 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
 Understand the family normal 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
 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
 Family Genogram
 Family Map
 Family APGAR
 SCREEM
 SCREEM Family Resource Survey
(SCREEM-Res)
 Family Lifeline
 Family Life Cycle
 Ecomap
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
 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
 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.
 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.
 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”
 Delineates relationships with other
members, identifies persons who can
give assistance to the patient, and
indicates conflicts not revealed in part I
 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
 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.
 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
 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.
 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.
 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.
 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.
 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.
 It can illustrate 3 separate dimensions for
each connections :
 STRENGTH of the connection
 IMPACT of the connection
 QUALITY of the connection
 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.
 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.
 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.
 Draft (Draw a Family Test)
 The Family Circle
 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.
 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.
 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.
 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.
 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.
 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