Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3107 — Routine Assessment of Functioning: The MIRECC Global Assessment of Functioning Scale (MIRECC GAF)

Young AS (VISN-22 MIRECC) , Niv N (UCLA), Cohen AN (VISN-22 MIRECC), Sullivan G (VISN-16 MIRECC)

The routine assessment of clinical outcomes has been a challenge in mental health. Now that the VA seeks to implement recovery-oriented services that improve patients’ functioning, it is especially important that reliable and valid measures of functioning be employed. Accurate data on functional status help clinicians manage treatment over time, and can be used to assess and improve the quality of care. The most commonly used functioning instrument is the Global Assessment of Functioning (GAF) scale. While VA providers routinely perform GAF scores and enter them into CPRS, previous research has cast doubt on the validity and reliability of the GAF. A problem with the standard GAF is that it asks providers to produce one rating (between 1 and 100) summarizing three distinct domains: social, vocational, and symptomatic functioning. This has made it difficult to achieve reliability and interpret ratings. The "MIRECC GAF" was developed to address this problem. It is a modified GAF that measures occupational functioning, social functioning, and symptom severity on three different scales, and provides anchors in each domain. This study examined the reliability, and convergent, discriminant, and predictive validity of the MIRECC GAF.

Trained raters assessed a random sample of 398 patients with schizophrenia at two VA medical centers. At baseline and nine months, assessments included the MIRECC GAF, PANSS, Quality of Life Interview, and other measures. Medical records were abstracted to obtain standard GAF scores performed by VA clinicians during the same time period.

All three MIRECC GAF scales exhibited very high levels of reliability. The GAF-occupational and GAF-symptom scales showed good convergent and discriminant validity. The GAF-social scale was related to measures of social functioning and, to a greater degree, symptom severity. The GAF-occupational and GAF-social scales significantly predicted their respective domains at nine-month follow-up, and the GAF-symptom scale was predictive of negative symptoms at follow-up. The GAF-social scale was predictive of cognitive disorientation at follow-up. Standard, clinician-administered GAF scores had little validity.

The three MIRECC GAF scales can be scored reliably and have good concurrent and predictive validity. Further work is needed on brief measures of patient functioning, and especially measures of social functioning.

The MIRECC GAF could be a useful tool in routine clinical practice.