Tools in Family

Assessment

Family
(Unit of Care)

Qualities of an Assessment Tool

1. Easily utilized by the practitioner
2. Not time consuming to use
Collecting, Storing,
3. Provide composite picture of
family strength and needs

Types of Assessment
Tools

Processing Information
Identify actual or
potential health
problems

1. The Family Genogram

The family name is placed above each major family

unit
o Given names and ages are placed below each symbol
o One number of the family is of greater medical
significance because of an illness and he is known as
the index patient and is identified with an arrow
o Date is indicated when the chart was developed so
that ages would be adjusted over time
o Males should be listed 1st (left to right) in the
genogram
FUNCTIONAL CHART
o Gives a more dynamic image of the family of the
relationship of the members
o Assess the totality of the family unit

Strengths (as in strong bonds between

husband and wife)

Weaknesses (as in presence of marital discord

or separation of parents)

Ability to withstand future stressful situations

(knowing those who are actually living
together in the household)
FAMILY ILLNESS/HISTORY
o Denotes the presence of inherited diseases or familial
tendencies indicating potential problems in the family
o

Develop plan to improve

wellness of the family
Definition: a scheme or
graphic chart representation
of both the (1) genetic pedigrees of the family and (2) key
psychosocial and interaction data using standardized symbols
Limited role in assessing family function, but is best used to
assess the family structure
Essentially contains the ff information
o Record of names and roles of each member of the
family
o Extended family and households
o Medical problems of each member of the family
o Significant date in the family
o More subtle information about the family
Genograms graphically represents the familys family tree,
functional chart and family illness/history
FAMILY TREE
o Must consist of 3 or more generations and each
generation is identified by Roman numerals
o The 1st born of each generation is farthest to the left,
with sibling following to the right in order of birth

1 | To o l s i n F a m i l y A s s e s s m e n t

2. The Family APGAR

Definition: asses family function or dysfunction using a set of

5 questions
o NOTE: Family map also assess family function and
dysfunction
o NOTE: APGAR is used for adults only
o Assess the influence/impact of the illness to the family
o Also helps the physician decide which families need
more careful assessment
4 basic situations where information about family
relationships are needed
1. The family will be directly involved in caring for the
patient

E.g. post MI/CVA patients who need

rehabilitation therapy

E.g. Asthma, terminally ill, CVA

2.
3.
4.

When treating a new patient in order to get

information to serve as a general view of the family
function
When treating a patient whose family is in crisis

Family therapy for drug adducts

When a patients behavior makes you suspect a
psycho-social problem possibly due to family
dysfunction

E.g. patients who have high clinic utilization

(>9 visits/year)

Lower APGAR SCORES (more dysfunctional

family

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2 Parts of APGAR

Part I (APGAR adaptation, partnership, growth, affection,

resolve)
o Adaptation

Capability of the family to utilize and share

inherent intra and extra familial resources

E.g. has resources but doesnt know hoe to

use it
o Partnership

Sharing of decision making

Measures the satisfaction attained in solving

problems by communicating
o Growth

Refers to both physical and emotional growth

Measures the satisfaction of the available

freedom to change

E.g. Family with adolescents

o Affection

How emotions like love, anger and hatred are

shared between members

Measures the members satisfaction with

intimacy and emotional interaction that exist
in the family
o Resolve

How time, space and money are shared

Measures the members satisfaction with

commitment made by other members of the
family

E.g. emotional blackmail of the patients

Part II
1. Delineates relationship with other members
2. Identifies persons who can give assistance to the
patient
3. Indicates conflict not revealed in part I
Scoring

8-10 : highly functional family

4-7 : moderately dysfunctional family

0-3 : severely dysfunctional family

3. The Family Circle

How it is done?

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Physician grows a large circle and instructs the patient

to draw circles of their significant people in their lives

Size of the circle: influence/significance to the

patient

Circle may be inside the patients on circle,

touching or outside it
Actual assessment occurs when the patient explains the
diagram made
Advantage: Physician can entertain another patient during the
time the other patient is busy completing the family circle.
Disadvantage: difficulty in interpreting the diagram due to
lack of standards in this technique
o

4. FACES (Family Adaptability and Cohesion

Evaluation Scale)

Definition: asses the family function using a self reported

scale wherein the patient rates his or her family on 30 items
on a 1 to 5 scale

5. FES (Family Environment Scale)

90 item questionnaire
Separate class of family parameters are included in the results
Compare health care results with family variable

6. Clinical Biographies and Life Chart

Definition: Tools used to facilitate to analyze the connection of

the patients personal life with his health/sickness
Life events and clinical events are put side by side according
to dates of occurrence, the correlation may be seen
o Starts at birth

7. SCREEM (Social, Cultural, Religious, Economic,

Educational, Medical)

Assess FAMILY resources

Assess familys capacity to
care or to cope with crisis
Resources
SOCIAL
Family member have well
balanced lines of comminuation

participate in provision of health

Pathology
Isolated from extrafamilial
Problem of over commitment

with extra familial social groups

(friends, sports clubs, etc)
e.g. chronically ill galit ang
lahat, paano hihingi ng favor?
CULTURAL
Cultural pride or satisfaction can
be identified especially in distinct
ethnic groups
RELIGIOUS
Religion offers satisfying spiritual
experiences as well as contacts
with extra familial support group
e.g. easy to accept that
eventually they die (terminally ill)
ECONOMIC
Economic stability is sufficient to
provide both reasonable
satisfactions with financial status
and an ability to meet economic
demands of normative life events
EDUCATION
Education of family members is
adequate to allow members to
solve or comprehend most of the
problems that arise within the
format of the lifestyle established
by the family
Capability to understand
MEDICAL
Medical health care is abailable
through channels that are easily
established and have previously
been experienced in satisfactory
manner
Curative aspect

Ethnic/cultural inferiority

Rigid dogma/rituals
e.g. atheist

Economic deficiency
Inappropriate economic plan

Handicapped to comprehend

Not utilizing health care

facilities/resources

8. ECOMAP

Graphic picture of the familys resources both

emotionally and financially
Significance
o Designed to identify as many people that can be part
of the patients therapeutic support

Determine the person most appropriate for

the task

Can open the way to calling a family network

meeting or creating a surrogate support group
o Show a persons place in the family and the
community
o

Assess COMMUNITYs resources

Definition: tool used to graphically depicts the familys
connections with other families, organizations and institutions
o Genogram + family circle
o Bends, tensions and host of OTHER relationship issue
presents are visualized

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