TOOLS IN FAMILY

ASSESSMENT

ED MARIE M. TOGONON-CRUZ, M.D.,DFM

July 16, 2021
Family as A Unit of Care
Definition of a Family
a group of persons united by ties of
marriage, blood or adoption; consisting of
single household; interaction and
communicating with each other in their
respective social roles of husband and wife,
mother and father, son and daughter,
brother and sister; and maintaining a
common culture.(Burges and Locke)
Family as a unit of Care
Definition
a small social system made up of
individuals related to each other by
reason of strong reciprocal affections
and loyalties and comprising a
permanent household
 Role of family in the
health of its members
1. Health promotion and
maintenance
2. Coping
3. Illness prevention
 Situations where family
relationships are
needed
1. Family needed for care
2. New patient -overweight of family
function
3. Family in crisis
4. Patients with high clinic utilization
 Family-Centered Care
See patient only - minor acute problems (URI,
Laceration) routine self-limiting problems
(back strain,influenza, fracture
Family conference desirable
-treatment failure or regular occurrence of
symptoms, routine preventive/ educational visits
(prenatal,premarital exam, well child care )
Family involvement essential-chronic illness,serious
acute illness, substance abuse, diagnostic or
treatment errors, undiagnosed cases, death
FAMILY SYSTEMS
MEDICINE
- A total evaluation of health care
involving family relationships,
family social and cultural systems
resulting to better evaluation and
better health care
 Steps in incorporating the
family systems approach to
clinical practice

1. Recognize the family structure

2. Understanding normal function
3. Learn to assess family structure and
function in clinical practice
 Recognizing family
structure
I. The Family Genogram
COMPONENTS
1. Pedigree chart or Family tree
2. Functional charting containing
psychosocial and interactional data
3. Medical history of family illness
 Description
1. 3 generations
2. first born to the left
3. Family name above each major family
unit
4. Index patient -arrow
5. Date indicated when the chart was
developed
Standard Symbols
male dizygotic twins

female monozygotic
twins

death marriage &

year

pregnancy 1980 divorce & year

Standard Symbols
not married, living together

separation and year

1980

consanguinous marriage
 Standard Symbols

Married couple, each with multiple spouses

4
A
adopted Induced Spontaneous 4 births
abortion abortion sex unknown
 LEGEND
￭ Alzheimer’s
Disease
Deceased
Male
Female
I
￭ Nimfa
, 75

II
Tarsilo, 52 Celia, 48 Arthur, 50 Nanette, 48 Francisco, 44 Grace, 43

III
Boy, 21 Chona, 16 Charisse, Romeo, 21 John, 13 Madel 18 Andrew, 16
14
 APGAR

The family APGAR is a five-item

function screening questionnaire in
which the patient is asked to
described how family members
communicate, eat, sleep and carry
out home, school and job
responsibilities.
 The Family APGAR
1. Adaptation - involves utilizing and sharing
resources
2. Partnership -sharing of decision making
measures satisfaction in
communication
3. Growth -measures the satisfaction of the
available freedom to change
4. Affection - how emotions are shared
5. Resolve - how time, money, space are
shared, measures commitment
1. Adaptation -The utilization of
intrafamilial and extrafamilial resources
for problem solving in times of crisis.
2. Partnership - The sharing of decision
making and nurturing responsibilities by
family.
3. Growth - The physical and emotional
maturation and self-fulfillment that are
achieved by family members through
mutual support and guidance
4. Affection - The caring or loving
relationship that exists among family
members
5. Resolve - The commitment to devote
time to other members of the family for
physical and emotional nurturing,
involving a decision to share wealth and
space.
The family APGAR
Questionnaire
 APGAR
Almost Some of Hardly
Always the time Ever

1. I am satisfied that I can turn to my family

for help when something is troubling me. ☺
2. I am satisfied with the way my family talks
over things with me and shares ☺
problems with me.

3. I am satisfied that my family accepts and ☺

supports my wishes to take on new
activities and directions.

4. I am satisfied with the way my family ☺

expresses affection and responds to my
emotions.
☺
5. I am satisfied by the way my family and I
share time together.
 PART II
-delineates relationship with
members
8-10 -highly functional family
4-7 - moderately dysfunctional
0-3 - severely dysfunctional
 Functional Chart
Gives a dynamic image of the
family, allows one to judge the
totality of the family unit, its
strengths and weaknesses and
ability to withstand future stressful
even
Family Circle Technique
Brief graphic method for disclosing,
gathering and discussing family
dynamics as discussed by 1 or more
family members
One can assess openness, boundaries,
support, function, triangulation and
interdependence in the family
Clinical Biographies and
Life Chart or lifeline
Life events and clinical events are
put side by side according to dates of
occurrence, showing correlation
Shows significant events among
family members over a period of time in
chronological sequence, explores
certain family issues
 Ex. of Family Lifeline
Year Age Life Event

1964 17 Mother died

1965 18 Graduation from high school
1966 19 To college-lived at home
1967 20 Arguments with father
1968 21 Difficulties with grades
1969 22 Graduation from college
1970 23 Graduate studies away from home
1971 24 Happy-enjoying school
1972 25 Married
1973 26 Began working-difficulties w/ employer
1974 27 Changed jobs
1975 28 Marital difficulty
 Family circle
A brief graphic method of disclosing
gathering and discussing family
dynamics as discussed by one or more
family member
Actual assessment of the family occurs
when the patient explains the diagram
Can assess openness, boundaries,
support, function, triangulation and
interdependence
Exploratory questions
1. what if you remove a significant member of the
circle?
Who do you run to for support
How would you like things to be different?
Who is missing? Why?
Why are there inside or outside he circle
What is the communication pattern?
Who is in the power position?
What does the distance mean?
Who are grouped together?
what is the fluidity within the circle?
 SCREEM
Social - social interaction with the family and
community
Cultural - pride and satisfaction ( ethnic groups)
Religious -spiritual experiences as well as
contacts with extrafamilial support groups
Education - adequate allowing comprehension
and problem solving
Economic- resources, ability to meet economic
demands
Medical -availability through channels
Minuchin’s Family Map
Facilitates the communication of information about
the family system and its dynamics in order to
address psychosocial issues. Allows for the physician
to view the relationships within the family structure
 Family Map
Enmeshment-over-involvement with each
other symbolized by 3 parallel lines
Disengagement-isolation from each other or
little emotional response, symbolized bye
dotted lines
Triangulation- talk directly to each other,
symbolized by an open ended arrow open end
embracing 2 individuals and the pointed end
embracing a 3rd person
Coalition- when 1 member is siding with
another member symbolized by a bracket
 Ecomap
A pictorial representation of a family’s
connections to persons and/or systems in
their environment
3 separate connections
 Strength of the connection( weak, tenuous/
uncertain, strong)
 Impact of the connection (none,
draining/draining resources or energy
 Quality of connection (stressful, not stressful)
 Example of Ecomap
John Educa-
Weak connection, draining tion
Energy/resources, not stressful

John Educa-
Strong Connection, Providing tion
Energy/resources, not stressful

John Educa-
Weak Connection, No impact tion
on Energy/resources, stressful

John Educa-
Tenuous/Uncertain Connection, tion
Providing Energy/resources,
Not stressful
Domains of the Ecomap
Neighborhood
Community services
Social groups
Education
Significant personal relationship
Employment
 Drawing the ecomap
Target family members are put in the center using
genogram symbols
Domains applying at the household level can be
charted at the household level
Each individual can be brought out of the center to its
on circle and domains
In complex cases- individuals or household can be
illustrated on its own in a separate page
Lines are used to illustrate the existence of a
connection and its strength ( dotted line-tenous
uncertain, dashed line-weak, straight line-strong
 Drawing an ecomap
An arrow is used to illustrate the impact of
the connection, with the arrow indicating
direction of the flow of the energy or
resources
A jagged line is used to illustrate a stressful
connection
Brief summary can be written inside the
domain circle
Domains should be identified in the ecomap,
Thank you