Genogram Form – Fill Out and Use This PDF

The state of Indiana requires that a genogram and ecomap be a part of the Adoption Home Study preparation. This can be a good exercise to help adoptive families evaluate their own family development. In addition, the genogram and ecomap are helpful to the home study preparer by identifying strengths and challenges of each family unit.

Please continue to read this information to help you begin you genogram and ecomap. You may draw them on plain paper. Feel free to draw in pencil, but please use pen on your final draft. Read through all of the directions before you begin. Please have the genogram and ecomap completed (or mostly completed) before your home visit. This will allow time for you to ask questions and receive assistance from your caseworker.

Be honest. Most families have some amount of discord or conflict. It is much better if you feel free to share any negative family influence with the caseworker. In all likelihood, discord or conflict will not affect the outcome of you home study.

The Genogram

Genograms are similar to family trees and are useful in describing the patterns and dynamics within a specific family. These “pictograms” use symbols to denote key events in the life development of the family. Genograms not only show who is in the family, but also can be useful in presenting relationships. Genograms depict marriage, birth, death, divorce, and may also include behaviors such as mental illness, physical illness and alcohol/drug problems.

The relationships among the family members can be depicted using different types of lines. Typical relationship types included on a genogram are conflicted relationships, close relationships, distant or tenuous relationships, and cut off relationships (no longer talk to each other.) The direction of energy in the relationship is shown with arrowheads. If the feeling flows in only one direction, there is only one arrowhead (which points to the family member who receives the emotion). For example, if Person A was always angry with Person B but the feeling was not reciprocal, the arrowhead would point from Person A to Person B. If the feeling was reciprocal, there would be arrowheads on both ends.

A angry with B (B not angry)

Very close

Cut off

Distant/tenuous

Conflicted

The male is noted by a square, the female by a circle. The male is placed to the left of the female in the father/mother dyad. Marriage is shown by a line connecting the two.

45

Tim

44

Sara

Children are noted oldest to youngest, left to right. Ages are often recorded inside the circle or square. 45

Tim

44

Sara

12

John

10

Amy

Other important notations are shown below:

44

Sara

45

Tim

Foster

Child

Adopted

Child

Stillborn

Miscarriage

Abortion

Identical	Fraternal
Twins	Twins

Marriage dates are recorded above the line connecting husband and wife. 45

Tim

44

Sara

m. 1990

Liasons or a couple living together are displayed similar to marriage, but with a dotted line. 44

Sara

45

Tim

A separation of a couple is marked with one slashed line. The date is usually recorded. 45

Tim

44

Sara

m =

married s = separated d = divorced

m. 1990

s. 1994

45

Tim

44

Sara

A divorce

of a couple is marked with two slashed lines. The date is usually recorded.

m. 1990

s. 1994

d. 1996

The death of a person is indicated by an “x” through the shape. The birth and death dates are usually recorded.

Tim

44

Sara

1945 - 1998

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. Note: If there has been more than one remarriage, the marriages are usually placed from left to right with the most recent marriage coming last.

45

Tim

44

Sara

47

Rob

m. 1990

d. 1996

m. 1999

Example genogram:

47

Rob

44

Sara

m. 1999

45

Tim

3

Joseph

1

Cassie

m. 1990

d. 1996

The Ecomap

An ecomap is a pictorial representation of a family’s connections to persons and/or systems in their environment, and how they are affected. Using symbols similar to those used in a genogram, an ecomap diagrams a family’s relationship with the world in which it functions. Econmaps can illustrate three separate dimensions for each connection:

1.The strength of the connection (weak, tenuous/uncertain, strong)

2.The impact of the connection (none, draining resources or energy, providing resources or energy)

3.The quality of the connection (stressful, non-stressful)

Some examples of relationships may include:

Weak connection, draining energy/resources. not stressful. John

School

Strong connection, providing energy/resources, not stressful. John

School

Weak connection, no impact on energy/resources, stressful. John

School

Tenuous/uncertain connection, providing energy/resources, not stressful. John

School

School

Example ecomap:

Work

John

Amy

Hobbies

Religion

Hobbies

Some general rules for drawing an ecomap:

1.At the center of the ecomap, a simplified view of the target family members in the household should be depicted, using genogram symbols.

2.The intent is for each individual in the household to be addressed.

3.There are some domains that will apply at the household level, or for all individuals in the family. These can be charted at the household level and do not need to be charted for each individual.

4.If no connection exists for an individual or a household, you may omit the domain altogether, indicating that no connection exists, or you may draw in the domain and not connect it to indicate no connection.

5.Brief summary comments are to be written inside the circles — they need not be very detailed.

Domains to include in your ecomap include a) neighborhood — the physical area in which your home exists (not a house or apartment, but the area in which the house or apartment exists, b) community services

—includes medical, mental health, substance abuse, child welfare, legal, etc., c) social groups — church, civic, gym, sports, spirituality, family, friends, d) education. e) significant personal relationships, f) employment. g) other.

Guiding questions for ecomap:

I.Neighborhood

1.Flow well do your family members know your neighbors?

2.What neighborhood activities do they attend?

3.Do your children play with other neighborhood children?

4.Flow long have you lived there?

5.What do your family members get from your neighborhood?

II.Community services

1.With what community organizations or agencies are your family members involved?

2.How long have they been involved? What frequency?

3.With whom do they have a relationship? Who gives them support?

4.What services work best for them?

5.How do they feel about the involvement?

Ill. Social groups

1.With which social groups are your family members involved?

2.How long have they been involved? What frequency?

3.With whom do they have a relationship? Who gives them support?

4.What services work best for them?

5.How do they feel about the involvement?

IV. Education

1.Who in your family goes to school?

2.How long? What is their status? What is their goal?

3.How do they feel about it?

4.With whom do they have a relationship? Who gives them support?

V. Significant personal relationships

1.With whom do your family members have significant personal relationships? Includes extended family members, friends, etc.

2.How long has the relationship lasted?

3.What do they do together?

4.How do they feel about this relationship?

5.What do they get it from it?

VI. Employment

1.Who in your family works?

2.How long? What is their status?

3.How do they feel about it?

4.With whom do they have a relationship? Who gives them support?

VII. Other

Example genogram #1:

John (42 years old) and Michelle (41) have been married since 1994. They have two children, Connor (10) and Suzie (8). John was previously married to Jill, and they divorced in 1990. They have one child, Alex (16). Michelle was previously married to Jack (43). They divorced in 1990, and have child. Mary (15). John’s parents are Tom (70) and Heather (68). John is an only child. Michelle’s parents are Bob

(69)and Lisa (68). Michelle has a younger brother, Drew (39). 42

John

41

Michelle

m. 1994

43

Jack

10

Connor

m. 1985

d. 1990

8

Suzie

16

Alex

70

Tom

69

Bob

39

Drew

m.1948 m. 1946

m. 1984

d. 1990

63

Heather

42

Jill

68

Lisa

15

Mary

Example Genogram #2:

This genogram is for the same family, with a few exceptions. John’s father passed away in 2000. John and Michelle have three children two biological, and one adopted, Daniel (5).

42

John

41

Michelle m. 1994

43

Jack

10

Connor

m. 1985

d. 1990

8

Suzie

16

Alex

Tom

69

Bob

39

Drew

m.1948 m. 1946

m. 1984

d. 1990

63

Heather

42

Jill

68

Lisa

15

Mary

5

Daniel

1926 - 2000

Example Ecomap:

John is employed at Berry Plastics, and Michelle is employed at Bristol Myers. Connor and Suzie both attend South Terrace Elementary School. Connor enjoys school and receives good grades. Suzie on the other hand, does not like school, and struggles to pass her classes. Connor is on the basketball team, and Suzie is involved in gymnastics. The family attends Zion Lippe United Church of Christ regularly, and their hobbies include camping, fishing and gardening together.

42

John

10

Connor

41

Michelle

8

Suzie

Employed at

Berry Plastics

Employed at

Bristol Myers

Family hobbies, camping, fishing, and gardening Gymnastics

Zion UCC

Basketball

South Terrace

Elementary