UST FACULTY OF MEDICINE AND SURGERY

DEPARTMENT OF PREVENTIVE, FAMILY AND COMMUNITY MEDICINE

FAMILY ASSESSMENT

A Requirement in Preventive, Family and Community Medicine Rotation at

Saint Martin Community Socio-Medical Center
Sapang Palay, San Jose Del Monte, Bulacan

Submitted by:

Dy, Nilda W.
Fortuno, Julius
Generillo, Arvin
Group 5 Medical Clerks 2010

UST FACULTY OF MEDICINE AND SURGERY

DEPARTMENT OF PREVENTIVE, FAMILY AND COMMUNITY MEDICINE
 FAMILY ASSESSMENT FORM

FAMILY NAME Daan Family NAME OF HEAD OF Alberto Daan Jr.

FAMILY
ADDRESS Blk 65 Lot 13 Area C Purok 3 San Martin I, Sapang Palay, SJDM,
Bulacan
CONTACT NO.
DATE October 27, 2009 RELIGIO Roman Catholic
N

1. Family Genogram. (Use different colors for mapping out the function)/
Functional charting: -- close / overly close / - - distant / ^^^ conflictual
Presence of any readily available conflict between family members (specify)

Daan Family
Blk 65 Lot 13 Area C Purok 3 San Martin I, Sapang Palay SJDM Bulacan
October 27, 2009
1975 1970
♦ ─Ο♦ ─Ο
Alberto Sr., 55 Feliza, 55 Benjamin Montalbo Delma
1996
^^^ 2003 2003 2002 ^^^

Ο ⊗ ─Ο Ο─ ▓⊗ ─Ο ▓ ─Ο
Alfeo 32 Jacqueline 30 Ariel 29 Roselyn Joanne 27 Warren 32 Allan 26 Alberto Jr. 33 Sheryl 30
26

Θ Ψ ΟΘ Ω Θ Ο Ο
♫
Clark Joshua Paul Jeric Rafael Adrian Louise Lawrence Sienna Claudine Carl Vincent Alberto III Mark
Kenneth
5 4 Francis Lee Martin Gabriel May 11 10 8
4
5 1 yr 6 5 4
5 mo

LEGEND:
- Close
^^^ - Conflictual
- Separated
▓ - Hypertension
♫ - Impacted cerumen
Θ - Asthma
♦ - Arthritis
⊗ - PTB
Ψ - URTI
Ω - Cerebral Palsy

2. Family structure and function.

a). Type of family: Nuclear b). Life cycle: Family with Young children

What problems does this phase in the life cycle raise for them?
a.1. In this phase, since the children’s schooling will start,the couple’s stable source
of income is an important aspect which should be dealt with.
a.2. In this phase, 2 of the children (Claudine and Carl Vincent) left their home.
Claudine started living with her paternal grandparents while Carl Vincent stayed
with his maternal grandfather. This event led to a conflict between the couple
(Alberto Jr. and Sheryl) and their parents.

Does the family feel these problems were dealt with satisfactorily?
Yes, since the family also receives financial assistance from their parents (e.g.
Alberto Jr., the head of the family helps in managing their family business). Also,
 Alberto Jr. works as a Baranggay Tanod in San Martin I which gives additional
support. This however, are sometimes not enough to fully sustain their needs
because only the head is working. The housewife isn’t allowed to work due to
personal reasons.
The 2 children which were separated lives closeby so they can easily visit their
family.

b). Role & functions

Breadwinner/s: Alberto Daan Jr. (father)
Decision maker/s: Alberto Daan Jr.
Caregiver/s: Sheryl Daan (mother)

c). What does each member expect from their parent/s or head of the family or spouse?
Alberto Jr. and Sheryl expect to be financially stable in the future. They also expect
to maintain the good relationship that they currently have.
Sheryl expects Alberto Jr. to allow her to work someday even if she has to go
abroad. Also, she expects her husband to stop smoking and drinking alcoholic beverages.
The children expect continued love and moral support from their parents.

d). What does the parent/s expect from their child/children?

The parents expect their children to finish their schooing, and to have stable jobs.
They also expect Claudine and Carl Vincent to move back to their home someday.

e). Are these expectations realistic? If yes, how can these be achieved? If no, why not?
Yes, these expectations are realistic. To fulfill the expectations of Sheryl and
Alberto Jr. from their children, they should coninue to rear their children properly and
guide them. To carry out their expectations from each other, they must have an open
communication at all times and should grab the good opportunities that come for them to
help each other especially those which are work-related.

f). Are these expectations met? If no, what are the possible hindrances?
No, these expectations were not met. Among the possible hindrances are: lack of
finances of the couple and inability of Alberto Jr. to allow Sheryl to work.

3. Family Lifeline. Major significant life events (positive and negative; successes and
losses) that had impact on the family. Indicate year of occurrence.

POSITIVE: 1998 = Birth of Claudine, the eldest

1999 = Birth of Carl Vincent
2001 = Birth of Alberto III
2005 = Birth of Mark Kenneth, the youngest
2008 = Alberto Jr. became Barangay Tanod of San Martin I
2009 = Alberto Jr. started to cut down on drinking and smoking

NEGATIVE: 2000 = Alberto was diagnosed with Pulmonary TB

4. APGAR. (At least 2-3 family members (>12 y/o), if applicable)

Sagutin ang mga sumusunod ayon sa relasyon Member Member
ninyong mag-anak (Sheryl) (Alberto Jr.)
Mother Father
A Ako’y nasisiyahan dahil nakakaasa ako ng 1 1
tulong sa aking pamilya sa oras ng
problema.
P Ako’y nasisiyahan sa paraang 1 1
nakikipagtalakayan sa akin ang aking
pamilya tungkol sa aking problema.
G Ako’y nasisiyahan at ang aking pamilya ay 0 2
tinatanggap at sinusuportahan ang aking
mga nais na gawin patungo sa mga bagong
landas para sa aking ikauunlad
A Ako’y nasisiyahan sa paraang ipinadadama 2 2
 ng aking pamilya ang kanilang pagmamahal
at nauunawaan ang aking damdamin
katulad ng galit, lungkot at pag-ibig.
R Ako’y nasisiyahan dahil sa ang aking 2 2
pamilya at ako ay nagkakaroon ng panahon
sa isa’t-isa.
TOTAL 6 8
TOTAL SCORE (Interpretation: 8-10 highly functional, 4-7 moderately
dysfunctional, <4 severely dysfunctional)
Likert Scale: 2- Palagi, 1- Paminsan-minsan, 0- Halos hindi

Kung hindi ka nakakahingi ng tulong sa inyong sariling pamilya, kani-kanino ka humihingi ng

tulong? Anong uri ng tulong (emotional, physical, spiritual, financial, others)
The couple usually asks help from their parents when they can no longer handle their
emotional and financial problems. They also seldom seek emotional and financial support from
Connie, their friend.

In the future, what is the family’s primary (most important) goal? Name two (2) other priorities.
The primary goal of the family is for the children to finish their studies and to have a
better life (become richer)

At this point, what does the family wish for? Why?

The family wishes to stay happy and together because it’s difficult to have a broken
family.

Do all the members work together toward these goals/desires? How? If not, what seems to be the
hindrance for working together? Who is the main person responsible for these goals?
Right now, since the children are still very young to understand the major issues/problems
which their family faces, only the parents are able to work together though Sheryl , the
housewife is not allowed to work. She still tries to help out in the family business of Alberto Jr.
(selling handicraft products). Nevertheless, their efforts are sometimes not enough to provide
completely for the needs of each member of their family as they are still financially lacking.
Alberto Jr., the head of the family, is the main person responsible for these goals.

5. SCREEM. Briefly specify/explain other items not included or described in the checklist.
PARAMETER STRENGTH
SOCIAL [] Open intrafamilial lines of
communication
[/] Absence of animosity/rivalry
[/] Healthy/supportive
intrafamilial relationships
[/] Healthy/supportive
extrafamilial relationships
Others: ____________________
CULTURAL [/] Absence of or very few
beliefs/practices that are
unacceptable to our culture or
negatively affect way of living
(e.g. institutionalization of
elderly, dependency of married
children to parents, value for
education, does not advocate
family closeness, seeking help
from traditional healers, etc.)
Others: ____________________
RELIGIOUS [/] Spirituality is positively
influencing way of life
[/] Practicing one’s faith,
enduring because of his faith
Others: goes to mass once a
month____________________
WEAKNESS
[/]lack of intrafamilial lines of
communication
[] Presence of animosity/rivalry
[] Unhealthy intrafamilial
relationships
[] Unhealthy extrafamilial
relationships
Others: ____________________
[]Presence of some belief/s
practices that are unacceptable
to our culture or negatively
affect way of living (Specify
these practices):
Both parents are not yet married
and are just living in together.
____________________________
____________________________
Others: ____________________
[] Spirituality is negatively or not
at all influencing way of life
[]Not practicing one’s faith
Others: only goes to mass a
least once or twice a year
 EDUCATIONA []Level of education is not a
L hindrance to achievement,
livelihood, success
[]Level of education facilitates
comprehension of most
challenging circumstances
Others: ____________________
ECONOMIC [/] Ability to allocate funds
appropriately
[/] Ability to make ends meet
most of the time
Others: ____________________
MEDICAL [/] Good compliance with medical
management
[/] Timely and appropriate
medical consultation
[/] Aware and practices wellness
and environmental sanitation
Others: ____________________
[/]Level of education is a
hindrance to achievement,
livelihood, success
[/]Level of education hinders
comprehension of most
challenging circumstances
Others: _
[]Inability to allocate funds
appropriately
[]Inability to make ends meet
most of the time
Others: They rely on relatives’
help some times for money and
they just applied for a loan
[/] Poor compliance with medical
management
[/] Inappropriate medical
consultation
[] Not aware/does not practice
wellness and environmental
sanitation
Others: ____________________

To what groups or organizations do the family members belong?

Alberto Jr., the head of the family, is one of the Baranggay officials (Baranggay Tanod) of
San Martin I.

What national / community resources has the family used?

The family uses the Health Center in San Martin I and the District Hospital of Sapang
Palay as their national/community resources.

What are the primary concerns of the family with their immediate environment?
Among the primary concerns of the family are: waste disposal/collection which causes
accumulation of waste in their compound and the habit of their neighbors to gossip about other
people’s lives which incites conflicts.

What are the positive and negative points of the community where the family resides?
Positive points Negative points

 The streets are well-lighted  Open drainages/canals in the

 Usage and purchasing of
Marijuana is incessantly monitored
 The community has several health
maintenance and surveillance
programs
community which cause floods
and accidents
 Peace and order is sometimes
disturbed due to drunk neighbors
 Habitual gossiping cause conflicts
in the community

6. Family Health Care Plan

Types of Care Family member: Problem Recommendation

Alberto Jr., 33 s
y/o
WELLNESS Slightly overweight Proper hygiene and
handwashing;
regular check-up;
diet and exercise
MEDICAL  Previous Follow-up Chest X-
case of ray and Sputum
 Pulmonary AFB (3); repeat BP
Tuberculosis; reading followed by
 Suspect for consult if BP
possible remains elevated;
Systemic compliance with
Arterial antihypertensive
Hypertension medications if
due to a BP of given upon
160/90 on PE consultation
PSYCHOSOCIAL  Lack of open Family counseling
family
communication
lines

Types of Care Family member: Problem Recommendatio

Sheryl Daan, 30 ns
y/o
WELLNESS No HPV vaccine Proper hygiene
and handwashing;
regular check-up;
HPV vaccine (3
doses); Pap smear
every year for 3
years then every 2
years thereafter
MEDICAL
PSYCHOSOCIAL Lack of open Family counseling
family
communication
lines

Types of Care Family member: Problem Recommendation

Carl Vincent, 10 s
y/o
WELLNESS No Hep A and B Hep A and B
vaccines vaccines; Proper
hygiene and
handwashing;
regular check-up;
visit to the dentist
twice a year
MEDICAL
PSYCHOSOCIAL

Types of Care Family member: Problem Recommendation

Alberto III, 8 y/o s
WELLNESS Undernourished Dental check-up
every 6 months ;
Proper dental care;
Proper hygiene and
handwashing;
regular medical
check-
 up;nutritional build-
up
MEDICAL (+) dental caries Dental check-up;
removal of dental
caries
PSYCHOSOCIAL

Types of Care Family member: Problem Recommendation

Mark Kenneth, 4 s
y/o
WELLNESS Undernourished Nutritional buildup;
dental check-up
twice a year;
proper hygienic
measures and
handwashing;
regular medical
check-up
MEDICAL  (+) ENT check-up;
impacted soften cerumen
cerumen, AU and then irrigate;
 (+) dental dental check-up
caries and removal of
dental caries
PSYCHOSOCIAL Frequent tantrums; Counseling on child
Does not share rearing
things/toys with
playmates

Appendix:
 Daan Family

The visit and

interview

Health Check-up

Giving out of
seedlings
 Daan Family
House

Outside Frontyard

Sala/Dining Area Bedroom