FAMILY ASSESSMENT TOOLS

1. FAMILY ASSESSMENT TOOLS DEPARTMENT OF PUBLIC HEALTH & PREVENTIVE MEDICINE FACULTY OF MEDICINE, UNIVERSITAS PADJADJARAN 2013

2. LEARNING OBJECTIVES • Describe the advantages for assessing family (C2) • Define the family genogram, family map, family APGAR and its function (C2)

3. Why do we Need tools to Assess the family? • assess family functioning • assess family dynamic • assess coping mechanisms of the family • assess resources • assess family structure

4. Why do we Need tools to Assess the family? • 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.

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

6. 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.

7. 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.

8. Family assessment tools

9. GENOGRAM Is a biopsychosocial family tree. It records the family in its life cycle, family illnesses and relationship A genogram is a versatile clinical tool that can help FP integrate a patient’s family information into the medical problem-solving processfor better patient care

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

11. GENOGRAM COMPONENTS Standardized Symbols used in Family Genograms date of divorce d Symbols male D Date of death female abortion or miscarriage Sex not specified Induced abortion Deceased/death Pregnancy-child in utero A Adopted female Dizygotic twins b date of birth Monozygotic Twins m date of marriage

12. Standardized Symbols used in Family Genograms Symbols of diseases or situation Obesity ♥ ♥ Heart disease Allergy Stroke Alcoholism xxx xxx   Depression Asthma War Casualty Hypertension

13. Commonly used Abbreviations

14. 1989 1989 1992 1992 Standardized Symbols used in Family Genograms Close relationship married and year 1989 Family living together Separation and year 1990 Divorce and year Unmarried relationship Conflictual relationship Distance relationship

15. 1. Symbols 2. Three or more generations 3. The name of family 4. A listing of the first born of each family to the left, with siblings listed sequentially to the right 5. The names of all family member Bakri, as of 8 April 2010 1969 Ardi,68 I Nia,64 1970 II III

16. 6. Age or year of birth of all family members 7. Any deaths, incl. age of death and cause 8. Dates of marriages and divorces 9. Significant diseases or problems of family members 10. Indication of members living together in the same household 11. A key depicting all symbols used 12. Symbols selected for simplicity and maximum visibility

17. Family information is used in 3 type situations: • Evaluating somatic complaint by testing biopsychosocial hypotheses • Assessing a patient’s risk for biomedical and mental disorders • Planning management by considering how family factors may facilitate or complicate it

18. Uses of the Genogram (Crouch and Davis, 1987) • Allowing the family physician and other health professional to review quickly the family situation • Building rapport by using the first names of family members, knowing who is living in the home • Identifying at a glance significant risk factors : Hypertension, DM, Ca, Obesity etc • Recognizing the need for screening in patients who at high risk • Promoting 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

19. Relationship of the members 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

20. Genogram : 24 January 2008 Ani Putro Sugeng Lung Ca AMI  myoma 84 1959 84 43 44 54 60 58 48 44 DM CA Colon/Renal FAM Sam 46 Utomo Sri Arti Tyio Tuti Nina 20 16 Imam Aria FAMILY MAP

21. APGAR • This is a five-item questionnaire designed to elicit the patient’s perception of the current state of his family relationships, and serves as a rapid screening instrument for family dysfunction.

22. APGAR • Adaptation is the capability of the family to utilize and share inherent resources • Partnership 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

23. APGAR • Affection 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.

24. 8-10 point (Highly functional family) • 4-7 point (Moderately dysfunctional family) • 0-3 point (Severely dysfunctional family)

25. BATHE TECHNIQUES (Stuart and Lieberman’s) • 15 minutes method of primary care counseling • It helps draw out the quiet patient and provides a structure of when to move on in a talkative patient B = Background A = Affect T = Troubling H = Handling E = Empathy

26. B = Background : assessing what’s the background situation (areas of psychological problems) • “How are things at home?” At work? • What’s different in your life between now and before? • A = Affect = the patient’s affect (about common areas generating strong feelings) • “How do you feel about your home life?” • “How do you feel about your work/school?”

27. T = Troubling: the problem that is most troubling for the patient • “What 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 difficulties • “How 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?”

28. E = Empathy : respons that conveys empathy,express understanding of the patient’s distress • “I can understand that you would feel angry” • “That must have been difficult” • “This is a tough situation to be in”

29. Thank you… • Rakel 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