Family Assessment Tools

UNIVERSITY OF SAINT LA SALLE

Department of Family & Community Medicine
Prof. Dr. B.S. Gareza
 Family Assessment Tools

What is a test?

It is an objective and standardized measure of a sample behavior. It is the

same way a clinician test human blood in order to come to a diagnostic overview.

Why is a test essential?

Demographic changes over the part two decades have increased the diversity of
various social institutions like the family and brought transformation in many ways. One
such example is the emerging varied definitions of family.

A problem, called the fallacy of a stereotyping occurs when people act on an

element of the schema as if it applied to all members of the classification (Scriven, 1976).

It is when faced with this situation, when one does not fit the general
population that testing is essential (Sandoval, 1999).

Individuals or institutions (family) are measured to establish their eligibility for

benefits or services, to determine which services are appropriate, to assess their needs, to
ascertain their current level of functioning, and to estimate their potential (NIDRR, 1992)
 Family Assessment Tools

Uses of Test (assessment/diagnostic tools)

1) to measure differences between individuals or between the reactions of the same

individual under different circumstances

2) examination of persons with severe emotional disorders and other types of

behavioral problems

3) important in individual or group counseling

4) to enhance self-understanding and personal development

5) use in the solution of practical problems

6) use in research

7) provide standardized tools for investigating such varied problems as life-span

developmental changes within individuals, the relative effectiveness of different
educational procedures, outcomes of psychotherapy, impact of community
program, and the influence of environmental variables on human performance
 Family Assessment Tools

Family Dynamics Test, What is it?

A measurement of a broad range of intra-familial relationship characteristics such

as problem solving, communication, affective involvement, affective
responsiveness roles, behavior control, and adaptability.
 Family Assessment Tools

Major Context of Current Test Used in the Clinical Setting:

1) psychological assessment one of its main characteristics is a focus on the

intensive study of one or more individuals (couple or family) through multiple sources
of data.By maintaining support, the clinician/researcher may elicit pertinent facts about
his/her family life not accessible in other ways.

Information derived from observation, interviewing, and the case-history is

combined with test scores to provide an integrated picture of the individual.

2) dynamic assessment for learning disabilities for learning potential assessment

using the testing the limits concept.

3) behavioral assessment helps in defining the individuals problem and includes a

description of the stimuli that elicit the target behavior, the situations in which such
behavior occurs, are the nature, magnitudes, and frequencies of particular responses.

4) clinical judgment throws considerable light on some of the possible sources of

error in this process, such as the influence of cultural stereotypes and reliance on
fallacious prediction principles.
 Family Assessment Tools

Ethical and Social Standards of Test:

1) confidentiality who shall have access to test results?

Guiding principle:
Such records should not be released without the knowledge and consent
of the test takers unless such a release is mandated by law or permitted
by law for valid purposes.

2) validity the extent to which a test measures what it purports to measure. Test
validation is a developmental process that begins with test construction and
continues indefinitely after a test is released for operational use.

Ex: Use of neuropsychological tests in the Dx of damage has lessened

because of the modern medical technology, but its importance lies in
measuring the effects of brain damage to the persons everyday life
and experience across time and culture.
 Family Assessment Tools

Ethical and Social Standards of Test:

3) reliability refers to the attribute of consistency in measurement within test

items,
and across independent raters.

4) cultural diversity involves test fairness in test interpretation. Is the test

appropriate for the entire cultural population of test takers?
 Family Assessment Tools

TEST INSTRUMENTS

I. FAMILY GENOGRAM (family pedigree, family tree, geneologic chart)

A tool used by physicians to summarize on one page a large amount of

information about the family. It includes:

1.1 hereditary background and the risk this places on family

1.2 social or environmental influences

1.3 habits or traits that will predispose members to the development of

some
problem

1.4 the degree of susceptibility of any individual can be identified by

noting the
frequency of occurrence in previous family members.
 Family Assessment Tools

TEST INSTRUMENTS

I. FAMILY GENOGRAM

Basic genogram containing family names, first names, and ages (A) or birthdates (B)
 Family Assessment Tools

TEST INSTRUMENTS

I. FAMILY GENOGRAM
 Family Assessment Tools

TEST INSTRUMENTS

I. FAMILY GENOGRAM
Commonly Used Abbreviations

ALC Alcoholic
ALL Allergy
ARTH Arthritis
CA Cancer
CAD Coronary Artery Disease
CVA Cerebrovascular Accident
DEP Depression
DM Diabetes Mellitus
GI GI Tract Disease
HBP or HT Hypertension
MI Myocardial Infarction
MVP Mitral Valve Prolapse
PUD Peptic Ulcer Disease
SLE Systemic Lupus Erythematosis
TB Tuberculosis
Family genogram with additional information on each individual at bottom of chart.
 JOHN (52) PENNY (32) JAY (30)
Back injury School teacher Sailor, 2 children, Divorced
Rectal fissure Migraine headaches Abdominal pain after
fathers death

CARL (17) BRAD (14) LAURA (8)

Hives Premature birth Meningococcal meningitis
Allergy to dust Hyperkinetic on Ritalin Wears corrective shoes
Undescended testicles Inferiority complex
 Family genogram with bipolar affective disorder.
(From Rakel RE: Principles of Family Medicine. Philadelphia, WB Saunders Company, 1988, p. 489)
 Components of a Genogram:

1. 3 or more generations
2. names of all family members
3. age or year of birth of all family members
4. deaths to include age at date of death, cause
5. significant diseases or problems
6. indication of members living together in some household
7. dates of marriages and divorces
8. listing of first born of each family to the left, with sibling listed
sequentially to the right
9. key depicting all symbols used
10. symbols selected for simplicity and maximum visibility
 INTERPRETATION:

Four (4) Components of the Family Genogram

(as to analysis and interpretation):

1. structure type of family structure, composition of the IPs current family unit
and its function, and marital status

2. family demographic information include ethnicity, education and occupation

3. family life events marriages, separations and divorce; birth and death;
major social of health problems;
the time and sequence of occurrence of these events
and the confluence or pile up of events

4. social and health problems number of problems and their consistency

among family members
Guiding Principle in Interpretation:
There is no normal genogram.
The interpretation of the reading depends on the desired
clinical decision the clinician wants to apply to the situation.
Theories Applied to Interpretation:
1. developmental theory or life cycle describes the hazards and risks pertaining
to structure and junction of the family as
it moves through the predictable
stages of the life span

2. stress - social support theory availability of resources for coping

3. genetic theory how health problems are transmitted from one generation to another

4. family systems theory this theory postulates that any stress or pain experienced
by one member is felt and reacted to in some ways by all the
members of the family, each in her own way.
Visualization of family roles and interpersonal
relationship allows one to judge totality of family unit.
II.FAMILY CIRCLE

Indicates the emotional relationships of a family as

depicted by one arrow; the size of the circle indicates
importance; the distance from others reflects the
degree of emotional attachment of closeness. The
date is very important because these relationship may
change over time.
My husband, son and I are the most important to me. My mom is also very important;
but I dont feel as close to her as I feel to my friend. I feel very distant from my dad.
Family circle chart. (From Kertesz J: Urban family mapping. In Birrer RB, (ed):
Urban Family Medicine. New York, Springer-Verlag, 1987, p. 74)
III.Smilkstein Family APGAR Score
assessment of family function:
functional or dysfunctional
IV. SCREEM assessment of the familys resources or lack of it,
strengths and weaknesses
SCREEM resources of the family

STRENGTH
Cultural WEAKNESSES
+
Social +
Religion
+
Education
+
Economic
+
Medical
+
 SCREEM
Very important in the assessment of the family as to its
capacity to participate in provision of health care or to
cope with crisis is the SCREEM method of analysis.
SCREEM is an acronym that stands for Social, cultural,
religious, Economic, educational and Medical factors
affecting health. These factors can be considered as
resource and as pathology.
 Resources Pathology
Social
Social interaction is evident among * Isolated from extra-familial
family members. Family members have
well-balanced lines of communication with * problem of over-commitment
extra-familial social groups suchReligious
as friends,
sports, clubs, and other communityspiritual
Religious offers satisfying groups * rigid dogma/rituals
experiences as well as contacts with
an extra-familial support group
Cultural
Cultural pride or satisfaction can be identified, * ethnic/cultural inferiority
especially in distinct ethnic groups

Religious
Religious offers satisfying spiritual * rigid dogma/rituals
experiences as well as contacts with
an extra-familial support group
 Resources Pathology
Economic
Economic stability is sufficient to provide * economic deficiency
both reasonable satisfaction with financial
status and an ability to meet economic * inappropriate economic plan
demands of normative life events

Educational
Education of family members is adequate to * handicapped to comprehend
allow members to solve or comprehend most
of the problems that arise within the format
of the life style established by the family
Medical
Medical Health care is available through * not utilizing health care
channels that are easily established and facilities/resources
have previously been experienced in a
satisfactory manner
 FILIPINO FAMILY APGAR QUESTIONNAIRE
Almost Some of Hardly
Always the Time Ever

A I am satisfied that I can turn my

family for help when something
is troubling me

P I am satisfied with the way my

family talks on things with me
and shares problems with me

G I am satisfied that my family

accepts & supports my wishes to
take on new activities or
directions

A I am satisfied with the way my

family expresses affection and
responds to my emotion such as
anger, sorrow, and love

R I am satisfied with the way my

family and I share time together

TOTAL
PART I: Helps define degree of patients satisfaction or dissatisfaction with family function.
 FAMILY APGAR II

Questionnaire:
Relationship Age Sex
Who lives in your home? How you get along?

Relationship Age Sex Well Fairly Poor

If you dont live with your own family

List the persons to whom you turn to How you get along?
for help

Relationship Age Sex Well Fairly Poor

Part II delineates relationship with other members.

Also, it identifies persons who can give assistance to the patient.
And lastly, it indicates conflict not revealed in Part I.
The scoring:
almost always = 2 points
some of the time = 1 point,
hardly ever = 0 point.

Then add up the points.

A total of 8-10 points = highly functional family

4-7 points = moderately dysfunctional family
0-3 points = severely dysfunctional family
Family Assessment Tools

End of Lecture