Tools in Family Assessment

Qualities of an Assessment Tool

1. Easily utilized by the practitioner
2. Not time consuming to use
3.

Provide composite picture of family

strength and needs

Types of Assessment Tools

1. The Family Genogram

Family
(Unit of Care)

Collecting, Storing, Processing

Information
Identify actual or potential
health problems

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
o 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

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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

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. When treating a new patient in order to get information to serve as
a general view of the family function
3. When treating a patient whose family is in crisis

Family therapy for drug adducts

4. 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

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?
o 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

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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

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 participate in provision of health care or to cope
with crisis
Resources
Pathology
SOCIAL
Isolated from extrafamilial
Family member have well balanced lines
Problem of over commitment
of comminuation with extra familial social
groups (friends, sports clubs, etc)
e.g. chronically ill galit ang lahat,
paano hihingi ng favor?
CULTURAL
Ethnic/cultural inferiority
Cultural pride or satisfaction can be
identified especially in distinct ethnic
groups
RELIGIOUS
Rigid dogma/rituals
Religion offers satisfying spiritual
e.g. atheist
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

Economic deficiency
Inappropriate economic plan

Handicapped to comprehend

Not utilizing health care

facilities/resources

8. ECOMAP

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
o 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

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