Tools for Family

Assessment
Dr. Nur Afrainin Syah, M.Med.Ed, PhD
With Courtesy to
Prof. Zorayda E. Leopando

 How many of you are physicians of families with several

generations?
How do you assess families in terms of health?
What tools do you use?

Diagnostic tools
Individual Patients
Newborn

APGAR
Newborn screening

Child

Growth and Development Chart

Pregnant Mother

Prenatal check up
Fundus height
Doppler
Laboratory exams

Diagnostic tools
Families

Function
Relationship
Structure

Community

Health indicators
Rates and ratios
Epidemiologic investigation

Family Oriented Primary Care

Learning to think family
The importance of genogram
The family within a larger system use an eco-map
Chronic illness and disability supporting family
caregivers
Working with family members the family conference
Identifying the family at risk

FAMILY ASSESSMENT
is the process of collecting data about the family
structure, and the relationships and interactions among
individual members.
It is a continuous process.
Its aim is to generate diagnoses with goals and
interventions for care created in collaboration with the
family and caregivers.

Tools for Family Assessment

1.
2.
3.
4.
5.
6.

Genogram
Family Apgar
Eco-map
SCREEM
Family Lifeline
Family Circle

1. Family Genogram
A graphic representation of a family tree that displays
detailed data about the relationships among individuals
in a family over a period of time, usually three
generations.
Allows the user to analyze hereditary patterns and
psychological factors that punctuate these relationships

Components of Family Genogram:

Family Tree

Family names; three generations; names and age

of all members; significant dates;

Family background on health

Illnesses; causes of deaths

Social and interactional

influences

Members living together; possible source of stress;

relationship

 The first born of each generation is farthest to the left

with the following siblings going to the right according
to order of birth
Family name is placed above each major family unit
Names and ages written below the symbol
Index patient is identified with an arrow
Date must be indicated when it was made to be able to
adjust the ages over time

Genogram

Veridiano Family
as of April 11, 2010
Project 4, Quezon City

1943

1947

Constantino, 64 2006

1967

1964 1968 1970

Mila Fatima 47 1994

1965

1982

2007

Thess 42

Nel 45

Ruptured aneurysm
Heart failure
Hypertension
Bronchial Asthma

May 39

Jojo 44

1973

Chok 36

1971

2005

Ja 4

Tere 38

Peng 27

Family Genogram: Uses

Quick overview on the family members and relationship
A way to visually overlay biomedical and psychological
information
A study tool for gaining a comprehensive understanding
of multigenerational family systems

2. Family APGAR
This is a 5-question assessment tool used for rapid
assessment of family function and dysfunction.
It measures an individuals level of satisfaction about
family relationships.

Family APGAR
Adaptation- the ability of a family to use and share
inherent resources which can be either intra- or extrafamilial
Partnership- the sharing of decision making which
measures the satisfaction of solving problems through
communicating
Growth- pertains to both physical and emotional aspects
and measures the satisfaction of the freedom to change
Affection- emotions that are shared with and between
family members which measures the satisfaction with
the intimacy and emotional interaction that exist in the
family
Resolve- refers to how time, money, and space are
shared; this measures the satisfaction with the
commitment made by members of the family

Family APGAR
There are 4 basic situations wherein the Family APGAR is
needed:
When the family is directly involved in caring for the
patient.
When treating a new patient in order to get information
to serve as general view of family function
When treating a patient whose family is in crisis.
When a patients behavior makes you suspect a
psychosocial problem possibly due to family dysfunction.

FAMILY APGAR QUESTIONNAIRE PART I

Helps define the degree of the patients satisfaction or
dissatisfaction with family function

Part I
Almost
always
(2)

I am satisfied that I can turn to my family for

help when something is troubling me.

I am satisfied with the way my family talks

about things with me and shares problems
with me.

I am satisfied that my family accepts and

supports my wishes to take on new
activities or directions.

I am satisfied with the way my family

expresses affection and responds to my
emotions such as anger, sorrow, and love.

I am satisfied with the way my family and I

share time together.

Some of
the time
(1)

Hardly
ever
(0)

Family APGAR
Scoring:
8-10 points = highly functional family
4-7 points = moderately dysfunctional family
0-3 points = severely dysfunctional family

Family APGAR Part II

Delineates relationships with other members, identifies
persons who can give assistance to the patient, and
indicates conflicts not revealed in part I

Part II
Who lives in your home?
Name

Relationship

Age

How do you get along?

Well

Fairly

Poor

Sex

Part II
If you dont live with your family, list
down the persons you turn to for help

Name

How do you get along?

Well

Relationship

Fairly

Age

Poor

Sex

3. Ecomap = Family Mapping

The family within a larger system
Reflects relationships and interaction
Provides schematic description whom to ask for
assistance in making decision for patients
Identify possible source of somatic complaints

Family Mapping
A double line between two people indicates a functional
relationship

 A single line with a break in the middle indicates

dysfunction

 Three parallel lines between two people denotes an

over-involved relationship where there is plenty of
intrusion.

 A solid line perpendicular to the relationship line

symbolizes a rigid boundary where the rules are but
non-negotiable

 A broken line perpendicular to the relationship lines

symbolizes a boundary that is clear but negotiable

 A dotted line perpendicular to the relationship line

signifies a boundary that is diffuse or unclear.

 A bracket encompassing several people signifies the

presence of a coalition or alliance between these people
[

 An arrow pointing away from the system signifies

escape from the system

 An open ended arrow with its open end embracing two

individuals and the pointed end pointing to a third
signifies that the third person is being triangulated by
the conflict between the other two

Ecomap

Ecomap

Ecomap

Ecomap

Ecomap

4. SCREEM
An important tool to assess a familys capacity to
participate in the provision of health care or to cope
with crisis. It makes use of 6 factors which can be
considered as resource or as pathology.

SCREEM
Resource

Pathology

Social

-Isolated from extra-familial

-Problem of over commitment

-social interaction is evident among family

members
-Family members have well-balanced lines
of communication with extra-familial social
groups

Cultural

- Ethnic and cultural inferiority

-cultural pride and satisfaction can be

identified
Religious
- Offers satisfying spiritual experiences as
well as contacts with an extra-familial
support group

- Rigid dogma/rituals

SCREEM
Economic
- Economic stability is sufficient to provide
both reasonable satisfaction with financial
status and an ability to meet economic
demands of normative life events

-Economic deficiency
-Inappropriate economic plan

Educational
- Education of members is adequate to
allow members to solve or comprehend
most problems that arise within the format
of the lifestyle established by the family

-handicapped to comprehend

Medical
- Medical health care is available through
channels that are easily established and
have previously been experienced in a
satisfactory manner

- Not utilizing health care

facilities/resources

5. Family Lifeline (Clinical Biographies /

Life Chart )
Clinical biographies and life charts make valuable tools
because it has the capacity to put side by side
significant life and clinical events with their dates of
occurrences and make a connection between these
facts.

6. Family Circle
Family circles are often used on individuals and in some small
groups.
Instructions are given to the patient to look at the circle as if it
is his family and then draw small circles to represent the
patient and those people who are important to him.
Physicians draw a big circle
Ask patient to draw smaller circles within the big circle or outside.
Each circle represent significant people in his/her life. Distance and
size vary according to degree of closeness and significance to the
patient

Difficulty of interpretation and standardization poses as a

disadvantage.

Family Circle
Dex

Mama Pesh

Mama
chuchi

Arra

Rihanne
Me
Ja

Kuya
Nel
Chok

Erin

Ate Tere

Actual Exercise Using the Tools

Work in pairs, assess each other
Reflect on the experience by answering the following
questions
What did you feel?
Were you able to finish? Why yes and why not??
How will you teach the tools to your medical students??