Family Health

Family in Health Family in Health and Diseaseand Disease

Objectives of the SessionObjectives of the Session

1.1. Discuss reasons in understanding Discuss reasons in understanding families in health care. families in health care.

2.2. Discuss characteristics of Filipino Discuss characteristics of Filipino familyfamily

3.3. Discuss types of familyDiscuss types of family4.4. Analyze the therapeutic triangle.Analyze the therapeutic triangle.5.5. Discuss family oriented approach.Discuss family oriented approach.

FAMILYFAMILY

SOCIAL GROUP CHARACTERIZED BY SOCIAL GROUP CHARACTERIZED BY COMMON RESIDENCE, ECONOMIC COMMON RESIDENCE, ECONOMIC COOPERATION AND REPRODUCTIONCOOPERATION AND REPRODUCTION

GROUP OF PERSON UNITED BY TIES OF GROUP OF PERSON UNITED BY TIES OF BLOOD, MARRIAGE OR ADOPTION BLOOD, MARRIAGE OR ADOPTION INTERACTING & COMMUNICATING WITH INTERACTING & COMMUNICATING WITH EACH OTHER IN THEIR RESPECTIVE EACH OTHER IN THEIR RESPECTIVE SOCIAL ROLESSOCIAL ROLES

CHARACTERISTICS OF FILIPINO CHARACTERISTICS OF FILIPINO FAMILYFAMILY

CLOSELY KNIT, BILATERALLY CLOSELY KNIT, BILATERALLY EXTENDEDEXTENDED

AVERAGE HOUSEHOLD SIZE IS 5AVERAGE HOUSEHOLD SIZE IS 5 AT POVERTY LEVEL OF P13,823/MO. AT POVERTY LEVEL OF P13,823/MO.

IN 2000, 34% OF FILIPINO FAMILIES IN 2000, 34% OF FILIPINO FAMILIES ARE BELOW POVERTY LEVELARE BELOW POVERTY LEVEL

FAMILY SPENDS P2,600/YEAR FOR FAMILY SPENDS P2,600/YEAR FOR MEDICAL CAREMEDICAL CARE

Characteristics of Characteristics of healthy familyhealthy family

Open to changeOpen to change High self worthHigh self worth Functional defensesFunctional defenses Clear rules discussedClear rules discussed People take risk to express feelingsPeople take risk to express feelings Can deal with stressCan deal with stress Welcomes life stagesWelcomes life stages Clear hierarchyClear hierarchy Affect is openAffect is open

Minimum basic needs to Minimum basic needs to attain decent quality lifeattain decent quality life

Needs for survivalNeeds for survival: food, health and : food, health and nutrition, safe water and sanitationnutrition, safe water and sanitation

SecuritySecurity: shelter, peace and order/ public : shelter, peace and order/ public safety; income and livelihoodsafety; income and livelihood

Empowerment:Empowerment: basic education, basic education, functional literacy, community development, functional literacy, community development, family and psychosocial carefamily and psychosocial care

FILIPINO FAMILY AND ITS FILIPINO FAMILY AND ITS VALUESVALUES

ASAL (UNSELFISHNESS, ASAL (UNSELFISHNESS, COMPASSION, PITY, COMPASSION, PITY, GRACIOUSNESS)GRACIOUSNESS)

DELICADEZADELICADEZA DANGALDANGAL RESPECTRESPECT VENERATION OF THE DEADVENERATION OF THE DEAD - Dolor, Incano- Dolor, Incano

UNIVERSAL IMPORTANCE OF UNIVERSAL IMPORTANCE OF THE FAMILY AMONG FILIPINOSTHE FAMILY AMONG FILIPINOS

The family as a social group is universal The family as a social group is universal and persistent, even in the midst of and persistent, even in the midst of continuing changes, stresses and continuing changes, stresses and development.development.

The first social group to whom the The first social group to whom the individual is exposed to, individual’s individual is exposed to, individual’s longest and earliest experience takes longest and earliest experience takes place in the family setting.place in the family setting.

UNIVERSAL IMPORTANCE OF UNIVERSAL IMPORTANCE OF THE FAMILY AMONG FILIPINOSTHE FAMILY AMONG FILIPINOS

The family is a very close and The family is a very close and intimate group in which the most intimate group in which the most meaningful relationship may grow.meaningful relationship may grow.

The family serves as link between The family serves as link between the individual and the larger the individual and the larger society. society.

FAMILY FUNCTIONSFAMILY FUNCTIONS

ReproductionReproduction Biological maintenanceBiological maintenance SocializationSocialization Status placementStatus placement Welfare and protectionWelfare and protection Functions in relation to other institutions:Functions in relation to other institutions:

EconomicsEconomics Citizenship and political behaviorCitizenship and political behavior ReligionReligion EducationalEducational

FAMILY TYPESFAMILY TYPES

NUCLEARNUCLEAR

EXTENDED – UNILATERAL, BILATERALEXTENDED – UNILATERAL, BILATERAL

BLENDEDBLENDED

COMMUNALCOMMUNAL

FAMILY AS A UNIT OF CAREFAMILY AS A UNIT OF CARE

FAMILY IS THE SOCIAL CONTEXT FAMILY IS THE SOCIAL CONTEXT FOR HEALTH CAREFOR HEALTH CARE

PATIENT’S PROBLEMS IS THE PATIENT’S PROBLEMS IS THE FAMILY’S PROBLEMFAMILY’S PROBLEM

THE FAMILY IS THE GREATEST ALLY THE FAMILY IS THE GREATEST ALLY IN TREATMENTIN TREATMENT

CIRCUMFLEX MODEL OF FAMILY CIRCUMFLEX MODEL OF FAMILY TYPOLOGIES (OLSON)TYPOLOGIES (OLSON)

FAMILY TYPOLOGIES FAMILY TYPOLOGIES (McCUBBIN)(McCUBBIN)

RESILIENTRESILIENT

RHYTHMICRHYTHMIC

REGENERATIVEREGENERATIVE

RESILIENT TYPOLOGYRESILIENT TYPOLOGY

RHYTHMIC TYPOLOGYRHYTHMIC TYPOLOGY

REGENERATIVE TYPOLOGYREGENERATIVE TYPOLOGY

FAMILY PROFILE RESILIENCY FAMILY PROFILE RESILIENCY MODELMODEL

FAMILY CHANGES – 15 ITEMSFAMILY CHANGES – 15 ITEMS

FAMILY COHERENCE – 4 ITEMSFAMILY COHERENCE – 4 ITEMS

FAMILY FLEXIBILITY – 7 ITEMSFAMILY FLEXIBILITY – 7 ITEMS

FAMILY BONDING – 7 ITEMSFAMILY BONDING – 7 ITEMS

FAMILY SOCIAL SUPPORT – 17 ITEMSFAMILY SOCIAL SUPPORT – 17 ITEMS

FAMILY PROFILE FAMILY PROFILE RESILIENCY MODELRESILIENCY MODEL

LOW MEDIUM HIGHLOW MEDIUM HIGH

CHANGES 0-3 4-5 6-15

COHERENCE 0-11 12-14 15-16

FLEXIBILITY 0-21 22-26 27-35

BONDING 0-28 29-33 34-35

SOCIAL 0-53 54-63 64-68SUPPORT

FAMILY CONTEXTFAMILY CONTEXT

STRESSOR- ILLNESS, FAMILY LIFE CYCLE, STRESSOR- ILLNESS, FAMILY LIFE CYCLE, EXTRAFAMILIALEXTRAFAMILIAL

ADAPTABILITY- COPING ABILITIESADAPTABILITY- COPING ABILITIES

COHESION- ENMESHMENT OR DISENGAGEDCOHESION- ENMESHMENT OR DISENGAGED

INTERACTION PATTERNS- COMMUNICATION, INTERACTION PATTERNS- COMMUNICATION, CONTROL & SUPPORT CONTROL & SUPPORT

FAMILY’S CONCEPT OF FAMILY’S CONCEPT OF HEALTHHEALTH

an active and effective mode of an active and effective mode of interaction within a given social, cultural, interaction within a given social, cultural, and natural milieu; and natural milieu;

a state of relative equilibrium, both a state of relative equilibrium, both physically and mentally with the physically and mentally with the surrounding world. surrounding world.

Premise of UnderstandingPremise of Understanding Families in Health Care Families in Health Care

Family is a primary source of many health beliefs Family is a primary source of many health beliefs and behaviors.and behaviors.

Family is an important source of stress and Family is an important source of stress and social supportsocial support

Physical symptoms may have an adaptive Physical symptoms may have an adaptive function within the family and be maintained by function within the family and be maintained by family patterns.family patterns.

Family has an influence on Family has an influence on physical and physical and psychological health and well-beingpsychological health and well-being..

Premise of UnderstandingPremise of Understanding Families in Health Care Families in Health Care

Marital and family relationships have Marital and family relationships have powerful impact on health outcomes.powerful impact on health outcomes.

Family members, not health professionals, Family members, not health professionals, provide most of health care of for patients. provide most of health care of for patients.

Family is a primary social context Family is a primary social context in which health issues are in which health issues are addressed.addressed.

Some EvidencesSome Evidences

Women with few or no family support have Women with few or no family support have 2 to 3 times the mortality rate compared to 2 to 3 times the mortality rate compared to other women who are recovering from MI. other women who are recovering from MI. (Ann Intern Med 1992;117(12):1003-9)(Ann Intern Med 1992;117(12):1003-9)

Divorced and unhappily married men and Divorced and unhappily married men and women have poorer immune function than women have poorer immune function than those in healthier marriage. those in healthier marriage. (Psychosomatic Med (Psychosomatic Med

1987;49(1):13-34)1987;49(1):13-34)

Some EvidencesSome Evidences

Conflict and criticism between family Conflict and criticism between family members can have negative influences members can have negative influences on blood pressure, diabetes and immune on blood pressure, diabetes and immune function. function. (Behavioral therapy 1984;15(5):478-84)(Behavioral therapy 1984;15(5):478-84)

Family psychoeducation is an effective Family psychoeducation is an effective intervention for health problems. intervention for health problems. (Arch Gen (Arch Gen Psych 1975;32(8):1031-38)Psych 1975;32(8):1031-38)

Working with FamiliesWorking with Families

Medical care is Medical care is enhanced by obtaining enhanced by obtaining information about the information about the familyfamily, , assessing family assessing family relationshipsrelationships, and , and encouraging encouraging appropriate family appropriate family involvementinvolvement..

Physician Patient

Family

THERAPEUTIC TRIANGLE

Family-oriented Approach Family-oriented Approach QuestionsQuestions

Has anyone else in your family had this Has anyone else in your family had this problem?problem?

It reveals not only whether the there is It reveals not only whether the there is a family history but also how the a family history but also how the family family respondedresponded to the problem in the past. to the problem in the past.


What do your family members believe What do your family members believe caused the problem or could treat the caused the problem or could treat the problem?problem?

Identifying Identifying explanatory modelsexplanatory models that that strongly influence the patient’s beliefs and strongly influence the patient’s beliefs and behaviors regarding the problem.behaviors regarding the problem.


Who in your family is most concerned Who in your family is most concerned about the problem?about the problem?

Identifying who is the most concerned Identifying who is the most concerned maybe helpful in maybe helpful in creating effective creating effective treatment plantreatment plan (therapeutic alliance) (therapeutic alliance)


Along with your illness, have there been Along with your illness, have there been any other recent changes in your family ?any other recent changes in your family ?

Useful way to screen for additional Useful way to screen for additional stressors, health problems and changes in stressors, health problems and changes in the patient’s family and how it is affecting the patient’s family and how it is affecting the patient. the patient.


How can your family be helpful to you in How can your family be helpful to you in dealing with this problem?dealing with this problem?

Discovering how family member can be a Discovering how family member can be a source to the patient in all treatment source to the patient in all treatment planning.planning.

INTERVIEWING INTERVIEWING INSTRUMENTSINSTRUMENTS

ETHNICETHNIC 1997 Levin, Like, Gottleib. A framework for 1997 Levin, Like, Gottleib. A framework for culturally competent clinical practice. Suitable for culturally competent clinical practice. Suitable for clinical students since use requires diagnostic and clinical students since use requires diagnostic and therapeutic skillstherapeutic skills

EE: : Explanation Explanation (How do you explain your illness?) (How do you explain your illness?) TT: : Treatment Treatment (What treatment have you tried?) (What treatment have you tried?) HH: : Healers Healers (Have you sought any advice from folk (Have you sought any advice from folk

healers?)healers?)NN: : Negotiate Negotiate (mutually acceptable options)(mutually acceptable options)II: (Agree on) : (Agree on) InterventionInterventionCC: : Collaboration Collaboration (with patient, family, and healers)(with patient, family, and healers)


BELIEF, BELIEF, 2000 Dobbie, Medrano, Tysinger,Olney. 2000 Dobbie, Medrano, Tysinger,Olney. Developed from early work on explanatory models Developed from early work on explanatory models LEARN and ETHNIC. Suitable for preclinical or early LEARN and ETHNIC. Suitable for preclinical or early clinical students since use does not require diagnostic or clinical students since use does not require diagnostic or therapeutic skills.therapeutic skills.

BB: Health : Health beliefs beliefs (What caused your illness/problem?) (What caused your illness/problem?) EE: : Explanation Explanation (Why did it happen at this time?), (Why did it happen at this time?), LL: : Learn Learn (Help me to understand your belief/opinion), (Help me to understand your belief/opinion), II: : Impact Impact (How is this illness/problem impacting your life?)(How is this illness/problem impacting your life?)EE: : Empathy Empathy (This must be very difficult for you)(This must be very difficult for you)FF: : Feelings Feelings (How are you feeling about it?)(How are you feeling about it?)


BATHE BATHE 1993 Stuart, Leibermann.Developed to elicit 1993 Stuart, Leibermann.Developed to elicit the psychosocial context of anyencounter, not the psychosocial context of anyencounter, not specifically cross-cultural interviewing. Use does specifically cross-cultural interviewing. Use does not require clinical skills.not require clinical skills.

BB: : Background Background (What is going on in your life?) (What is going on in your life?) AA: : Affect Affect (How do you feel about what is going on?)(How do you feel about what is going on?)TT: : Trouble Trouble (What troubles you most?)(What troubles you most?)HH::Handling Handling (How are you handling that?)(How are you handling that?)EE: : Empathy Empathy (This must be very difficult for you)(This must be very difficult for you)

“Caring without science is well-intentioned kindness, but not medicine. On the other hand, science without caring empties medicine of healing and negates the great potential of an ancient profession. The two complement and are essential to the art of doctoring.”

Bernard Lawn, 1996

WORKSHOP 1WORKSHOP 1

DIVIDE INTO 4 GROUPSDIVIDE INTO 4 GROUPS

ANALYZE ONE OF YOUR GROUP ANALYZE ONE OF YOUR GROUP MATES FAMILY USING THE FAMILY MATES FAMILY USING THE FAMILY RESILIENCY MODELRESILIENCY MODEL

REPORT TO CLASSREPORT TO CLASS

WORKSHOP 2WORKSHOP 2

USING THE SAME GROUPINGS, USING THE SAME GROUPINGS, DISCUSS WITH YOUR GROUP YOUR DISCUSS WITH YOUR GROUP YOUR FAMILY HEALTH BELIEFS AND ITS FAMILY HEALTH BELIEFS AND ITS IMPLICATION ON HEALTHIMPLICATION ON HEALTH

Health & Medicine

Family Health