Global function of assessment presentation

Presentation for class.

1. Cierra Beck Global assessment of functioning

2. What is it? The Global Assessment of Functioning was part of the old DSM (1) It is used to rate the overall psychological, social and occupational functioning of adults in a mental health setting (1) This scale began in 1962 with the publication of the health-sickness rating scale, which was also rated 0-100 (1) The updated DSM uses an assessment called WHODAS – World Health Organization Disability Assessment Schedule (1)

3. Reliability It has been found that this assessment is not very reliable, this could be part of the reason the new DSM-5 includes the WHODAS assessment In a Swedish psychiatric care system they are using the GAF to measure outcomes, using intraclass correlation coefficients assessed inter-rater ability and factors associated with reliability (2) In layman's terms the GAF was assessed and had satisfactory reliability So not great, but not terrible What they found was that the GAF’s measurement of error was too large for assessment of change in an individual patient (2)

4. Reliability The GAF is a broad and not specific indicator of mental health (3) There was another study done with 36 psychologists who have used the GAF and some scored it high, deeming it had high information value, while others deemed it had low information value (4) This shows us that the GAF may be useful at times, but not very useful at other times This does not make it a very reliable assessment

5. Validity The GAF is well known internationally and widely used for scoring in mental health (5) Although it is so widely used, it has many issues with its reliability and validity (5) In a study of the reliability and validity of the GAF they studied a total of 432 outpatients with a current major depressive disorder. In this study the GAF showed a strong correlation with disease severity and social and physical functioning (6) In conclusion the GAF showed rather poor inter-rater reliability as well as poor discriminant validity (6).

6. Critique One of the reasons there are gaps in the GAF scale is because it is currently continuous rather than categorical (5) There is also not much supporting the validity or reliability which makes it a very flawed assessment Although its validity and reliability are not too strong, I still think the results can show us important information. The GAF is scored within 10-point intervals (7). There are different guidelines for different conditions, which can make the assessment confusing (7). Also , current guidelines for rating the GAF are not comprehensive which also causes further problems (7). Although this assessment would not be my first choice, I think it is adequate.

7. Scale The GAF scale is a continuous scale ranging from 1-100 (1) (5) A 0 means there is not enough information to rate the client (1) A low score on the GAF (1-10) shows that the patient is in persistent danger of severally hurting self or others or unable to maintain minimal personal hygiene or in danger of a serious suicidal act (1). The higher scores (91-100) show no symptoms, a superior range of functioning, and are sought out by others because of his or her many positive qualities (1).

8. GAF Scale   91 - 100 No symptoms. Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. 81 - 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns. 71 - 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). 61 - 70 Some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. 51 - 60 Moderate symptoms (e.g., flat affect and circumlocutory speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers) .

9. GAF Scale Continued 41 - 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job, cannot work). 31 - 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed adult avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). 21 - 30 Behavior is considerably influenced by delusions or hallucinations or serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends) 11 - 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) or occasionally fails to maintain minimal personal hygiene (e.g., smears feces) or gross impairment in communication (e.g., largely incoherent or mute). 1 - 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death. Inadequate information

10. Life as a CTRS A CTRS would utilize this assessment when working with people with mental health problems. The type of location that you would use the GAF could be the following; a psychiatric hospital, a behavioral health center, or a VA . I would use this at any of these locations as a CTRS. To begin the initial assessment with the client I would conduct an interview using the interview guide approach. Once that was finished I would start at the bottom (most impaired functioning) and read upwards until I found a statement that accurately describes the person you are evaluating (8).

11. References Global Assessment of Functioning. ( n.d. ). Retrieved February 21, 2015, from http://en.wikipedia.org/wiki/Global_Assessment_of_Functioning Soderberg , P., Tungstrom , S., & Bengt , A. (2005, April 1). Special Section on the GAF: Reliability of Global Assessment of Functioning Ratings Made by Clinical Psychiatric Staff. Retrieved February 21, 2015, from http://search.proquest.com.byui.idm.oclc.org/docview/213075703/8A19D5240C9A4675PQ/4?accountid=9817 Anderson, L., & Heyne L. (1999). Therapeutic recreation practice: A strengths approach. State College, PA: Venture Publishing. Woldoff , S. (2004, January 1). Reliability of the Global Assessment of Functioning Scale. Retrieved February 21, 2015, from http://search.proquest.com.byui.idm.oclc.org/docview/305175531/abstract/8A19D5240C9A4675PQ/7?accountid=9817 Global Assessment of Functioning (GAF): Properties and frontier of current knowledge. (2010, May 7). Retrieved February 21, 2015, from http://www.annals-general-psychiatry.com/content/9/1/20 Van der Wee, N., Grootenboer , E., Giltay , E., Van der Lem , R., Van Veen , T., & Zitman , F. (2012, April 1). Reliability and validity of the Global Assessment of Functioning Scale in clinical outpatients with depressive disorders. Retrieved February 21, 2015, from http://web.b.ebscohost.com.byui.idm.oclc.org/ehost/detail/detail?vid=2&sid=dae99909-f49b-4367-a0a2-0cc7bf4dee99@sessionmgr114&hid=110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ==#db=aph&AN=72417249 Aas , M. (2011, January 1). Guidelines for rating Global Assessment of Functioning (GAF). Retrieved February 21, 2015, from http://web.b.ebscohost.com.byui.idm.oclc.org/ehost/detail/detail?vid=5&sid=dae99909-f49b-4367-a0a2-0cc7bf4dee99@sessionmgr114&hid=110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ==#db=aph&AN=58885414 GLOBAL ASSESSMENT OF FUNCTIONING. ( n.d. ). Retrieved February 22, 2015, from https:// www.omh.ny.gov / omhweb / childservice / mrt / global_assessment_functioning.pdf