THE FAMILY

Basic Concepts on the Family Burgess and Locke (1960) defined the family as a group of persons united by ties of marriage, blood or adoption; consisting a single household; interacting and communicating with each other in their respective social roles of husband and wife, mother and father, son and daughter, brother and sister and creating and maintaining a common culture

Basic Concepts on the Family Berman defines the family as a small social system made up of individuals related to each other by reason of strong reciprocal affections and loyalties and comprising a permanent household

Basic Concepts on the Family Rogers considers the family as a semi-closed system of actors occupying interrelated positions defined by society of which the family system is a part as unique to that system with respect to the role content of the positions and to the ideas of kinship relatedness

The Filipino Family CHARACTERISTICS: Closely knit Bilaterally extended Strong family orientation Authority is based on seniority / age Externally patriarchal, internally matriarchal High value on education of members Predominantly Catholic (80%) of population Child-centered Average number of members is 5 (NEDA statistics) Environmental stresses: economic, political, urbanization and industrialization/ urbanization, health problems

The Family as a Very Special Unit Lifelong involvement Shared attributes Genetics – physical and psychological Developmental – shared home, lifestyle and social activities Sense of belonging Security / defense against a potentially hostile environment companionship

The Family as a Very Special Unit Societal expectations Sense of responsibility towards members Sense of responsibility towards others Basis of affection/care Built-in problems Generation gap Dependence of members Emotional attachment/involvement The family endures inspite of problems Resource utilization Authority Individual sense of responsibility

FAMILY STRENGTHS The ability to provide for the family’s needs PHYSICAL: Space management, nutritionally balanced meals, family’s general health status EMOTIONAL: Helping family members recognize and develop their capacity for sensitivity to each other’s needs SPIRITUAL & CULTURAL: Sharing of basic beliefs and cultural values

FAMILY STRENGTHS Child-rearing practices and discipline: The capability of both parents to respect each other’s views and decisions on child-rearing practices If a single parent, the capacity of the single parent to be consistent and effective in raising the child or children

FAMILY STRENGTHS Communication: The ability to communicate and express a wide range of emotions and feelings both verbally and non-verbally

FAMILY STRENGTHS Support, Security & Encouragement: The capacity of the family to provide its members with feelings of security and encouragement Balance in the pattern of family activities

FAMILY STRENGTHS Growth-producing relationships The family’s ability to maintain and build friendships and relationships in the neighborhood

FAMILY STRENGTHS Responsible community relationships The capacity of family members to assume responsibility through participation in social, cultural or community activities

FAMILY STRENGTHS Self-help & Accepting Help Family members’ ability to seek and accept help when they think they need it

FAMILY STRENGTHS Flexibility of family functions and roles Family members’ ability to “fill in” for one another during times of illness or when needed

FAMILY STRENGTHS Crisis as a means of growth Family members’ ability to unite and become supportive during a crisis or traumatic experience

FAMILY STRENGTHS Family unity, Loyalty, and intra-family cooperation: Family members’ ability to recognize and use family traditions and rituals that promotes unity and pride

FAMILY HEALTH CARE Taking care of all individuals in the family on a one by one basis Dealing with the family as object of management Influencing family members to change factors affecting each individual’s health

FAMILY AS THE UNIT OF CARE The Family as the social context for health care Transmission of infectious/communicable diseases Health behavior requirements in the unit Resource utilization/source of support Health and illness definitions Health decisions/ approaches and strategies

FAMILY AS THE UNIT OF CARE The patient’s problem is the family’s problem Doherty and McCubbin, 1985: Important ways in which the family plays a role in the health of its members Health promotion/maintenance and illness/injury prevention Coping with stressful life events Family based health and illness appraisal Family interaction and level of functioning in response to specific illness Help seeking or deciding on the issue of seeking medical support Family adaptation/coping with illness including care giving strict adherence to prescribe treatment and lifestyle modification

FAMILY AS THE UNIT OF CARE The family is the greatest ally in the patient’s treatment 90% of cases are ambulatory/out-patient consultations with home confinement/prescriptions Presence of the family in the interview/consultation Family’s influence on the patient’s and physician’s personality, values, beliefs and experiences

Types of Families Nuclear Extended Single-parent Blended Communal

NUCLEAR The basic unit from which all other forms evolve, the nuclear family typically consists of a married man and woman and their children The household is economically independent, subsisting on the occupational earnings of the husband or father

EXTENDED This type of family is linked together by virtue of kinship bond between parents and children and/or between sibling It includes three generations the family of procreation merges with the family of origin could either be unilaterally or bilaterally extended

SINGLE PARENT FAMILY Children <17 years of age in a family unit with a single parent, another relative, or a non-relative May result from the loss of spouse by death, divorce, separation, desertion Out-of-wedlock birth of a child From an adoption One parent is working outside the Philippines (OCWs, DHWs, etc)

BLENDED includes stepparents and stepchildren brought about by annulment, with separation and remarriage

COMMUNAL/CORPORATE Composed of a group of individuals who are formed for specific ideological or societal purposes considered as an alternative lifestyle for people who feel alienated from the predominantly economically oriented society Vary within social context Highly formalized structures: e.g. Amish community in Lancaster County Pennsylvania Loosely knit groups: e.g. Sta. Cruz mountains near Boulder Creek in California

BASIC AREAS OF FAMILY FUNCTION BIOLOGIC reproduction Child rearing/caring Nutrition Health maintenance Recreation ECONOMIC Provision of adequate financial resources Resources allocation Ensure financial security of members

BASIC AREAS OF FAMILY FUNCTION EDUCATIONAL Teach skills, attitudes and skills relating to other functions PSYCHOLOGIC/AFFECTION Promotes the natural development of personalities Offer optimum psychological protection Promotes ability to form relationship with people in the family circle SOCIO-CULTURAL Socialization of children Promotion of status and legitimacy

FAMILY RELATIONSHIPS ORDINAL POSITION First born: generally persevering Serious More responsive to adults Achievement oriented Middle Child: optimistic Sociable Aggressive Competitive Occasionally manipulative Youngest: demanding Outgoing Occasionally narcissistic By nature are affectionate

FAMILY SOCIAL CLASS PATTERNS Upper class Much more closely-knit Greater concern for maintaining family name and prestige Middle class Believes in hard-work, initiative, independence, responsibility, economic security and self-improvement through education/schooling Lower class Sees life as a continual struggle for survival Resigned to a life of frustration and defeat

FAMILY SET-UP Democratic Authoritarian Parents respect their child’s decisions and ideas Understanding and permissiveness prevail Authoritarian Unquestioned obedience conformity to parental guidance Pattern of punishments than praise Suspicious of adults Stand poorly in stressful situation Become hostile with pain or discomfort

FAMILY LIFE CYCLE Represents composite of the individual developmental changes of family members Shows the evolution of the marital relationship Presents cyclic developmental of the evolving family unit

FAMILY LIFE CYCLE Why do we study the family life cycle? It provides a predictable, chronologically oriented sequence of events in family life with which family physicians and other health professionals are already familiar It involves a sequence of stressful changes that requires compensating or reciprocal readjustments by the family if it is to maintain viability Events of Family Life Cycle can be related to clinical events and to health maintenance of the family

TWO LEVELS OF ORDERS OF MAGNITUDE OF CHANGE First Order changes Involve increments of mastery and adaptation A “NEED TO DO” something new Do not involve change in the main structure of the family Do not involve a change in an individual’s identity and self-image Additions to existing stage of the individual’s self and family Tasks that must be accomplished by the family and family members working within a stage of the family life cycle e.g. a change that is present when a family moves to a new residence

TWO LEVELS OF ORDERS OF MAGNITUDE OF CHANGE Second Order changes Involve transformation of an individual’s status and meaning A “NEED TO BE” something new Change in the very basic attributes of the family system Change in the role and identity of family members Occur between stages of the family life cycle One characteristic intergenerational connectedness E.g. a change that is present when a family moves into the stage of the birth of the first child. Husband becomes the father and wife becomes the mother of a dependent sibling

In the Philippine setting, the typical Filipino family is characterized by a strong family orientation where authority is egalitarian. Although there has been a general decline in the size of the household, the Filipino family remains child-centered. The members place a high value on education.

The Family Systems Theory Family-oriented medical care involves assessing how a family’s functioning plays a part in both the illness and health of its members. In the systems concept of Minuchin (1978), the family is a continuous interlocking human relationship, organized in such a way that when there is a change in one family member, the other family members are affected.

The Family Systems Theory The concept emphasizes the interconnnectedness of human beings in their intimate environment, and is based on the following axioms: The family is more than a collection of individuals Families have repeating interaction patterns that regulate member behavior An individual’s symptoms may have a function within the family The ability to adapt to change is the hallmark of healthy family functioning There are no victims and victimizers in families

Through the application of the systems concept, we se the family as more than the sum of its parts. It is organized by interpersonal structures and processes that enable it to be both stable and adaptable over time. In a family system, there are variuos changes which occur as related to illness. How each member copes can lead to either dysfunction or adaptability.

The family system is influenced by its structure, processes and life cycle.

Family Structure Hierarchy is how power or authority is distributed in the family Boundaries are the rules defining who participates in the subsystem and how they participate. Coalition is the relationship between at least 3 people, where two collude against the other. Alliance is a positive relationship between any two members of a system Role selection is the unconscious assignment of roles to each family member

Family Process Enmeshment occurs when boundaries are diffuse, as when the parents have no privacy from their children or when members are overly reactive to stress on one member and demonstrate a lack of individual autonomy. Disengagement is characterized by boundaries that are too rigid, as when the mother-child subsystem excludes the father’s involvement in parenting. Triangulation occurs when a third person is drawn into a two-pair system so as to diffuse anxiety or conflict. Family patterns are ordered sequences of interaction that typify how families function.

The Family Life Cycle The family life cycle is the normal process of family development Involves a sequence of stressful changes that require compensating or reciprocal readjustment by the family members to make it functional. Each stage is associated with a certain developmental task in order to proceed to the next stage

The Family Life Cycle Unattached young adult Newly married couple Family with young children Family with adolescents Launching family Family in later life

UNATTACHED YOUNG ADULT “Between families” At this stage the young adult separates fro the family of origin without fleeing to a substitute emotional refuge. He or she formulates personal goals in developing as an individual, including forming a new family.

NEWLY MARRIED COUPLE “The joining of families through marriage” This is the transition stage of the couple from their family of origin and their lives as individual to the life of a couple

STAGES OF MARRIAGE Honeymoon stage (0-2 years) Emotional issues: commitment to the marriage Stage critical tasks: Differentiation from family origin Making room for spouse with family and friends Adjusting career demands

STAGES OF MARRIAGE Early Marriage Stage (2-10 years) Emotional issues: Maturing of relationship Stage Critical tasks: Keeping romance in the marriage Balancing separateness and togetherness Renewing marriage commitment

STAGES OF MARRIAGE Middle Marriage Stage (10-25 years) Emotional issues: Post-care review Stage critical tasks: Adjusting to mid-life changes Renegotiating relationship Renewing marriage commitment

STAGES OF MARRIAGE Long-Term Marriage Stage (25+ years) Emotional issues: Farewells and planning Stage critical Tasks: Maintaining couple functioning Closing or adapting family home Coping with death of spouse

FAMILY WITH YOUNG CHILDREN Starts at the pregnancy with the first child and continues up to the emergence of adolescents. The coming of children defines a new family status as the wife becomes the mother and the husband, becomes the father. During this stage, children start going to school, which is their first contact with other people. Conflict with practices in the home and school regulations may occur during this stage

FAMILY WITH ADOLESCENTS The 3 hallmarks are: Changes in the balance of responsibility along with overfunctioning and underfunctioning Marked shifts in intensity of relationships Surge of exchange with the community at large Parents are approaching a middle life stage and the grandparents are in the later stage. Hence, it is not only teenagers but also their parents who are undergoing crisis (i.e. identity) at this stage

LAUNCHING FAMILY Begins when the first child leaves home. Ends when the last child leaves home During this stage, the parents must develop adult-type relationships between the grown children and themselves. In the Philippines, this is prolonged because unmarried children usually stay with parents. Launched children start their own family life cycle.

FAMILY IN LATER LIFE Begins with the departure of the last child and continues through retirement of one or both of the couple and ends when both are dead

FAMILY LIFE CYCLE For each stage of the family life cycle, there arise a first- and second-order change as well as medical and psychosocial problems. Anticipatory guidance is warranted.

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