Using Family Tools
Family assessment tools are a systematic way of understanding the family and aid them in evaluating the impact of illness on a person and on his/her role in the family.
Step 1
- Recognize the Family Structure.
- Know the individual members of the family.
- A systematic way of obtaining and recording this information is through the use of a Family Genogram.
Step 2
Understand the normal family function
Step 3
- Learn to assess Family Structure and Function in Clinical Practice.
- Family assessment tools have been made to aid the family physician in assessing the family structure and function in clinical practice.
Family Screening Assessments
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 tests. Members of the family are given the opportunity to express themselves and consequently reveal innate difficulties within the family system. 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. Found to be useful and revealing because of the following reasons:
- 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.
- The unconscious label which represents adultered basic needs can be expressed through drawing.
- Drawings are the first to show incipient psychopathology and the last to lose the signs of illness after patient recovery.
Family Genogram: a graphic representation of a family tree that displays the interaction of at least 3 generations within a family. The genogram graphically shows all the living and dead people who genetically, emotionally, and legally comprise a family.
Family APGAR: This is a 5-question assessment tool used for rapid assessment of family function and dysfunction. It measures an individual’s level of satisfaction about family relationships:
- Adaptation- the ability of a family to use and share inherent resources which can be either intra- or extra-familial.
- Partnership- the sharing of decision making which measures the satisfaction of solving problems through communicating.
- Growth- pertains to both physical and emotional aspects and measures the satisfaction of the freedom to change.
- Affection- emotions that are shared with and between family members which measure the satisfaction with the intimacy and emotional interaction that exist in the family.
- Resolve- refers to how time, money, and space are shared; this measures the satisfaction with the commitment made by members of the family.
EVALUATION: Highly Functional 8-10, Moderately Functional 4-7, Severely dysfunctional 0-3
FACES (Family Adaptability and Cohesion Evaluation Scale): This is an assessment tool based on Olson’s circumflex model of family function. The patient rates his family on a 30-item questionnaire on a 1-5 scale which measures the adaptability and cohesion of a family. It costs $95 to use clinically –Faces-IV
FES (Family Environmental Scale): This is a tool developed by Moos which is a 90-item questionnaire used as a research tool to compare health care results with family variables.
Clinical Biography and Life Events: a tool that has the capacity to put side by side significant life and clinical events with their dates of occurrences and make a connection between these facts.
SCREEM: It is an 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 patients. It can also be used to assess the resources of difficult and non-compliant patients.
Family Lifeline: It is a 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 of the health of the individual or the family.
- It is used to show the family’s significant events over a period of time in a chronological sequence.
- It includes normative and nonnormative crisis
- It is sometimes placed side by side with the illness history
- It helps process how flexible a family is when dealing with these changes
Family Life Cycle: 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.
- The difficulty of interpretation and standardization poses a disadvantage.
Ecomap: At the center of the ecomap, a simplified view of the target 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 for Drawing an Ecomap:
- At the center of the ecomap, a simplified view of the target 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 its 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.
In-depth Family Assessment
- Calgary Family Assessment Model (Wright & Leahey, 1994): gather information about family structure, development & functioning.
- Friedman Family Assessment Model (Friedman, 1998): consists of six broad categories of interview questions.
Levels of Family Involvement: Lastly, it is essential to know how far they can go in assessing 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 advice.
- Level III: Feelings and support.
- Level IV: Assessment of family dysfunction and provision of intervention.
- Level V: Family Therapy.
Additional Information & References
- Family Tools and Assessment in SlideShare
