orientation on family assessment family wellness planning dept of family and community medicine up...

Orientation on Orientation on Family Assessment Family Assessment

Family Wellness PlanningFamily Wellness Planning

Dept of Family and Community Medicine

UP College of Medicine

FCH 260.1

General ObjectivesGeneral 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.

Specific ObjectivesSpecific ObjectivesTo 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

The Person, His Family, and CommunityThe Person, His Family, and Community

World/Universe

Nation

Community

Family

Family

Community

Nation

World/Universe

Family-Oriented Primary CareFamily-Oriented Primary Care

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.

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.

Family Oriented Health CareFamily 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

Definitions of the FamilyDefinitions of the Family

Sociologic

Biologic

Psychologic

The enduring social form in which a person is incorporated

Genetic transmission unit

Matrix of personality development

The most intimate emotional unit of society

Roles of Family Members in the Roles of Family Members in the Health of its Members:Health of its Members:

Health promotion/maintenance Illness/ injury preventionCoping with stressful life eventsFamily based health and illness appraisalFamily interaction and level of functioning in

response to specific illness

Roles of Family Members in the Roles of Family Members in the Health of its Members: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

HealthHealth

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

The Biopsychosocial ModelThe Biopsychosocial Model

The World

SOCIAL SYSTEMS

Examples of systems included:SocietyFamilyCommunity

The Person

BIOLOGICAL SYSTEMS Genetics and Physiology

Examples of systems included:

OrgansTissuesCells

PSYCHOSOCIAL SYSTEMS

Experience & Behavior

Examples of systems included:

Cognition Emotion Motivation

BADL

YRS

CBA

LEVELS OF FUNCTIONING

50 70 80 90 100 11060

OPTIMAL FUNCTION

Advanced Life Pursuits

Homemaking

Self-care

Dmdcamagay, 2006

IADL

AADL

Family AssessmentFamily 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.

Characteristics of the FamilyCharacteristics of the Family

Structure

Areas of Functioning

Nuclear, extended, single-parent or blended

Biologic Economic Education Psychologic/Affection Socio-cultural

Family Psychodynamics and Family Psychodynamics and Effects on HealthcareEffects on Healthcare

Ordinal Position

Family Socioeconomic Class Patterns

First Born Middle Child Youngest

Upper Class Middle Class Lower Class

Family Psychodynamics and Family Psychodynamics and Effects on HealthcareEffects on Healthcare

Family Set-up

Parent-Child /Sibling-Sibling Interaction

Democratic Authoritarian

Symptom-carrier? Caregiver? Follower? Devil’s Advocate?

Family Assessment ToolsFamily Assessment Tools

Family

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

Torres- Uy FamilyTorres- Uy Family

25 December, 2007

THE FAMILY LIFE CYCLE AND LENGTH THE FAMILY LIFE CYCLE AND LENGTH OF TIME IN EACH STAGEOF TIME IN EACH STAGE

60

0

0

40

married couples

childbearing families

families with pre-school

families with schoolchildren

families with teenagers

families with launchingyoung adults

middle-aged parents

aging family members

10-15 yrs

15 yrs

8 yrs

7 yrs

7 yrs

3.5 yrs

2.5 yrs2 yrs

Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, 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


CHILDBEARING

Wife-Mother Husband-Father Infant Daughter or

son

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


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


SCHOOL AGE


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


TEEN-AGE


Balancing freedom with responsibility as teenagers mature and emancipate themselves

Establish postparental interests and careers as growing parents

Sex education and STD Teenage pregnancy


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


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


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


Family

APGAR

A-daptation

P-artnership

G-rowth

A-ffection

R-esolve

Rapid screening tool for family dysfunction.

Normal 8-10Moderately Dysfunctional 6-7Severely Dysfunctional <5


Family

Map (Salvador

Minuchin)


Family

SCREEM

Resources Pathololides

S - ocial

C - cultural

R - eligious

E - conomic

E - ducational

M- edical


Family Lifeline

Impact of Illness on the Family

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

Rapid Community Med Rapid Community Med CheckCheck

Community Resources available?Healthcare Delivery SystemDistance of the Family from the resources

WELLNESS MODEL

TREATMENT MODEL

DISABILITYSYMPTOMS SIGNS AWARENESS EDUCATION GROWTH

NEUTRAL POINT

THE ILLNESS-WELLNESS CONTINUUM

Family Wellness PlanFamily Wellness Plan

Incorporates family assessment in clinical practice

One-on One basis for every memberIncludes health promotion and all stages of

prevention strategies, if applicableIncludes age- specific periodic health

examination of every member

A Related Journal AppraisalA Related Journal Appraisal

Application of knowledge of critical appraisal of a journal based on the index case

Appreciation of the information gatheredApplication of the journal to the index case

or to family medicine in general

SUMMARYSUMMARY 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