Pero yun nga if
• Family Genogram you look at the psychosocial history din niya kasi OFW siya
• Family Map tapos naassign pa siya sa East Africa, not that we are
• Family Lifeline jusging East Africa pero sila rin yung parang maraming STI/
• Family Resources STD din noon. So yun yung medyo mahirap parang what
happened nga lang because of the depression, because
• Family Apgar
this patient was lonely, he resorted to multiple
Sabi ko nga Anatomy (Genogram), Map and Lifeline- unprotected sexual contacts – unfortunately with
Function, resources – yun yung SCREEM test. promiscuous female partners as well. It’s very important
to counsel our patients as well kasi even right now, we still

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have the stigma, especially patients with STI. Sometimes dates. If walang dates pwede mong ilagay ‘6 years ago’ or
we judge, knowing the gender of these patients - yun yung mga ‘5 years ago’ kung anong nangyari kasi we look at the
sanang gusto nating alisin that is why before we talk to crisis that they actually have suffered. So yun yung mga
these patients if you have this judgmental mind, we really significant clinical events and the crisis that happened to
have to practice ‘bracketing’ (a mental skill). even if you their family during those times. And you can actually can
know the patient, without prejudice sana as physicians we also counsel, educate your patients based on that. Sinabi
try to prevent the bias we try not to be judgmental. We din sito sa resources when they did the SCREEM,
have to remember that we all are people, we may not unfortunately they have unstable finances. So it’s a good
have suffered but we try to understand. We learn, we are thing lang na actually libre naman yung gamot it’s
learning from experience not only with our experience but nakadepende kung malayo siya or not, if the patient can
with the experience of our colleagues, in school, etc. follow up. Unfortunately lang it was mentioned here na
Despite all that’s happen to them (family in the inaccessibility of medicinesand including the medical
case) functional naman. Yun lang if you look at the services kasi malayoand of course yung hiya, the shame
boundary sabi nga nila they have a very clear but the patient is feeling na nastigmatized nga siya so that’s a
negotiable boundaries kaya ginawa ditto is broken lines problem na could actually hinder also the patient to get
naman. Pero yun nga it’s a good thing lang din na the the medication sana. And of course yung nafifeel din
family is not inflicted. Of the virus. Though JD and ND niyang, although nagging okay sila of course sometimes
resumed with their sexual relationship – yun din yung baka yung hindi na 100% yung trust. Although the patient
mahirap. It’s difficult for the female, for the mom na lied the fami8ly is still there, which is a good
tanggapin din, but actually if you really love that person thing.kumbaga the burden was shared not only with the
talagang you will try to help him cope up. patient but by the family, which is yun naman ang gusto
Based on the index patient ano yung kanilang life natin - we share the burden as family, kasi family kayo di
cycle? Anong stage na sila in the life cycle even just by lang siya magisa. And we have to try to make people
eyeballing this genogram lang? - LAUNCHING. understand na ito yung HIV ito si AIDS and other STIs as
Family lifeline is briefly discussed. Sa family lifeline well na hindi dapat sila pinandidirian instead you have to
kasi in chronological order you place the dates, significant help them.

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 PFCM 3A | Family Assessment Tools
Tutor: Dr. JD Velasco | Lecture Date: Nov. 11, 2021 | 1st SEMESTER

TOPIC OUTLINE ▪ It’s similar to the anatomy of our body,

I. FAMILY ASSESSMENT TOOLS hini-himay himay yan, it’s usually the
II. TOOLS members of the household
A. Anatomy
a. Family Genogram
• Development
B. Development o Family Life Cycle
a. Family Life Cycle ▪ Remember there are tasks that are
C. Function supposed to be involved, para siyang in
a. Family APGAR
pediatrics the developmental
b. Family Lifeline
D. Resources milestones. Also in the family,
a. Family map depending on the stage of the family,
b. Ecomap where the family is in, if you want to
c. SCREEM check for the normalcy, the right track
d. SCREEM-RES
E. Others
where the family is, we should check
a. DRAFT the task that are supposed to be done
b. Family Circle in this stage of the family life cycle. It’s
III. SAMPLEX also very important that we know
because that’s part of development.
I. FAMILY ASSESSMENT TOOLS Kasi baka they are arrested on that
• This will help us clinicians on how we can help stage of the family, hindi na sila
more our patients nakapag move-on, and kawawa din
• Especially if you want to identify allies in the yung mga iba na family members
family to help in the therapeutics of your patient, • Function
in the financing side also, in educating your o Family APGAR
patient, you want to assess ano ba yung ▪ This is separate from the APGAR na
educational attainment ng mga family members binibilang kapag sa pediatrics
with tact, hindi naman yung parang bara-barang i- o Family Lifeline
ask anong tinapos mo. • Resources
• You know also how to assess the functionality of o SCREEM
the family, how are they coping, are these o SCREEM-RES
families resilient enough to cope with crisis they o Family Map
are in o Ecomap
• Challenge:
o Need to be sensitive to the stresses,
transitions, and expectations of family
members over time and the effect of
these and other family interactions on the
health of individuals
o We have to take note that it’s also
difficult to just approach a family without
rapport, we need to establish rapport first
• Systematic way of understanding the family and
to aid them in evaluating the impact of illness on
a person and his/her role in the family
o Example if [a] certain disease will affect
the family, we really need to also assess
how are they coping. Importante yung
coping mechanism nila sa ganitong set-
up.
• Anatomy
Figure 1: Schematic representation of hierarchy and
o Family Genogram
continuum of natural systems as applicable to Engel’s
definition of the biopsychosocial model adapted from
“The clinical application of the biopsychosocial model”

Trans 7|FRIGILLANA| GARDINGAN | MEJOS P a g e 1 | 14

 - This was initiated by George Engel, but may o Family structures
dinagdag na, it’s also on spiritual. In the o Emotional patterns
biopsychosocial approach, remember it’s a two- • Useful strategy in encouraging family members
way. Aside from sa atin in the molecular level, we who may have been reluctant to get involved in
also have to look at our biosphere. Tinitignan din discussions on family matters to participate.
natin yung ating environment as a whole, hindi • The genogram provides a clear picture of the
lang yung self natin but from our self, from one medical, familial, and social factors that affect the
person, to two person, to family, to community, treatment process and management of patients.
and then the rest of the environment as well. • Recognition of these (medical, familial and social
factors) through the genogram will definitely help
SCOAP the attending physician to be more sensitive and
• Subjective compassionate in providing care to patients and
• Context (Biopsychosocial) their families.
o We write here the biopsychosocial
concerns of the patients
• Compulsory part of the patient’s chart for
admitted patients since it provides the following:
• Objective
o Quick overview of the family members
• Assessment
and relationships
• Plan o Visual illustration of the biomedical and
• Kapag naman SOAP, dinadagdag namin siya sa psychosocial information
either subjective and then yung objective type o Depicts the comprehensive
depending if you have used your family understanding of the multigenerational
assessment tools so kasama din dun sa objective family systems
yun. It’s just like doing also laboratory exams, o It’s minimum of 3 generations, example I
parang ganun din yung [ano din] doon. From our was admitted or [I am the] index patient
assessment tools that were done, isasama na rin or had consult. Aside from my generation
namin sa aming diagnosis. But if we’re using the or yung below me, dapat may isa pa.
SCOAP version, usually nandiyan yan sa letter C. Either 2 generations above me or below
me. Minimum of 3 generations talaga
II.TOOLS dapat si genogram.
IDEAL TOOL
• Easy to use
• Complete Genogram
1. The names of the two families with the
• Brief but concise
address of the index family, kung sino
• Non-intrusive
yung mag-asawa, so yung mag partner,
o Patients are comfortable to fill these
the side of the father and the side of the
forms
mother. Even if I’m the index patient I
• Clinically relevant
have to get also the genogram from my
o Use the appropriate tools, hindi lahat ng
father side and my mother side. I have to
situation you will use all of the tools, you
know also their parents, so my
should know what assessment tools to
grandparents, uncles and aunts, or the
pick
siblings of your parents you should know
• Can serve as basis for intervention them.
o We hold family meetings, we hold
2. The date the genogram was generated,
counselling sessions for our patients, kaya
when you have created the genograms
we really need the assessment tools to
this will help you form an idea, kasi this is
get allies especially in the management,
developing, there are others that could be
or baka kelangan ng decision-making if
one time if you’ll not see the patients, but
the patient cannot decide on his or her for the patients that you have seen since
own childhood it’s developing also. You can
A. Anatomy
enter in the genogram, you can always
a. Family Genogram/ Tree
not edit, but add on the genogram from
• Layman’s term: Family tree time to time especially depending on the
• Scientific term: Genogram development of the patient
• Graphic representation of the following: 3. The informant/s, it’s usually the patient
o Inheritance patterns but if your patient cannot talk to you or
o Family illnesses cannot speak, you should also use the
o Family members informants as well (?)

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 4. Information on three or more generations
5. Names and ages of ALL family generations
6. The exact date of births, marriage,
separation, divorce (annulment or legal
separation in the Philippines), death and
other significant life events
7. Illnesses (hereditary or significant
problem or illness), hindi naman lahat
sinusulat but we have signs and symbols,
legend
- Kung female siya, circle yan (the image above
8. The first born of each family to the LEFT
shows an adopted male child), if male square siya.
with other siblings sequentially to the
If sa twins, if males use square, females use circle
RIGHT, eldest on your left side, your
youngest on your right side
9. Indication of members living together in
the same household, the male side is on
the left side, the female side or mother
side is on the right side as well
10. Legend
Other information in the genogram can be obtained like:
• Family history of diseases
• Possible sources of stress
• Genogram symbols

- We usually put the name, the disease, then kahit

kung hindi maalala yung date, kahit man lang
yung year when the patient died
- If you cannot write in words, you can use symbols

- If there’s an unknown sex (), ginagawa din

namin kapag masyadong maraming kapatid and
maliit lang ang papel, example one of your
parent’s has 10 siblings, we usually use this and
write the significant siblings nalang according to
the patient

- Family household (right side)

o You have to encircle those who are living
together in one household
o If there is repeat marriages, practical side,
tignan nyo rin kung sino ang mag partner
talaga
- Either use the arrows or duplicate, you indicate it o (correction daw sa part na to, interchange
either square for males you duplicate the square si female at male haha pacheck nalang po
inside [then duplicate the] circle for females sa video recording huhu)
inside. Commonly, we use the arrows to indicate
the index patient

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 • Can help the physician form appropriate
hypotheses about the problems experienced by
patients at a particular stage (Murtagh, 1999)
• Predictable and chronological sequence of events
in the family's life which can be related to clinical
events and to the health maintenance of family
members (Samaniego, 1995)

*Refer to last page for bigger pictures, check also for the
video recording for clearer explanation from doc
B. Development
a. Family Life Cycle
• Description of the family dynamics through
clearly defined stages of development

STAGE TASK HEALTH IMPLICATIONS

Establishing personal independence Episodic medical problems; STDs;

Leaving Home
Beginning emotional separation from parents Unwanted Pregnancy
Establishing an intimate relationship with
spouse (just like on the previous genogram,
Newly Married Couple you base the FLC on the index patients)
Early Pregnancy, STDs; Infertility,
Developing further the emotional separation
Gynecologic problems
from parents especially if they will leave
outside of their families

Opening the family to include a new member

especially if they had children
Family with Young Children Accidents; Poisoning: Mental
Dividing the parenting role especially if they
retardation: Behavioral problem
both work together

Increasing the flexibility of the family

boundaries to allow the adolescents to move in
Family with Adolescent Drug & other substance abuse, STDs;
and out of the family system, there are times
Gynecologic problems; Skin diseases;
that we should allow the adolescent to explore
Menstrual problems; Circumcision
also outside of the environment

Accepting multitude of exits from and entries

into the family system
Launching Family
Adjusting to the ending of parenting roles, we Pre/postmenopausal syndrome;
have to launch all your children hanggang kayo Degenerative diseases; Malignancies
nalang ang natira

Adjusting to the ending of the wage-earning

roles (retirement)
Dealing with lessening abilities and greater Degenerative diseases; Chronic
Family in Later Life dependence on others illnesses; Malignancies: Gynecologic
Dealing with losses of friends, family members Urologic problems
and eventually each other

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 C. Function o Measures patients' satisfaction with their
a. Family APGAR family functioning NOT the family
• Screening instrument for family dysfunction functioning itself
• Measures the patients' perception and level of ▪ How satisfied is the patient when
satisfaction on the current state of their family it comes to the help the family
members' relationship gives, how does the patient feel.
• Developed by Gabriel Smilkstein in 1978 Kaya nga dalawa rin yung APGAR
• Five-item self-administered questionnaire kasi there are times we have also
(administer only to those who can read and write, to get the APGAR scores of the
pag 18 and above pwede naman, pero pag below other members of the family
medyo alanganin, it’s not an interview) • APGAR is found to be of value in the following:
• A tool that qualitatively measures a family o Symptoms that manifest themselves as
functioning. It is a 10 to 15-minute paper pencil psychosomatic disorder
technique that elicits the patient’s perception and o Difficult patients
level of satisfaction on the current state of her o Marital and sexual difficulties
family member’s relationship. o Multiple presentations by a family
• A – Adaptation member, example there are problematic
o How does the family address the problem areas, or may mga ibang families in
o Family's utilization of the resources conflict
available within and outside of the family o Multiple presentations by multiple family
system when significant life events pose a members ("thick file syndrome"), multiple
crisis, how does the family adapt family members, extended family
• P – Partnership members
o How does the family cooperate with each o Drug or alcohol abuse
other o Evidence of sexual and physical abuse
o Sharing of the family members in The total score obtained from the different
decision-making and responsibilities parameters becomes the basis of interpretation. Because
• G – Growth it provides an overview of how a family functions, the
o Physical and emotional growth attained presence of dysfunction that can impose hindrances to
by each family member from the family's the delivery of patient care can be appropriately
ability to support and guide addressed.
o This is a way of knowing how the family
reach their potential especially each i. FAMILY APGAR PART I Statements
member of the family • ADAPTATION
• A – Affection o I am satisfied that I can turn to my family
o Loving and caring relationship of the for help when something is troubling me
family o Ako'y nasisiyahan dahil nakakaasa ako ng
o This is where the family express and tulong mula sa aking pamilya sa oras ng
accept their feelings pangangailangan
• R – Resolve • PARTNERSHIP
o Commitment of the family members to o I am satisfied with the with the way my
develop time to support each other's family talks over things with me and
physical and emotional growth shares problems with me
o Sharing of wealth and space o Ako'y nasisiyahan sa paraang
o There is a commitment on time and nakikipagtalakayan sa akin ang aking
resources pamilya tungkol sa aking mga problema
• Limitations of APGAR • GROWTH
o Data obtained is restricted to what the o I am satisfied that my family accepts and
patients are willing to disclose about supports my wishes to take on new
themselves and their family activities or directions
▪ Mahirap kasi huliin dito kung sino o Ako'y nasisiyahan at ang aking pamilya ay
yung nagsisinungaling [etc] kasi tinatanggap at sinusuportahan ang aking
self-administered. But there are mga nais gawin patungo sa mga bagong
times when you need to probe, landas para sa aking ikauunlad
especially if you really need to • AFFECTION
look for allies in the family

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 o I am satisfied the way my family expresses • they seldom spend time
affection and responds to my emotions with each other
such as anger, sorrow, and love
o Ako'y nasisiyan sa paraamg ipinadadama ii. APGAR II
ng aking pamilya ang kanilang • Delineate the patient's relationship with
pagmamahal at pag-unawa sa aking individual family members or other persons who
damdamain katulad ng galit, lungkot at have supportive roles in his/her life
pag-ibig
• RESOLVE • May well indicate conflict between the patient
o I am satisfied with the way my family and and a family member that is not revealed in
I share time together APGAR I
o Ako'y nasisiyahan na ang aking pamilya at
ako ay nagkakaroon ng panahon sa isa't
isa
• FAMILY APGAR Scoring & Interpretation
o APGAR SCORE
▪ 2 – Almost always (Palagi)
▪ 1 – Some of the Time (Paminsan-
minsan)
▪ 0 – Hardly ever (Halos Hindi)
o APGAR SCORE INTERPRETATION
▪ 8-10 – Highly Functional
▪ 4-7 – Moderately Dysfunctional
▪ 0-3 – Severely Dysfunctional
• APGAR Sample
o Magdalena Curaraton: Mother

- same questions din naman, hindi na namin ito iniiscore,

but this helps on how to identify an ally whom we can tap
when we try to counsel the patients

b. Family Lifeline
• Family's significant experiences over a period in a
chronological sequence
• Includes how the family coped with these
stressful life events
• Allows exploration of certain family issues
• There are times that the family members become
symptomatic, not necessarily organic problems
• INTERPRETATION
when they are stressed or when they are exposed
o APGAR SCORE 7
to certain stressors
o MODERATELY DYSFUNCCTIONAL
▪ Pag moderately dysfunctional, • It is useful when anticipating a long-term illness,
there are times we also intervene the presence of difficult caregiving, non-
here, we try to do some adherence to treatment strategies, and in
counseling, family meetings as situations where the doctor needs to “think
well. Try to address yung mga family”. The latter includes abnormal behavior in
hindi perfect na score: a child, inappropriate behavior in the antenatal
and/or post-partum period, drug or alcohol
• (just like in this sample)
abuse, and evidence of sexual or physical abuse.
they have problems in the
support from the family, • Interpretation is based on the most the
• how they express their significant event that probably affected the
affection or baka hindi health of each member or influenced health-
seeking behavior or perception on health of the
nya masyadong ma-
individual or family
express kasi the family
members might interpret
it inapprorpriately,

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 *Note regarding enmeshed or over -involved relationship:
don’t mistake these with those relationships from the
family genogram.
- The age here is the age of the patient *Usually naman ang iniinvolve lang namin sa family
- At the ages of 21 and 22, these are significant genogram is yung closeness of the relationship. Pero
events where he had severe headaches. If you kapag sa family map if you really want a detailed
look at this, these were the times that the patient description kapag may conflict in the family, pag na
was actually stressed. Then when he went away identify niyo yun you can use all of these (refer to the
from home [tignan mo] no headaches at all. But images above) naman.
when he started to begin working and had
difficulties with the employer, nagkaroon ng
changed jobs, marital difficulty the headaches
recurred. This is what we call the family lifeline.
- There are certain events in life that would trigger
certain symptom. Kaya lagi nyong tatanungin yan
especially for headache, abdominal pain, na
minsan it’s psychologically healed if they are not
stressed anymore, if they have resolved their
problems, may ganun din. Hindi naman lahat ng
pasyente e may organic na sakit, pwede rin
naman psychological. Hindi rin biro ang
psychological problems, kasi that depends on the
coping mechanism of the patient.

D. Resources
a. Family Map
• Reflects the family system in terms of:
o Relationships among family members For example, this one (please refer to the image
o Boundaries between generations above) if you look at this si Jose at si Alicia they are both
▪ Rules, enmeshment, married and have three sons, si Juan – 19, Noel – 16, and
triangulations, coalition, Jun is 15. Alicia has a functional relationship with her son
disengage, discord, etc. Noel, also silang magkakapatid they also have a functional
o Presence of conflicts and/or alliance relationship. Enmeshed si Alicia kay Jun, pero meron din
silang diffused na boundary. Then si Jose atsaka si Jun
• Obtain the therapeutic ally for the delivery of
close naman sila pero meron siyang dysfunctional
care in the family
relationship – si Jose at si Noel, si Jose at si Juan, even
• Schematic description on who to ask for
silang magasawa, they have a dysfunctional relationship.
assistance in making decisions for the patient
With Jose and Jun, they have clear boundaries which
• Developed by Salvador Minuchin
mean, makuha ka sa tingin isang mistake mo lang pwede
• Possible source of somatic complaint may also be
ka na rin ma-ano jan. Even sa kanilang tatlo
identified based on the mapping of family
(magkakapatid) they have a clear understanding na ito
relationships.
ang bawal, wag mong gawin to, etc. And itong si dalawa
(Juan and Noel) unfortunately, ito mahirap pag
magkaroon ng kakampi, they tend to coalesce each other
– si Juan at si Noel. Siguro kung magaway away silang
tatlong magkakapatid kawawa si Jun. That’s why itong si
Jun pwede din siyang magescape from the system or
nagdisengage siya dahil may coalition yung dalawa niyang
kapatid di man lang siya sinama, lalo na ito (relationship

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with the mother and Jun) supoer enmeshed, siguro relationship with the social welfare pero they are stressed
favorite siya kaya ayun din pwedeng ibang factor, kaya with the health care because of the ill child. Si mom din if
magkakaroon din sila ng conflict sa family. you will apply the family map, enmeshed siya kay ill child
b. Ecomap kasi nga may sakit si anak. Pero baka nagkaconflict sila,
• Kung si family map it’s within the family si mom and dad, and mom and sibling kasi mas
ecomap naman it includes the environment binabantayan niya si ill child. Tapos si extended family
• A "snapshot" of the patient within his/her family parang wala lang tenuous kasi, tenuous kasi is yung
and social environment at a particular point in parang yun lang relationship nila. Pero si Recreation this
time could either be that they ggive each other energy so okay
• A graphical representation that shows all the siya pag yung straight line na yan. So this is the ecomap
systems at play in an individual's life. pwede as an individual or as a whole family – relationship
ng whole family to the whole environment.
c. SCREEM
• Assessment of family’s capacity to participate in
the provision of health care, to cope with crisis or
to implement plan (Corales & Medina, 2011)
• Family members identify and assess their
resources to meet a crisis
• It is commonly used when the need for care is
long or lasts a lifetime such as in the case of
chronically ill, terminally ill, and hospice care
patients. It can also be used to assess the
resources of difficult and non-compliant patients.
RESOURCES PATHOLOGY
(For the bigger image, please check the last page.) system
B and C they are stressing each other kaya yung energy SOCIAL Social The family is
flow both, kasi nageestressan sila lang sila. At the same interaction is socially
time ito naman si system C iniistress niya si H, pero yung evident among isolated from
flow ng energy si C papunta kay H si H papunta din kay C. family members extra-familial
So si C nagrereceive ng positive energy kay H. an dthen ito groups
naman si sytem B and G, system G is receiving both the Family members
stress and positive energy from B (Correction sa picture sa have well-
relationship ni G and B daw, it should be- System G balanced lines of
receiving both stress and positive energy from system B). communication
System G and H, system G is causing stress kay H. Eto with extra
namang relationship between F and G, they have a familial social
tenuous relationship, pero si systems E and F, they are groups such as
both giving each other stress and positive energy. friends, sports
groups, clubs
and community
organizations
other
CULTURAL Cultural pride or The family has
satisfaction can feelings of
be identified cultural ethnic
especially in inferiority or
distinct ethnic shame
groups
RELIGIOUS Religion offers Dogma and
satisfying rituals are so
spiritual rigid that they
experiences as limit the
(refer to image above) The problem here is, the dad, may
well as contacts family's
sakit na nga yung bata tapos iniistress niya. Tapos since with an extra- problem-
may sakit siya iniistress pa siya either or - wala kasing familial support solving
arrow, if you look at these na wala they are stressing each group capacity
other – si ill child and si school, iniistress nila each other.
With social welfare, the whole family has a tenuous

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 ECONOMIC Economic Financial
stability is problems
sufficient to make it
provide both a difficult for the
reasonable family to meet
satisfaction with monetary
financial status demands of
and an ability to crisis or illness
meet the
economic
demands of
normal life
events and
illness
EDUCATIONAL Educations of Handicaps
the family limit the ability
members is of family
adequate to members to
allow members comprehend
to solve or the problem or
comprehend recommended • SCREEM-RES INTERPRETATION
most of the solutions o 0-12: Severely Inadequate Family
problems that Resources
arise within the o 13-14: Moderately e Inadequate Family
format of the Resources
lifestyle o 25-36: Adequate Family Resources
established by
the family E. Others
MEDICAL Medical care is A family has a. DRAFT: Draw-a-family Test
available not • Designed by Drs. Cruz and Pineda
through established • Community-based assessment of family function
channels that lines of administered individually or in group
are easily medical care • Family members are given opportunity to express
established and or is unable to oneself, in turn, may reveal innate difficulties
have previously use health within the family system
been care facilities
experienced due to
satisfactorily problems such
as
unwillingness
to seek care,
inadequate
finances,
absence of
transportation,
etc b. Family Circle
• Brief, graphic method for disclosing, gathering
d. SCREEM FAMILY RESOURCE SURVEY and discussing family dynamics using circles
• SCREEM-RES • Assess openness, boundaries, support, function,
• 12-item self-administered questionnaire triangulation and interdependence in the family

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 VI. SAMPLEX
Matching type
1. Measures the patients' perception and level of
satisfaction on the current state of their family
members' relationship
2. Can help the physician form appropriate
hypotheses about the problems experienced by
patients at a particular stage
3. Useful strategy in encouraging family members
who may have been reluctant to get involved in
discussions on family matters to participate.
4. Includes how the family coped with these
stressful life events
5. Assessment of family’s capacity to participate in
Like for example here, yung patient dito is si Mary Jane the provision of health care, to cope with crisis or
kasi siya yung pinakamalaking circle. So the ones na to implement plan
nakadikit sa kanya are the ones closest to her. 6. Community-based assessment of family function
Unfortunately di masyadong close si mom and dad and administered individually or in group
the others. Tapos si Rede and si tito nandoon sila sa labas 7. A "snapshot" of the patient within his/her family
ng circle. Usually pinapagawa naming to sa mga kids if you and social environment at a particular point in
want to know the situation as well, kasi it’s also easier. time
And of course you also ask them to interpret, pwedeng
magkakwentuhan lang kayo. Maybe the child will reveal A. Family Genogram
something with regards to the relationship niya in the B. Family Life Cycle
family. C. Family APGAR
D. Family Lifeline
“No family is perfect... we argue, we fight. We even stop E. SCREEM
talking to each other at times. But in the end, family is F. DRAFT
family. The love will always be there.” G. Ecomap

G. 7.
F. 6.
E. 5.
D. 4.
A. 3.
B 2.
C. 1.
Matching Type
Answers:

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Trans 7| FRIGILLANA | GARDINGAN | MEJOS | P a g e 11 | 14
Trans 7| FRIGILLANA | GARDINGAN | MEJOS | P a g e 12 | 14
Trans 7| FRIGILLANA | GARDINGAN | MEJOS | P a g e 13 | 14
Trans 7| FRIGILLANA | GARDINGAN | MEJOS | P a g e 14 | 14
 PFCM 3A | Family Health Care Program (FHCP)
Tutor: Dr. JD Velasco | Lecture Date: December 9, 2021 | 1st SEMESTER

TOPIC OUTLINE II. Part 1 of 3: Family-oriented Care: the BPS

I. INTRODUCTION Approach
II. Part 1 of 3: Family-oriented Care: the BPS
Approach
III. FHCP – Mission
IV. Family Health Care
FHCP Educational Objectives: WELLNESS
FHCP Educational Objectives: ILLNESS &
DYSFUNCTION
FHCP Team
Criteria for Admission
Services Offered
Classification of Patients
Activities Figure 1
V. Part 3 of 3: Processes of the FHCP
Biomedical Assessments
Family Assessment
The FHCP Green Chart
Evaluations in the FHCP
Criteria for Discharge
VI. SAMPLEX

Reference: Dr. JD Velasco’s PPT dated 12/09/2021

I. INTRODUCTION
• Levels of wellness of individuals, families and
communities are directly or indirectly Figure 2
interrelated. This depends kasi, as family they
could be your source of motivation, they could be We still use the biopsychosocial approach, hindi pwedeng
source of your stressor, they can be your enablers mawala kasi ito. We should go back to the interplay
or barriers so that depends on the family between the patient and the physician and of course the
dynamics. That’s why it’s very important that you family, kaya nga siya therapeutic triad (it’s not a diad
have to understand family dynamics of your anymore).
patients in order for you to understand also your (Refer to Figure 2) and of course ito as a clinician it’s not
patient. Sino kaya mga allies niya? Who would only me o ano. For example, if I’m the attending
they like to inform of their condition, as well as physician, there are times when I also need the help of
kung kanino sila nagsasabi ng problema nila. other healthcare team, not only my colleagues as a
• The family serves as a moderator between the physician but also yung nurses natin, nurse aids, our
wellness of its individual members and the institutional workers as well, of course mga laboratory
wellness of the community (Dunn, 1967) This is technicians natin, our radiotechnologist natin, so marami
naman on the wellness side. Sabi nga nila a well and also pharmacists kasama sila sa team. And with this
family also influences the wellness of the team we need to deliver the integrated delivery system,
community, especially if these families are active. which is supposedly a quality type of care. Kaya nga lagi
• Communities with many unhealthy families will ko sinasabi if you want to describe quality care dapat safe
suffer ill effects because families are less able to daw siya – may acronym tayong finafollow eh, STEEEP:
fulfill societal roles and they place demands on the Safety, Timeliness, Efficiency, Effectivity, Economic and
community’s health care delivery systems People centeredness (meaning to say we have to put the
(Stanhope & Lancaster, 1998) So these families patients in the center, kaya inurture natin yung autonomy
who are unhealthy, instead of helping the or as well as people’s initiative in order for them to help
community medyo nagiging pabigat pa. Kaya nga also themselves. So you have to consider also the
it’s very important that keeping the patient perception of your patients. And of course on the side of
healthy, or a person healthy will keep the family the patient – a patient has a family and the family also has
healthy and will also keep the community healthy a community. So community kasi it’s not necessarily
community within, pero even nga sa workplaces they are
also called community (yung mga population based
community nga na tinatawag natin. Aside from the whoile
community where you reside. We also have the

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community where the patient for example is working, so levels of care nay an kasi they are actually
community pa rin niya yun or pwedeng family yung saan very important kung primary, tertiary,
yung section niya kung saan siya. So we still have to secondary care. Siyempre may katumbas
consider all these aspects. din yung primary, secondary and tertiary
(Refer to Figure 1) And of course, if were talking to the prevention. So depending kasi where the
patient usually ‘inaano’ lang natin is yung biomedical. But illness lies. Dapat it’s only important that
of course if we talk of yung the whole including the family kung nandon na siya you have to maintain
-community that’s actually the psychosocial aspect. So we it na there rather than being into more
should not forget this aspect of the biopsychosocial complicated type of illness or disease then
approach, kahit saang specialty kayo pumunta you have to it’s also difficult din for our patient. As
elicit the psychosocial concerns of all your patient. physicians it’s our role to emphasize
(Refer to Figure 2) the family is one of the major health promotion and maintenance.
influences and source of health information, kasi nga diba o Early detection and prevention of illness.
we still have yung health beliefs nila sometimes they We have screening, when we interview
consult their family before they consult a professional our patients we also get the family
opinion and of course also kahit na sinasabi natin na history, their social environment, kasi
pauuwiin na sila pero yun nga in order for our patients to nandito lahat yun. We see kung sino
be satisfied with the care, we should always also din talaga yung you need to screen as early as
personal care not only to the patient but also we include now.
the family kasi remember sometimes it’s the family who o Disability limitation and rehabilitation.
gives the personal care for the rest of the time of your This is very important lalo na in tertiary
patient for your sake and sabi nga if a family member gets care cases, diba yung mga strokes natin if
sick all family members have their role, nagkakaroon tayo they have residuals di na dapat
ng swapping of roles, changing of roles, especially if yung madagdagan yun dapat either
si panganay nagkasakit who would take charge or if maovercome ni patient yung mga
mother nagkasakit who would take charge. So residuals nay an lalo na yung may
nagkakaroon tayo ng swapping or shifting of roles. In our paralysis dapat malimit na hanggang dun
instution or department we practice the family healthcare lang siya, hindi siya lalala. And of course
program because this is actually the practice of the five- we encourage rehabilitation din to these
star physician. And this is actually where we provide the patients.
best or evidence based and of course ethically sound • Instill social commitment in the practice of
medical services to our patients especially to our index medicine by talking into consideration the impact
patients and their respective families in target of illness on the family and the impact of the
community, kaya natin sinasama si family healthcare family on illness and health. Very important din
program. yung family health program for this types of
The biopsychosocial model is a model of health and patients specially if we have problem with
disease, but this roughly divides up, for reasons treatment adherence. We always ask our patients
understandable in terms of the model, into, on the one to talk to us, to relay their concerns specially
hand, the business of the healthcare sector—illness, with concerning families or communities.
the negative conception of health as avoidance of or
recovery from illness—and, on the other hand, prevention IV. FAMILY HEALTH CARE
of illness, which merges into resilience and thriving, which • Process which encompasses:
are protections against ill health from the point of view of ✓ screening for abnormalities;
healthcare, but which from all other, non-illness ✓ early detection of disorders that can be
preoccupied sectors, are another thing altogether: alleviated;
education, work, economics, politics, environmental ✓ prevention of disorders if we could catch
policy and security. them early
• The DOH - Family Health Office is tasked to
III. FHCP - Mission operationalized health programs geared towards
• Increase health consciousness of Filipino families the health of the family. It is responsible for the
through: creation, implementation and evaluation of health
o Health promotion & maintenance. This is family programs.
very important no, you promote health • The summary of its objective is to improve the
and of course you also help in survival, health and well being of each members
maintaining. Kaya nga meron tayong mga of the family as well as the reduction of morbidity
levels of care, you have to remember mga and mortality rates in the family and community

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 FHCP Educational Objectives: WELLNESS 3. Formulate a family health care plan
1. Analyze both biomedical as well as psychosocial • Set goals (long term and short term) for each
needs of the family as they go through the various identified problem
transitions in its life cycle (in the different • Conduct the following (not all of this ha):
psychosocial stage may kanya kanyang concerns per ▪ Family meeting
stage or period, kaya it’s important na you should ▪ Family CEA (Catharsis Education
know the dynamics, who’s the decision maker, who’s Action)/ counseling
the financier, the diff roles of these family members in ▪ Individual CEA/ counseling
order for you to help them more appropriately): ▪ Anticipatory grief (especially if you
✓ Conduct anticipatory guidance on career came across a patients na in stage 4
issues and life cycle changes cancer or with patients with poor
✓ Perform counseling on marital adjustment prognosis, you have to prepare them
and management of family planning and as well, kaya meron kaming palliative
fertility care unit, we have surrogate’s
✓ Conduct family meeting on health parenting decision making and of course yung
✓ Counsel adolescents patients din naman. The best pa rin is
✓ Facilitate end of life care to talk on the end of life care if the
✓ Conduct bereavement counseling when called patient can actually decide for
for. Sa bereavement counseling kasi it’s themselves it’s difficult if they are not
normal to have grief when we experience there to decide for themselves.
death, but pag nag more than 6 months kasi Remember, it’s still their body, it’s still
that’s already pathologic. That’s why it’s very their decision to be honored kasi
important to give support to these patients or katawan nila yun eh. The earlier for
to the significant others of these patients, we giving anticipatory, kaya nga
monitor them baka nakalagpas nga naging anticipatory kasi anticipate especially
depressed na sila. Again it’s very important to if you know the prognosis of the
monitor, kaya nga importante yung support disease, is you really have to tell
system. them, disclose. But of course as I have
2. Analyze the family psychodynamics said, we have proper disclosing to our
▪ Conduct a risk assessment of the family patients so hindi kaabog abog na sir
situation vis-à-vis the anticipatory care maam, mr ganito may cancer po kayo.
needed for their current life cycle stage Wag po ganun ang pagkakabigay mo
▪ Use the tools in family assessment (family ng disclosure. We have protocol in
genogram, family map, APGAR, SCREEM) in breaking the bad news about we say
analyzing the current family dynamics sa patients) and bereavement
3. Prepare a wellness plan for the family. So it’s not counseling
only the patient whom we prepare the wellness plan, ▪ Training of family caregivers.
we also need to prepare wellness plan for the Especially for those long term na
members of the family. aalagaan nila mga patients for
example colorectal cancer who
FHCP Educational Objectives: ILLNESS & DYSFUNCTION underwent resection of the colon or
1. Assess the different factors that may affect the index nagkaroon ng colostomy. Syempre
patients and their family kailangang alagaan yun, so there are
• Use appropriate family assessment tools to times na we ask our friends from the
collect data: nursing service or those who are
✓ Genogram trained no.
✓ APGAR ▪ Social networking to mobilize family
✓ SCREEM/ SCREEM-RES resources
✓ ECOMAP ▪ Home care, hospice care and home
✓ Family Map visitation when appropriate
✓ Family Circle
4. Apply interdisciplinary care to management of
2. Analyze family data to identify various problems that identified problems
may affect the family • Refer to other specialties when appropriate
Classify problems into 5 domains according to the identified needs of the family
Physiologic Psychosocial Economic Environmental Health
behaviors

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 • Coordinate services of other professionals or CLASSIFICATION OF PATIENTS
agencies in the care of families (Malasakit AMBULATORY PATIENTS
centers or Social services) • Patients admitted with common chronic illnesses
but whose conditions are affected by psychosocial
5. Evaluate the family health care plan (tailored fit for problems that hinder the management of illness
this family) • Home visit allows observation of patients in the
• Conduct pre-/ post-home visit conference context of the family and living environment
• Maintain and update family health record
HOMEBOUND PATIENTS
FHCP TEAM • Patients admitted for chronic illness needing
• Consultant • Medical home care
• Resident-in-charge technologist • Families are at risk of caregiver fatigue
• Nurse • Midwife
• Nutritionist • Physical therapist ACTIVITIES
• Social worker • Ambulance driver Done once a month,
depending if may
CRITERIA FOR ADMISSION ieenroll si resident
1. Medical merit Get feedbacks, update
• Acutely severe illness of census, final
• Chronic illness Case management disposition (enrolled
✓ Recurrent and relapsing ba siya or hindi,
✓ Communicable & noncommunicable accepted ba siya or
• Terminal illness hindi) of patient to be
2. Receptivity and willingness to be accepted and enrolled into the
participate in the program. We also entail program
participation kasi ofcourse even as doctors di naman Service hour with the
Done at least weekly
tayo yung primary decision makers, we still leave it to consultant
the patient or the family who would actually decide. Review previous data
Pre- and Post-home visit
3. Accessibility (within 5 km-radius of the institution/ and plan of home visit
conference
adopted community) this is very important sa amin scheduled
kasi nga kung malalayo masyado, hindi siya Done every month
mafafollow up. So it’s very important din na Screen the patients to
magkakroon tayo ng limit kasi naman if lagpas ng 5 km be enrolled into the
radius we usually endorse na sa municipal healthcare program. Done after
officer na yung mga ganung gawain. case management
Screening conference
4. No family doctor* but of course this is not an absolute titignan din naming,
requirement, hindi naman lahat ng Pilipino may family another screening is
doctors, sabi nga sa studies eh there are lots of done. Depende na
Families still haven’t seen a Doctor in their lives, kung maenroll talaga
especially those who are living in the far flung areas. siya
5. Financial status* Not an absolute requirement. Family Case Presentation
This is a requirement.
SERVICES OFFERED Required to enroll five
• Medical Services families per years. Before
o Home care their (residents) graduation
o Hospice and palliative care they should have 15
o Home visitation** families na inaalagan,
Done once a year
o Counseling** though they can endorse
• Social service these families sa next
• Laboratory service residents not necessarily
• Dietary nap ag wala na si resident
• Physical Therapy makacut din yung family
• Ambulance Service program, hindi! Kaya nga
continuous siya.
• Counseling.
Family Medicine Lectures Covers the core
**Scheduled
Family Med principles, competencies needed

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 especially those on the by the residents eyes di naman necessary na gamitan mo siya ng family
topics about family and tool, or magperform ka ng digital rectal exam.
communication.
Hospice & Palliative Care Profile/
STRUCTURE Genogram Life Cycle
Lectures Lecture series Roles
Depends on the need emphasizing on
disclosure ba siya pwedeng disclosures, issues on
issues on death and dying death and dying and
or plan of management or pain management
anticipatory guidance.

V. Part 3 of 3: Processes of the FHCP

STEPS SERVICE TRAINING
DELIVERY
Secure consent Case
Case Selection
of care Screening
Initial BPS
Initial
Diagnosis and Consultations
Assessment
Service
Case
Presentation
Follow-up Follow-up Care
and Program
Evaluation
Case
End of Care Discharge Management
Audit
Aside from the services, we actually incorporate din
naman yung training. So di pwedeng service lang siya.
Kinukuha din naming ditto consent of care, usually ang
consent naming dito it’s not necessarily na papel, pag kasi
nadevelop mon a rapport sa patients usually yung verbal
consent niya sa amin pero for purposes of data privacy so
nagpapapirma na rin kami ngayon. Kasi we use the
records for presentation purposes for training.

Bio-medical Assessments:
1. History taking including data for periodic health
exams
2. Physical Examination including neuropsychiatric
assessments and screening

Note: These assessments are done for the index patient

and for EACH MEMBER in the household

Family Assessment
Profile/ Profile/
STRUCTURE Genogram Life Cycle STRUCTURE Genogram Life Cycle
Roles Roles
SCREEM- Changes in Family Status
Emotional Process
RESOURCES Eco Map Budget Stage required to Proceed
RES of Transition
Developmentally
Family Family I Unattached Accepting financial • Differentiation of self in
PSYCHODYNAMICS Anamnesis
APGAR Map young adult and emotional relation to the family of
ENVIRONMENT Access Internal External responsibility for origin
oneself • Development of
Family Info Illness- intimate peer
HEALTH BELIEFS
Career Sources Trajectory relationships
We use these different assessment tools according to the • Establishment of self in
need. Like for example your patient came in with a sore relation to work, and
financial independence

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II Newly Commitment to the • Formation of the Profile/
married new system marital system STRUCTURE Genogram Life Cycle
Roles
couple • Realignment of
relationships with
extended families and
friends to include the
spouse
III Family with Accepting new • Adjusting the marital
young members into the system to make space for
children system children
• Joining in child-rearing,
and financial and
household tasks
• Realignment of
relationships with the
extended family to
include parenting and
grand-parenting roles SCREEM-
IV Family with Increasing flexibility • Shifting of parent-child RESOURCES Eco Map Budget
RES
adolescents of family boundaries relationships to permit
to include children’s adolescents to move in
independence, and and out of the system
grand-parent’s • Focus on mid-life
frailties marital and career issues
V Launching Accepting a • Beginning shift toward
family multitude of exits joint caring for the older
from and entries generation
into the system • Renegotiation of
marital system as a dyad
• Development of adult-
to-adult relationships
between grown-up
children and their parents
• Realignment of
relationships to include
in-laws and grandchildren
• Dealing with disabilities
and death of grand-
parents
VI Family in Accepting the • Maintaining own
later life shifting of and/or couple
generational roles functioning and interests
in the face of physiologic
decline; exploration of
new familial and social
role options
• Support for a more
central role of middle
generation
• Making room in the
system for the wisdom
and experience of the
elderly and supporting
the older generation
• Dealing with the loss of
spouse, siblings, peers;
preparation for one’s
own death
• Life review and
integration

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 SCREEM- kunin niyo yung individual na Family APGAR that’s actually
RESOURCES Eco Map Budget
RES in the Family APGAR 2. Ask each family member.

Family Family
PSYCHODYNAMICS Anamnesis
APGAR Map

Family Family
PSYCHODYNAMICS Anamnesis
APGAR Map Family Family
PSYCHODYNAMICS Anamnesis
APGAR Map

Yung anamnesis depending on the date of events that

followed during this time – maging chronological din to.

ENVIRONMENT Access Internal External

Not ganun kaspecific si APGAR, na once na may Family

APGAR 1 na severely dysfunction yung nakuha dapat

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ENVIRONMENT Access Internal External Processes of the FHCP: The FHCP Green Chart

ENVIRONMENT Access Internal External

We usually ask baka these are some of their trigger

sources, kung may asthma or COPD.

Family Info Illness-

HEALTH BELIEFS
Career Sources Trajectory

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 Cont’d Process of the FHCP
STEPS SERVICE DELIVERY TRAINING
Case Selection Secure consent of care Case Screening
Consultations
All the gathered
Initial Initial BPS Diagnosis data and the
Assessment and Service initial plans will
be brought up for
discussion
Follow-up Care
Done by the medical Case
and paramedical Presentation and
staffs. Follow up Program
Follow-up cares for those who Evaluation
are needed to be Either we present
seen more these or titignan
frequently depende yung charts.
sa sakit.
Case Management
End of Care Discharge
Audit

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 Evaluations in the FHCP discharge and
this patient’s got
another problem
and they need to
be reenrolled.

CRITERIA FOR DISCHARGE

• Transfer of residence to an area not covered by
the program
• Refusal to cooperate without justifiable reason
• Needs of the family were addressed and goals /
objectives have been attained
• Discharged patients from the program would
continue under the service of the resident-in-
charge with less frequent visits
• Patient and family may be seen for annual
wellness check-up and for consultation as needed

**Ambulatory patients: OPD service follow-up or if

need arises
**Homebound patients: annual home visit or if need
arises

VI. SAMPLEX
True or False
1. The family serves as a moderator between the
wellness of its individual members and the wellness of
the community
2. Family Health Care is a process which encompasses
screening for abnormalities; early detection of
disorders that can be alleviated; and treatment of
disorders
3. Homebound patients allow observation of patients in
the context of the family and living environment
STEPS SERVICE TRAINING
DELIVERY Enumeration
Secure consent of 4-8. Processes of the FHCP
Case Selection Case Screening
care 9-10. Two FHCP educational objectives
Initial BPS
Initial Assessment Diagnosis and Consultations Matching Type
Service 11. Info sources a. Structure
Case 12. SCREEM-RES b. Resources
Presentation 13. Access c. Psychodynamics
Follow-up Follow-up Care
and Program 14. Life Cycle d. Environment
Evaluation 15. Anamnesis e. Health Beliefs
Discharge
There are times
when we have to
15. c
14. a
13. d
12. b
11. e
9.-10. Wellness, Illness & Dysfunction

4.-8. Case Selection, Initial Assessment, Follow-up,

3. False, Ambulatory patients…
2. False, …prevention of disorders
1. True
Text Box: Answer Key:
End of Care

discharge
Case
patients not
Management
necessarily bec
Audit.
End of Care they died but
Finalize the
nakikita na
disposition of
naming that the
the patient
patient can now
go on their own.
Pero kung
sakaling after the

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