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Orientation on Family Assessment Family Wellness Planning

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

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Orientation on Family Assessment Family Wellness Planning

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

  5. 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 Primary Care

  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. 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 Definitions of the Family

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

  12. A B C OPTIMAL FUNCTION BADL YRS 60 50 80 70 90 100 110 LEVELS OF FUNCTIONING 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. Structure Areas of Functioning Nuclear, extended, single-parent or blended Biologic Economic Education Psychologic/Affection Socio-cultural Characteristics of the Family

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

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

  17. 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 Family Assessment Tools

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

  21. 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 Stages of the Family Life CyclePositions, Tasks and Health Issues

  22. 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 Stages of the Family Life CyclePositions, Tasks and Health Issues

  23. 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 Stages of the Family Life CyclePositions, Tasks and Health Issues

  24. 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 Stages of the Family Life CyclePositions, Tasks and Health Issues

  25. 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 Stages of the Family Life CyclePositions, Tasks and Health Issues

  26. 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 Stages of the Family Life CyclePositions, Tasks and Health Issues

  27. 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 Stages of the Family Life CyclePositions, Tasks and Health Issues

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

  29. Family Map (Salvador Minuchin) Family Assessment Tools

  30. Family SCREEM Family Assessment Tools

  31. 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 Family Assessment Tools

  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 GROWTH HIGH LEVEL WELLNESS 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

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