[02.15] The Family as a Unit of Care_ Family Systems, Family Assessment Tools V2.pdf

A wholistic approach

What framework promotes patient-centeredness and reminds us that a patient's context is important alongside the disease process?

Biopsychosocial Approach to Health Care

What framework tells us that both biomedical and psychosocial aspects of a patient's condition affect the illness process and should be considered in management?

The family

What plays a critical role in the course of disease and the outcome of treatment?

Therapeutic ally

What must a doctor enroll the family as to help in the treatment of an individual's illness?

Connectivity

When discussing families, what aspect should be emphasized rather than completeness?

A group of two or more persons related by birth, marriage, adoption or emotional ties residing together in a single household

What is the standard textbook definition of a family?

Burgess and Locke

Who defined a family as a group of persons united by ties of marriage, blood or adoption; consisting of a single household; interacting and communicating in their social roles; and maintaining a common culture?

Murdock

Who defined a family as a social group characterized by a common residence, economic cooperation, and reproduction?

Nuclear family

What type of family structure consists of parents and dependent children, is economically independent, and lives in a separate dwelling?

Family of Origin/Orientation

What type of nuclear family includes parents and siblings?

Family of Procreation

What type of nuclear family includes a spouse and children?

Extended family

What type of family structure includes three generations living together as a group?

Kinship network provides function to all members

What is a key functional aspect of an extended family?

Unilaterally Extended

What type of extended family includes parents of either the husband or wife?

Bilaterally Extended

What type of extended family includes parents of both the husband and wife?

Lineal family

What type of family consists of two or more generations with each generation composed of one married couple (or a divorced person, widow, or widower)?

Joint family

What type of family consists of two or more married couples (or a divorced person, widow, or widower) of the same generation?

Single Parent Family

What type of family consists of children under 17 years of age living with a single parent, another relative, or non-relative?

Loss of spouse by death, divorce, separation, desertion; Out of wedlock birth; Adoption; Migration (OFWs)

Name some causes that may result in a single parent family.

Blended family

What type of family includes step-parents and step-children, often caused by divorce, annulment with remarriage, or separation?

Communal family

What type of family is a grouping of individuals formed for specific ideological or societal purposes, often considered an alternative lifestyle?

Biologic, Economic, Psychologic/Affection, Educational, Sociocultural

What are the five basic areas of functions of the family?

Reproduction, Child-rearing/caring, Nutrition, Health Maintenance, Recreation

Name the functions under the Biologic area of family function.

Provision of adequate financial resources, Resource allocation, Ensure financial security

Name the functions under the Economic area of family function.

Promotes natural development of personalities, Offer optimum psychological protection, Promotes ability to form relationships

Name the functions under the Psychologic/Affection area of family function.

Teach skills, attitudes and skills relating to other functions

Name the function under the Educational area of family function.

Socialization of children, Promotion of status and legitimacy, Agent of stratification

Name the functions under the Sociocultural area of family function.

Social context where illness occurs and recovery takes place

Why is it important to study the family in relation to illness?

Families

What transmits infectious diseases (like respiratory infections, acute gastroenteritis) and inherited health conditions (like hypertension and diabetes)?

From the family

Where are health behaviors, such as taking fruit juices for colds or applying toothpaste for burns, acquired?

Families

Who makes health decisions, especially for minors or incapacitated members, and defines health and illness?

When someone has to be brought to the physician for consultation; Give consent for certain procedures

What specific health decisions do families make?

Stress; Sources of social support

What two contrasting impacts can families have on their members in times of crisis?

Closely knit, Bilaterally extended, Authority based on seniority/age (or economic capacity), Externally patriarchal, Internally matriarchal, High value on education, Predominantly Catholic

List the attributes that describe a typical Filipino Family.

Urban and global migration, Changing commitments, Changing roles of women

According to Dr. Michael Tan, what factors have brought about changes in Filipino families?

Single parents, Step parents, Absconding fathers or mothers, Absent fathers or mothers, Surrogate parents, Bicultural parents, Two daddies, two mommies

Name some new parental configurations that have resulted from changes in Filipino families.

An emotional unit; A system with members with roles to play and rules to follow

What two characteristics define a family within the Family Systems Theory?

An entity composed of discrete parts which are connected in such a way that a change in one part results in changes in all other parts

What is a system?

Crib mobile analogy

What analogy is used to illustrate that a change in one part of a system affects all other parts, eventually leading to a new stable configuration?

To understand the family system of that individual

According to Family Systems Theory, to understand an individual, what must we understand?

Circular changes

What type of changes do families, as systems, exhibit, meaning a change that happens to one member also affects the rest of the family?

Resist change and maintain a state of homeostasis

What do families, as systems, have a tendency to do regarding change and balance?

Reaches a state of equilibrium

Even if change happens within a family system, what state does it eventually reach?

Dr. Salvador Minuchin

Who pioneered the Structural Approach to Family Systems?

The clarity and appropriateness of its structure

According to the structural approach, what does a family's ability to adapt to stressors depend on?

Clear hierarchy, roles, subsystems, and boundaries

What four aspects must a family have according to the structural approach?

Structures, Rules, Boundaries, Subsystems, Roles, Coalitions, Power Structures

List the elements of the family system.

Behavioral patterns repeated over and over again; Behavioral skeleton; Practices, customs, or traditions passed on

What are Structures in the family system context?

Series questions

What type of questions may be used to identify the structures in a family, asking "When situation A happens, what happens to member 1?"

Commonly agreed upon ways of dealing with each other, situations, and the external environment

What are Rules in the family system context?

Overt Rules

What type of rules are explicitly stated, such as a 10 PM curfew or a zoom prayer time at 8 PM?

Covert Rules

What type of rules are not stated but understood by the rest of the family, such as seating arrangements at a dinner table?

Graver consequences

What may happen when a covert rule is violated, especially because the violator may be unaware?

Specific functions assigned to family members

What are Roles in the family system context?

Primary Breadwinner, Primary Caregiver, Symptom carrier, Family Doctor, Medical specialist

Give examples of roles within a family.

Symptom carrier

What role describes a family member who tends to have symptoms, like an asthma attack or abdominal pain, without physical reasons, when there is conflict within the family?

Family Doctor

What role describes the family member, like an eldest tita or lola, who is asked for advice when someone is sick in the family?

Medical specialist

What role describes the individual approached in the family if the advice of the "Family Doctor" does not work?

"Who-Does-What-And-When" questions

What type of questions are used to explore the different roles in the family during history taking, such as "When someone gets sick in the family, who do you usually go to first?"

Grandparental, parental, sibling subsystems

What are examples of subgroups within a family separated by a significant period of time?

Special rules that govern the interactions between subsystems in the family

What are Boundaries in the family system context?

Clear, Rigid, Diffuse

What are the three types of boundaries?

Clear

What type of boundary is characterized by clarity, negotiability, and flexibility, allowing an adolescent freedom to become independent?

Rigid

What type of boundary is not open to negotiations, marked by indifference, and exemplified by an overly strict parent preventing a child from exploring friendships?

Diffuse

What type of boundary lacks clarity and leads to intrusions by one subsystem into another, such as an overly dependent son whose mother makes all his decisions?

Alliances between members; Informal groupings of people who usually side with each other

What are Coalitions in the family system context?

Cinderella's stepmother and stepsisters

What example is given for a coalition?

"Who agrees with whom" questions

What type of questions are used to explore coalitions within the family, such as "Who is the person that the patient usually disagrees with in the family?"

Decision-makers

What are Power Structures in the family system context?

Parental generation (parents or grandparents)

Who are usually the decision-makers in a family's power structure?

The ones who finance different processes within the family

Who, besides parents or elders, might be the decision-makers in a family, especially in cases like OFWs?

Enmeshment

What family process, introduced by Dr. Minuchin, describes families where personal boundaries are diffused, subsystems are undifferentiated, and there is an overconcern for others, leading to a loss of autonomous development?

Disengagement

What family process describes members who tend to be cold or distant, lead separate lives, and have very little emotional connection, even if living in the same house?

Triangulation

What family process involves a pair of family members incorporating or rejecting a third one, often a child feeling symptoms due to conflict between parents?

"Closer-Farther" questions

What type of questions are used to explore emotional closeness and distance (resonance) within the family, such as "Who is closest to this patient?"

Circular questions

What general type of questions may be used to explore behavior, roles, resonance, and coalitions within the family?

Series questions, "Who-does-what-and-when" questions, "Closer-farther" questions, "Who agrees with who" questions

Name the four specific types of circular questions mentioned and what they explore.

Family map

What tool can be used to reflect family psychodynamics, including relationships and interaction patterns, and is important for physicians to identify therapeutic allies?

Characteristics (members), Structure (boundaries, alliances, coalitions), Process (enmeshment, disengagement), Across time (intergenerational coalition)

What information does a family map typically include?

Standard symbols

What does a family map use to represent relationships?

Functional relationship

What does a single straight line between two individuals mean in a Family Map?

Enmeshed or over-involved relationship

What does a triple parallel straight line between two individuals mean in a Family Map?

Dysfunctional relationship

What does a wavy line between two individuals mean in a Family Map?

Clear

What does a single perpendicular line on a relationship line mean in a Family Map?

Rigid

What does a double perpendicular line on a relationship line mean in a Family Map?

Diffused

What does a dotted perpendicular line on a relationship line mean in a Family Map?

Coalition or Alliance

What does a curved line connecting three individuals mean in a Family Map?

Escape from the system; disengagement

What does a broken line with an arrow pointing out from an individual mean in a Family Map?

Triangulation

What does a triangle connecting three individuals mean in a Family Map?

Systematic ways of understanding the family; Enable physicians to anticipate and address the impact of illness

What is the purpose of family assessment tools?

Easy to use, Short, Non-intrusive, Elicits clinically relevant data

What are the characteristics of an ideal family assessment tool?

Family Structure Genogram, Family Development Family Life Cycle, Family Function APGAR/Lifeline, Family Resources SCREEM/Ecomap

List the different categories of family assessment tools and an example for each.

Family Structure Genogram

What tool uses standard symbols to depict inheritance patterns, family illnesses, members, relationships, and significant dates across generations?

Index patient, Names/ages of all family members, Date the genogram was generated, Legend of symbols for medical conditions, Exact dates of birth/marriage/etc., Information covering 3 or more generations, Illnesses, Firstborn to the left/siblings to the right, Indication of household members (circle), Names/address of 2 families, Informant/s

List the information that should be included when constructing a genogram.

A work in progress

How should genograms be viewed when first encountering a family, as it's often impossible to get all information immediately?

When a good relationship is established with the patient and they regularly come for follow-ups

Under what conditions can a complete genogram only be constructed over time?

Family Life Cycle

What is a conceptual tool for understanding family development, describing transitions between stages that are rarely clear-cut?

Coupling, Expansion, Contraction

What are the three general phases of the Family Life Cycle?

Unattached Young Adult, Newly Married Couple, Family with Young Children, Family with Adolescents, Launching Family, Family in Later Years

List the six stages of the Family Life Cycle.

Provide support, Establish autonomy/independence, Create rules, Adapt to change, Communicate

List the basic functions of the family.