Friedman Family Assessment Model

Identifying data

1. Family name

2. Address & phone number

3. Family composition (Genogram)

4. Type of family form

5. Cultural & ethnic background – extent of acculturation:

a. Stated ethnic background

b. Language spoken at home. Do all members speak English

c. Country of origin, length of time in Canada, what generation are members in

relation to immigrant status, family reason for immigrating

d. Family social network from same ethnic group

e. Family residence – ethnically homogeneous neighbourhood

f. Religious, social, cultural, recreational, educational activities – within cultural

group

g. Dietary habits & dress – traditional or westernized

h. Home decor – cultural influences

i. Traditional or modern family roles & power

j. The portions of community family frequents – territorial complex in ethnic

community
 k. Use of health care services & practitioners – folk practitioners, folk remedies,
traditional health beliefs

1. Religious identification
a. Family religion

b. Members differ in their religious beliefs & practices

c. How actively involved is family in church, temple, mosque or other religious

organizations

d. Religious practices does family engage in

e. Religious beliefs & values are central in family life

1. Social class status – occupation, education, income

a. Estimate family social class

b. Economic status

c. Who makes money

d. Supplementary money or assistance – where from

e. Does family think income is adequate – how are they managing financially

1. Social class mobility

Genogram
Family Genogram
Ecomap
Family Ecomap
Developmental Stage & History of family

2. Families present developmental stage

3. Extent to which family is fulfilling developmental tasks appropriate for present
developmental stage

4. Family history from inception thru present – includes: developmental history,

unique health & health related behaviour, health related events & experiences –
divorce, death, loss

5. Both parents family of origin – what family life was like, past, present relations
with parents of parents

2 parent nuclear family career/life cycle stages: 9 stages

Transitional stage – btw families (unattached young adult)
– When individuals are in 20’s, financially independent, have left home
– They have not started own family
– The cornerstone for all successive stages to follow, affects individuals choice of partner, when & how marriage
occurs
– Individual must separate self from family, but not cut them off
Developmental tasks:
○ Individual in nature
○ Coming to terms with family of origin
○ Form personal life goals & sense of self
○ Development of intimate relationships & establish self financially & productive member of society
○ Difficult stage
○ Experienced differently depending on gender: Men taught to pursue self identification thru self expression,
Women taught to pursue self thru self sacrifice
○ Each has different identity issues to resolve, men struggle with attachment issues, women with autonomy
issues
Health concerns
○ Personal & family
○ Birth control & family planning
○ STD’s
○ Accidents & suicide
○ Mental health problems - issues of separation from family
○ Lifestyles are not typically conducive to health promotion – drugs, alcohol, diet
Stage 1 - Beginning families/stage of marriage
– Formation of the couple
Developmental tasks:
○ Establishing satisfying marriage – preparing life together, combine resources, new roles & fcns, learning to
live together, providing for each others needs, must accommodate each other, must set a pattern of
transactions & maintain them, satisfactory way to handle differences & conflicts, affects from separation
from family, sexual differences & needs
○ Relating to family network- role shift as move from family to own home, become members of 3 families,
task of separating themselves & working out new relationships with family
○ Family planning – children/not & when, type of health care during prenatal time is crucial
Health concerns:
○ Sexual & marital role adjustment, family planning, communication
○ lack of info creates many problems which means couple can not plan stable lives
Stage 2 - Childbearing families
– Birth of first child 30th month
– Transition to parenthood is key, family becomes a threesome, making a permanent system
– Stressful life transition – period of disequilibrium, can lead to family crisis, inadequacy & disruption to
marriage
– Loss of personal freedom, less time for marriage – major stressor
– There is little preparation for parenthood & many myths
Developmental tasks:
○ Husband, wife & baby must learn new roles, family unit expands in fcns & responsibility
○ Changes family organization, infant care tasks,
○ External Family relationships change – grandparents
○ Mother changes & adapts to parenthood faster than father
○ Parents learn meaning of baby’s cues, accept development & growth of child
○ New communication patterns btw individuals when becoming parents, must re-establish personal & sexual
needs
Health concerns
○ Preparation for parenthood – family planning, frequent-close-spaced pregnancies are bad
○ Maternity education for family, home visits for family after birth, infant care well baby care
○ Inaccessibility & inadequacy of child facilities for working mothers, abuse, neglect
Stage 3 - Families with preschool children
– Oldest child 2.5 – 5 yrs old
– 3-5 people, more complex & differentiated
– Busy, demanding for parents, greater demands on their time
– Must keep marriage alive & well
– Preschool children – learn independence, autonomy, self sufficient – schools foster this
– Adequate child care
– Single parent families – role strain
Developmental tasks
○ Housing & space problems – parents need space, children need to explore
○ Childproofing – accidents, prevention
○ Husband assumes greater household roles
○ Multiple children strains the relationship more – personality changes, lack of warmth, sex, satisfaction,
conversations
○ Many divorces occur at this time – weak marriage ties
○ Socializing children – developing self concepts, language, takes on more self care
○ Integrating new children, preparing children for new baby is key
○ Parents learn to separate from children & child from parents
○ Parents need outside interests & contacts
Health concerns
○ Communicable diseases of children, falls, burns, poison, accidents
○ Children’s contact with infection/disease – major problem
○ Marital relationship – strengthen & invigorate
○ Child abuse, neglect, home safety, communication problems
○ Preventions of major health problems
Stage 4 - Families with school aged children
– First born enters school full time 5 – 13 yrs
– Families usually reach max number in this stage
– Children & parents have own interests, activities, responsibilities
– Parent – finding fulfillment in rearing next generation & own growth
– Children – developing sense of industry & ward of inferiority
– Parents learn to deal with Childs separation – peer relationships & activities outside of home
– Pressure to have children conform to community standards for children – achievement & productivity
Developmental tasks:
○ Socializing children – promoting school achievement
○ Maintain satisfying marriage – diminishes at this stage
Health concerns
○ Children’s handicaps crop up at this stage
○ Nurses fcn to watch for many problems that arise, also counselling & teaching
Stage 5 - Families with teens (oldest child 13-20)
– 13 -19 yrs of oldest child, when child leaves home
– Loosening family ties to allow greater responsibility & freedom for teenager
– Profound shift in relationship patterns across generations & is signalled by physical maturity
– Most difficult stage – turmoil, organizational challenges, autonomy & independence, rule changing, limit
setting, role renegotiation
– Teen undergoes cognitive, identity & biological changes
Parental roles, responsibilities & problems
○ Stand firm against testing of limits
○ Balance freedom with responsibility, accept rejection
○ Set patterns of acceptance of self for teen
○ Parents feel in competition with social institutions
○ Parents unable to help teen with vocation plans
○ Immigrant families – generational clashes & value conflicts
Developmental tasks
○ Balancing freedom & responsibility
○ Parents must change their relationships with child – from dependent to independent
○ Set up new roles & norms
○ Marital relationship – preoccupation with roles, career, kids; also teens more independent, so parents can
pursue own interests
○ Communication problems – generation gap, rejection of values/lifestyle by parent & teen
 ○ Maintaining ethical & moral standards – teens searching for self
Health concerns:
○ Health promotion – risk factors
○ Parents - Risk of coronary heart disease, vulnerable to ill health
○ Teens – accidents, drug use, birth control, pregnancy, sex education, STD’s
○ Strengthen & support marital relationship
Stage 6 - Families launching young adults
– First child leaves home empty nest
– Economics force children to stay home longer
– Reorganizing family into a unit & releasing mature children into world
– Parents – early middle age, caught btw youth – elderly expectations
Developmental tasks:
○ Launch oldest child & help younger children become independent
○ Parents have more time for other activities & relationships
○ Challenge to marital relationships
○ Women continue to be busy in their job & partner roles
○ Menopause
○ Men face developmental crisis, drive to get ahead in career, diminished masculinity, financial worries
○ Assisting aging and ill parents – calling, financial, transportation, visiting, caring for them, nursing home vs
home
Health concerns
○ Communication problems btw young adults and their parents
○ Role transitional problems for wife and husband
○ Caretaker concerns for aging parents
○ Emergence of chronic health conditions or predisposing factors – high BP, etc
○ Menopausal
○ Drinking, smoking & bad diet effects
○ Health promotion strategies, wellness lifestyle
Stage 7 – Middle aged parents
– When last child departs form home & ends with retirement/death
– 45-65 yrs old
– Changes in marital adjustment, distribution of power btw husband and wife, roles change
– The prime of life
– Marital & family satisfaction peaks
– Greater economic security
– Mutually enjoyable activities & companionship = marital satisfaction
– Problems of aging, loss of children, sense of themselves as failures in parenting and work
Family developmental tasks
○ Women rechanneled energies from children, sometimes middle age crisis
○ Redefining relationships with children
○ Women live healthier lifestyle
○ Men find frustrations & disappointment with work, can be career peak or monotonous
○ More leisure activities
○ Preparation for retirement
○ Taking on healthier lifestyle, improving lifestyle – fear of getting illness
○ Find satisfying & meaningful relationships with children & their parents
○ Accepting & welcoming grandchildren – couples to continue to feel like a family
○ Grandparents are becoming the primary care givers – divorce, unemployment, alcohol, drugs – parent
generation – can have a toll – stress, financial, social isolation or – rewards & support
○ Problematic role – relating & assisting aging parents & other family members – care giving, women do
majority, generational squeeze, multiple roles & relationships – leads to physical, emotional, financial strain,
marital problems
○ Strengthening of marital relationship, alone now, can be difficult, renegotiate marital system
Health concerns
○ Health promotion & needs
 ○ Marital relationship
○ Communication with children, in-laws, aging parents, grandchildren
○ Caregiver concerns, assisting with aging parents
○ Physiological changes, menopause
Stage 8 – Families in retirement and old age
– Retirement of one or both spouses, thru loss of spouse, ends with death
– 65 yrs and up, elderly has doubled in population
– More people survive longer due to improved health care and disease prevention
– Some are miserable, others are happy, depends on financial, satisfaction, health status
Societies attitude
○ Aging is viewed as a decline, disease is perceived as the norm, negative connotation, burdened, society
doesn’t allow elderly to be productive – affects elderly’s self image
○ Attitudes are changing, new generation of old people – educated, healthy, active, affluent
Losses
○ Stressors/losses:
• Economic – reduced income, dependency
• Housing – move to smaller home, assisted living facilities, institutional setting
• Social – death of sibling, friend, spouse
• Work – retirement, loss of work role, productivity
• Health – decline physical, mental, cognitive fcns
○ Retirement – life cycle turning point – loss of status, social support, lifestyle changes, money, reorientation
of values, goals, energies
○ Retirement yrs – quarter of persons life
Developmental tasks
○ Maintaining satisfying living arrangements – move out, location of home, condition of home – predictor of
persons wellbeing, relocation is traumatic
○ Adjusting to reduced income
○ Maintaining marital relationships
○ Adjusting to loss of spouse
○ Maintaining intergenerational ties
○ Continuing to make sense of one existence – life review and integration
Health concerns
○ Increasing functional disabilities
○ Mobility impairment
○ Chronic illness
○ Diminished physical vigour and function
○ Long term care services
○ Care giving
○ Social isolation
○ Grief/depression
○ Cognitive impairment

Environmental Data

1. Characteristics of Home
a. Dwelling type – home, apartment, rooming house, does family rent or own

b. Homes condition – interior & exterior, number of rooms, types of rooms –

bedroom, living room, room uses, how they are furnished, condition and
adequacy of furniture, adequate light – artificial/daylight, heat, ventilation,
floors, stairs, railings in adequate condition

c. Kitchen – assess water supply, sanitation, adequacy of refrigeration

d. Bathrooms – sanitation, water supply, toilet facilities, presence of towels &

soap, do members share towels, grab bars in tub

e. Sleeping arrangements – adequate for members, considering age, relationship,

special needs

f. Cleanliness & sanitation – hygiene & cleanliness practices, infestations, vermin

(interior), sanitation problems due to pets

g. Paint – flaking, old paint, lead poisoning

h. Territorial unit – family comfortable driving out of neighbourhood to use

resources & services

i. Privacy arrangements, how members feel about privacy

j. Homes safety hazards – presence or absence

k. Waste & garbage disposal – adequate

 l. Satisfaction/dissatisfaction with housing arrangements, is home adequate for
their needs

1. Characteristics of neighbourhood & larger community

a. Physical characteristics of immediate neighbourhood & larger community –
type of neighbourhood, community – rural, urban, suburban, intercity, types of
dwellings – residential, industrial, combined residential & industrial, agrarian,
condition of dwellings & streets – kept up, deteriorating, dilapidated,
revitalized, sanitation of streets, home – cleanliness, trash, garbage collected,
presence & type of industry, air, noise, water pollution problems

b. Demographic characteristics of neighbourhood & community – social class &

ethnic characteristics of residents, occupations & interests of families, density
of population, recent demographic changes in neighbourhood

c. Health & basic services available in neighbourhood & community – marketing

facilities – food, clothes, drugs, health agencies – clinics, hospitals, emergency
facilities, social service agencies – welfare, counselling, employment,
Laundromat – if needed, family church/temple
d. Accessibility of schools & condition, busing & integration problems

e. Recreational facilities

f. Availability of public transport – how accessible – distance, suitability, hours to

family

g. Incidence of crime, safety problems

1. Families geographic mobility

a. How long family lived in area

b. Family history of geographical mobility

 c. Where did family move or migrate

1. Family associations & transactions with community

a. Who in family uses what community services

b. How often does members use these services

c. Family territorial patterns – communities or areas frequented

d. Family aware of community services relevant to needs – transportation

e. Family feel about groups, organizations from whom receives assistance or

relates

f. How family views community

Family structure
1. Communication patterns
a. After observing family as whole & set of relationships – how is fcnal & dysfcnal
communication patterns used – diagram & give examples. How firmly & clearly
members state their needs & feelings, what extent members use clarification &
qualification in interacting, member elicit & respond favourably to feed back or
do they discourage feedback & exploration of an issue. How well members
listen & attend when communicating. Members seek validation from each
other. Degree members use assumptions & judgemental statements in
interaction. Interact in offensive manner to messages. Frequency of
disqualification utilitized.

b. How emotional – affective msgs conveyed in family & within family subsystems.
How frequent are emotional messages conveyed. What types of emotions are
transmitted in family subsystems – negative or positive or both.

c. What is frequency & quality of communication in communication network &

familial sets of relationships. Who talks, in what manner, patterning of
transmitting important msgs, intermediary exist, msgs sent appropriate for
developmental stage of members

d. Are msgs congruent in content & instruction – observations of nonverbal msgs,

if not who manifests what kind of incongruency

e. Types of dsyfncal process seen in family communication patterns

f. What are areas closed off to discussion that are important issue of family
wellness or adequate fcning

g. How do these affect family communication patterns:

– Context, situation

– Family life cycle stage

 – Family cultural background

– Gender differences in family

– Family form

– Family socioeconomic status

– Family unique miniculture

1. Power structure
Power outcomes
a. Who makes what decisions – last say, wins

b. How important are decisions/issues to family: specific questions:

– Who budgets, pays bills, decides how money is spent, decides on how to
spend evening, what friends/relatives to visit, decides on changes in
job/residence, disciplines/decides on child’s activities

Decision making process

a. Specific techniques utilized for making decisions in family & extent they are
utilized – consensus, accommodation-bargaining, compromising, coercion, de
facto, how does family make decisions

Power bases – the various bases/sources of power are legitimate power/authority, and
variation of helpless power, referent power, expert power/resources power, reward power,
coercive power, informational power – direct/indirect, affective power, tension
management power
b. What bases of power do family members make decisions – variables affecting
power

c. Recognizing existence of variables helps assessor interpret family behaviour,

family power can be assessed, power hierarchy:
– Type of family form

– Formation of coalition
 – Family communication network

– Gender differences

– Age & family life cycle factors

– Cultural & interpersonal factors

– Social class

Overall family system & subsystem power

a. Deduce family power as dominated by husband/wife, child, grandparent – is it
egalitarian-syncratic, automatic, leadershipless, chaos, family power continuum
used for visual presentation of analysis

Family power continuum – if dominance found, who is it

b. Determine overall power pattern – broad open ended questions of spouse &
children:
– Who has last say, makes decision about important issues

– Who is really in charge & why

– Who runs family

– Who wins important arguments/issues

– Who wins in disagreements

– Who gets way when spouses/parents disagree

– Are members satisfied with how decisions made & who makes them – present
power structure
1. Role structure
Formal role structure
a. What formal position &roles do each members fulfill. Describe how each
member carries out their roles

b. Are these roles acceptable & consistent with member expectations – any role
strain or conflict

c. How competently members feel they perform their roles

d. Any flexibility in roles when needed

Informal role structure

e. Informal or covert roles exist. Who plays them & how frequently or consistent
are they enacted, covertly playing roles different from their position

f. Purpose of informal covert roles serve

g. Informal roles that are dysfcnal to family or member in long run

h. Impact of persons who play these roles

Analysis of role models – when role problems are present

b. Who are models that influence members in early life, who gave feelings &
values about growth, new experiences, roles & communication techniques

c. Who acted as role model for mates in roles as parents & marital partners, what
were they like

d. If informal roles are dysfcnal, who modeled these for them

Variables affecting role structure

e. Social class influences – social class background influence formal & informal
roles

f. Cultural influences – role structure affected by ethnic & religious background

 g. Developmental & life cycle stage influences – are roles developmentally
appropriate

h. Situational events – members health status changes, health problems affected

roles, reallocation of roles/tasks, member adjusted to new roles, evidence of
role stress, conflicts, member who is sick – reaction to his/her loss of role

Family Values
1. Use of compare & contrast method is suggested with values of either dominant
culture, families reference group, ethnic group with whom they identify or both:
– Productivity vs individual achievement

– Individualism

– Materialism vs the consumption ethic

– The work ethic

– Education

– Equality

– Progress and mastery over the environment

– Future time orientation

– Efficiency, orderliness, practicality

– Quality of life and maintaining health

Disparity in value system

a. Extent there is congruence btw family values & family reference group and
interacting systems like educational & health care systems & wider community
b. Extent there is congruence btw family values & members values
Family values
c. How important identified values to family – rank in order of family values

d. Values conscious /unconscious

e. Value conflicts within family

f. Family social class, cultural background & degree of acculturation, generational

differences, geographical setting – rural, urban, suburban influence family
values

g. Family values affect health status of family

Family Functions