1. THE FAMILY

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

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

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

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

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

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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Types of Families
Nuclear
Extended
Single-parent
Blended
Communal

23. 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

24. 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

25. 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)

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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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.

38. 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.

39. 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

40. 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.

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

42. 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

43. 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.

44. 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

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

46. 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.

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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.

55. 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

56. 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.

57. END