FAMILY MODELS,

STAGES AND TASK

1

DR. A. E. AYUK
LECTURER/CONSULTANT FAMILY
PHYSICIAN
DELIVERED ON 27TH FEBRUARY,
2019
 LEARNING OBJECTIVES
2

 Definition of family
 Brief overview of Family Systems and Family
development theory
 Define the meaning of family development task
and life cycle
 Describe different types of family models
 Describe the developmental task of different family
stages
 Clinical application
 Criticism of family models
 Traditional Definition of family
3

 NUCLEAR FAMILY Comprises of a married couple and their children

by birth or adoption
 STRUCTURAL DEFINITION Includes kinship members with
differentiated positions in the family system such as grandparents
,aunts, uncles, cousins and any genetic relatives
 FUNCTIONAL DEFINITION OF FAMILY is any social group engaged
in certain family activities such as child rearing, nurturing, socializing
etc
 IN SHORT A FAMILY IS A GROUP OF 2 OR MORE PEOPLE WHO
ARE Committed to each other, who may or may not be related
genetically or by marriage but care about each other
 THIS LAST DEFINITION ENCOMPASSES DIVERSE GROUPS
INCLUDING
 SINGLE PARENT,EXTENDED,NUCLEAR,FAMILIES
 ,MARRIED AND UNMARRIED, AGING COUPLES.
 COMMUNES,CONVENTS ,MONASTRIES
 DEFINITION OF FAMILY IN FAMILY
PRACTICE
4

The family may be defined

A social and intimate nurturing group of
individuals sharing a past, a present and a future,
including all who contribute in one way or the
other to the family culture, connected
biologically, legally, or by choice; from whom one
can reasonably expect a measure of support in the
form of food, shelter, finance and emotional
nurturing.
 IMPORTANCE OF THE FAMILY IN FAMILY
MEDICINE
5

The family plays a major role in the preventive and wellness aspects of
healthcare through culture, beliefs, religion and spirituality.
The family generates events, tolerates and corrects healthcare problems
within its membership through the following means:
 Genetic and disease susceptibility
 Prenatal and perinatal transmission of diseases
 Child rearing/nurturing
 Nutrition and lifestyle
 Access to quality care
 Spread of infectious diseases
 Outcome of acute/chronic illness
 The family determines the degree of mental health and illness and
determines the therapeutic success or failure of any illness or disease.
 FUNCTIONS OF THE FAMILY
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 Educational - Pass on culture e.g. religion, ethnicity

 Reproductive - Pass on generation
 Sexual satisfaction
 Provide economic security
 Emotional – serve as protective mechanism for family
members against outside forces, and provide closer human
contact and relations
 Health – physical maintenance and healthcare
 FAMILY SYSTEMS THEORY
7

 A theory introduced by Dr. Murray Bowen, suggesting that an

individual cannot be understood in isolation from one another
 Families are a system of interconnected and interdependent individuals,
none of whom can be understood in isolation.
 In the system, each member has a role to play and rules to respect.
 Within the boundaries of the system, patterns develop as certain family
members’ behaviour is caused by and causes other family members’
behaviour in predictable ways.
 Maintaining the same pattern of behaviours within a system may lead
to a balance in the family system, but can also lead to dysfunction.
 The action of one member affects all others, and that member in turn is
affected by the reaction of others.
 BRIEF OVERVIEW OF FAMILY
DEVELOPMENT THEORY
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 Family development theory focuses on the systematic

and patterned changes experienced by families as they
move through their life stages.
 It offers a unique way of thinking about and studying
families because of its emphasis on evolution of families
over time, the developmental task facing families and
their individual members, and the recognition of family
stress at critical periods of development.
 The knowledge of family life cycle has helped in making
clinical distinctions between normative and
dysfunctional behaviour among families.
 Contributions to family developmental theory were
drawn from symbolic interactionism, structural
functionalism, the sociology of work
9 and professions,
systems theory, and from familylife stress and crisis
theory (Mattessich & Hill, 1987).
 Evelyn Duvall and Reuben Hill, beginning in the 1940s,
were the two family scholars who first developed this
theoretical perspective (Burr, 1995).
 The three basic assumptions of family developmental
theory, as outlined by Aldous (1996), are:
1. Family behavior is the sum of the previous experiences
of family members as incorporated in the present and in
their expectations for the future.
2. Families develop and change over time in similar and
consistent ways.
3. Families and their members perform certain time-
specific tasks that are set by them and by the cultural and
societal context
 Define family development task and life cycle
10

 Family development task are the growth

responsibilities that arise at certain stages in the
lifespan of the family.
 Family life cycle divides the family experiences into
stages of the life span of families. It describes
changes in family structure and the roles during each
stage. Seeks to explain change in the family system,
including changes in interactions and relationships
among family members that occur over time.
 Family models
11

 These models were developed within the discipline of

psychology or sociology
 Each model has a unique perspective of understanding
the family
 Family models have been categorized according to their
basic focus as;
developmental,
interactional;
structural-functional, and
systems models.
 Family model 2
12

Family developmental models include,

 Duvall’s
 Stevenson’s,
Family Interactional Model
 Satir’s
Structural-Functional Model
 Friendman’s
 Calgary’s Family Model,
 Systems approach.
 Evelyn Duvall’s family development model
13

 Evelyn Duvall’s (1977) family developmental framework provides a

guide to examine and analyze the basic changes and developmental
tasks common to most families during their life cycle.
 Every family has unique characteristics but there are descriptive
normative pattern of sequential development
 The stages of family development are marked by the age of the
oldest child,
 although there can be an overlapping of stages when there are
several children in the family
 This model is based on traditional, nuclear, intact family form and
does not consider families whose life cycles are characterised by
alternative development sequence i.e couples who live together but
not married, childless couples, divorced, single parent, or remarried
families.
DUVALL’S DEVELOPMENTAL STAGES
14

STAGES
 Beginning family (married couple with out children)
 Early childbearing (oldest child from birth to 30
months)
 Families with preschool children (oldest child from
2.5years to 6years)
 Families with School children( oldest child from 6-
13years)
 Families with Teenagers (oldest child from 13-20years)
 Launching center family (from first child gone to last
child leaving home)
 Middle-aged family (“empty nest” to retirement)
 Ageing family (retirement to death of both spouses)
 DUVALL’S DEVELOPMENTAL TASK
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8 BASIC FAMILY TASK

 Physical maintenance
 Allocation of resources
 Division of labor
 Socialization of members
 Reproduction, recruitment and release of members
 Maintenance of order
 Placement of members in larger society
 Maintenance of motivation and morales
 BEGINNING FAMILY
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 MARRIAGE-establishment of mutually satisfying

relationship
Tasks.
 Separate from family of origin
 Forming and intimate relationship and balance in their lives
together.
 Learn to set values and boundaries in their new home.
 Family planning
 Establish a harmonious relationship with in-laws and new friends.
 Adjusting to pregnancy and planning for parenthood
 Assume spousal roles
 Establish rules of interactions as regards intimacy and distance.
 BEGINNING FAMILY
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Challenges
 Problems frequently arise when one of the partners has
difficulty separating from his/her family of origin, or if
one of the partners come from a dysfunctional family.
 Allowing undue influence from family members
 Pressure to procreate
 Failure to create a balance between in-laws and friends.
 Failure to plan for pregnancy
 Spousal roles are not assumed.
 BEGINNING FAMILY
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Role of the Family physician

 Help the couple to develop good communication skills
 Offer pre-conception care, immunization, screen for genetic
diseases especially haemoglobinopathy .
 Screen for factors that make the family high risk such as diabetes
and other endocrine diseases, anaemia, under-nutrition, blood
group antibodies – rhesus incompatibility.
 Encourage the woman to gain weight, if underweight. Folic acid
supplementation to prevent neural tube defects.
 Sexual education of the newlywed couple e.g. ovulation,
menstrual cycle, safe and unsafe period.
 Inform couple to prevent diseases like ‘Honeymoon cystitis’, and
that they should not expect conception at the first intercourse
.
 EARLY CHILD BEARING
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 BEGINS when age of 1st child is between birth and 30

months
Tasks.
 Assume parental roles, expectations and values
 Assume child rearing responsibilities
 Adjusting to the critical needs and demands of an infant
 Negotiate changes in work, recreation, housing,
relationships with extended family. In-laws initially,
then a reliable nanny, and sometimes a dependable
neighbour may help with baby-sitting.
 EARLY CHILD BEARING
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 Challenges
 Health problems that can be encountered include;
i) Acute illnesses like malaria, diarrhoea, Upper Respiratory Tract Infection etc.
ii) Care of a child with birth defects
iii) Malnutrition.
iv) Failure to thrive
v) Home accidents/poisons
vi) Anxiety state in parents
vii) Sleep problems
 Establishing rules and communication regarding children.
 Problems result when one parent, traditionally the mother, becomes over- invested
in her role as a parent, leadings to feelings of isolation in her partner who may
begin to spend more time at work and away from home.
 Marital satisfaction begin to decline.
 EARLY CHILD BEARING
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Roles of the Family Physician.

 Attend to the health needs of the family.
 Counsel on the following;
 Complementary feeding
 The importance of immunizations
 Preventing home accidents
 The need to get help if overwhelmed with care of the infant
 Counselling and psychotherapy
 Balanced relationship between couple.
 Families with preschool children
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 Begins when oldest child is 2.5years to 6years

 Families at this stage deal with the emergence of their children’s identity
including his/her sexual (learning to be a boy or girl).
 Children at this stage try to test out limits and ascertain their independence.
Tasks
 Adapting to the pre-schooler’s needs, the parents’ energy and privacy reduce.
 With the addition of another infant, parents experience increased childrearing
responsibilities.
 Need for more living space in the home
 More personal time to maintain intimacy and communication
 Continue development of parental roles
 Allow development of the new individual and relate to the developing
personality.
 Families with preschool children
23

Challenges
 Conflict arises when one parent becomes the ‘good cop’ or
the permissive partner while the other parent plays the role
of the ‘bad cop’ or the rule enforcer. This leads to stress
between the parents when the child misbehaves.
 Opportunities for intimacy between partners are reduced

Role of the Family Physician

 Counsel the parents to set firm boundaries which are
consistently enforced in a non-violent manner. The couple
has to be unanimous in their decision.
 Counsel the parents to maintain closeness
 FAMILY WITH SCHOOL CHILDREN
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 This stage begins as the oldest child (6-13years) starts school.

 As the children begin school, they come in contact with a new
power structure with different rules and values.
 It is during this stage that children begin to experiment and tests
social norms, it is also a time when they begin to define
themselves in relation to others.
 Within the home, children begin taking on responsibilities in the
form of chores, self-care and homework.
 Parents take up new roles as task assignment, discipline and
transportation.
 FAMILY WITH SCHOOL CHILDREN
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Tasks
 Expand parental roles
 Support child’s first separation
 Accept child’s developing autonomy and accept changes in
family organization.
 Balancing time and energy to meet the demands of work, the
children’s needs and activities
 Adjusting to community activities involving the child
 Relate to outside institutions like school, church, sport club etc
 Encourage the child’s educational achievement
 Maintaining a satisfying marital relationship
 Harmony in the marital home and in-law relationships
 FAMILY WITH SCHOOL CHILDREN
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Challenges
 Overprotection
 Neglect
 Not allowing discipline
 Bullying, name calling
 Social isolation

Role of the Family Physician

 Explore child’s school performance and socialization skills
 Help parents anticipate questions about identity that child may
bring home with them.
 Screen child for worm infestation
 FAMILIES WITH TEENAGERS
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 This stage begins when the oldest child becomes an adolescent (10 – 20years).
 The child develops increasing independence and autonomy.
 During this period, the family prepares for the emerging independence and eventual departure of their
adolescent.
 This period is characterized by multiple crises as the teenager and parents define and redefine boundaries
and responsibilities within the boundary.
Tasks
 Deal with emerging sexual identity of the child
 Promote differentiation and autonomy of the child
 Accept increasing influence of peer group
 Families adapt to balancing freedom for growth with meeting family responsibilities
 Maintaining open communication between parents and teenagers
 Facilitate greater participation of child in decision making
 Participate in child’s education and career planning
 Continuing intimacy in the marital relationship
 Establishing outside interests and careers as teenagers leave home
 Accept lessening of the tie to the family of origin
 FAMILIES WITH TEENAGERS
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 Challenges
 Authority is often questioned and devalued
 Adolescents tend to engage in risky behaviour like precocious
sexual activity, engaging in unprotected sex which could lead
to STIs and unwanted pregnancies, illicit use of drugs and
alcohol abuse, reckless driving which could lead to motor
vehicular accidents; others include runaways, homicide and
suicide.
 Incidentally, parents could be going through mid-life crisis and
would be trying to expand their own life achievements,
 Family members often react to the demands and crises of
adolescents by either distancing themselves from their
behaviour, or becoming over-involved.
 FAMILIES WITH TEENAGERS
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 Role of the Family Physician

 Play a supportive role by helping parents set reasonable
and firm boundaries
 Help identify when a family is having a hard time with
this stage, so a referral for family therapy can be made.
 Interview adolescents to hear them out, bearing in mind
their privacy. This reinforces that the teenager needs to
begin taking responsibility for his/her own health, and to
discuss confidential issues such as sexuality and healthy
living.
 LAUNCHING CENTRE FAMILIES
30

 Begins when 1st child leaves home and last until last
child has left
 Parents must both prepare their children to live
independently and accept the departure of the
children.
 After the children have left, the parents must
reorganize to reestablish the family unit.
 Husband and wife roles and responsibilities will shift
during this period if the wife returns to work.
 With the birth of grandchildren, parental roles and
self-images require some family accommodation.
 Launching center families-the age of decrease
31

persons between ages 40-60 are caught up with aging pains

and growing pains
Hair begins to turn gray
Skin become dry and wrinkled
DECREASED
muscle tone
bone density
30% in cardiac output
50% in maximum breathing capacity
Esophageal and gastric motility
50% in Basal Metabolic rate
Deep sleep
Diminishing sexual function-depending on opportunity
for sexual expression
 For women
32

 Women must adjust to the physical and psychologic changes that

accompany menopause
 For most women it Begins at 50
 Continues till ovaries stop producing estrogen and progesterone
 Changing hormone levels results in vasomotor instability
 Hot flushes/flashes
 Numbness in the extremities
 Cold hands and feet
 Headaches
 Irregular menstrual cycles with decreased flow
 Spotting
 Skipped periods
 Emotional liability
 Sudden changes of mood and depression
 LAUNCHING CENTRE FAMILIES
33

Tasks
 Parents prepare their children to live independently and learn to accept the
departure of their children
 Accept independent adult role of the child
 Parents should face their own middle age transition issues and recognise to re-
establish the family unit
 With the birth of grandchildren, parental roles and self-images require some family
accommodation.
Challenges
 One or more of the children may continue to stay on in the house beyond
acceptable social norms
 One of the partners may begin to experience ‘empty nest syndrome’
 Parents who neglected devoting time to their relationship during the busy years of
parenthood may have a hard time adjusting to being alone together
 Physical illness may occur like hypertension, diabetes, cancer and other non-
communicable diseases.
 LAUNCHING CENTRE FAMILIES
34

Role of the Family Physician

 Encourage intimacy
 Screen for non-communicable diseases
 Managing illnesses through lifestyle modification and
other appropriate means
 MIDDLE AGE FAMILIES
35

 Last child has left home

 This stage begins after all the children have left the home, commonly
referred to as the ‘empty nest’ stage
 Sometimes, adult children may return home and begin care taking
activities of the elderly relatives especially parents and parents-in-law.
 period for rebuilding the marriage and maintaining satisfying
relationships both with aging parents and with the children and
their families.
 Freedom to cultivate social and leisure interest
 Task planning for retirement
 Maintenance of physical and emotional health and careers are
major family concerns.
 Adjusting to physiological changes of aging
 MIDDLE AGE FAMILIES
36

Tasks
 Work out separation issues around children
 Rework spousal roles
 Face unresolved issues of the past
 Middle aged parents have more time and freedom to cultivate
their social and leisure interests
 Rebuilding the marriage and maintaining satisfying relationships
both with
 aging parents and with the children and their families
 Planning for retirement
 Maintaining physical and emotional health, as well as their
careers
 MIDDLE AGE FAMILIES
37

Challenges
 Not having enough time for each other
 Interfering with children’s affairs
 Decline in health and energy
 Death of a spouse
Role of the Family Physician
 When working with older couples, the Family Physician should ask
how the couple has changed since one or both retired, how the couple is
spending their time and how they share the workload in the household
 The Family Physician should find out how they reacted to losses such
as death of a spouse or close friend/relative, decline in function and
health
 It is important and helpful to give counselling on end of life decisions
like living will, designating a power of attorney, estate planning etc.
 AGEING FAMILIES
38

 Begins with retirement of one or both spouses and continues until death of
both marital partners
Tasks
 Develop other activities other than work and family responsibilities
 Finding sufficient energy and motivation to seek and engage in pleasurable
activities within financial and health limitations
 Accepting retirement with changing lifestyle
 Accepting the death of spouse and friends
 Face the physical and emotional problems of ageing
 Deal with significant loss
 Begin life review
Challenges
 Chronic illnesses
 Death of a spouse
 Loneliness and regret
 Difficulty in coping alone, leading to a short life span after death of spouse
 AGEING FAMILIES
39

Role of the Family Physician

 Rehabilitation
 Palliative care
 Prevention and management of illness
 Maintenance of general health and nutrition-
fresh food
exercise,
 contact with family members,
maintain interest in politics, social events,
 modification of sexual technique,
cohabitation
 Prevention of accidents-
 falls,
 burns
 Combating ageism-Arranging the use of their skills and knowledge for the benefit of
the younger generation eg schools
 not treating the aged like children
 overprotection of the handicap,
 assuming all>65 act the same way
 Stevenson’s Family Development Model
40

Joanne Stevenson (1977) describes the basic tasks

and responsibilities of families in four stages:
 She views family tasks as
 maintaining a common household,
 rearing children,
 and finding satisfying work and leisure.

 These tasks also include sustaining appropriate

health patterns and providing mutual support and
acculturation of family members.
 The four stages are delineated by the number of
years the couple are married and their
approximate age.
Stevenson’s Family Development Model
41

 Emerging family-from marriage for 7 to 10 years

 The Crystallizing Family-with teenage children
 The Interacting Family-children grown and small
grandchildren
 The Actualizing Family-Aging couple alone
 Satir’s Interactional Family Model
42

 Virginia Satir (1972) believes that the family’s interactional

health depends on its ability to share and understand the
member’s feelings, needs, and behavior patterns.
 She thinks that healthy, nurturing families help their
members know themselves through communication of
everyday events. This communication promotes each
individual’s self-confidence and self-worthy.
 Satir’s model of the healthy family consists of four
concepts; self-worth, communication, rules, and links to
society.
Friedman’s Structural-Functional Family Model
43

 Friedman’s family model was developed from

sociological frameworks and systems theory by
Marilyn Friedman (1986).
 The family is the focus of the model, as it interacts
with suprasystems in the community and with
individual family members in the subsystem.
 Friedmans model comprises of structural and functional
components
44

 The structural component examines the family unit,

how it is organized, and how members relate to one
another in terms of their values, communication
network, role systems, and power.
 The functional component refers to the
interactional outcomes resulting from the family
organizational structure.The structural-functional
components and parts all intimately interrelate
and interact: each component and part is affected
by the other
 Calgary
45

 Calgary’s family model is an integrated conceptual

framework of several theorists’ work that was
adapted for nurses at the University of Calgary.
The model is based on three major categories:
family structure,
 function,
 and development.
 Each of the three categories is further subdivided.
 Although the family may be examined by looking at
specific parts, each part interacts with others and
changes the whole family configuration.
 Dysfunctional families
46

 Within each of the successive stages of family

development, Duvall identified eight basic tasks, that lead
to successful family life within society.
 These tasks promote family adjustment and adaptation of
the individual members.
 When families fails to accomplish these tasks, the family
collectively or its members individually may experience
unhappiness, societal disapproval, and difficulty in
achieving harmony and self-actualization.
 The 8 basic tasks of the family

47

 The family tasks involve responsibilities to satisfy the

biological, cultural, and personal needs and
aspirations of the members at each stage of family
development.
 General family Tasks
48

 Physical Maintenance – The family is responsible for

providing shelter, clothing, food, and health care.
 Allocation of resources-Resources include finances,
personal time, energy, and relationships.
Family members’ needs are met through division of cost
and labor to provide material goods, space, and facilities,
and through interpersonal relationships to share authority,
respect, and affection.
 General family Tasks 2
49

 Division of labour - Family members decide who will

assume what responsibilities, such as providing income,
managing the house-hold tasks, maintaining the home
and caring for young, old, or incapacited family
members, and other designated tasks.
 Socialization of family members – The family assumes
responsibility for guiding development of mature and
acceptable patterns of socially acceptable behaviour in
eating, elimination, sleeping, sexuality, aggression, and
interaction with others.
 General family Tasks 3
50

 Reproduction recruitment, and release of family

members-Childbearing, adoption, and rearing of
children are family responsibilities, along with
incorporating new members through marriage.
Policies are established for including others in
the family, such as in-laws relatives, step-
parents, guests, and friends.
 Maintenance OF ORDER-Order is maintained by
the communication of acceptable behavior. The
types of intensity of interactions, patterns of affection,
and sexual expression are sanctioned by parental
behavior to ensure acceptance in society.
 General family Tasks 4
51

 Placement of members in the larger society-Family members

establish roots in society through relationships in the church,
school, political and economic system, and other
organizations. The family also assumes responsibility for
protecting family members from undesirable outside
influences and may prohibit membership in objectionable
groups.

 Maintenance of motivation and morale- Family members reward

each other for their achievements and provide for an individual’s
needs of acceptance, encouragement, and affection. The family
develops a philosophy of life and sense of family unity and
loyalty, thereby enabling members to adapt to both personal and
family crises.
 Criticism of family models
52

 These models are based on traditional, nuclear, intact

family form and does not consider families whose life cycles
are characterised by alternative development sequence i.e
couples who live together but not married, childless
couples, divorced, single parent, or remarried families,
Lesbian or Gay families etc.
 The use of life cycle is inappropriate since the cycle
does not repeat itself. Rather “family career” has
been suggested.