blok 22 kk_family assessment tools_dr.oryzati_3feb2014

7/24/2019 Blok 22 KK_Family Assessment Tools_dr.oryzATI_3Feb2014

1/40

Family Dynamics and

Assessment Tools

Dr. Oryzati Hilman Agrimon, MSc.CMFM, PhD (C) PhD Candidate in General Practice/ Family Medicine,

the University of Adelaide, Australia Lecturer

Department of Public ealth and Family Medicine

Faculty of Medicine and ealth !ciences

Universitas Muhammadiyah "o#ya$arta


2/40

Discussion Topics

Family Structure

Family Dynamics

Family Assessment Tools


3/40

Family !tructure %&'(Goldenberg, 1980)

1. Nuclear Family (keluarga inti):

suami, istri, anak-anak kandung

2. Extended Family (keluarga besar):

suami, istri, anak2 kandung, sanak saudara:

baik vertikal maupun horizontal3. Blended family (keluarga campuran):

suami, istri, anak-anak kandung tiri

4. Common law family (kel menurut hukum

umum): pria !anita terikat hukum sipil, anak2 mereka

5. Single parent family (kel orang tua tunggal):

karena "erai, berpisah, ditinggal mati, tidak pernah

menikah anak2 mereka


4/40

6. Commune family (kel hidup bersama): berbagi hak, tanggung #a!ab keka$aan bersama

7. Serial family (keluarga serial):

sudah ber"erai, menikah lagi mempun$ai anak2,

dan menggangap satu keluarga8. Composite family (keluarga gabungan):

poliandri poligini dg anak-anakn$a

. Cohabitation family (keluarga tinggalbersama):

tanpa ada ikatan perka!inan $g s$ah

Family !tructure %('(Goldenberg, 1980)


5/40

%pa bentuk keluargan$a&


6/40

Five basic functions of families (Goh et al, 200' ineda,1999) 1. Families provide support to each other 2. Families establish autonomy & independence for

each person in the system which enhance personal

growth of individuals within the family . Families create rules that govern the conduct of the

family & of the individuals within the family !. Families adapt to change in the environment

". Families communicate with each other

Family Dynamics %&'


7/40

Family dynamics (Goh et al, 200' *akel, 1998)

# The interactions & relationships among theindividual members of a family which reflect &influence the physical$ mental & spiritual health ofthe individuals in a family%

The developmental or adaptive challenges thatface the family 'e.g. birth of a child$ coping withloss of function through illness & in(ury)

The family*s uni+ue combination of resources &burdens 'e.g. educational & economic status$available supports & vulnerabilities)

Family Dynamics %('


8/40

# ,nderstanding of family dynamics%

- helps the FD to diagnose the disease & illness

and recognie the factors that may help or hinder

the recovery of the patient

- to formulate ways to help the family be moreeffective & adaptive in their health tas/s

# Family dynamics may be assessed through%

family assessment tools

Family Dynamics %)'


9/40

Family

Assessment

Tools

Family

Dynamics

appy/

Functional

FamilyMid*ran#e

Family

Unhappy/

Dysfunctional

Family

??


10/40

Happy/ FunctionalFamilie

Mi!"range

Familie

Dy#unctional

FamilieRadiate a sense of integrity &caring

Most families exhibit fluctuatingmixtures of happy & unhappyfeatures

Communication often manifest disorganization &rigidity

Adult members live by clearhuman values, communicateeffectively & share power whilenegotiating decisions

Representing the ma!ority offamilies as referred by researchers& family therapists

Family members behave in ways that indicate ahigh level of chronic underlying anxiety &regularly engage in negative, hostile, or criticalexchanges

All family members encouragedto develop their own goals &emotional independence whilestaying connected with thefamily

"ach mid#range family has its ownstrengths &vulnerabilities

$hey can be caring & considerate when lifecircumstances are calm% when stressed, theyshift into counterproductive modes, avoidingresponsibility by clinging, attacing, or escaping

Cope relatively well withadversity, often coming out of acrisis stronger

'hysicians can be most effectiveby helping families capitalize ontheir strengths & deal withvulnerabilities in healthier ways

'ersonal values may be adopted uncritically fromauthority figures or friends( peers% Alternatively,values may be formed & behavior shaped byreacting in opposition to the espoused or actualvalues of influential people

At one extreme, they often express intensenegative feelings which creates a hot, conflictualfamily atmosphere

At the extreme opposite, they shut off, blunt, orhide their feelings, creating a cold, unfeelingatmosphere, that mass an underlying emotionalintensity

)ifficulty in dealing with stress


11/40

Family Assessment Tools %&'

*hy do we need family assessment tools+ 1. to assess family functioning 2. to assess coping mechanisms of the family . to assess resources !. to assess family structure

". to have a picture of the multigenerational patternsof behavior or illnesses.

0. to assess the normal crisis or common illness to be

encountered in each stage of development. . to provide anticipatory care and guidance.


12/40

Family Assessment Tools %('

Family assessment tools%peran#$at penilaian $eluar#a'

(+"aniel, 200. Goh et al, 200' *akel, 2002,ineda,

1999 /amaniego, 1999)1. Family genogram (Pohon keluarga)2. Family life cycle (Siklus kehidupan keluarga)

3. Family map (Peta keluarga)

4. Family life line (Garis kehidupan keluarga) 5. Family A3A4 (Penilaian fungsi keluarga)

6. Family S54667 (Penilaian sumer da!a keluarga)


13/40

$. Family %enogram&A graphic representation of the family

structure8 anatomy$ including% family tree$

functional chart$ family illness8history)

'. Family li#e cycle4epresents composite of the individual

developmental changes of family members$ shows

the evolution of the marital relationship & presents

cyclic developmental changes of family members9

includes% stages of development$ developmental

tas/s & health implications


14/40

(. Family map

Describes family system$ relationships & interaction

patterns$ boundaries between generations$

conflicts8alliances

). Family li#e line

Describes chronological stressful life8 clinical

events & coping 'how they were handled)


15/40

*. Family AP%A+-Adaptability, 'artnership,.rowth, Affection, Resolve/

Screening instrument for family dysfunction$individual satisfaction about family relationships

,. Family SC+--M-0ocial, Cultural, Religious,"conomic, "ducational, Medical/

Describes available resources$ assessment of

family*s capacity to participate in the provision of

the health care or to cope with crisis


16/40

!enogram %&'

ohon keluargabiopsikososial $angmenggambarkan

siklus hidup keluarga,pen$akit dalamkeluarga danhubungan antar

anggota keluarga

iasan$a genogramini dibuat generasi.


17/40

!enogram %('

ntuk mengetahuise"ara "epathubungan diantaraanggota keluarga,

sebagai "ara untukmelihat masalahmedis dan psikologiskeluarga dan

sebagai alat untukmengerti keluargadari multigenerasi


18/40

!enogram %)'

1 3ama kepala keluarga

ditulis diatas keluarga2 3ama dan umur

setiap anggotakeluarga ditulisdiba!ah s$mbol

%nggota keluarga$ang men#adi 4okuspela$anan kesehatandokter keluargadisebut sebagai

"inde# pasien5 danditandai denganpanah

' 6anggal pembuatangenogram ditulis

I

II

III

Bakri, as of 8 April 2010

Ardi,68 Nia,6419701969


19/40

!enogram %+'. %nggota keluarga

$ang tinggal dalamsatu rumah ditandaidengan menggambarlingkaran

7 en$akit dalamkeluarga di tulisdengan simbol

standar $ang diberiketerangan diba!ahgenogram

aktu dan sebabkematian anggotakeluarga ditulis

dengan s$mbol $angdiberi tanda silangdidalam lingkaranatau bu#ur sangkar

8 6anggal pernikahandan per"eraian

di"antumkan pula

I

II

III

Bakri, as of 8 April 2010

Ardi,68 Nia,641970

1969


20/40

!tandardied !ymbols used in Family Geno#rams %&'

A

b

m

d

D

male

female

!e- not specified

Deceased/death

Adopted female

date of birth

date of marria#e

date of divorce

Date of death

abortion or miscarria#e

Pre#nancy*child in utero

Diy#otic t.ins

Monoy#otic T.ins

nduced abortion


21/40

!tandardied !ymbols used in Family Geno#rams %('

married and year

Divorce and year

Unmarriedrelationship

!eparation and

year

&010

&002

&00(

Conflictual relationship

Distance relationship

Close relationship

&010

&010

&00(

Family livin# to#ether


22/40

!tandardied !ymbols used in Family Geno#rams %)'

!ymbols of diseases or situation

Aller#y

Alcoholism

3besity

Asthma

ypertension

xxx xxx

eart disease

!tro$e

Depression

4ar Casualty


23/40

!tandardied !ymbols used in Family Geno#rams %+'

A5C Alcoholic

A55 Aller#y

A6T

Arthritis

CAD Coronary ArteryDisease

C7ACerebrovascularAccident

CA Cancer

D8P Depression

DM Diabetes mellitus

G G tract disease

T ypertension

M Myocard nfarction

M7P Mitral 7alve Prolapse

PUDPeptic Ulcer Disease

!58 !ystemic 5upus8rythematosis

T9Tuberculosis

Commonly used Abbreviations

!


24/40

Ca

!enogram8spinosa* Fernande Family

9

:358;8


25/40

$amil% &i'e %cle(;arter +"Goldri"k,1989)

Family i#e Cycle

Stage

-motional

proce o#

tranition&4ey principle

Secon! Or!er

Change in Family

Statu re5uire!to procee!

!e0elopmentally

Firt or!er

change or

ta3 in0ol0e!

Pro6lem

encountere! at

each tage o#the cycle

5eavin# home>

!in#le youn#adults

The ?oinin# offamilies throu#hmarria#e> Thene. couple

Families .ithyoun# children

Families .ithadolescents

5aunchin#children @movin# on

Families in laterlife


26/40

This assessment tool was developed by a psychiatrist:family therapist Salvador 7inuchin to facilitate thecommunication of information about a family system tocolleagues through the use of symbols

$amil% ap %&'


27/40

$amil% ap %('

A double line between two peopleindicates a functional relationship

A single line with a break in the middleindicates dysfunction


28/40

$amil% ap %)'

Three parallel lines between two peopledenotes an over-involved relationshipwhere there is plenty of intrusion

A solid line perpendicular to therelationship line symbolizes a rigid

boundary where the rules are but non-negotiable


29/40

$amil% ap %+'

:358;8

8fron

:oy

Ayn

vy

96A;

ael

!alva

5ucil

6ia

:un

MA8

-%-/D&

7 functional

dysfunctional

7 clear butne#otiable

boundaries

Family Lifeline -Stressful life


30/40

Family Lifeline -Stressful lifeevents)

Family *+!*, Family function)


31/40

Family *+!*, Family function)ComponentComponent 8n!icator8n!icator Score&Score&

9"'9"'ADAPTAT3;ADAPTAT3; The capability of the family to utilie @ share inherentThe capability of the family to utilie @ share inherent

resources, either intra*familial or e-tra*familialresources, either intra*familial or e-tra*familial

9"'9"'

PA6T;86!PPA6T;86!P The sharin# of decision*ma$in#B This measures theThe sharin# of decision*ma$in#B This measures thesatisfaction attained in solvin# problems bysatisfaction attained in solvin# problems bycommunicatin#communicatin#

9"'9"'

G634TG634T t refers to both physical @ emotional #ro.thB Thist refers to both physical @ emotional #ro.thB Thismeasures the satisfaction of the available freedom tomeasures the satisfaction of the available freedom to

chan#echan#e

9"'9"'

AFFF8CT3;AFFF8CT3; o. emotions li$e love, an#er, and hatred are sharedo. emotions li$e love, an#er, and hatred are sharedbet.een membersB This measures the membersbet.een membersB This measures the memberssatisfaction .ith the intimacy @ emotional recation thatsatisfaction .ith the intimacy @ emotional recation thate-ist in the familyBe-ist in the familyB

9"'9"'

68!357868!3578 6efers to ho. time, space, money are sharedB This6efers to ho. time, space, money are sharedB This

measures the members satisfaction .ith themeasures the members satisfaction .ith thecommitment made by other members of the familyBcommitment made by other members of the familyB 9"'

9"'

TotalTotal 9"$99"$9Scoring&2 = almost always1 = some of the time0 = hardly ever

AP%A+ Score&8-10 = Highly functional family4-7 = Moderately dysfunctional family0-3 = everely dysfunctional family

*+!*, (1)


32/40

*+!*,(1)

+etode ini digunakan dengan menilai lima

4ungsi keluarga sehingga dapat diketahuiapakah sebuah keluarga 4ungsional atau tidak4ungsional

*daptasi !daptation)

inilai tingkat kepuasan anggota keluargadalam menerima bantuan $ang diperlukann$a

dari anggota keluarga $ang lain-emitraan "artnership)

/aling berpartisipasi dalam pengambilankeputusan dan komunikasi $ang baik


33/40

*+!*, (2) +ertumbuhan #rowth)

inilai tingkat kepuasan anggota keluarga terhadapkebebasan $ang diberikan keluarga dalam pertumbuhandan perkembangan


34/40


35/40

nterpretasi /ilai *+!*,-eluarga

801 poin menggambarkan bah!a4ungsi keluarga baik (Highly functionalfamily)

407 poin menggambarkan bah!a4ungsi keluarga kurang baik(Moderately dysfunctional family)

03 poin menggambarkan keluargatidak 4ungsional (Severelydysfunctional family)


36/40

+eource+eource PathologyPathology

!3CA5!3CA5 !ocial interaction is evidentamon# family members

Family members have .ell*

balanced lines of

communication .ith e-tra*

familial social #roups such

as friends, sports, clubs @

other community #roups

solated from e-tra*familial

Problem of over*

commitment

CU5TU6A5CU5TU6A5 Cultural pride or satisfactioncan be identified, especially

in distinct ethnic #roup

8thnic/ cultural inferiority

685G3U!685G3U! 6eli#ion offers satisfyin#spiritual e-perience and

contacts .ith an e-tra*

familial support #roup

6i#id do#ma/ rituals

5o. faith %iman'

$amil% , ($amil% ,esources)%&'An important tool to assess a family*s capacity to participate in the provision of health

care or to cope with crisis. ;t ma/es use of 0 factors which can be considered as

resource or as pathology


37/40

+eource+eource PathologyPathology

8C3;3MC "#onomi# stailit! is suffi#ient to

pro$ide oth reasonale satisfa#tion

%ith finan#ial status and an ailit! to

meet e#onomi# demands of

normati$e life e$ents.

"#onomi# defi#ien#!

&nappropriate e#onomi#

plan

8DUCAT3; "du#ation of famil! memers is

ade'uate to allo% memers to sol$e

or #omprehend most of the prolems

that arise %ithin the formal lifest!le

estalished ! the famil!

andi#apped to

#omprehend

M8DCA5 ealth #are is a$ailale through

#hannels that easil! estalished and

ha$e pre$iousl! een eperien#ed in

a satisfa#tor! manner

*ot utili+ing health #are

fa#ilities, resour#es

$amil% , ($amil% ,esources)%('

i i


38/40

&earning +oints...

& ih di - l


39/40

&atihan di -elas

1!amily Structure"!amily #ife $ycle

%&enogram'A(&A)*S$)++M


40/40

:han3 you #or your attention;

blok 22 kk_family assessment tools_dr.oryzati_3feb2014

Documents