family attachment student guide 1) introduction and …

Department of Community & Family Medicine, Faculty of Medicine, University of Jaffna-2018

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FAMILY ATTACHMENT STUDENT GUIDE

1) Introduction and objectives

The Family Attachment provides the opportunity for students to follow up a family residing in the

University Field Project Area (Nallur MOH Area) for a period of about eight months. The attachment is is

a group activity; each student group will consist of three students, among whom there will be at least one

female student, and one Tamil-speaking student.

By the end of the family attachment, students should be able to:

o Demonstrate knowledge on health beliefs, attitudes and practices prevalent in the family and

community;

o Identify salient social problems that shape health and illness at the family and community level;

o Demonstrate knowledge of the family and community implications of healthcare beyond the

level of individual treatment;

o Self-evaluate and critically reflect on activities undertaken to uplift the health status of the

assigned family and their limitations;

o Communicate effectively and professionally with a family; and

o Demonstrate stronger writing skills.

2) Family visits

Once your family is assigned, please make your initial home visit with the relevant Public Health

Midwife (contact details are posted on the Department notice board and LMS). At your first visit, you

should explain the purpose of your visit, obtain consent for follow-up, and ensure that the family will

reside in the Nallur MOH Area for the next 8 months. If the family is not willing to be followed up or

informs you that they may change their residence, please inform the Department immediately and an

alternative family will be assigned to you. You are expected to regularly visit the assigned family (as a

group) over a period of 8 months. During the visits, you are expected to:

• Develop rapport with family members;

• Identify health and social problems and address them to the best of your ability;

• Review the medical records of family members and ensure appropriate follow-up;

• Meet relevant healthcare providers and community leaders;

• Provide health education and intervene where necessary;

• Make as many visits as necessary until you get the required information; and

• Be honest and admit when you do not know or cannot do something.

Please ensure that you demonstrate professionalism in all interactions with families. Understand that the

families are contributing to your learning by agreeing to be followed up. In return, you are expected to

contribute in whatever way you can towards uplifting their health status to the best of your abilities as a


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medical student. Some examples of activities you might undertake include directing/linking the individual

with available healthcare and social services, making the relevant service providers aware of any

unidentified health/social problems, and health promotion. Note that the Department will be obtaining the

family’s feedback when assessing your work.

3) Outputs

You are required to upload the outputs listed below via LMS. Instructions will be provided on LMS for

submission. Please refer supplementary Timeline for Family Attachment on LMS for details of deadlines.

3.1 Diary (due at 6-weekly intervals)

You should record the date of your visit, any problems identified, steps taken, and any additional

experiences that you felt were important after each visit. Summarize your diary entries on a 3-weekly

basis on LMS (follow instructions on LMS and refer Timeline for Family Attachment on LMS).

3.2 Preliminary assessment of problems (due date: after ~ 8 weeks)

Assess your family in relation to the following aspects: 1) sociodemographic data; 2) Economic status; 3)

Housing and environment; 4) Water supply; 5) Sewage disposal; 6) Refuse disposal; 7) Health status of

the family; 8) Health practices; 9) Availability and utilization of services; and 10) Sociological aspects.

The key areas that you need to cover under each section are listed below. Please note each section should

be about 50-100 words in length with the exception of section 7 (Health Status of family) where you are

expected to include a summary (~ 100 words) of your health assessment of each family member. You will

build on this assessment in your final report; it is to your advantage to carry out a thorough assessment at

this stage (follow instructions on LMS and refer Timeline for Family Attachment on LMS).

1. Sociodemographic data

Location of house

Number of occupants, their names, sex, age and relationship to the chief occupant

Civil status (married/unmarried/divorced/deserted/widow/widower) and type of family

(nuclear/extended)

Religion of family members

Education level of family members

Occupations of family members

2. Economic status of the family

Total monthly income of the family

Labour income (from employment)

Property income (e.g. rent)

Other income (e.g. social welfare assistance, relatives abroad, home

garden)


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Land/house ownership

Assets and possessions (movable and immovable)

Employment status of family members

Livelihood assistance (e.g. equipment from donors/NGOs)

Expenditure pattern and priorities of expenditure

Ask to maintain a diary for a month to write the monthly expenditure including

expenditure on foods and other consumables

Debt and reason for falling into debt

3. Housing and environment

Surroundings of compound

Exposure to dust, smoke, noise

Mosquito breeding sites

Compound

Cleanliness and presence of risk factors for communicable disease

Small collections of water (dengue)

Rearing of pigeons/other birds (atypical pneumonia)

Rearing of cats, dogs (bronchial asthma trigger, risk of typhus)

Rabies vaccination status of pets

Presence of home garden

Housing

Describe roof, walls, floor

Adequacy of ventilation

Adequacy of light

Kitchen

Whether kitchen smoke enters the rest of the house

Water supply to the kitchen

Proper waste disposal and water drainage

Proper storage of groceries and preparation of food

Protection of food from flies and cockroaches

4. Water supply

Source: Well/tube well/pipe-borne water


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Well inside compound/shared well/common well

Protected well/semi-protected well/unprotected well

Parapet wall

Fully covered with concrete with a man hole

Internal plaster

Platform

Lead way drain

How water is obtained from well

Water stagnation around well

Location of well

Absence of public drains within 200 feet from well

Absence of dumping place and toilet pits within 50 feet from well

Chlorination

5. Sewage disposal

Availability of latrine

Type of latrine

Latrine in compound/shared latrine

Facilities for washing hands with soap and water

Habit of open defecation and disposal of faeces

6. Refuse disposal and collection

Describe refuse disposal methods

Availability of garbage collection services

7. Health status of the family

You should assess the physical, mental, and spiritual health status of family members. Provide a

brief outline of the health status of each family member in relation to the following areas:

For all family members:

History of health related complaints (if any)

Findings of general examination and relevant system examination

Summary of management to date


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In addition to the above,

For children:

Take a birth history, identify birth related complications and their consequences

Assess growth

Monitor weight/height and assess nutritional status

Identify underlying causes for failure thrive and/or nutritional issues

Asses developmental milestones

For breast fed infants, assess adequacy of breast feeding and feeding technique

For those on complementary feeding, assess diet by a 24-hour dietary recall

Immunization status

For adolescents:

Look for anemia and low/high BMI

Behavioural issues

For couples in the reproductive age group:

Sexual health

Preconception preparedness

Family planning

Number and age at pregnancy/ies

Outcome of pregnancies

Birth spacing

Whether planned/unplanned pregnancies

Desired family size

Contraceptive method

Compliance

Presence of unmet need

Reason for not using contraception

Subfertility management

For pregnant mothers:

A comprehensive antenatal history

Presence of complications of pregnancy


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How they manage minor complications in pregnancy

Whether high risk pregnancy

If high risk pregnancy

Whether mother knows about the risks associated with the pregnancy

Regularity of clinic follow up and drug compliance

For family members > 35 years:

Risk assessment for non-communicable diseases

BMI

Dietary habits

Smoking/alcohol consumption

Physical activity

Family history

Screen for diabetes mellitus, hypertension, and hyperlipidaemia

For those with non-communicable diseases: (diabetes mellitus, hypertension, hyperlipidaemia,

ischemic heart disease, stroke, chronic kidney disease, chronic lung disease, rheumatic arthritis):

Identify complications of the disease (if any)

Assess knowledge about the disease

Assess life style

Assess regularity of clinic follow up and drug compliance

For elders (> 60 years):

Assess hearing and vision

Assess mental status and cognitive function

Assess basic activities of daily living (e.g. bathing, feeding, dressing etc.) and

instrumental activities of daily living (e.g., shopping, preparing meals, using phone)

Assess risk of fall

Presence of constipation, fecal/ urinary incontinence

Family rapport

Negligence

For people with disabilities:

Health problems related to disability


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8. Health beliefs and practices

Communicable disease prevention

Hand washing before cooking, before eating and after the defecation

Proper hand washing method

Keeping nails short

Use of slippers to the toilet

Drinking boiled cooled water

Proper cleaning of kitchen utensils

Non-communicable disease (NCD) prevention

Healthy life style

Dietary practices

Physical activity

Stress management

Assess risk of road traffic accidents

Occupational hazards

Myths and taboos

9. Availability and utilization of services

Map the health care services available to the family

Identify the nearest preventive and curative primary health care centers

List the services provided by the primary health care center:

antenatal clinic; postnatal clinic; child welfare clinic; family

planning clinic; well women clinic; healthy lifestyle clinic;

dispensary; non communicable disease clinic; home visits

Whether family members access services from the centres or not

If not, identify reasons for non-use

Lack of knowledge; poor accessibility; poor quality of care

Whether family members access alternative primary healthcare

facilities (private sector, siddha medicine)

Services from PHM and PHI

Whether they make home visits or not

Impressions of these services


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Private practitioners

Reasons for use/non-use

Secondary/tertiary government hospitals

Reasons for use/non-use

Map the public services available outside the health sector

Grama Niladhari Office

Pradeshiya Sabha Office

Divisional Secretariat

Police

Bank

Market

Social services

Department of Social Services

Samurdhi Office

Self-help groups/organizations

Schools and pre-schools

NGOs and charities

Places of worship

10. Psychosocial aspects

Familial harmony/disharmony

Relationship between spouses

Relationship between parents and children

Relationship between family and their relatives

Poor relationships with neighbors

Trauma

Bereavement

War-related deaths/disappearances

Domestic violence/intimate partner violence

Child abuse

Child labour


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Neglect

Physical/sexual/emotional abuse

School dropout and educational problems of children

People with disabilities

Negligence

Accessibility issues, transport

Social support and assistance

Stigma

Suicide

Suicide ideation (having suicidal thoughts)/attempted suicide/suicide

Use of addictive substances

Alcohol consumption

Number of units consumed per week

Safe level/hazardous level/dangerous level

Presence of heavy alcohol consumption (binge drinking)

Presence of dependence

Physical, psychiatric and social problems due to alcohol consumption

Smoking

Number and packs per day

Pack years

Betel nut chewing

Use of other addictive substances

Help seeking behaviour and coping strategies

3.3 Priority list of problems (due: after 8 weeks)

After you identify problems in your preliminary assessment, divide them into acute and chronic

problems, and list them according to priority. You will then submit the problem list via LMS (follow

instructions on LMS and refer Timeline for Family Attachment on LMS).

3.4 Action plans for acute and chronic problems

Develop two action plans (see table below for guidance) to address identified acute and chronic

problems separately and submit via LMS (follow instructions on LMS and refer Timeline for Family

Attachment on LMS).


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Table X. Action plan for acute problems

Problem

Action steps

(what is to be done to address problem)

Responsible people

(who will do it- family

members/group members/service

providers etc.)

Time line

(By when- date/

month)

Required resources

(mark if available and × if not available)

Expected barriers to implementation

Communication plan

(To whom, method, and how often)

Problem1:

Step1

Step2

Step3

Step4 .

Step 5

Problem 2:

Step 1

step2

Step3

Step4

Step5


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Example:

Problem and date

identified

Action steps

Responsible people

Time line

Required resources

Expected barriers Communication plan

Mosquito breeding sites in compound

(24/6/2018)

Inform PHI Students 24/6/2018 Time

None

Students will communicate with PHI and follow up after a week

Advise family members

Students

24/6/2018 Time

Knowledge

Low literacy level

Lack of cooperation owing to absence of garbage disposal/collection

Students will advise family members

Students will follow up with the family weekly to ensure progress

Search for and identify breeding sites outside the compound

PHI

Students 26/6/2018

Time

Knowledge None

Students will contact PHI to schedule activity and follow up after a week

Remove identified breeding sites within compound

PHI

Students 26/6/2015

Time

Knowledge

Equipment

Breeding sites in unoccupied lands

Students and PHI will advise family members

Students reassess situation weekly

PHI will inform local authority regarding garbage disposal issue

Students will follow up with PHI

Inform relevant authorities about sites outside compound

PHI 30/6/2018

Time

Legal procedures

Ineffective legal procedures

PHI will communicate with property owners as necessary

Students will follow up with PHI

Organize dengue awareness session for community

Students

PHI

MOH

15/7/2018

Time

Cooperation from PHI and MOH

Appropriate venue

Health education material ×

Community mobilization strategy ×

Scheduling difficulties

Lack of resources to develop health education material

Inability to mobilize community owing to lack of strategy

Students will communicate with PHI and MOH regarding awareness session and schedule a suitable date

Students will follow up with MOH and PHI


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3.4 Steps taken to solve problems (4 submissions due 6 weekly; first due after 3 months)

Next, implement the action plan to the best of your abilities. You will be required to write up the steps

you took towards implementing your action plan and submit on four specified dates on LMS.

Describe the steps you took, the challenges faced during implementation, and your successes and

failures (Follow instructions on LMS and refer Timeline for Family Attachment on LMS).

3.5 Reflections on Family Attachment (4 submissions due 6 weekly; first due after 3 months)

You will be required to write short reflections on four specified dates on LMS. In the reflections,

describe your experiences and skills gained/ changes in attitude that may have occurred as a result of

these experiences. Reflections should not describe what you did during your visits, but should instead

focus on how the visits impacted you. Please see here for guidance of reflection writing. Follow

instructions for submission on LMS and refer Timeline for Family Attachment on LMS.

3.6 SWOT analysis (due after 4 months)

Assess your contribution towards solving the problems you identified by performing a SWOT

analysis. Identify your group’s strengths (S) and weaknesses (W) in relation to achieving the

objectives of the family attachment, which are listed on p.1 of this document. Then consider the

opportunities (O) and threats (T) you faced in achieving the objectives. Remember that strengths and

weaknesses are attributes of your group while opportunities and threats are factors in the environment

that facilitated (opportunities) or impeded (threats) achieving your objectives. The SWOT analysis

should focus on your group’s attributes, NOT the family’s. You may include family aspects as

opportunities or challenges, but do not limit these sections to the family. See here for guidance.

3.7 Family attachment presentation (Term 9)

You will make a presentation on your Family Attachment to the Department in Term 9 where you

will be assessed and receive feedback. Please note that the presentation should consist of the work

you have undertaken up to this point. The presentation will account for 30% of your Family

Attachment grade/marks. You will be asked to upload your PowerPoint presentations via LMS on a

specified date. Please follow instructions for submission on LMS and refer Timeline for Family

Attachment on LMS.

Instructions to prepare the power point presentation:

1. Introduction

1.1 Identification details

Name of chief occupant

What type of family (nuclear/extended)

Address

Grama Niladhari Division

PHI Range (Kondavil, Kokuvil, Nallur)

http://www.port.ac.uk/media/contacts-and-departments/student-support-services/ask/downloads/Reflective-writing---a-basic-introduction.pdf

https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/swot-analysis/main


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PHM Area (Ariyalai I, Ariyalai II, Arukalmadam, Kondavil Centre, Kondavil East,

Kondavil North, Kondavil South, Konawalai, Kulappiddy, Manchavanapathy,

Pirampady, Thirunelveli East, Thirunelveli North, Thirunelveli South)

1.2 Sketch maps of house and location

Sketch map of house and compound

Sketch map indicating availability of health and other services in the vicinity of the

house

1.3 Details of the family members

Tabulate names, ages, sex, civil/marital status, ethnicity/religion, educational status,

occupation and any other points you may wish to highlight about your family

1.4 Family tree

Draw a family tree denoting diseases that run in the family, as depicted in Figure 1 below.

Refer this source for further guidance.

1.5 A short summary of the health and social status of the family for your audience to understand

the social background of the family and their vulnerability to health problems.

2. Problem lists and discussion

Present the list of problems you identified in your preliminary assessment and the updated list of

problems. Comment on the differences between the lists.

Figure 1. Example of a family tree

3. Steps taken to solve the problems

Describe the steps you took to solve the problems in your list, in the order of priority.

https://www.genomicseducation.hee.nhs.uk/takingfamilyhistory101/how-do-i-draw-a-family-history/


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4. SWOT analysis

Present your SWOT analysis. Again, remember that strengths and weaknesses are attributes of

your group while opportunities and threats are factors in the environment that facilitated

(opportunities) or impeded (threats) achieving your objectives. The SWOT analysis should focus

on your achievements, NOT the families.

General points to note in your presentation:

Use slides with a simple background. Do not make it clumsy by using different fonts and

colures. Do not use animations.

Be brief - no more than 6 bullets/points per slide. Use simple sentences

Font - calibri or any other font that has same thickness all over the letters. Font size should be

>24 so that all can read your slides.

Limit your content to 12-15 slides; devote more slides to areas covered by points 2 and 3

above (i.e. identified problems, contributory factors, and steps taken to solve them).

Do NOT use unnecessary images like photographs of family members, scanned diagnosis

cards or other medical records that may compromise the privacy and dignity of the family. If

you think an image is essential, please use only with consent from the family.

Do NOT read your slides; summarize the content of each slide before your final presentation

and rehearse.

Use this source if you need further guidance.

5. Next steps

6. Acknowledgement

Acknowledge the family’s cooperation and any guidance/assistance you received from service

providers and community leaders (PHI, PHM, MOH, GS and others)

3.8 Family Attachment Final Report (due at the end of the Family Attachment)

The final report should not be a print out of your presentation slides, and should contain the following

sections:

1. Summary (~300 words)

A brief introduction to the family and area of residence

Key health and social problems

Key achievements of family during the Family Attachment

Key achievements of students during the Family Attachment

2. Introduction (follow presentation requirements listed above under ‘introduction’)

https://www.dartmouth.edu/~library/biomed/guides/powerpoint.html?mswitch-redir=classic


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3. Family health and social status

Provide a brief account about the health status of each family member (150-200 words per family

member) followed by a description of the social status of the family (~300 words).

4. Problem list and action plan

Tabulate acute and chronic problems in the order of priority along with your action plan.

5. Implementation

Describe how you addressed each problem and the facilitators/barriers you encountered when

addressing each identified problem

6. Recommendations

List your recommendations for the family to improve health status, in order of priority.

7. Discuss your achievements and failures

8. Acknowledgement

Acknowledge the family’s cooperation and guidance/assistance received from service providers

and community leaders (PHI, PHM, MOH, GS and others).

Formatting instructions:

The family attachment report should:

Consist of 20 to 25 pages, printed on both sides with double spacing and 3 cm margins; use

Times Roman font size 12.

Contain a title page which should have the following particulars:

Title: Family Attachment Report

Names of the students and their registration numbers

The bottom of the page should contain the following statement:

“This Family Attachment Report is submitted as a requirement in Community

Medicine at the Second Examination for Medical Degrees [YEAR]”

family attachment student guide 1) introduction and …

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