CLINICAL HANDBOOK OF SCHIZOPHRENIA

14. Assessment of Psychosocial Functioning 137ment), social competence (including social skills, problem-solving skills, and interpersonalrelations), and vocational functioning (overcoming barriers to employment, workbehaviors). Independent living skills are an essential part of community functioning andinclude basic skills in terms of hygiene (personal hygiene, as well as taking care of one’sliving space), cooking and nutrition, managing money, using some mean of transportation,and taking care of one’s physical and mental health (e.g., taking meds, making doctor’sappointments, if needed). The presence and/or absence of these skills can guide cliniciansand clients in determining the most appropriate housing option, as well as planningspecific courses or training sessions. Social competence is perhaps the most important aspectof social functioning. Many individuals with schizophrenia live in isolation and havegreat difficulties in engaging in meaningful relationships, yet when asked, a vast majoritymention wishing they had a significant other and close friends. Many rehabilitation programsare geared toward improving social competence; a careful assessment can thereforebe extremely valuable. As such, it is important not only to ask how many friends a clienthas but who those friends are (e.g., does the client consider the clerk at the coffee shopwho does not know his or her name a friend?), how many contacts the client has, and soforth. Social skills are included within social competence and imply abilities such as beingable to engage in a conversation; to keep good eye contact, voice tone, body posture, andso on, as well as to know how to create friendships. It also means being able to recognizeverbal and nonverbal cues from the person with whom one is trying to converse. One importantaspect of social skills training is social problem solving, which should also be assessed.Because problems with landlords, employers, family members, or roommates arelikely to occur, it is important to determine whether your clients know how to deal effectivelywith these situations. Given the motivation that most individuals with severe mentalillness have to obtain and maintain a job, vocational functioning is an important aspectof social functioning to assess. Clients’ abilities to overcome potential barriers toemployment, as well as work behaviors, should be assessed to help clients improve theirchances to obtain and maintain their jobs. Similar concepts should also be assessed forthose who prefer to study or go back to school. However, other than looking at gradesand teachers’ comments, the dearth of instruments currently described in the literature regardingschool functioning have led us to not present any here.The following measures all tap into one or all three of the social functioning domainsmentioned (i.e., independent living skills, social competence, and professional or vocationalintegration) and sometimes also assess other concepts, such as symptoms, health,goals, or roles. They are presented in three categories: (1) global measures: offer a globalscore or general scales that together measure several aspects of social functioning, as wellas other clinical domains; (2) comprehensive measures: assess multiple specific aspects ofsocial functioning; and (3) specific measures: address only one domain or aspect of socialfunctioning in a detailed manner.As mentioned previously, many psychosocial functioning measures exist, and othersare still being developed. Following a thorough review, we propose a few measures thatare either widely used or are so useful and well designed that we expect they will beadopted by many clinicians in the near future. To facilitate the reader’s understanding, wehave categorized the scales as global measures, comprehensive measures, or measures of aspecific domain of social functioning. We also offer a brief description of each assessmentand have grouped the following information in Table 14.1: the type of assessment (i.e.self-rated, other-rated, interview, role play), the length of administration, the type of clientswith whom the assessment was validated, whether there is a need for training, thelanguages in which the measure is available, and where to get more information aboutobtaining or using the assessment.