Presentation for class.

1. C I E R R A B E C K
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.
• 0 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