FAMILY ASSESSMENT

TOOLS
DEPARTMENT OF PUBLIC HEALTH & PREVENTIVE MEDICINE
FACULTY OF MEDICINE, UNIVERSITAS PADJADJARAN
2013
 LEARNING OBJECTIVES

• Describe the advantages for assessing

family (C2)
• Define the family genogram, family map,
family APGAR and its function (C2)
Why do we Need tools to Assess the family?

• assess family functioning

• assess family dynamic
• assess coping mechanisms
of the family
• assess resources
• assess family structure
Why do we Need tools to Assess the family?

• to have a picture of the multigenerational

patterns of behavior or illnesses.
• to assess the normal crisis or common
illness to be encountered in each stage of
development.
• to provide anticipatory care and guidance.
 An understanding of the family in terms of the
struggles to be functional will enable FP to make
correct diagnosis and intervention
 FAMILY DYNAMICS
• An interactions and
relationships among
the individual
members of a family
• Reflects and
influence the
physical, mental and
spiritual health of the
individuals in a
family.
 FAMILY DYNAMICS

• An understanding of the dynamics helps the

attending family physician to diagnose the
disease and dis-ease in the patient sitting in
his consultation room and to recognize the
factors that may help or retard the recovery of
this patient.
 FAMILY ASSESSMENT TOOLS

Anatomy Development Function Impact

• Genogram • Family • APGAR • BATHE
life cycle • Family
Map
• Lifeline
• SCREEM
GENOGRAM

Is a biopsychosocial family tree.

It records the family in its life cycle,
family illnesses and relationship

A genogram is a versatile clinical tool

that can help FP integrate a patient’s
family information into the medical
problem-solving process for better
patient care
• A genogram supplements the problem list  giving
FP an overview of the main problems affecting the
family over 3 or more generations
• A genogram can be drawn in skeletal form during
one of the first few visits, ideally the first visit and
then it can elaborated during subsequent visits as
more is known about the family
 GENOGRAM COMPONENTS
Symbols
Standardized Symbols used in Family Genograms

d date of divorce
male
D Date of death
female
abortion or miscarriage
Sex not specified
Induced abortion
Deceased/death Pregnancy-child in utero

A Adopted female Dizygotic twins

b date of birth Monozygotic Twins

m date of marriage
 STANDARDIZED SYMBOLS USED IN FAMILY GENOGRAMS

Symbols of diseases or situation

Obesity ♥ ♥ Heart disease

Allergy Stroke

xxx xxx Alcoholism

  Depression

Asthma
War Casualty

Hypertension
COMMONLY USED ABBREVIATIONS

ALC Alcoholic GI GI tract disease

ALL Allergy HT Hypertension

ARTH Arthritis MI Myocard Infarction

MVP Mitral Valve Prolapse

CAD Coronary Artery
Disease
Cerebrovascular PUD Peptic Ulcer Disease
CVA
Accident
CA Cancer SLE Systemic Lupus
Erythematosis
DEP Depression
TB Tuberculosis
DM Diabetes mellitus
STANDARDIZED SYMBOLS USED IN FAMILY GENOGRAMS

Close relationship
married and year
1989
Family living together

1990 Separation and

year

1992 Divorce and year

1989

Unmarried 1989
relationship

Conflictual relationship 1992

Distance relationship
 Bakri, as of 8 April 2010
1. Symbols
2. Three or more generations
3. The name of family 1969 Ardi,68
I 1970 Nia,64
4. A listing of the first born of
each family to the left, with
siblings listed sequentially to II
the right
5. The names of all family
member
III
6. Age or year of birth of all family members
7. Any deaths, incl. age of death and cause
8. Dates of marriages and divorces
9. Significant diseases or problems of family members
10. Indication of members living together in the same
household
11. A key depicting all symbols used
12. Symbols selected for simplicity and maximum visibility
FAMILY INFORMATION IS USED IN 3 TYPE
SITUATIONS:

1. Evaluating somatic complaint by testing

biopsychosocial hypotheses
2. Assessing a patient’s risk for biomedical and
mental disorders
3. Planning management by considering how
family factors may facilitate or complicate it
 USES OF THE GENOGRAM
(CROUCH AND DAVIS, 1987)

• Allowing the family physician and other health professional to

review quickly the family situation
• Building rapport by using the first names of family members,
knowing who is living in the home
• Identifying at a glance significant risk factors : Hypertension,
DM, Ca, Obesity etc
• Recognizing the need for screening in patients who at high risk
• Promoting lifestyle changes and health education (healthy
living)
• Demonstrating that family relationship are a concern of the
family physician and important to the health of each family
member
Relationship of the members

This is a self-drawing by an 8 year

old girl who participated in a
support group for children
affected by domestic violence
sponsored by Cedar Valley
Friends of the Family.

One cannot escape sensing this

child's unhappiness; the frown she
drew on her little face clearly sets
the mood. However, the up-side-
down rainbow is perhaps the most
significant message... Generally,
we think of rainbows as a happy
reminder of hope for the future. In
this simple drawing, the little girl
innocently, but quite vividly
 FAMILY MAP

Genogram : 24 January 2008

Sugeng Ani Putro

Lung Ca
AMI  myoma

43 84 1959 84

60 58 54 48 44 44
DM FAM
CA Sam 46
Utomo Sri Colon/Renal Arti Tyio Tuti Nina

20 16

Aria Imam
 APGAR

• This is a five-item questionnaire

designed to elicit the patient’s
perception of the current state of his
family relationships, and serves as a
rapid screening instrument for family
dysfunction.
 APGAR

• Adaptation is the capability of the family to utilize and

share inherent resources
• Partnership is sharing of decision making. This measures
the satisfaction attained in solving problems by
communicating.
• Growth refers to both and emotional growth. This
measures the satisfaction of the availability freedom of
change
 APGAR
• Affection is how emotions like love, anger and hatred are shared
between members. This measures the members’ satisfaction
with intimacy and emotional interaction that exist in the family.
• Resolve refers to how time, space and money are shared. This
measures the members’ satisfaction with the commitment made
by other members of the family.
• 8-10 point (Highly functional family)
• 4-7 point (Moderately dysfunctional family)
• 0-3 point (Severely dysfunctional family)
 BATHE TECHNIQUES
(Stuart and Lieberman’s)

• 15 minutes method of B = Background

primary care counseling
A = Affect
• It helps draw out the quiet
patient and provides a T = Troubling
structure of when to move on
in a talkative patient H = Handling

E = Empathy
• B = Background : assessing what’s the background
situation (areas of psychological problems)
• “How are things at home?” At work?
• What’s different in your life between now and before?

• A = Affect = the patient’s affect (about common

areas generating strong feelings)
• “How do you feel about your home life?”
• “How do you feel about your work/school?”
• T = Troubling: the problem that is most troubling for
the patient
• “What most worries you about your life?”
• “How stressed are you by this problem?”
• “What do you think this problem means to
you?”

• H = Handling: the manner in which the patient has

been handling the problem, problems are often
mishandled life difficulties
• “How are you handling the problems in your
life?”
• “What have you tried to solve the difficulty?”
• “How much support are you getting at
home/work?”
• “Who gives you support for dealing with
problems?”
• E = Empathy : respons that conveys
empathy,express understanding of the patient’s
distress
• “I can understand that you would feel angry”
• “That must have been difficult”
• “This is a tough situation to be in”
 Thank you…

1. Rakel RE. The Family Genogram. In Rakel RE.

Textbook of Family Practice. Sixth Edition. WB Saunders
Co. Philadelphia. 2002. pp 19 – 30.

2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine

Practice. Singapore, 2004. section 3 chapter 3 pp 58-62