DEPARTMENT OF PUBLIC HEALTH & PREVENTIVE MEDICINE FACULTY OF MEDICINE, UNIVERSITAS PADJADJARAN 2013

FAMILY ASSESSMENT TOOLS

LEARNING OBJECTIVESDescribe the advantages for assessing family (C2)Define the family genogram, family map, family APGAR and its function (C2)

Why do we Need tools to Assess the family?

assess family functioningassess family dynamicassess coping mechanisms of the familyassess resourcesassess family structure

to have a picture of the multigenerational patterns of behavior or illnesses. to assess the normal crisis or common illness to be encountered in each stage of development.to provide anticipatory care and guidance. Why do we Need tools to Assess the family?

An understanding of the family in terms of the struggles to be functional will enable FP to make correct diagnosis and intervention

FAMILY DYNAMICS An interactions and relationships among the individual members of a family Reflects and influence the physical, mental and spiritual health of the individuals in a family.

FAMILY DYNAMICS An understanding of the dynamics helps the attending family physician to diagnose the disease and dis-ease in the patient sitting in his consultation room and to recognize the factors that may help or retard the recovery of this patient.

Family assessment tools

GENOGRAMIs a biopsychosocial family tree. It records the family in its life cycle, family illnesses and relationshipA genogram is a versatile clinical tool that can help FP integrate a patients family information into the medical problem-solving process for better patient care

A genogram supplements the problem list giving FP an overview of the main problems affecting the family over 3 or more generationsA genogram can be drawn in skeletal form during one of the first few visits, ideally the first visit and then it can elaborated during subsequent visits as more is known about the family

GENOGRAM COMPONENTSSymbols Standardized Symbols used in Family Genograms

Standardized Symbols used in Family GenogramsSymbols of diseases or situation AllergyAlcoholism Obesity AsthmaHypertensionxxxxxxHeart disease StrokeDepressionWar Casualty

Commonly used Abbreviations

ALCAlcoholicALLAllergyARTHArthritisCADCoronary Artery DiseaseCVACerebrovascular AccidentCACancerDEPDepressionDMDiabetes mellitus

GIGI tract disease HTHypertensionMIMyocard InfarctionMVPMitral Valve Prolapse PUDPeptic Ulcer Disease SLESystemic Lupus ErythematosisTBTuberculosis

Standardized Symbols used in Family Genograms

1. Symbols2. Three or more generations3. The name of family4. A listing of the first born of each family to the left, with siblings listed sequentially to the right5. The names of all family member

6. Age or year of birth of all family members7. Any deaths, incl. age of death and cause8. Dates of marriages and divorces9. Significant diseases or problems of family members10. Indication of members living together in the same household11. A key depicting all symbols used12. Symbols selected for simplicity and maximum visibility

Family information is used in 3 type situations:

Evaluating somatic complaint by testing biopsychosocial hypothesesAssessing a patients risk for biomedical and mental disordersPlanning management by considering how family factors may facilitate or complicate it

Uses of the Genogram (Crouch and Davis, 1987)Allowing the family physician and other health professional to review quickly the family situationBuilding rapport by using the first names of family members, knowing who is living in the homeIdentifying at a glance significant risk factors : Hypertension, DM, Ca, Obesity etcRecognizing the need for screening in patients who at high riskPromoting lifestyle changes and health education (healthy living)Demonstrating that family relationship are a concern of the family physician and important to the health of each family member

This is a self-drawing by an 8 year old girl who participated in a support group for children affected by domestic violence sponsored by Cedar Valley Friends of the Family.

One cannot escape sensing this child's unhappiness; the frown she drew on her little face clearly sets the mood. However, the up-side-down rainbow is perhaps the most significant message... Generally, we think of rainbows as a happy reminder of hope for the future. In this simple drawing, the little girl innocently, but quite vividly

Relationship of the members

FAMILY MAP

APGARThis is a five-item questionnaire designed to elicit the patients perception of the current state of his family relationships, and serves as a rapid screening instrument for family dysfunction.

APGARAdaptation is the capability of the family to utilize and share inherent resourcesPartnership is sharing of decision making. This measures the satisfaction attained in solving problems by communicating.Growth refers to both and emotional growth. This measures the satisfaction of the availability freedom of change

APGARAffection is how emotions like love, anger and hatred are shared between members. This measures the members satisfaction with intimacy and emotional interaction that exist in the family.Resolve refers to how time, space and money are shared. This measures the members satisfaction with the commitment made by other members of the family.

8-10 point (Highly functional family)4-7 point (Moderately dysfunctional family)0-3 point (Severely dysfunctional family)

BATHE TECHNIQUES (Stuart and Liebermans) 15 minutes method of primary care counselingIt helps draw out the quiet patient and provides a structure of when to move on in a talkative patientB = BackgroundA = AffectT = TroublingH = HandlingE = Empathy

B = Background : assessing whats the background situation (areas of psychological problems)How are things at home? At work? Whats different in your life between now and before?

A = Affect = the patients affect (about common areas generating strong feelings)How do you feel about your home life?How do you feel about your work/school?

T = Troubling: the problem that is most troubling for the patientWhat most worries you about your life? How stressed are you by this problem? What do you think this problem means to you?

H = Handling: the manner in which the patient has been handling the problem, problems are often mishandled life difficultiesHow are you handling the problems in your life?What have you tried to solve the difficulty?How much support are you getting at home/work?Who gives you support for dealing with problems?

E = Empathy : respons that conveys empathy,express understanding of the patients distressI can understand that you would feel angryThat must have been difficultThis is a tough situation to be in

Thank youRakel RE. The Family Genogram. In Rakel RE. Textbook of Family Practice. Sixth Edition. WB Saunders Co. Philadelphia. 2002. pp 19 30.

Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, 2004. section 3 chapter 3 pp 58-62