CLINICAL HANDBOOK OF SCHIZOPHRENIA

138 II. ASSESSMENT AND DIAGNOSISGLOBAL MEASURES OF PSYCHOSOCIAL FUNCTIONINGGlobal Assessment of FunctioningThe Global Assessment of Functioning (GAF; American Psychiatric Association, 1994;Hall, 1995) gives one global score of overall functioning based on the client’s clinical, social,and professional state. The score is based on a continuum of functioning ranging from 1 to100. The GAF gives one score that is compared to the highest score in the past year. It is aquick and global way of assessing clinical change and is often used by psychiatrists. Themeasure typically does not include questions, so the clinician must generate questions to obtainthe needed information. However, there is a more comprehensive version with detailedanchor points, as well as a self-rated version, though these are not as widely used. The scoreobtained is in fact highly correlated to clinical symptoms. It does not allow assessment of detailsor variations in specific domains of functioning and only provides (in its most frequentuse) the clinician’s perspective. The scale is divided into nine intervals: 1–10, 11–20, 21–30,up to 91–100. The scale is not meant for people who function at a high level.Behavior and Symptom Identification ScaleThe Behavior and Symptom Identification Scale (BASIS-32; Eisen, Dill, & Grob, 1994)measures symptoms and social functioning with 32 items divided into five subscales: Psychosis,Impulsivity, Anxiety/Depression, Interpersonal Relations, and Living Skills. Thescale measures the degree of difficulty the person has experienced in the last 7 days foreach item. The BASIS-32 is quick and easy to administer, and offers the client’s perspective.Since it only assesses the past week, it can also be used at regular intervals to assesschange over time. The five subscales were statistically derived, meaning that they weredetermined by statistical analyses and not theoretically conceived; therefore, they may bedifficult to interpret in a clinical context. The BASIS-32 is more often used for assessinglarge groups of clients and determining their clinical and social functioning than for specifictreatment purposes.Short Form 36-Item General Health SurveyThe Short Form 36-Item General Health Survey (SF-36; Ware & Sherbourne, 1992) assesseseight areas of health, including physical functioning, physical limitation in rolefunctioning, pain, general health, vitality, social functioning, emotional limitations infunctioning, and general mental health. The SF-36 is quick to administer and is mostlyuseful for determining multiple aspects of health—not specifically psychosocial functioningonly. It is widely used by health management authorities and is often reported in reallylarge-scale studies. Because it is available in many languages and validated with somany samples, it is easy to compare the results from one clinical site with others. It is,however, of limited clinical relevance in terms of a detailed assessment of social functioning,because only a small number of items cover that domain.COMPREHENSIVE MEASURES OF PSYCHOSOCIAL FUNCTIONINGMultnomah Community Ability ScaleThe Multnomah Community Ability Scale (MCAS; Barker & Barron, 1997) offers scoreson four subscales (Obstacles to Functioning, Adaptation to Daily Life, Social Competence,and Behavioral Problems) of the client’s community functioning in the past 3–6 months.