The Family APGAR:  Dimensions of Family Functionality 5/21/21

We are all familiar with the APGAR score as a critical tool in neonatal assessment.  Not so, the Family APGAR, which is a tool that measures important elements of a family system that can be helpful in assessing a family’s resources and functionality in responding to the vicissitudes and challenges in their lives.   As with the APGAR, scores will range from 0 to 10 with higher scores indicating better functionality.

While potentially more relevant as a screening and monitoring tool for family therapists, a brief discussion of the Family APGAR’s dimensions is offered herein to assist the primary care physician in their more informal psychosocial assessment and appraisal of their patient’s families.  Our goal is to assist PCPs in identifying ways in which a distressed family may be at risk and then facilitating their referral for educational intervention, supportive services, and/or formal therapies that will be most appropriate.

The five functional components of the Family APGAR are: Adaptability, Partnership, Growth, Affection, and Resolve.   Substantial deficits or distortions in any of these arenas may lead to challenges in child-rearing and child development that can lead to dysfunction that may manifest in physiological, psychological, and/or social domains.  For parent and other adult patients’ similar concerns about dysfunctional coping are of equivalent concern.  Families with greater functionality in the APGAR domains can deal better with adversity (medical, financial, sociocultural, etc.) in addressing both routine and exceptional challenges in their lives.

THE FAMILY APGAR DOMAINS

Component                                                                                         Definition

Adaptation              Adaptation is the utilization of familial resources for problems solving in the face  of life change(s) that disrupt the                                                        family’s equilibrium

Partnership             Partnership is the sharing of decision making and nurturing responsibilities within the family

Growth                     Growth is the physical and emotional maturation and self-fulfillment achieved by family members through mutual                                                     support  and guidance

Affection                 Affection is the caring or loving relationship that exists among family members

Resolve                   Resolve is the commitment to devote resources to other family members for physical and emotional nurturing

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THE FAMILY APGAR QUESTIONAIRE:   Five questions rated using a 0, 1, or 2 score to represent

0   =    Hardly ever

1    =  Some of the Time

2   =   Almost Always

  1. I am satisfied with the help I receive from my family when something is troubling me
  2. I am satisfied with the way my family discusses items of common interest and shares problem solving with me
  3. I find that my family accepts my wishes to take on new activities or make changes in my life
  4. I am satisfied with the way my family expresses affection and responds to my feelings
  5. I am satisfied with the amount of time my family and I spend together

In the ideal world, it would likely be desirable to utilize the Family APGAR, or a similar instrument, routinely to obtain both baseline and post-incident measures of a family’s resilience and adaptability, however, the realities of current day practice, with demands for screening of multiple health and behavioral health concerns, make implementation unlikely.  That said, it is hoped that this discussion of the Family APGAR screening tool will serve to highlight the various dimensions of family functionality and identify means of inquiry to assess these domains and result in enhanced clinical awareness and responsiveness for families in distress.

We encourage your making referrals of parents and families to the SmartCare Parent Line @ (858) 956-5900 when further evaluation attention may be desired to address psychosocial and behavioral health issues. Our staff can provide supportive guidance and assist in making referrals for those who present with service needs.

Reference:

The Family APGAR:  A Proposal for a Family Function Test and Its Use by Physicians,  G. Smilkstein, MD, The Journal of Family Practice, Vol 6, No 6, 1978

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