Community Health Manual
Guideline
Birth to School Entry
3.8
Resources/Tools/Guides
3.8.1
Genograms
Background
A Genogram is a drawing of a family tree that contains information about
family members and their relationships. Emphasis is on identifying structural
and functional patterns, the quality of relationships, and significant life events.
It is one step in formulating an overall picture of the family’s background prior
to assessing the inner workings of the family unit. It needs to be noted that a
Genogram will reflect the client’s point of view, may be expressed differently
by other family members, and will change over time.
Uses for a Genogram
Document communication patterns and barriers.
Explore emotional and behavioural patterns in an intergenerational context.
Assist the family to see itself as an interdependent group of individuals,
connected in important ways.
Assist family members to identify commonalities and uniqueness in other
members (useful in identity development).
Clarify options for changes in the family (perhaps moving from an enmeshed
family with children to an 'empty nest').
Identify the potential isolation of one member of the family as a 'scapegoat' or
person 'with the problem' independent of the total family structure.
Benefits of Genograms
Facilitate alternate interpretations of family experiences.
Convey a great deal of information visually compared to writing down
relationships in long hand.
Time taken for client to describe relationships can contribute to ‘relationship’
building.
Commonality across health disciplines.
Barriers to Use
May not demonstrate the different views of ‘family’ in some cultures if it is only
reflecting a family as a ‘biological’ entity.
Time to develop the Genogram.
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 1 of 10
Community Health Manual
Guideline
Birth to School Entry
General principles
Using the genogram aims to improve the quality of service delivery by enhancing
knowledge of the client’s family experiences, enabling the Community Child Health
Nurse (CCHN) to initiate and build a supportive relationship with the family.
Role of community health staff
As a Genogram contains information about family members and their relationships, it
should be completed as part of the ongoing family assessment. Emphasis is on
identifying structural and functional patterns, quality of relationships, and significant
life events. It is one step in formulating an overall picture of the family’s background
prior to assessing the inner workings of the family unit.
Documentation
The Genogram is recorded in the Child health record, page CHS800A-2. CCHNs
should refer to the appropriate record keeping guidelines for documentation storage
and use.
Follow up and service planning
Once an assessment is made, the CCHN together with the parent will then develop a
plan outlining frequency of visits, venue, and referral needs. Include other family
members in developing the plan where necessary.
Related policies, procedures and guidelines
3.8 Resources
3.8.2 Indicators of Need
3.3 Guidelines for Birth to School Age Entry Universal Contact Schedule
3.3.3 Universal postnatal first contact
Useful resources
http://www.genograms.org/components.html
Policy Owner
Portfolio Birth to School Entry
Director, Clinical Services Community
Health
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 2 of 10
Community Health Manual
Guideline
Birth to School Entry
Outline for a brief Genogram Interview
For each person in the Genogram the following baseline information may be included; staff should determine its
relevance for inclusion dependent on the issues the family is concerned about.
Demography: First name
Age
Date of
Birth
Occupation
Ethnic or
Religious
background
Dates of marriages, divorces,
separations, commitments, de
facto remarriage
Health
problems
Family
structure:
Nuclear
Blended
Singleparent
Gaylesbian
relationship
Defacto
Separation/s
Divorce
Sibling
subsystem:
Birth order
Gender
Patterns of
repetition
across
generations:
Family
structure
Family
Behaviour
Distance
between
children
Family
health
problems
Patterns of
Family
relationships violence
Abuse issues
Poverty
Life events:
Similar type
of events
across
generations
Family
transitions
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
Family
traumas
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 3 of 10
Cause
of death
Education
Community Health Manual
Guideline
Birth to School Entry
Standard symbols for Genograms
Males are identified on a genogram with a square
and
females with a circle
The male is always at the left of the family and the female is always at the
right of the family.
If the sex is unknown, this is indicated by an inverted triangle
Other symbols
Gay
Lesbian
Client
Client/ Family
The death of a person is indicated by a
through the shape and the date of
death is recorded below the shape or marker.
d 4.5.02
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 4 of 10
Community Health Manual
Guideline
Birth to School Entry
Children and Birth Symbols
Abortion
Biological Child Identical Twins
Fraternal Twins
Adopted
Foster, Stillbirth
Miscarriage
Pregnancy
Children of the marriage or partnership are shown along a connecting line below the
parents. Children are noted oldest to youngest, left to right. The child’s age is
generally recorded inside the shape and the date of birth shown below.
45 yo
m 1985
b 6.2.58
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 5 of 10
Community Health Manual
Guideline
Birth to School Entry
Children living with one parent; line goes from the side of divorce // symbol nearest
to parent who the child lives with.
Joint Custody
Children from previous relationship along same generational line to side of this
relationship’s offspring
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 6 of 10
Community Health Manual
Guideline
Birth to School Entry
Family Relationships
The next genogram component is the family relationship; the union of two
individuals. Family relationships are marriage, divorce, separation, de facto and
engagement.
Marriage is shown by a line connecting father and mother. The male is placed to the
left of the female in the father/mother dyad. Marriage dates are recorded above the
line connecting husband and wife.
m 1975
A separation of a couple is marked with one slashed line. The date is also usually
recorded.
m 1975, s 1994
A divorce of a couple is shown by two slash lines running through the connecting
line. The date is also usually recorded.
m 1975, d 1996
De facto relationships and liaisons are shown as similar to marriage, but with a
dashed line.
Engagement is shown as similar to de facto relationships, but with longer dashed
lines.
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 7 of 10
Community Health Manual
Guideline
Birth to School Entry
A remarriage (or former marriage) is shown to the side with a smaller shape. The
focus couple is the one in the middle with the larger shapes. If there has been more
than one remarriage, the marriages are usually placed from left to right with the most
recent marriage placed last.
m 1975, d 1996
m 1999
Lesbian relationships are shown as similar to marriage, but with a dashed line.
Gay relationships are shown as similar to marriage, but with a dashed line
(LT = living together)
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 8 of 10
Community Health Manual
Guideline
Birth to School Entry
Emotional Relationships
Although the family relationship may to some extent describe the emotional bond
between the two parents, the emotional relationship component can be used to
describe the emotional bond between any two individuals in the genogram.
Close
Focused On
Hostile
Distant
Sexual Abuse
Fused-Hostile
Close-Hostile
Fused
Cut Off
Physical/Emotional Abuse
Each of the above emotional relationships is described below:
Close: a close relationship (friendship) between two individuals.
Fused: a relationship between two individuals. Each submerges “self” in the
other, and the partners become fused with little space for their own identities.
Distant: a distant relationship between two individuals. Communication is very
limited usually because of geography or lifestyle differences.
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
Page 9 of 10
Community Health Manual
Guideline
Birth to School Entry
Hostile: a hostile relationship between two individuals. The two individuals have
conflicts and argue on major issues.
Close-hostile: a close-hostile relationship between two individuals. These
people have frequent contacts but argue and keep secrets from one another.
Fused-hostile: a fused-hostile relationship between two individuals.
individuals are always together yet unable to live without arguing.
These
Focused On: one individual is focused unhealthily (obsessed) on another
individual.
Cut off: A cut off relationship is where the two individuals have no contact at all,
characterized by extreme disengagement and emotional intensity.
Sexual Abuse: One individual is sexually abusing another individual. Any sexual
act between an adult and child, or a forced sexual action between two adults.
This includes fondling, penetration, intercourse, exploitation, pornography,
exhibitionism, child prostitution, group sex, oral sex, or forced observation of
sexual acts.
Physical/Abuse: One individual is physically and/or emotionally abusing another
individual. Physical abuse is any non-accidental injury to an individual, typically to
a child or a woman. This includes hitting, kicking, slapping, shaking, burning,
pinching, hair pulling, biting, choking, throwing, shoving, whipping, and paddling.
Emotional abuse: is any attitude or behaviour which interferes with mental
health or social development. This includes yelling, screaming, name-calling, and
shaming, negative comparisons to others, telling them they are “bad, no good,
worthless” or a “mistake”.
Date Issued: 2007
Date Reviewed: July 2015
Next Review: July 2018
NSQHS Standards:
1.7
3 Birth to School Entry
3.8 Resources/tools/guides
3.8.1 Genograms
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