FAMILY ASSESSMENT

TOOLS
Tabaranza, Brigitte Ulrike MD
Introduction
 Every patient is a member of a family
 A physician must always keep in mind that
the way a patient reacts to an illness will
depend a lot on his family
 It will depend on the family physician as to up
to what level he will involve a patient’s family
to evaluate his problem
 Step II

 Understand the family normal function

 5 Basic Family Function

 Provide support to each other

 Establish autonomy and independence
for each person in the system
 Create rules that govern the conduct of
the family and its members
 Adapt to change in the environment
 Communicate with each other
 Step 3

 Learn to assess Family Structure and

Function in Clinical Practice
 Family assesssment tools have been
made to aid the family physician in
assessing the family structure and
function in clinical practice
 Different Family
Assessment Tools
 Family Genogram
 Family Map
 Family APGAR
 SCREEM
 SCREEM Family Resource Survey
(SCREEM-Res)
 Family Lifeline
 Family Life Cycle
 Ecomap
 Family Genogram

1. Family Tree
 Must consist of 3 or more generations
with each generation identified by Roman
numerals
 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 unity
 Family Map

 A tool designed to reflect family

relationships and interaction patterns
 This application is use for the
communication of information about
the family system and I dynamics in
order to address psychosocial issues
 It also provides a schematic description
on whom to ask for assistance in
making decisions for the patient
 APGAR
 It is a tool that quality measures family
functioning.
 It is a 10 to 15-minute paper and pencils
technique that elicits the patient’s perception
and level of satisfaction on the current state
of her family member’s relationships
(Smilkstein, 1978)
 This is a 5 item questionnaire designed to
elicit the patient’s perception of the current
state of his family relationships and which
serve as a rapid screening instrument for
family dysfunction.
APGAR
 4 Basic Situations
where the Family APGAR
is needed
 When the family will be directly involved
in caring for the patient.
 When treating a new patient in order to
get info to serve as general view of family
function.
 When treating a patient whose family is in
crisis.
 When a patient’s behavior makes you
suspect a psychosocial problem possibly
due to family dysfunction.
 Family APGAR is also valuable in the
following conditions or situations :

 Symptoms that manifest themselves as

psychosomatic disorders.
 Difficult patients.
 Marital or sexual difficulties.
 Multiple presentations by multiple family
members.
 Drug or alcohol abuse.
 Evidence of sexual and physical abuse on wife or
a child.
 Multiple presentations of a family member – “The
thick file syndrome”
 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
 APGAR Scoring
 Scoring
Almost always – 2
Some of the time – 1
Hardly ever – 0

 Total
8-10 – highly functional
4-7 – moderately dysfunctional
0-3 – severely dysfunctional
 SCREEM
 It is acronym that represents family
resources and is a tool where the family
physician helps the family members
identify and assess their resources to
meet a crisis. If there is a lack of
resources, it can also serve as a kind of
pathology in certain situations.
 Relationships of health behavior,
practices and utilization of health
services and barriers to patient care.
 SCREEM
 It is commonly used when the need for
care is long or lasts a lifetime such as
in the case of chronically-ill, terminally-
ill, and hospice care patient.
 It can also be used to assess resources
of difficult and non-compliant patients
 SCREEM Family Resource
Survey (SCREEM-RES)
 It is 12 item self-administered family
resources questionnaire in Filipino based
on SCREEM.
 It is a appropriate in assessing the
family’s capacity to participate in the
provision of health care or to cope with
crisis (Corales & Medina, 2011).
 The format of the tool is user-friendly and
therefore, apt for a doctor in a busy
Family Practice.
 SCREEM Family Resource
Survey (SCREEM-RES)
 Family caregivers are asked to choose one of the
following responses :
• Strongly disagree
• Disagree
• Agree Strongly Agree

 The interpretation of SCREEM-RES is similar to the

Family APGAR where the sum of the scores is
interpreted (Medina et al. 2011) :
• 0-6 = the family has severely inadequate family
resources.
• 7-12 = moderately inadequate family resources.
• 13-18 = adequate family resources.
 Family Lifeline
 It is tool that summarizes the history of the
family, particularly the individual or the
family’s significant experiences over a
period of time in a chronologically-
sequenced manner, and includes how the
family has coped with these stressful life
events.
 The interpretation is based on the most
significant event that probably affected the
health of each member or influenced the
health-seeking behavior or perception on
health of the individual or the family.
 Family Life Cycle
 This is a description of the family
dynamics through clearly defined
stages of development.

 It provides a predictable and

chronological sequence of events in the
family’s life, which can be related to
clinical events and to the health
maintenance of family members.
 ECOMAP
 It is a pictorial representation of a family’s
connections to persons and/or systems in
their environment.

 It’s purpose is to support classification of

family needs and decision making about
potential interventions, and it is to create
shared a awareness of the family’s
significant connections and the constructive
influences those connections may be having.
 ECOMAP

 It can illustrate 3 separate dimensions

for each connections :
 STRENGTH of the connection
 IMPACT of the connection
 QUALITY of the connection
ECOMAP is Necessary & Valuable
because it :
 Enables a structures, consistent process for gathering specific,
valuable information related to the current state of a family or
individual being assessed
 Supports the engagement of the family in a dialogue.
 Indentifies and illustrates strengths that can built upon and
weaknesses that can be addressed.
 Summarizes complex data and information into a visual, easy to
see and understand format to support understanding and
planning.
 Illustrate the nature of connections and the impact of
interactions in pre-defined “domain” areas.
 Provides a consistent base of information to inform and support
intervention decisions.
 Allows objective evaluation of progress.
 Helps support integration of the concept of family assessment as
an ongoing process.
 Reduces narrative in other parts of the family assessment
process.
 Integrates the values and concepts in a practical way.
 Rules in Drawing the

Ecomap
At the center of the ecomap, a simplified view of the
family members in the household should be depicted,
using Genogram symbols and conventions.
 The intent is for each individual in the household to
be addressed.
 There are some domains that will, for some families,
apply at the household level, or for all individuals in
the family.
 Each individual can be “brought out of the center”
into its own circle and then domains that need to be
addressed for the individual can be.
 If a family or an individual is so complex that the
ecomap becomes messy, you can illustrate any
individual or household on its own.
 Rules in Drawing the
Ecomap
 Illustrate the existence of a connection and the
strength of it.
 Illustrate the impact of a connection, place an
arrow on the end of the line indicating whether
resources and energy are flowing to a person or
away from a person.
 If a connection is stressful, illustrate with a
jagged line superimposed on the connection line.
 Brief summary comments may be written inside
the domain circles.
 Domains should be identified on the ecomap.
 Other Family Assessment
Tools
 Draft (Draw a Family Test)
 The Family Circle
 DRAFT

 Draw a Family Test

 This is a simple, practical, and cost-
effective tool for assessing family
functions that can be administered
individually or in-group test.
 Members of the family are given the
opportunity to express oneself and
consequently reveal innate difficulties
within the family system.
 DRAFT
 Found to be useful and revealing because of the
following reasons :

1. Evasive and guarded patients are more likely to

reveal their underlying traits because subjects are
more intellectually aware of what they may reveal
through verbal communication.

2. The unconscious label which represents adultered

basic needs can be expressed through drawing.

3. Drawings are the first to show incipient

psychopathology and the last to lose the signs of
illness after patient recovery.
 Draw A Family Test
 It tells a lot about the patient’s
feelings, relationships they have with
people around, self-esteem and
intellectual problems.
 A very informative method of getting to
know the patient especially when
working with kids.
 Family Circle
 A brief, graphic method for disclosing,
gathering and discussing family dynamics as
discussed by one or more family members.
 Are often used in individuals but they can be
applied to small groups.
 Through this tool one can assess openness,
boundaries, support, function, triangulation
and interdependence in the family.
 Difficulty of interpretation and
standardization poses as a disadvantage.
 Level of Family
Involvement
 Lastly, it is essential for family
physician to know how far they can go
in assesssing family dynamics and their
relation to health care.
 Doherty et al. (1999) created a model
of the five levels of involvement with
families.
 Five Levels of Family
Involvement
 Level I : Minimal emphasis on the family in the
delivery of health care.

 Level II : Ongoing medical information and advise.

 Level III : Feelings and support.

 Level IV : Assessment of family dysfunction and

provision of intervention.

 Level V : Family Therapy

THANK YOU