Global Assessment of Functioning

CASE SCENARIOS

Anthony’s Case

• Anthony is a single veteran in his mid 60s who was admitted into the Intensive Psychiatric Community Care (IPCC) in Massachusetts about 2 years ago following lengthy hospital stays and repeated failures to adjust to residential care placements. One residential care staff described him as being very dependent and requiring constant supervision and attention. Anthony was re-hospitalized in 2002 when he assaulted a residential care staff after she told him to take a shower because he had been unable to retain his feces voluntarily.

• During that admission he developed some delusions about having cancer, his activities of daily living (ADL) continued to be very poor, and he began to smear feces. With IPCC support, he was discharged in Nov. 2005 and placed in a rest home because he required a high level of care and supervision of his activities. Anthony attends activities at the community-based IPCC day program 3 days a week. His speech is digressive and incoherent at times, but he will usually cooperate if given explicit directions.

• Despite the fact that Anthony has been able to live outside the hospital for the past 2 years, he remains very dependent on the rest home and IPCC staff for all his needs, and smearing feces continues to be a problem. (Vignette adapted from the Brockton/West Roxbury VAMC)

Anthony’s Case

• Anthony is a single veteran in his mid 60s who was admitted into the Intensive Psychiatric Community Care (IPCC) in Massachusetts about 2 years ago following lengthy hospital stays and repeated failures to adjust to residential care placements. One residential care staff described him as being very dependent and requiring constant supervision and attention. Anthony was re-hospitalized in 2002 when he assaulted a residential care staff after she told him to take a shower because he had been unable to retain his feces voluntarily.

• During that admission he developed some delusions about having cancer, his activities of daily living (ADL) continued to be very poor, and he began to smear feces. With IPCC support, he was discharged in Nov. 2005 and placed in a rest home because he required a high level of care and supervision of his activities. Anthony attends activities at the community-based IPCC day program 3 days a week. His speech is digressive and incoherent at times, but he will usually cooperate if given explicit directions.

• Despite the fact that Anthony has been able to live outside the hospital for the past 2 years, he remains very dependent on the rest home and IPCC staff for all his needs, and smearing feces continues to be a problem. (Vignette adapted from the Brockton/West Roxbury VAMC)

Anthony’s GAF Score?

A. Between 1 and 10

B. Between 11 and 20

C. Between 21 and 30

D. Between 41 and 50

E. Between 71 and 80

Suggested GAF Score & Reasons

• Anthony = 20 (range 11 – 20)– “occasionally fails to maintain minimal

personal hygiene, e.g., Smears feces...”

Henry’s Case

• Henry is a divorced in-country Vietnam Veteran in his late 40s with a dual diagnosis of depressive disorder with psychotic symptoms and alcoholism, although he has been abstinent from alcohol for several years and has not been overtly psychotic since entry into the IPCC program in 2000.

• However, he becomes very anxious in social situations or when confronted with a stressful situation. He had not worked for several years until two years ago when he obtained part-time employment bagging groceries at a supermarket. Henry worked successfully part-time, and then quit the part-time job in order to try full-time employment in a job which required a higher level of skill.

• He couldn't cope with the demands of the new full-time position, so he quit that job and remains unemployed because he did not go back to part-time work. His employment record suggests he is capable of holding down a part-time job at an appropriate skill level.

• Due to unemployment, he became depressed and required admission to inpatient psychiatry. He resides in a rooming home and manages his own medications and funds. (Vignette adapted from the Brockton/West Roxbury VAMC)

Henry’s Case

• Henry is a divorced in-country Vietnam Veteran in his late 40s with a dual diagnosis of depressive disorder with psychotic symptoms (schizoaffective disorder) and alcoholism, although he has been abstinent from alcohol for several years and has not been overtly psychotic since entry into the IPCC program in 2000.

• However, he becomes very anxious in social situations or when confronted with a stressful situation. He had not worked for several years until two years ago when he obtained part-time employment bagging groceries at a supermarket. Henry worked successfully part-time, and then quit the part-time job in order to try full-time employment in a job which required a higher level of skill.

• He couldn't cope with the demands of the new full-time position, so he quit that job and remains unemployed because he did not go back to part-time work. His employment record suggests he is capable of holding down a part-time job at an appropriate skill level.

• Due to unemployment, he became depressed and required admission to inpatient psychiatry. He resides in a rooming home and manages his own medications and funds. (Vignette adapted from the Brockton/West Roxbury VAMC)

Henry’s GAF Score?

A. Between 11 and 20

B. Between 31 and 40

C. Between 41 and 50

D. Between 51 and 60

E. Between 71 and 80

Suggested GAF Score & Reasons

• Henry = 52 (range 51 – 60)– “moderate symptoms" and "moderate difficulty

in social, occupational, or school functioning“