The use of The use of Genograms in Genograms in Safeguarding in Safeguarding in Primary CarePrimary CareDr Venetia Young Dr Venetia Young

GP, Penrith, CumbriaGP, Penrith, Cumbria

The aim of todayThe aim of today

Is transformationIs transformation

Why Genograms?Why Genograms?Combine biomedical and psychosocial informationCombine biomedical and psychosocial informationAre an excellent database for future referenceAre an excellent database for future reference

Emphasise the clinician’s interest in the context of their patients livesEmphasise the clinician’s interest in the context of their patients lives

Produce unexpected storiesProduce unexpected storiesMake connections between people and eventsMake connections between people and events

Trans-generational patterns of disease and problem behavioursTrans-generational patterns of disease and problem behaviours

Place presenting problem in a historical context. This can be non Place presenting problem in a historical context. This can be non blaming and help to relieve shameblaming and help to relieve shame

Arouse curiosity in clinician and patientArouse curiosity in clinician and patientDiagnostic and therapeutic. They put the patient in the observer role of Diagnostic and therapeutic. They put the patient in the observer role of their own family dramatheir own family dramaEvidence of time saved: 4 times information from 20 minute interviewEvidence of time saved: 4 times information from 20 minute interview

When genograms are When genograms are usefuluseful

Presentation of distressPresentation of distress Feeling stuckFeeling stuck Wanting to widen your understandingWanting to widen your understanding Heart-sink feelingHeart-sink feeling Illness historyIllness history Cultural migrationCultural migration Domestic abuseDomestic abuse

Why in safeguarding Why in safeguarding cases?cases?

History of relationships and their qualityHistory of relationships and their quality History of drug and alcohol problemsHistory of drug and alcohol problems History of mental health problemsHistory of mental health problems Which professionals are involvedWhich professionals are involved Invisible childrenInvisible children Invisible men (Baby H)Invisible men (Baby H) Look for strengths and protective factorsLook for strengths and protective factors More accurate referrals, with greater chance of More accurate referrals, with greater chance of

appropriate response. Discussion with colleaguesappropriate response. Discussion with colleagues Risk assessment: suicide, self and other harmRisk assessment: suicide, self and other harm

Cases. 1 Child Protection Cases. 1 Child Protection

7 year old boy presenting with distress 7 year old boy presenting with distress after access visits to his father and his after access visits to his father and his new partner.new partner.

Discussed with HV and SN at monthly Discussed with HV and SN at monthly meetingmeeting

Referral made to SSDReferral made to SSD

Case 2. Vulnerable adult Case 2. Vulnerable adult at risk of financial abuseat risk of financial abuse

Family known to have high expressed emotionFamily known to have high expressed emotion Young man has neurological problems, LD and Young man has neurological problems, LD and

occasional episodes of psychosisoccasional episodes of psychosis Professional network walking on eggshellsProfessional network walking on eggshells Sister talks of sexual abuse by older brother and Sister talks of sexual abuse by older brother and

presents evidence.presents evidence. Concerns re financial abuse as he has power of Concerns re financial abuse as he has power of

attorneyattorney Discussed with other GP leadsDiscussed with other GP leads Discussed with mental capacity expertDiscussed with mental capacity expert Meeting with care team and the aboveMeeting with care team and the above

Case 3. Domestic Case 3. Domestic violenceviolence

39 year old Lithuanian woman with 3 39 year old Lithuanian woman with 3 presentations to MIU in last 6 months with presentations to MIU in last 6 months with bruises. Admits to being hit by husbandbruises. Admits to being hit by husband

HV and SSD already involved in monitoring HV and SSD already involved in monitoring harm to the childharm to the child

Presentation to primary care with lower Presentation to primary care with lower abdominal pain and probable pelvic infectionabdominal pain and probable pelvic infection

Sister-in law dies and she wrecks the Sister-in law dies and she wrecks the graveyard.graveyard.

If you don’t tell anyone you can be my trusted If you don’t tell anyone you can be my trusted doctor.doctor.

Case 3 continuedCase 3 continued

Power and control wheelPower and control wheel Marac questionnaireMarac questionnaire Stress cycleStress cycle 7/11 breathing7/11 breathing Discussion with HV and school nurseDiscussion with HV and school nurse SupervisionSupervision Liaison with CMHT, adult safeguarding lead in Liaison with CMHT, adult safeguarding lead in

SSD and Children and families SWSSD and Children and families SW

Making the connectionMaking the connection

Introducing the genogram , seeking consent and asking some questionsIntroducing the genogram , seeking consent and asking some questions Who can you talk about your concerns to?Who can you talk about your concerns to? Who are most/least sympathetic?Who are most/least sympathetic? Who do you try to keep how you feel a secret from?Who do you try to keep how you feel a secret from? What would happen if they found out?What would happen if they found out?

Most families have someone with a drink problem. Who is it in yours?Most families have someone with a drink problem. Who is it in yours? What is the impact of the abuses you have suffered on family What is the impact of the abuses you have suffered on family

relationships?relationships? What are your fears about leaving?What are your fears about leaving? What should your fears about leaving be?What should your fears about leaving be? How do you keep yourself safe?How do you keep yourself safe? Who helps you to keep yourself safe?Who helps you to keep yourself safe? What strengths do you have? Who taught you these?What strengths do you have? Who taught you these?

The Art of lensesThe Art of lenses

GenderGender PowerPower ReligionReligion IllnessIllness CultureCulture EthnicityEthnicity Social classSocial class Family patternsFamily patterns

Summing upSumming up

What do you notice about what we have drawn What do you notice about what we have drawn together?together?

Would you like to hear what I have noticed?Would you like to hear what I have noticed? Does that make sense to you?Does that make sense to you? Would it be helpful to have a copy of this or talk Would it be helpful to have a copy of this or talk

about it with a member of your family/friend?about it with a member of your family/friend? Create a planCreate a plan Breaking ‘bad news’ of referralBreaking ‘bad news’ of referral

Patient views of the process Patient views of the process of doing a genogram for of doing a genogram for safeguarding purposessafeguarding purposes

See their problems more clearlySee their problems more clearly Like having their lives explained in one Like having their lives explained in one

go – quicker than some therapists get to go – quicker than some therapists get to in 10 sessionsin 10 sessions

Take their problem more seriouslyTake their problem more seriously Some vote with their feet – but only Some vote with their feet – but only

occasionally.occasionally.

Practical considerationsPractical considerations

Where to store the genogramWhere to store the genogram ConfidentialityConfidentiality Practice with your own genogramPractice with your own genogram Practice with easy patients – newly Practice with easy patients – newly

pregnantpregnant Find a buddy to share learning Find a buddy to share learning

experiences with.experiences with. Family therapist to support learningFamily therapist to support learning

References and linksReferences and links

Ten minutes for the family. Asen, Ten minutes for the family. Asen, Tomson, Tomson and Young 2004 Tomson, Tomson and Young 2004 RoutledgeRoutledge

www.caada.org.ukwww.caada.org.uk RCGP guidelines on Domestic ViolenceRCGP guidelines on Domestic Violence www.kwango.comwww.kwango.com www.cumbrialscb.comwww.cumbrialscb.com