Family Health

Objectives of the Session Discuss reasons in understanding families in health care. Discuss characteristics of Filipino family Discuss types of family Analyze the therapeutic triangle. Discuss family oriented approach.

FAMILY SOCIAL GROUP CHARACTERIZED BY COMMON RESIDENCE, ECONOMIC COOPERATION AND REPRODUCTION GROUP OF PERSON UNITED BY TIES OF BLOOD, MARRIAGE OR ADOPTION INTERACTING & COMMUNICATING WITH EACH OTHER IN THEIR RESPECTIVE SOCIAL ROLES

CHARACTERISTICS OF FILIPINO FAMILY CLOSELY KNIT, BILATERALLY EXTENDED AVERAGE HOUSEHOLD SIZE IS 5 AT POVERTY LEVEL OF P13,823/MO. IN 2000, 34% OF FILIPINO FAMILIES ARE BELOW POVERTY LEVEL FAMILY SPENDS P2,600/YEAR FOR MEDICAL CARE

Characteristics of healthy family Open to change High self worth Functional defenses Clear rules discussed People take risk to express feelings Can deal with stress Welcomes life stages Clear hierarchy Affect is open

Minimum basic needs to attain decent quality life Needs for survival : food, health and nutrition, safe water and sanitation Security : shelter, peace and order/ public safety; income and livelihood Empowerment: basic education, functional literacy, community development, family and psychosocial care

FILIPINO FAMILY AND ITS VALUES ASAL (UNSELFISHNESS, COMPASSION, PITY, GRACIOUSNESS) DELICADEZA DANGAL RESPECT VENERATION OF THE DEAD - Dolor, Incano

UNIVERSAL IMPORTANCE OF THE FAMILY AMONG FILIPINOS The family as a social group is universal and persistent, even in the midst of continuing changes, stresses and development. The first social group to whom the individual is exposed to, individual’s longest and earliest experience takes place in the family setting.

UNIVERSAL IMPORTANCE OF THE FAMILY AMONG FILIPINOS The family is a very close and intimate group in which the most meaningful relationship may grow. The family serves as link between the individual and the larger society.

FAMILY FUNCTIONS Reproduction Biological maintenance Socialization Status placement Welfare and protection Functions in relation to other institutions: Economics Citizenship and political behavior Religion Educational

FAMILY TYPES NUCLEAR EXTENDED – UNILATERAL, BILATERAL BLENDED COMMUNAL

FAMILY AS A UNIT OF CARE FAMILY IS THE SOCIAL CONTEXT FOR HEALTH CARE PATIENT’S PROBLEMS IS THE FAMILY’S PROBLEM THE FAMILY IS THE GREATEST ALLY IN TREATMENT

CIRCUMFLEX MODEL OF FAMILY TYPOLOGIES (OLSON)

FAMILY TYPOLOGIES (McCUBBIN) RESILIENT RHYTHMIC REGENERATIVE

FAMILY PROFILE RESILIENCY MODEL FAMILY CHANGES – 15 ITEMS FAMILY COHERENCE – 4 ITEMS FAMILY FLEXIBILITY – 7 ITEMS FAMILY BONDING – 7 ITEMS FAMILY SOCIAL SUPPORT – 17 ITEMS

FAMILY PROFILE RESILIENCY MODEL LOW MEDIUM HIGH CHANGES 0-3 4-5 6-15 COHERENCE 0-11 12-14 15-16 FLEXIBILITY 0-21 22-26 27-35 BONDING 0-28 29-33 34-35 SOCIAL 0-53 54-63 64-68 SUPPORT

FAMILY CONTEXT STRESSOR- ILLNESS, FAMILY LIFE CYCLE, EXTRAFAMILIAL ADAPTABILITY- COPING ABILITIES COHESION- ENMESHMENT OR DISENGAGED INTERACTION PATTERNS- COMMUNICATION, CONTROL & SUPPORT

FAMILY’S CONCEPT OF HEALTH an active and effective mode of interaction within a given social, cultural, and natural milieu; a state of relative equilibrium, both physically and mentally with the surrounding world.

Premise of Understanding Families in Health Care Family is a primary source of many health beliefs and behaviors. Family is an important source of stress and social support Physical symptoms may have an adaptive function within the family and be maintained by family patterns. Family has an influence on physical and psychological health and well-being .

Premise of Understanding Families in Health Care Marital and family relationships have powerful impact on health outcomes. Family members, not health professionals, provide most of health care of for patients. Family is a primary social context in which health issues are addressed.

Some Evidences Women with few or no family support have 2 to 3 times the mortality rate compared to other women who are recovering from MI. (Ann Intern Med 1992;117(12):1003-9) Divorced and unhappily married men and women have poorer immune function than those in healthier marriage. (Psychosomatic Med 1987;49(1):13-34)

Some Evidences Conflict and criticism between family members can have negative influences on blood pressure, diabetes and immune function. (Behavioral therapy 1984;15(5):478-84) Family psychoeducation is an effective intervention for health problems. (Arch Gen Psych 1975;32(8):1031-38)

Working with Families Medical care is enhanced by obtaining information about the family , assessing family relationships , and encouraging appropriate family involvement . Physician Patient Family THERAPEUTIC TRIANGLE

Family-oriented Approach Questions Has anyone else in your family had this problem? It reveals not only whether the there is a family history but also how the family responded to the problem in the past.

Family-oriented Approach Questions What do your family members believe caused the problem or could treat the problem? Identifying explanatory models that strongly influence the patient’s beliefs and behaviors regarding the problem.

Family-oriented Approach Questions Who in your family is most concerned about the problem? Identifying who is the most concerned maybe helpful in creating effective treatment plan (therapeutic alliance)

Family-oriented Approach Questions Along with your illness, have there been any other recent changes in your family ? Useful way to screen for additional stressors, health problems and changes in the patient’s family and how it is affecting the patient.

Family-oriented Approach Questions How can your family be helpful to you in dealing with this problem? Discovering how family member can be a source to the patient in all treatment planning.

INTERVIEWING INSTRUMENTS ETHNIC 1997 Levin, Like, Gottleib. A framework for culturally competent clinical practice. Suitable for clinical students since use requires diagnostic and therapeutic skills E : Explanation (How do you explain your illness?) T : Treatment (What treatment have you tried?) H : Healers (Have you sought any advice from folk healers?) N : Negotiate (mutually acceptable options) I : (Agree on) Intervention C : Collaboration (with patient, family, and healers)

INTERVIEWING INSTRUMENTS BELIEF, 2000 Dobbie, Medrano, Tysinger,Olney. Developed from early work on explanatory models LEARN and ETHNIC. Suitable for preclinical or early clinical students since use does not require diagnostic or therapeutic skills. B : Health beliefs (What caused your illness/problem?) E : Explanation (Why did it happen at this time?), L : Learn (Help me to understand your belief/opinion), I : Impact (How is this illness/problem impacting your life?) E : Empathy (This must be very difficult for you) F : Feelings (How are you feeling about it?)

INTERVIEWING INSTRUMENTS BATHE 1993 Stuart, Leibermann.Developed to elicit the psychosocial context of anyencounter, not specifically cross-cultural interviewing. Use does not require clinical skills. B : Background (What is going on in your life?) A : Affect (How do you feel about what is going on?) T : Trouble (What troubles you most?) H : Handling (How are you handling that?) E : Empathy (This must be very difficult for you)

“ Caring without science is well-intentioned kindness, but not medicine. On the other hand, science without caring empties medicine of healing and negates the great potential of an ancient profession. The two complement and are essential to the art of doctoring.” Bernard Lawn, 1996

WORKSHOP 1 DIVIDE INTO 4 GROUPS ANALYZE ONE OF YOUR GROUP MATES FAMILY USING THE FAMILY RESILIENCY MODEL REPORT TO CLASS

WORKSHOP 2 USING THE SAME GROUPINGS, DISCUSS WITH YOUR GROUP YOUR FAMILY HEALTH BELIEFS AND ITS IMPLICATION ON HEALTH

Family Health

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