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QME PSYCHIATRIC IMPAIRMENT: A COMPREHENSIVE REVIEW OF THE GAF - 3 Credit Hours

BehavioralHealthCE.com

Objectives

· Explain the four step GAF scoring method
· Describe the history of the GAF beginning with the HSRS (1962)
· List the three major problem categories with the GAF
· List four methods of improving the quality of a GAF rating

Confirmation Notes

BehavioralHealthCE.com is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. BehavioralHealthCE.com maintains responsibility for this program and its content.

BehavioralHealthCE.com is accredited by the California Department of Industrial Relations Division of Workers’ Compensation Medical Unit to provide Qualified Medical Evaluator (QME) continuing education credits for the specifically designated QME courses (provider number 1250). QME designated courses are applicable to ALL disciplines for QME continuing education credits. Only those courses beginning with “QME” are approved.

BehavioralHealthCe.com is approved by the California Board of Behavioral Sciences (CA-BBS) to offer continuing education for marriage and family counselors (MFT, MFCC) and Licensed Clinical Social Workers (LCSW). CA-BBS provider number PCE4682.

BehavioralHealthCE.com is approved by the California Board of Registered Nursing (BRN Provider number CEP 15457). This document is to be retained by the licensee for a period of four years after the completion of the course.

BehavioralHealthCe.com is approved by the California Board of Vocational Nurses and Psychiatric Technicians (CA-BVNPT) to offer CE credits to LVN’s and Psychiatric Technicians (Approval Code V10685).

BehavioralHealthCE.com is approved by the Canadian Psychological Association to sponsor continuing education for psychologists. BehavioralHealthCE maintains responsibility for this program and its content. For a copy of the Participation in the CPA CE Data Bank form click here.

BehavioralHealthCE.com (provider # 1216) is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) through the Approved Continuing Education (ACE) program. BHCE maintains responsibility for the program.

BehavioralHealthCE.com is a National Board for Certified Counselors (NBCC) Approved Continuing Education Provider (ACEP). All courses meet the continuing education requirements including the word count per hour standard (Provider Number 6491). BHCE maintains responsibility for the program.

It is the responsibility of each individual user to understand what his or her state licensing board requires for license renewal, as well as what the licensing board identifies as acceptable continuing education. Please contact your board for verification if you are unsure of your continuing education requirements, including online and distance learning formats.

Description

IMPORTANT NOTE: In My Account, please be sure to add QME to your Degree List and your QME Provider Number to your licenses. All degrees and license numbers will be printed on the CE certificate. The certificates cannot be changed once the course is purchased.

At BehavioralHealthCE.com all of the courses and tests can be viewed for free. You pay for the continuing education credits after completion of the course and only if you are satisfied. Courses can be done at any time and results are stored in your account. The credits can then be purchased either immediately, or at a later date.

The Global Assessment of Functioning Scale (GAF) is a standard method for a clinician to judge a patient’s overall level of psychosocial functioning. The GAF requires a clinician to develop an overall judgment about the patient’s current psychological, social, and occupational functioning. This global rating is made on a scale from 1-100, with 1 being the lowest level of functioning and 100 being the highest level of functioning. The primary purpose of the GAF is a quick and efficient method of assessing and summarizing a patient’s current psychiatric status (symptoms and functioning) and to assess change. It is most commonly used to assess patients at the beginning of psychiatric treatment, to monitor their progress throughout the intervention, and to provide a status at discharge.

Currently, the GAF is the most widely used method for assessing impairment among patients with psychiatric disorders (Moos et.al. 2002). The GAF was introduced as a new rating scale of overall psychiatric disturbance as Axis V in the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R, American Psychiatric Association, 1987). The GAF Scale was retained in the DSM-IV (1994). Interestingly, Goldman (1992) stated that the GAF was “not widely used” as of the early 1990’s. As will be discussed subsequently, mandates for its use by such organizations as the VA Medical Center system and managed care companies have no doubt contributed to its current popularity. The GAF was retained in the DSM-IV-TR (Text Revision, 2000) with a slight modification in the instructions. The modification was necessary due to confusion regarding the time frame for the GAF rating (how was “current” defined) and how the clinician is to appropriately integrate the contributions of a patient’s psychiatric symptoms and functioning to the final GAF score (First and Pincus, 2002). In 2005, the GAF was adopted by the State of California as the primary method for determining permanent psychiatric disabilities in the workers’ compensation population. As discussed in the Schedule For Rating Permanent Disabilities (SRPD, 2005), psychiatric impairment is to be evaluated using the GAF, which is then converted to a whole person impairment (WPI). All of these issues will be discussed in great detail in this course.

The course will begin with an overview of the DSM-IV Multiaxial Diagnostic System. The GAF comprises Axis V of this system. For those in the mental health field, this will be a review. The history of the development of the GAF Scale in its current form will then be discussed. This review begins with a predecessor of the GAF, the original 100 point Health Sickness Rating Scale (HSRS) developed by Luborsky (1962). Gaining an understanding of the various revisions of the scale can help give the clinician insight into some of its current strengths and weaknesses. The scale began as the Health Sickness Rating Scale in 1962 which was revised to form the Global Assessment Scale (GAS; Endicott et al., 1976). Subsequently, the GAS was revised and developed as the GAF for inclusion in DSM III-R (1987). The GAF remained essentially the same for inclusion in DSM-IV and DSM IV-TR with the exception of a slight modification in the instructions.

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