1. Orientation on Family Assessment Family Wellness Planning
Dept of Family and Community Medicine
UP College of Medicine
FCH 260.1

2. General Objectives
To be able to formulate and implement a family-oriented, patient-centered, and community-based health management plan for an index patient, taking into consideration the totality of his being and wellness of the family.

3. Specific Objectives
To formulate, implement, and discuss a patient-centered health management plan.
To describe the family psychodynamics using widely used family assessment tools.
To discuss the social environment, its resources, and hindrances to a successful wellness plan
To be able to formulate family wellness plans
To critically appraise a related journal article and show its application to the case/community

4. The Person, His Family, and Community
World/Universe
Nation
Community
Family

5. Family-Oriented Primary Care
Rose is a 32-yr old woman presenting with severe depression. She has been married to Ken for 13 years. There are 2 children, Like, 12, and Candy, 10. Ken and children accompany Rose to therapy expressing the desire to help her and themselves. They report having recently moved to the area. Their new home is out in the country with no close neighbors. They all express missing their friends and disliking the isolation they currently experience.
Rose is a 32-yr old presenting with severe depression. She has been married to Ken for 13 years. There are 2 children: Luke, 12 and Candy, 10.

6. Family Oriented Health Care
The family as a whole is your object of management
Encompasses all ages, both sexes, each organ system, every disease entity
It is about the biopsychosocial wellness of every member of the family
PAFP, 1999

7. Definitions of the Family
The enduring social form in which a person is incorporated
Genetic transmission unit
Matrix of personality development
The most intimate emotional unit of society
Sociologic
Biologic
Psychologic

8. Roles of Family Members in the Health of its Members:
Health promotion/maintenance
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

9. Roles of Family Members in the Health of its Members:
Help seeking or deciding on the issue of seeking medical support
Family adaptation/coping with illness
Caregiving
Adherence to prescribed treatment
Lifestyle modification

10. Health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"
Include the ability to lead a "socially and economically productive life".
World Health Organization Constitution, 1946

11. The Biopsychosocial Model
The World
SOCIAL SYSTEMS
Examples of systems included:
Society
Family
Community
The Person
BIOLOGICAL SYSTEMS
Genetics and Physiology
Organs
Tissues
Cells
PSYCHOSOCIAL SYSTEMS
Experience & Behavior
Cognition
Emotion
Motivation

12. LEVELS OF FUNCTIONING BADL YRS C B A AADL Advanced Life Pursuits IADL50 70 80 90
100
110 60
OPTIMAL FUNCTION
AADL
Advanced Life Pursuits
IADL
Homemaking
Self-care
Dmdcamagay, 2006

13. Family Assessment
Recognition of the family’s strengths and weaknesses in the face of a crisis through the use of standardized tools for the purpose of implementing interventions—pharmacologic, behavioral, education, counseling, referral, etc – which will be part of the Family Wellness Plan.

14. Characteristics of the Family
Nuclear, extended, single-parent or blended
Biologic
Economic
Education
Psychologic/Affection
Socio-cultural
Structure
Areas of Functioning

15. Family Psychodynamics and Effects on Healthcare
First Born
Middle Child
Youngest
Upper Class
Middle Class
Lower Class
Ordinal Position
Family Socioeconomic Class Patterns

16. Family Psychodynamics and Effects on Healthcare
Democratic
Authoritarian
Symptom-carrier?
Caregiver?
Follower?
Devil’s Advocate?
Family Set-up
Parent-Child /Sibling-Sibling Interaction

17. Family Assessment Tools
Genogram
Identifies Structure
Nuclear, Extended, Single-parent, Blended, Communal
Documents health risks/medical problems of each member
Records names/ages/deaths of each family member
Reveals more subtle information about the family

18. Torres- Uy Family
25 December, 2007

19. THE FAMILY LIFE CYCLE AND LENGTH OF TIME IN EACH STAGE
2 yrs
2.5 yrs
3.5 yrs
10-15 yrs
7 yrs
7 yrs
15 yrs
8 yrs

20. Stages of the Family Life Cycle Positions, Tasks and Health Issues
MARRIED COUPLE
Wife
Husband
Establishing a mutually satisfying marriage
Fitting into the kin network
Adjusting to pregnancy and parenthood
Family planning
Infertility

21. Stages of the Family Life Cycle Positions, Tasks and Health Issues
Having, adjusting to and encouraging the development of infants
Establishing a nurturing/satisfying home for both parents and infants
Breastfeeding
Infant immunizations
Family Planning
Safe pregnancy and delivery
CHILDBEARING
Wife-Mother
Husband-Father
Infant Daughter or son

22. Stages of the Family Life Cycle Positions, Tasks and Health Issues
PRESCHOOL AGE
Wife-Mother
Husband-Father
Daughter-Sister
Son-Brother
Nurturing the growth of pre-school children in stimulating growth-promoting ways
Coping with energy depletion and lack of privacy as parents
Immunizations
Accident and injury prevention
Deworming

23. Stages of the Family Life Cycle Positions, Tasks and Health Issues
SCHOOL AGE
Wife-Mother
Husband-Father
Daughter-Sister
Son-Brother
Fitting into the community of school-age families in constructive ways
Encouraging children’s educational achievement
Immunizations
Accident and injury prevention
Infectious and communicable diseases

24. Stages of the Family Life Cycle Positions, Tasks and Health Issues
TEEN-AGE
Wife-Mother
Husband-Father
Daughter-Sister
Son-Brother
Balancing freedom with responsibility as teenagers mature and emancipate themselves
Establish postparental interests and careers as growing parents
Sex education and STD
Teenage pregnancy

25. Stages of the Family Life Cycle Positions, Tasks and Health Issues
LAUNCHING
Wife-Mother-Grandmother
Husband-Father-Grandfather
Daughter-sister-aunt-mother
Son-brother-uncle-father
Releasing young adults into work, military service, college, marriage, etc. with appropriate rituals and assistance
Maintaing a supportive home base
Empty nest syndrome
Chronic illnesses of adulthood

26. Stages of the Family Life Cycle Positions, Tasks and Health Issues
Middle-aged Parents
Wife-Mother-Grandmother
Husband-Father-Grandfather
Rebuidling the marriage relationship
Maintaining kin ties with older and younger generations
Establishing meaningful relationships with peers
Chronic illnesses of adulthood

27. Stages of the Family Life Cycle Positions, Tasks and Health Issues
AGING FAMILY
Widow/widower
Husband-Grandfather
Wife-Grandmother
Coping with bereavement and living alone
Maintaining functional independence
Adapting to aging and frailty
Adjusting to retirement
Degenerative diseases

28. Family Assessment Tools
APGAR
A-daptation
P-artnership
G-rowth
A-ffection
R-esolve
Rapid screening tool for family dysfunction.
Normal 8-10
Moderately Dysfunctional 6-7
Severely Dysfunctional <5

29. Family Assessment Tools
Map (Salvador
Minuchin)

30. Family Assessment Tools
Resources
Pathololides
S - ocial
C - cultural
R - eligious
E - conomic
E - ducational
M- edical
Family
SCREEM

31. Family Assessment Tools
Timeline of events
I – Onset of illness /impact of illness
II -Impact of the diagnosis
III - Major Therapeutic Efforts
IV - Recovery Phase
V-Adjusting to the Permanency of the Outcome
Family Lifeline
Impact of Illness on the Family

32. Rapid Community Med Check
Community Resources available?
Healthcare Delivery System
Distance of the Family from the resources

33. THE ILLNESS-WELLNESS CONTINUUM
WELLNESS MODEL
DISABILITY
SYMPTOMS
SIGNS
HIGH LEVEL WELLNESS
GROWTH
AWARENESS
EDUCATION
PREMATURE DEATH
TREATMENT MODEL
NEUTRAL POINT

34. Family Wellness Plan
Incorporates family assessment in clinical practice
One-on One basis for every member
Includes health promotion and all stages of prevention strategies, if applicable
Includes age- specific periodic health examination of every member

35. A Related Journal Appraisal
Application of knowledge of critical appraisal of a journal based on the index case
Appreciation of the information gathered
Application of the journal to the index case or to family medicine in general

36. SUMMARY Chose and managed an index case in the community
Identified and utilized various family assessment tools to describe the psychodynamics of the family of the index case and the role of the family in their health status
Described the community and noted the influence of the environment on the heatlh of the constituents
Formulated wellness plans for the index case and the family members
Critically appraised a journal related to the case

37. thank you