In June 2016, the SABS will be introducing the 6th edition of the AMA Guides to combine the physical with mental and behavioural assessment for catastrophic impairment determination.
On the OCF 19, the mental and behaviour criterion states:
“A mental or behavioural impairment, excluding traumatic brain injury, determined in accordance with the rating methodology in Chapter 14, Section 14.6 of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 6th edition, 2008, that, when the impairment score is combined with a physical impairment described in paragraph 6 in accordance with the combining requirements set out in the Combined Values Table of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 percent or more impairment of the whole person”.
This 6th edition method uses three scores to evaluate 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 focus on the PIRS. Visit our other posts for more information on the BPRS and the GAF.
PIRS Rating Measurements
The PIRS is a rating scale from 0-5 used to measure functional impairment including:
- Activities of daily living
- Self-care and personal hygiene
- Social and recreational activities
- Social functioning
- Concentration, persistence and pace
- Employability and resilience
Each of these functional impairments receives a rating from 0-5 to evaluate the level of impairment. Once a class score has been arranged for all 6 areas of functioning, the scores are arranged from lowest to highest. The client’s score is determined by calculating the average of the two middle scores.
Let’s take a closer look at an example of the rating system with the Self-Care and Personal Hygiene category.
Example: Self-Care and Personal Hygiene
Class 1: The client has no deficit, or a minor deficit that is attributable to the normal variation in the general population.
Class 2: Mild impairment: The client is able to live independently and look after themselves adequately. They may look unkept occasionally, sometimes miss a meal, or rely heavily on take-away food.
Class 3: Moderate impairment: The client cannot live independently without regular support. For example, they need prompting to shower daily and wear clean clothes, they do not prepare meals independently and frequently miss meals. A family member or community nurse should be visiting two or three times per week to ensure a minimum level of nutrition and hygiene.
Class 4 Severe impairment: The client cannot live independently and needs supervised residential care. If unsupervised, the client may intentionally or unintentionally hurt themselves.
Class 5 Totally impaired: The client requires assistance with basic functions, such as feeding and using the bathroom.
Let’s say the client’s scores were 1, 2, 3, 3, 5, 5. In this example, the median class is 3. If the score falls between two classes, for example 1, 2, 2, 3, 5, 5, then it is rounded up to the higher class.
Each median class score represent a range of impairment:
Class 1 = 0 -3%
Class 2 = 4 -10%
Class 3 = 11-30%
Class 4 = 31-60%
Class 5 = 61-100%
To determine an exact percentage of impairment, we must calculate the aggregate score.
For example, using the numbers 1, 2, 3, 3, 5, 5 that we used above, the aggregate score would be 19 (1 + 2 + 3 + 3 + 5 + 5 = 19).
We must then use the Conversion Table provided in the assessment to convert to a percentage score. In this example, it would convert to 24% when we consider a Median Class of 3. This percentage was found by following the Class 3 level with the aggregate score of 19. If the Median Class was higher or lower with the same aggregate score of 19, the percentage of impairment would be different. The Conversion Table works to give a different percentage even with the same aggregate score when we use a different Median Class.
The Role of Occupational Therapists
The PIRS can only be officially completed by a psychiatrist. However, because the scale relates mainly to the function of the individual, this can be difficult to gauge with only a couple of sessions.
Because of this, the occupational therapist plays a large role in obtaining the correct information to decide the scores on the scale. An OT’s job focuses on the client’s ability to function in their daily activities (personal care, work, leisure, social participation, and IADLS). The OT can complete sessions in the client’s home and community to report on all areas of functioning in the PIRS. The OT can then pass this objective information on to the psychiatrist to determine a rating. The OT plays a critical role with this scale to determine if the client falls into 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.