The SABS is updating the AMA Guides in June 2016. This update introduces a new definition and rating method for a catastrophic impairment designation.
In this new method, the rater determines three scores by evaluating the client using three different scales:
- Brief Psychiatric Rating Scale (BPRS)
- The Global Assessment of Functioning Scale (GAF)
- The Psychiatric Impairment Rating Scale (PIRS)
In this post, we will be looking at the GAF in more detail. For more information on the BPRS and the PIRS, please visit our other blog posts.
The first version of this scale was introduced in 1962 and was revised in 1976. In 1987, the GAF was included with the third edition of the Diagnosis and Statistical Manual of Mental Disorder (DSM) to assist with client assessment.
The GAF is the fifth stage of the assessment process that clinicians use to determine a client’s level of psychosocial functioning. The stages are as follows:
- Axis I – Clinical Disorders
- Axis II – Personality Disorders
- Axis III – General Medical Conditions
- Axis IV – Social and Environmental Problems
- Axis V – Global Assessment of Functioning
The GAF assigns a number based on the client’s symptoms to make a clinical judgement in a client’s overall functioning level. The scale ranges from 0 to 100, with 100 being “superior functioning.” This scale considers impairments in psychological, social, and occupational or school functioning, but not those related to physical or environmental limitations.
The clinician will start either at the bottom of the assessment or the top, and go up or down the list until they find the most accurate description of the client’s functioning. The clinician will asses either the symptom severity or the level of functioning – whichever is worse of the two. The client’s score is rated in relation to the “current period”. This period is determined by the clinician. It could be the past week, the past month, or the past six months.
GAF Assessment of Symptoms Score
|Score||Assessment of Symptoms|
|100-91||The client shows no symptoms. They have superior functioning in a wide range of activities and daily problems are not overwhelming or get out of hand. They are often sought out by others because of their many positive qualities.|
|90-81||The client has absent or minimal symptoms (e.g., some anxiety before writing an exam). They show good functioning in all areas, are interested and involved in a wide range of activities, and are socially effective. The client is generally satisfied with life and has average everyday problems or concerns, such as an occasional argument with family.|
|80-71||The client shows some symptoms, but they are transient and understandable reactions to psychosocial stressors, such as difficulty concentrating after an argument. They have no more than a slight impairment in social or occupational functioning. For example, they may temporarily fall behind on projects.|
|70-61||The client exhibits some mild symptoms, like a depressed mood or mild insomnia, or they have some difficulty in social or occupational functioning, like theft within the household. The client generally functions well and has some meaningful interpersonal relationships.|
The client shows moderate symptoms, such as flat affect and circumstantial speech or occasional panic attacks, or they have a moderate difficulty in social or occupational functioning. The client could have few friends or conflict with peers in various environments.
|50-41||The client exhibits serious symptoms, such as suicidal ideation, severe obsessive rituals, or frequent shoplifting, or any serious social or occupational functioning impairment, like having no friends or a lot of conflict with peers.|
|40-31||The client has some impairment in reality testing or communication. Their speech can be illogical, obscure, or irrelevant at times. The client has major impairments in several areas, such as work, familial relations, judgement, thinking, or mood. For example, they actively avoid friends or neglect family.|
|30-21||The client’s behaviour is considerably influenced by delusions or hallucinations. The client has a serious impairment in communication or judgement, such as being incoherent, acting inappropriately, or having suicidal preoccupation. The client has an inability to function in almost all areas, perhaps staying in bed all day and lacking friends.|
|20-11||The client is in some danger of hurting themselves or others. There could be suicide attempts without a clear expectation of death, frequent violence, or manic excitement. The client fails to maintain minimal standards of personal hygiene, like smearing faeces. The client has a gross impairment in communication, like being largely incoherent or mute.|
|10-1||The client is in persistent danger of severely hurting themselves or others and has recurring acts of violence. The client has seriously attempted suicide with a clear expectation of death. The client has a persistent inability to maintain minimal personal hygiene.|
|0||There is inadequate information about the client.|
While the GAF offers insight into the client for psychosocial evaluation, the major limitation of this scale is the conflation of symptom severity with functional impairment. For the majority of motor vehicle accident cases, a GAF score between 31-40 is unlikely. This implies a maximal mental WPI of 20%.
The score of the GAF will convert to a Whole Person Impairment (WPI) rating, which is then used in combination with the PIRS and BPRS to obtain the median WPI rating. The media WPI rating is then combined with the physical WPI rating to obtain the client’s total WPI. This is necessary for establishing a client’s CAT designation.
If you have any questions about these scales or the upcoming changes to the SABS, please contact us. We would be happy to provide you with more information.