MindMap-GAF

MindMap-GAF

• What is GAF?
  • Global Assessment of Function

    The GAF is a 100-point tool rating overall psychological, social and occupational functioning of people over 18 years of age and older. It excludes physical and environmental impairment.

    The GAF is included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) in the section on multi-axial assessments.

    ~ http://www.ct.gov/dmhas/LIB/dmhas/MRO/Kaxis.pdf

• GAF Scoring:
  • 91-100
    • Superior functioning in a wide rage of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms.
  • 90-81
    • Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range or activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.
  • 80-71
    • If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning
  • 70-61
    • Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.
  • 60-51
    • Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.
  • 50-41
    • Serious symptoms OR any serious impairment in social, occupational, or school functioning.
  • 40-31
    • Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.
  • 30-21
    • Behavior is considered influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas.
  • 20-11
    • Some danger or hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication.
  • 10-1
    • Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death.
• GAF Online Training
  • ~ http://depts.washington.edu/washinst/Resources/CGAS/GAF%20Index.htm
• GAF-Psychological Index-Short Description:
  • 100 Superior functioning

    90 Minimal symptoms; good functioning

    80 Transient and expected reaction to stress

    70 Mild psychological symptoms

    60 Moderate psychological symptoms; has clear mental problems to those who know him/her well

    50 Serious psychological symptoms; moderately depressed mood, moderate lethargy, severe phobia

    40 May have hallucinations or delusions; however, probably realizes they are not a part of reality

    30 Behavior is considerably influenced by delusions or hallucinations; severely depressed mood

    20 Gross Impairment in Thinking and communication; largely incoherent or mute; very disorganized, bizarre thinking

    10 Thinking is totally disorganized; completely incoherent or mute; unable to focus attention for even a few seconds

• GAF-Social Skills Index-Short Description:
  • 100 Outstanding social skills

    90 Good social skills

    80 No more than slight impairment in social skills

    70 Some difficulty with social skills

    60 Moderate difficulty with social skills; moderately awkward socially

    50 Serious impairment in social skills; no friends, but some peer relationships

    40 Attempts to approach others quickly leads to embarrassing situations

    30 Acts grossly inappropriately toward others, e.g., openly masturbates

    20 Very few social skills; acts very shockingly inappropriate in front of others, such as smearing feces

    10 Few if any social skills; extremely vulnerable to victimization

• GAF-Violence Index-Short Description:
  • 100 No violence or aggression

    90 No more than everyday conflicts

    80 No more than slight problem with anger

    70 Mild problems with anger and thoughts that life may not be worth living

    60 Moderate problems with anger and some evidence that self-destructive thoughts may be present

    50 Serious problems with anger; occasionally hits someone; occasional suicidal ideation

    40 Real danger or hurting self or others; hitting or biting someone is not unusual; suicidal gesture within the last month

    30 Often hitting or biting others; suicidal attempt without clear expectation of death during the last month

    20 Frequently violent; very real danger or hurting self or others; serious thoughts of killing someone; constant suicidal preoccupation

    10 Persistent danger of severely hurting self or others; little or no control of impulses to hurt self or others

• GAF-ADL-Occupation Index-Short Description: Activities of Daily Living
  • 100 Superior work skills

    90 Good work skills

    80 No more than slightly impaired work skills

    70 Mild difficulty with work

    60 Moderate impairment with work

    50 Serious impairment with work; unable to keep a job for more than a few weeks

    40 Major impairment with work; unable to work at a job for any significant period

    30 No job and unable to independently maintain a home

    20 Gross impairment in skills needed to perform ALDs and tasks at home; almost totally unable to follow simple instructions

    10 Demonstrates almost no ADL skills; totally unable to follow instructions

• GAF-Substance Abuse Index-Short Description:
  • 100 Model for abstinence

    90 No more than average problems

    80 No more than slight impairment; smokes cigarettes

    70 Mild impairment due to substance abuse; heavy smoker

    60 Moderate difficulty in functioning due to substance abuse

    50 Behavior and/or lifestyle is considerably influenced by substance abuse

    40 Major impairment in several areas due to substance abuse

    30 Drugs or alcohol pervade one’s thinking and behavior; injection of heroin or cocaine into one’s veins daily

    20 Functioning is extremely impaired by daily use of drugs, such as LSD, PCP, cocaine, heroin or inhalants

    10 One’s life is totally controlled by drugs or alcohol; clear evidence that drugs or alcohol will lead to severe physical harm or death

• GAF-Medical Index-Short Description:
  • 100 Superior medical health

    90 Good medical health

    80 Minimal and transient medical problems

    70 Mild functional impairment due to medical problems

    60 Moderate functional impairment due to medical problems

    50 Serious functional impairment due to medical problems

    40 Major impairment in several areas due to medical problems

    30 Behavior and/or lifestyle is considerably impaired by medical problems

    20 Major medical problems confine one to bed all of the time and intensive treatment is required to prevent rapid progression to death

    10 Chronic medical incapacity requiring basic life support; chronic vegetative or near vegetative state

• GAF-Ancillary Index-Short Description:
  • 100 Superior life situation

    90 Good life situation

    80 Somewhat more than average life situation problems

    70 Mild life situation problems

    60 Moderate difficulty with life situation; high risk for jail or homelessness

    50 Serious difficulty with life situation; threats of moderate violence in one’s environment

    40 Major problems with life situation; real danger of being injured in one’s environment

    30 Frequent mild to moderate physical injuries from violence in one’s environment

    20 Major ancillary problems, e.g., one is in a very dangerous homeless or jail situation all of the time; unable to obtain basic food, shelter and/or clothing

    10 One’s life is continually at serious risk due to lack of basic resources or because of extremely high level of violence in one’s environment

• GAF-Psychological Index-Long Description
  • 100 Superior Psychological Functioning/Coping, no psychological impairment; life’s everyday problems never seem to lead to any significant anxiety or depression. No Symptoms.

    90 Absent or Minimal Symptoms (e.g., mild anxiety before an exam), good psychological functioning in all areas; interested and involved in a wide range of activities; generally satisfied with life; no more than everyday problems or concerns.

    80 If Symptoms Are Present, They Are Transient and Expected Reaction to Psychosocial Stressors (e.g., upset by breakup with girlfriend; difficulty concentrating after family argument; mild preoccupation with problems; a woman has many friends, functions extremely well at a difficult job, but says “The stress is too much.”); not considered to have mental problems by those who know him/her.

    70 Some Mild Symptoms (e.g., depressed mood with mild insomnia, occasional truancy, theft within the household, difficulty trusting others, mild insensitivity to the feelings and needs of others), but generally functioning fairly well; however, those who know him/her well might express some concerns about his/her mental state.

    60 Moderate Symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks; frequently preoccupied; moderate impairment in attention span); moderate insensitivity to the feelings and needs of others; to those who know him/her well it is clear the he/she has mental problems.

    50 Serious Symptoms (e.g., moderately depressed mood, moderate lethargy, severe obsessional rituals, severe phobia, severe sexual perversion, moderate problems with anorexia/bulimia, frequent shoplifting, frequent anxiety attacks, moderately guarded, mild but definite manic syndrome).

    40 Major Psychological Impairment; some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant; moderate paranoia; may have hallucinations or delusions; however, probably realizes they are not a part of reality); major impairment in several areas, such as judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is not motivated to work or moderate negative symptoms of schizophrenia); even to those who do not know him/her well would likely consider him/her to have mental problems.

    30 Behavior Is Considerably Influenced by Delusions or Hallucinations; appears to be responding to hallucinations; serious impairment in communication or judgment (e.g., sometimes incoherent, thinking is occasionally grossly inappropriate); severely depressed mood; withdrawn with few spontaneous communications; inability to function in almost all areas (e.g., stays in bed all day and does not care for own living space; no job, home, or friends due to paranoia, poor motivation, social withdrawal, extremely poor insight and/or being almost totally insensitive to the feelings and needs of others); at times attention span is markedly impaired; Severe Sociopathic Behaviors Have Lead to Multiple Arrests; severe sexual perversion toward prepubescent children.

    20 Thinking and Communication Are Generally Grossly Impaired; manic excitement or catatonia; largely incoherent or mute; generally markedly impaired attention span; occasionally fails to maintain minimal personal hygiene due to severe lethargy or very disorganized, bizarre thinking (e.g., too lethargic to attempt to wipe food off one’s shirt; smears feces for bizarre, delusional reasons).

    10 Thinking Is Totally Disorganized; totally insensitive to the feelings and needs of others; completely incoherent; completely mute, extremely catatonic; persistent inability to maintain minimal personal hygiene or minimal safety due to totally disorganized thinking or Very Severe Lethargy; unable to focus attention for even a few seconds; chronic, self-induced vomiting has lead to a very life threatening situation.

• GAF-Social Skills Index-Long Description
  • 100 Superior Social Skills; is sought out by others because of his or her outstanding social/communication skills; has many friends and no difficulty making new friends. No Symptoms.

    90 Good Social Skills; no difficulty being pleasant and engaging; good communication skills; Socially Effective.

    80 No More Than Slight Impairment in Social Skills; slightly inappropriate social behavior leads to infrequent interpersonal conflicts; no more than slight difficulty maintaining several friendships.

    70 Some Difficulty with Social Skills (e.g., mild difficulty knowing how to share with others, show sympathy for others and/or understand feelings of others); social skills are not obviously impaired; generally functioning fairly well; has some meaningful interpersonal relationships.

    60 Moderate Difficulty with Social Skills (e.g., conflicts with peers due to inappropriate teasing or other inappropriate social behavior; attempts to be pleasant and engaging are usually moderately awkward; moderate difficulty knowing what to say even when talking with friends; moderate difficulty knowing how to share with others, show sympathy toward others and/or understand feelings of others); Hardly Any Friends Because of Problems with Social Skills; communications are understandable but vague.

    50 Serious Impairment in Social Skills; Has No Friends Because of Clearly Impaired Social Skills; However, Has Some Peer Relationships, Despite Social Skills Being Clearly Impaired; frequent conflicts with peers or co-workers because of inappropriate social behavior; conversations are often socially inappropriate; great difficulty communicating thoughts and feelings; unable to introduce self and a second person without clear difficulty; frequently intrusive; inappropriate, non-sexual touching.

    40 Major Impairment in Social Skills; Attempts to Approach Others Quickly Leads to Embarrassing Situations; no friends and virtually no peer relationships because of poor social skills; unable to appropriately engage in almost any social activity; continually intrusive with little understanding of the inappropriateness of the behavior; major acts of socially inappropriate behavior Leads to Being Assaulted, being fired from work or expelled from school; Great Difficulty Recognizing or Coping with Inappropriate Sexual or Aggressive Advances by Others; great difficulty recognizing that his/her sexual advances are not welcome.

    30 Acts Grossly Inappropriately Toward Others; virtually no understanding of the feelings of others, how to share with others and/or how to show sympathy toward others; conversations with others are grossly inappropriate; unaware of or ignores most social norms as manifested by openly masturbating, inappropriate sexual touching, etc.

    20 Very Few Social Skills; generally unable to communicate in an organized, understandable way, uses short phrases or gestures to get basic needs met; acts very shockingly inappropriate in front of others, such as smearing of feces or making sexual advances toward young children; however, may have some understanding that such behavior is inappropriate.

    10 Few If Any Social Skills; unable to communicate in an organized, understandable way; shows no apparent awareness of social norms (e.g., doesn’t realize that it is inappropriate to grab food or cigarettes from others); Extremely Vulnerable to Victimization (e.g., has no understanding of the inappropriateness and/or dangers of approaching strangers or assaulting others; needs constant care and supervision to prevent client from getting into dangerous social situations).

• GAF-Violence Index-Long Description
  • 100 No Evidence of Violence to self or others; very satisfied with life; life’s problems never seem to lead to any inappropriate anger, frustration or conflicts. No Symptoms.

    90 No Significant Evidence of Violence to self or others; generally satisfied with life, no more than everyday problems or conflicts (e.g., an occasional argument with family members).

    80 No More Than Slight Problems with anger and irritability; if symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., occasional “blow-up” with family members or friends; mild anger after family argument); no suicidal ideation.

    70 Mild Symptoms (e.g., mild problems with anger and irritability; occasional thoughts of violent behavior; thoughts that life may not be worth living); symptoms are not interfering significantly with client’s functioning; Severely Assaulted Others or Serious Suicidal Attempt Over Five Years Ago; however, for years, has had no significant problems with violence or self-harm.

    60 Moderate Difficulty with Anger and Irritability (e.g., moderate conflicts with peers or co-workers due to anger and hostility; occasional threats of violent behavior); some evidence that self-destructive thoughts may be present. Murdered Someone Over Ten Years Ago; however, for many years, has had no significant problems with violence.

    50 Serious Problems with Anger and Irritability; moderate threats of violence; becomes verbally threatening when needs/demands are not immediately met or when pushed to do something; Occasionally Hits Someone; Occasional, Relatively Minor, Sexual Assault; Occasional Suicidal Ideation; non-suicidal self-abuse, such as burning self with cigarettes or cutting self superficially; not felt to be a real danger of seriously hurting self or others; however, some precautions including close observation may be indicated.

    40 Major Problems with Anger and Irritability; Some Real Danger of Hurting Self or Others; violent outbursts toward family and neighbors; frequent threats of violence; hitting or biting someone is not unusual; occasionally difficult to redirect from aggressive behavior; induces much fear of physical assault in others; Single Suicidal Gesture Within the Last Month; moderate suicidal ideation; actively making plans to hurt self or others; set a relatively minor fire within the last three months or is having fire setting impulses with history of setting one or two minor fires.

    30 Often Hitting or Biting Others; becomes physically aggressive when needs are not immediately met; suicidal attempt without clear expectation of death during the last month; frequent suicidal preoccupation; actively following through with plans to hurt self or others (e.g., obtaining a gun, pills, rope, etc.); At Times Close Observation or Restraints May Be Necessary to Prevent Serious Harm to Self or Others.

    20 Frequently Violent; very real danger of hurting self or others; serious thoughts of killing someone; attempted to very violently harm or violently rape someone within the last month; Constant Suicidal Preoccupation; However, Client is Felt to Have Some Control of the Suicidal Impulses; two or more suicidal attempts without clear expectation of death within the last month; close observation to prevent harm to self or others may be required 1 or 2 days a week.

    10 Persistent Danger of Severely Hurting Self or Others; attempted to kill someone within the last month; attempted to very violently harm or violently rape a child within the last month; set a fire within the last month with intent of hurting others; serious suicidal attempt within the last month with clear expectation of death; Little or No Control of Impulses to Hurt Self or Others; expressing loss of control of command hallucinations to hurt self or others; 1-to-1, at arms length observation and/or physical restraint for prevention of serious harm to self or others may be required 3 or more days a week; Murdered Someone Within the Last Two Years.

• GAF-ADL-Occup. Index-Long Description
  • 100 Superior ADL-Occupational Skills in a Wide Range of Activities (e.g., in school, on the job, as a homemaker, pursing a complicated hobby); superior workmanship; work challenges never seen to get out of hand; is sought out by others because of his or her work skills. No Symptoms. Skills are consistent with that expected of a successful college graduate.

    90 Good Skills in All ADL-Occupational Activities; no more than average difficulties with any work assignment. Absent or minimal symptoms. Skills are consistent with that expected of a successful high school graduate.

    80 No More Than Slight Impairment in Occupational Skills or Skills in School; having slight difficulty performing at an average level; slight difficulties with routine chores, work assignments or schoolwork assignments; slight impairment in workmanship.

    70 Mild Difficulty with Occupational Skills or Skills in School (e.g., minor difficulty following instructions, workmanship is somewhat sloppy), But Generally Functioning Fairly Well.

    60 Moderate Difficulty with Occupational Skills or Skills in School (e.g., probably employed; however, has trouble carrying through assignments; some difficulty problem solving or following instructions; some difficulty driving a car; some difficulty knowing how to budget money; some difficulty maintaining a home or apartment).

    50 Serious Impairment in Occupational Skills or Skills in School (e.g., unable to keep a job from more than a few weeks due to poor occupational skills; almost failing in school; moderate difficulty following instructions; moderately sloppy workmanship); needs supervision when shopping for food; some difficulty using public transportation; some difficulty preparing self a reasonable, family-style meal; some difficulty ordering, eating properly, tipping, etc. in a regular restaurant; some difficulty making a long distance phone call.

    40 Major Impairment in Occupational Skills or Skills in School (e.g., unable to work at a job for any significant period or do routine housework due to poor work skills; failing in school due to poor academic skills); needs supervision to use public transportation; mild to moderate difficulty ordering and eating in a fast food restaurant; poor understanding of how to budget money.

    30 No Job and Unable to Independently Maintain a Home due to serious impairment in skills needed to perform ADLs and tasks at home; serious difficulty following instructions; needs some supervision to prepare simple meals for self, such as a sandwich and beverage; needs supervision to dress self, make a local phone call, follow a very simple self-medication procedure; needs constant supervision to complete more complicated ADLs (e.g., operating a washer and dryer); very sloppy workmanship; some difficulty responding appropriately to a fire alarm; difficulty finding way back from short errands.

    20 Gross Impairment in Skills Needed to Perform ADLs and Tasks at Home (e.g., needs some supervision to maintain minimal personal hygiene; is almost totally unable to follow simple instructions; needs supervision to feed self; Unable to Function Independently (e.g., needs constant supervision to complete most simple tasks; does not know the value of money; unable to dial 911 in an emergency; unable to find way back from short errands).

    10 Demonstrates Almost No ADL Skills (e.g., is totally unable to follow instructions; unable to complete most tasks even with constant supervision; may even have to be physically assisted to complete a task, including eating or dressing. Persistent Inability to Maintain Minimal Personal Hygiene; considerable external support (e.g. nursing care and supervision) is needed to prevent client from accidentally harming self (e.g., wandering into traffic, danger of seriously burning self when attempting to cook or when smoking); unable to appropriately respond to a fire alarm.

• GAF-Medical Index-Long Description
  • 100 Superior Medical Health; physical exam and laboratory tests are normal, including no significant weight problem; illnesses never seem to affect him or her; few if any problems with even common medical problems (e.g., colds, headaches, indigestion, constipation, diarrhea); virtually never has to miss work or school due to medical problems; exercises regularly; on no medication, except may take a prophylactic medication, such as a multivitamin; doesn’t wear glasses/contacts; No Significant Medical Problems or Symptoms.

    90 Good Medical Health; has few if any medical problems; physical exam and laboratory test reveal no more than minor abnormalities; illnesses seldom seem to affect him or her; average difficulties with common medical problems (e.g., colds, headaches, indigestion, constipation, diarrhea); wears glasses/contacts that correct minor visual problems; wears dentures; only occasionally misses work or school due to medical problems; occasionally needs OTC medication.

    80 IF Medical Problems Are Present, They Are Transient and Cause Minimal Impairment In Social, Occupational or School Functioning; somewhat more than average missing work or school due to medical problems; impairment in mobility, use of hands or hearing that is Totally Corrected by the use of a prosthesis, hearing aids, etc.; mild obesity or mild emaciation; occasional urinary incontinence due to organic problems.

    70 Mild Medical Problems Which May Cause Some Difficulty in Social, Occupational or School Functioning; however, generally functioning fairly well; missing no more than about one to two weeks a year from work or school due to medical problems; mild impairment in mobility, speech, use of hands, vision or hearing despite use of prosthesis, glasses, hearing aids, etc.; chronic illness, however, has few if any overt signs or symptoms of the illness (e.g., mild asthma, mild hypertension, mild diabetes, mild arthritis; mild dysphagia; epilepsy easily controlled with medication; mild tardive dyskinesia); requires medical follow-up several times a year; taking prescription medication on a daily basis.

    60 Moderate Difficulty in Social, Occupational or School Functioning Due to Medical Problems; missing no more than about one month a year from work or school due to medical problems (e.g., moderate asthma, moderate hypertension, moderate diabetes, moderate COPD, mild to moderate hyponatremia secondary to polydipsia, HIV positive, chronic hepatitis, mild cerebral palsy, mild cystic fibrosis, mild hemophilia, mild angina on exertion); medical problems requiring daily or weekly monitoring and treatments beyond p.o. medications (e.g., injections, blood levels, nebulizer, physical therapy); needs bladder bag.

    50 Serious Impairment in Social, Occupational or School Functioning Due to Medical Problems; serious impairment in mobility, speech, use of hands, vision or hearing despite use of prosthesis, glasses, hearing aids, etc.; considered a serious risk for falling; only partially controlled epilepsy; equipment is needed for mobility (e.g., wheelchair, portable oxygen); Medical Problems Prevent One from Driving a Car.

    40 Major Impairment in Several Areas (such as work or school or family relations) because of medical problems; missing about two months a year or more from work or school due to medical problems; medical problems results in major impairment in mobility, speech, use of hands, vision, or hearing despite use of prosthesis, glasses, hearing aids, etc.; frequently confined to bed or wheelchair because of chronic medical problems.

    30 Behavior and/or Lifestyle Is Considerably Impaired by Medical Problems; very serious medical problems confine one to bed or wheelchair most of the time (e.g., very symptomatic cases of diseases such as metastatic cancer, multiple sclerosis, cerebral palsy or AIDS); chronic failure of a major body system (e.g., heart, lung, kidney, liver); on dialysis for kidney failure.

    20 Major Medical Problems Confine One to Bed All of the Time and intensive, continuous medical treatment is required without which one would rapidly progress to death (e.g., Late Stages of metastatic cancer, multiple sclerosis; AIDS, etc.); chronic, near terminal failure of a major body system (e.g., heart, lung, kidney, liver); quadriplegic.

    10 Chronic Medical Incapacity Requiring Basis Life Support (e.g. ventilator); removal of life support would rapidly lead to death; patient in chronic vegetative or near vegetative state; persistent delirium or coma.

• GAF-Ancillary-Index-Long Description
  • 100 Superior Life Situation; currently in or has ready access to ideal living environment (neighborhood, home, school, work, etc.); superior financial resources for his/her needs; no legal problems; extremely safe environment; No Significant Ancillary Problems or Symptoms.

    90 Good Life Situation; has few if any ancillary problems; no more than minor problems with living environment, financial resources and/or legal problems, e.g., occasionally living environment doesn’t fully meet one’s needs, rare late payment on a bill, rare parking or traffic ticket.

    80 If Ancillary Problems Are Present, They Are Transient and Cause No More Than Minimal Difficulty with one’s Living Situation, Financial Resources or the Law; somewhat more than average problems with one’s living environment, financial resources or legal problems.

    70 Mild Ancillary Problems, e.g., Some Difficulty in one’s Living Environment, Financial Resources or with the Law; mild difficulty paying bills/credit cards; mild difficulty with parking or traffic tickets; occasional mild verbal violence in one’s environment; However, Generally Safe Living Situation.

    60 Moderate Difficulty with Living Situation, Finances or the Law; high risk for being in a dangerous homeless or jail situation; criminal charges place one at high risk of incarceration; no stable residence and/or income, often having to move from one living situation to another; moderate difficulty paying bills/credit cards; Evaluation and/or Disposition Is Being Made for Nonviolent Criminal Activity (e.g., trespassing, stealing, defacing/destruction of property, or lewd behavior); Evaluation and/or Disposition Is Being Made for Competency to Make Decisions Concerning Person, Estate and/or Treatment.

    50 Serious Problems with Living Situation, Finances and/or the Law; frequent risks or threats of moderate violence in one’s environment; Evaluation and/or Disposition Is Being Made for Relatively Minor, But Violent or Dangerous Criminal Activity, (e.g., minor assault, threats to do physical harm, driving while under the influence, sexually touching someone or exposing oneself); Serious Placement Difficulties, Even When Ready for Placement.

    40 Major Problems with Living Situation, Finances and/or the Law; Some Real Danger of Being Physically Injured in one’s Environment; Evaluation and/or Disposition Is Being Made for Very Violent Criminal Activity (e.g., vicious assault, attempted rape, attempting to molest a child, arson).

    30 Lifestyle Is Considerably Influenced by Ancillary Problems; one is in a very dangerous homeless or jail situation most of the time; unable to obtain basic food, shelter and/or clothing; frequent, mild to moderate physical injuries from violence in one environment.

    20 Major Ancillary Problems (e.g., One Is in a Very Dangerous Homeless or Jail Situation All of the Time); at times one’s life is at serious risk due to lack of resources for basic food, shelter and/or clothing or because of high level of violence in one’s environment; Evaluation and/or Disposition Is Being Made for Extremely Serious Criminal Charges (e.g., attempted murder, vicious rape, viciously molesting a child).

    10 Living/Financial Situation Is Totally Inadequate; one’s life is continually at serious risk due to lack of basic food, shelter and/or clothing or because of extremely high level of violence in one’s environment; Evaluation and/or Disposition Is Being Made for the Most Extreme Charges of Violence (e.g., murdering anyone, very viciously harming or very viciously raping a child, arson with intent of hurting

• GAF Questions:
  • 100 Perfect Condition

    90 Absent or Minimal Symptoms and no Impairment in Functioning

    90 Group H Criteria: -Minimal or absent symptoms (e.g., mild anxiety before an examination)

    90 Good functioning in all areas and satisfied with life

    90 Interested and involved in a wide range of activities

    90 Socially effective

    88-90 No psychological symptoms and no problems of living or functioning

    84-87 Minimal symptoms and no everyday problems

    81-83 Minimal symptoms and some everyday problems

    80 Some Transient Mild Symptoms or temporary Mild Impairment in Functioning

    80 Group G Criteria: -Mild symptoms are present, but they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument).

    80 Slight impairment in social, work, or school functioning (e.g., temporarily falling behind in school or work).

    78-80 EITHER mild symptom(s) OR mild impairment in social, work or school functioning

    74-77 Mild impairment in more than one area of social, work or school functioning

    71-73 BOTH mild symptoms AND slight impairment in social, work & school functioning

    70 Some Persistent Mild Symptoms or persistent Mild Impairment in Functioning

    70 Group F Criteria: -Mild symptoms are present that are NOT just expectable reactions to psychosocial stressors (e.g., mild or lessened depression and/or mild insomnia)

    70 Some persistent difficulty in social, work or school functioning (e.g., occasional truancy, theft within the family, or repeated falling behind in school or work)

    70 But has some meaningful interpersonal relationships

    68-70 EITHER mild persistent symptoms OR mild difficulty in social, work, or school functioning

    64-67 Mild persistent difficulty in more than one area of social, work or school functioning

    61-63 BOTH mild persistent symptoms AND some difficulty in social, work, and school functioning

    60 Moderate Symptoms or Moderate Impairment in Functioning

    60 Group E Criteria: -Moderate symptoms (e.g., frequent, moderate depressed mood and insomnia and/or moderate ruminating and obsessing; or occasional anxiety attacks; or flat affect and circumstantial speech; or eating problems and below minimum safe weight without depression).

    58-60 EITHER moderate depressed mood, symptoms OR moderate difficulty in social, work, or school functioning

    54-57 Moderate difficulty in more than 1 area of social, work or school functioning

    51-53 BOTH moderate symptoms AND moderate difficulty in social, work, and school functioning

    50 Some Serious Symptoms or Serious Impairment in Functioning

    50 Group D Criteria: -Serious impairment with work, school or housework if a housewife or househusband (e.g., unable to keep job or stay in school, or failing school, or unable to care for family and house)

    50 Frequent problems with the law (e.g., frequent shoplifting, arrests) or occasional combative behavior

    50 Serious impairment in relationships with friends (e.g., very few or no friends, or no current friends)

    50 Serious impairment in judgment (including inability to make decisions, confusion, disorientation)

    50 Serious impairment in thinking (including constant preoccupation w/thoughts, distorted body image, paranoia)

    50 Serious impairment in mood (including constant depressed mood plus helplessness and hopelessness, or agitation, or manic mood)

    50 Serious impairment due to anxiety (panic attacks, overwhelming anxiety)

    50 Other symptoms: some hallucinations, delusions, or severe obsessional rituals

    50 Passive suicidal ideation

    48-50 1 of the criteria in Group D

    44-47 2 of the criteria in Group D

    41-43 3 of the criteria in Group D

    40 Major Impairment in Several Areas of Functioning

    38-40 4 of the criteria in Group D

    34-37 5 of the criteria in Group D

    31-33 6 of the criteria in Group D

    30 Inability to Function in Almost All Areas

    30 Group C Criteria: -EITHER Suicidal Preoccupation or frank suicidal ideation with preparation

    30 OR behavior considerably influenced by delusions or hallucinations

    30 OR serious impairment in communication (sometimes incoherent, acts grossly inappropriately)

    30 OR profound stuporous depression

    28-30 7 of the criteria in Group D

    24-27 8 of the criteria in Group D

    20-23 9 of the criteria in Group D

    21 1 of the criteria in Group C

    21 Suffering from Neglect or in Danger of Hurting Self or Others

    20 Suffering from Neglect or in Danger of Hurting Self or Others

    20 Group B Criteria: -Suicide attempts without clear expectation of death

    20 Some severe violence or self-mutilating behaviors

    20 Severe manic excitement, or severe agitation and impulsivity

    20 Occasionally fails to maintain minimum personal hygiene (e.g., diarrhea due to laxatives, or smearing feces)

    20 Urgent/emergency admission to the present psychiatric hospital

    20 In physical danger due to medical problems (e.g., severe anorexia or bulimia and some spontaneous vomiting or extensive laxative/diuretic/diet pill use, but without serious heart or kidney problems or severe dehydration and disorientation)

    18-20 1-2 of the criteria in Group B

    14-17 3-4 of the criteria in Group B

    11-13 5-6 of the criteria in Group B

    10 Immediate Danger from Serious Neglect or Self-Injurious Behavior

    10 Group A Criteria: -Serious suicidal act with clear expectation of death (e.g., stabbing,

    10 shooting, hanging, or serious overdose with no one present

    10 Frequent severe violence or self-mutilation

    10 Extreme manic excitement, or extreme agitation and impulsivity (e.g., wild screaming, ripping the stuffing out of a bed mattress)

    10 Persistent inability to maintain minimal personal hygiene

    10 Urgent/emergency admission to present psychiatric hospital

    10 In acute, severe danger due to medical problems (e.g., severe anorexia or bulimia with heart or kidney problems)

    8-10 1-2 of the criteria in Group A

    4-7 4 of the criteria in Group A

    1-3 5-6 of the criteria in Group A

    0 0

• GAD-7 Anxiety Assessment [Generalized Anxiety Disorder]
  • Over the last 2 weeks, how often have you been bothered by the following problems?
  • 1. Feeling nervous, anxious or on edge
  • 2. Not being able to stop or control worrying
  • 3. Worrying too much about different things
  • 4. Trouble relaxing
  • 5. Being so restless that it is hard to sit still
  • 6. Becoming easily annoyed or irritable
  • 7. Feeling afraid as if something awful might happen
  • Scoring:
    • 0-Not at all

      1-Several Days

      2-More than half the days

      3-Nearly everyday

      Scores of 5, 10, and 15 are taken as the cut off points for mild, moderate, and severe anxiety, respectively.

      When used as a screening tool, further evaluation is recommended when the score is 10 or greater.

      Using the threshold score of 10, the GAD-7 has a sensitivity of 89% and a specificity of 82% for generalised anxiety disorder.

      It is moderately good at screening three other common anxiety disorders – panic disorder (sensitivity 74%, specificity 81%), social anxiety disorder (sensitivity 72%, specificity 80%), and post-traumatic stress disorder (sensitivity 66%, specificity 81%).

  • ~ http://www.phqscreeners.com/
• PHQ-9 Depression [Patient Health Questionnaire]
  • 1. Little interest or pleasure in doing things.

    2. Feeling down, depressed, or hopeless.

    3. Trouble falling or staying asleep, or sleeping too much.

    4. Feeling tired or having little energy.

    5. Poor appetite or overeating.

    6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down.

    7. Trouble concentrating on things, such as reading the newspaper or watching television.

    8. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving .around a lot more than usual.

    9. Thoughts that you would be better off dead or of hurting yourself in some way.

    Scoring:

    • 0-Not at all

      1-Several Days

      2-More than half the days

      3-Nearly everyday

      Scores of 5, 10, and 15 are taken as the cut off points for mild, moderate, and severe anxiety, respectively.

      NOTE: If your answer on Question 9 is not 0, please seek help immediately. This is a known marker for suicide.

      0 – 4 Depression Severity-None, Treatment-None

      5 – 9 Depression Severity-Mild, Watchful waiting; repeat PHQ-9 at follow-up

      10 – 14 Depression Severity-Moderate, Treatment plan, considering counseling, follow-up and/or pharmacotherapy

      15 – 19 Depression Severity-Moderately Severe, Active treatment with pharmacotherapy and/or psychotherapy

      20 – 27 Severe Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management

    ~ http://www.phqscreeners.com/instructions/instructions.pdf

    ~ http://www.phqscreeners.com/

• PHQ-15 Physical Symptoms [Patient Health Questionnaire]
  • 1. Stomach pain
  • 2. Back pain
  • 3. Pain in your arms, legs, or joints (knees, hips, etc.)
  • 4. Menstrual cramps or other problems with your periods WOMEN ONLY
  • 5. Headaches
  • 6. Chest pain
  • 7. Dizziness
  • 8. Fainting spells
  • 9. Feeling your heart pound or race
  • 10. Shortness of breath
  • 11. Pain or problems during sexual intercourse
  • l2. Constipation, loose bowels, or diarrhea
  • 13. Nausea, gas, or indigestion
  • 14. Feeling tired or having low energy
  • 15. Trouble sleeping
  • Scoring:
    • This is calculated by assigning scores of 0, 1, and 2 to the response categories of ―not at all, ―bothered a little, and ―bothered a lot,
• Cases:
  • Case #1-Sheri, GAF Score: 63-83
    • Sheri is a 47 year old African American female with Borderline Personality Disorder. She has a history of substance abuse. She has a long history of crisis contacts, mostly around her depression and relationship issues. She entered a Dialectical Behavioral Program about a year ago. Since that time, she has had only one crisis contact and no self-abusive behaviors. Sheri broke up with her boyfriend about six months ago and has been single ever since. She has been in a women’s support group for the past five months. She has maintained a job for the past 18 months and is seen as an “excellent waitress.” She says that, aside from some minor conflicts with her sister, her life is going well in all areas.
  • Case #2-Chia, GAF Score: 51-70
    • Chia is a 68-year-old Asian woman who is diagnosed with Schizophrenia. She entered mental health services 18 months ago when her family could no longer manage her behavior. An Asian Mental Health Specialist has been working with Chia and her family to understand the biological basis of her disorder. The specialist also included a spiritual leader from their community to assist with the process. Chia is stable on her medications and has been participating in activities in the Asian community with her family for the past few months.
  • Case #Victor, GAF Score: 2-16
    • Victor is a 48-year-old Caucasian male who had his leg amputated while serving in Vietnam. He is diagnosed with Post-Traumatic Stress Disorder and Paranoia. Victor has had suicidal ideation since his time in the service. His family lives in the Midwest and he has not had any contact with them for over five years. He is currently homeless and was released 3 days ago from a 8-day psychiatric hospitalization after a serious suicide attempt. He has been using drugs and alcohol for the past three days and is threatening suicide again.
  • Case #3-Marie, GAF Score: 31-41
    • Marie is a 35 year-old Hispanic female living in a rural agricultural community. She has been diagnosed with Post-Traumatic Stress Disorder and Psychosis. She has auditory and olfactory hallucinations. Marie lived with her father after two failed marriages, both involving domestic violence. Her father is an elderly migrant farm worker who cannot care for her any longer. She was recently discharged from a 21-day community hospitalization. Marie is tentatively stable in her Section 8 housing with a caregiver in her home 6 hours daily to assist with chores and meals. She is sporadically attending the local day treatment program.
  • Case #4-Robert, GAF Score: 13-33
    • Robert is a 71 year-old Caucasian male with a full-scale IQ of 83. He is obese, incontinent, and suffers from esophageal reflux, which causes him to choke. He has Post-Traumatic Stress Disorder from severe sexual and physical abuse by his alcoholic stepfather. He is unable to maintain his own hygiene and needs assistance with his ADLs. Robert has been getting increasingly agitated and verbally aggressive towards his new male in-home caregiver.
  • Case #5-Jake, GAF Score: 15-35
    • Jake is a 20 year-old Caucasian male who had his first psychotic break last year. He is diagnosed as Schizophrenic but has refused medications. His grandparents are currently paying for his apartment. Jake smokes marijuana 4-7 times a week. He had enrolled in the auto-body program at the local community college but is being dropped from registration due to poor attendance. The majority of his thinking revolves around delusions regarding government conspiracies. Jake has no friends and spends most of his time camping up in the woods.
  • Case #6-Rick, GAF Score: 43
    • Rick is a 54 year-old, African-American, male with a diagnosis of Post-Traumatic Stress Disorder with paranoid features. His onset of symptoms coincided with his service in Vietnam. Rick was married when he was 27 years old and was divorced just over a year later. He has dated sporadically, but has not had a relationship in 8 years. He lives in a trailer on his parent’s property. His parents are supportive and set clear boundaries. They are also supporting his 92 year-old grandmother and are having a difficult time with Rick’s level of stress and anxiety. Rick is resistant to mental health services. He just lost the factory job he had obtained six weeks ago. He has a meeting next week with the Division of Vocational Rehabilitation.
  • Case #7-Geraldo, GAF Score: 59-79
    • Geraldo is a 52 year-old Mexican male. He was raised in Mexico, his mother died when he was 3 years old and he left home at 9 years-old to escape his abusive father. He is diagnosed with Paranoid Personality Disorder. He is medication compliant and works successfully at his own local landscaping business. He is divorced but has frequent visits with his 14 year-old daughter.
  • Case #8-Rebecca, GAF Score: 67
    • Rebecca is a 23 year-old Asian American female. She is currently diagnosed with Bipolar Disorder. From 11-17 years old, she was psychiatric hospitalized on five occasions due to suicide attempts. She is currently employed at the local mall, is returning to the University next semester, and has been dating her current boyfriend for over six months. Rebecca reports this is the most stable her life has been since she can remember. She also acknowledges a low level of anxiety and depression as the structure and stability continues.
  • Case #9-Abby, GAF Score: 38-58
    • Abby is a 29 year-old Caucasian female. She is bulimic with a history of hospitalizations. She is also diagnosed with Bipolar Disorder and Generalized Anxiety Disorder. Abby has a 13 year-old daughter whom her parents adopted ten years ago. Her apartment is not very well kept, she is isolating from her family and friends, and her job is in jeopardy due to her frequent absences.
  • Case #10-Ted, GAF Score: 39-59
    • Ted is a 52-year-old Caucasian male with Schizoaffective Disorder. He had a severe decompensation four years ago where he attempted to stab a County Designated Mental Health Professional who was evaluating him for involuntary detention to a state hospital. He was just released from the Legal Offender Unit of the state hospital six months ago. Ted is in a supported housing placement since his release and is stable on his medications. He is seeing his outpatient psychiatrist monthly for medication management and has been attending a day treatment program for the past month. Ted’s thinking is relatively clear. He reports no significant relationships outside of the contact and support he receives from his mother and brother. He also notes a low level of depression and a general lack of interest in daily activities.
  • Case #11-Delia, GAF Score: 47-67
    • Delia is a 64 year-old Caucasian woman with Paranoid Personality Disorder. She was discharged eight months ago after two years in the state psychiatric hospital. She was placed in a supported living home with four other women. In the past two months, Delia has learned the bus system and goes shopping and on outings several times a week. Her children are shocked by her improved functioning and her granddaughter is visiting her every Sunday. In the next few weeks, Delia and her roommate will join the local senior center.
  • Case #12-Jared, GAF Score: 57-77
    • Jared is a 26 year old Caucasian male who has been deaf since birth. He spent most of his childhood and adolescents living at a school for the deaf. His mother later learned he had been physically, emotionally, and sexually abused at the boarding school. He has been diagnosed with Post-Traumatic Stress Disorder and Atypical Psychosis. He is currently stable on medication, he is receiving mental health services with the assistance of an interpreter, and has his own apartment. Although he still feels stressed in social situations, he wants to prepare to enroll in the local community college.
  • Case #13-Melinda, GAF Score: 33-53
    • Melinda is a 43 year-old Native American female. She has been diagnosed with Schizoaffective Disorder and is borderline Mildly Mentally Retarded. She reports a long history of sexual abuse. For the past several weeks she has been making allegations of sexual abuse by staff at her housing facility. The allegations have been proven to be unsubstantiated. She has medical issues with diabetes and a hyperthyroid condition but is medically stable.
  • Case #14-Thom, GAF Score: 19-39
    • Thom is a 36 year-old Caucasian male with Psychosis. He has severe and chronic delusions that revolve around religious and somatic themes. Thom has been incarcerated many times with various assault charges, the most recent being life-threatening to the victim. His mother has been very supportive throughout the years and has been a strong advocate for Thom. He was released from jail to a community placement two weeks ago. His psychiatrist says that his mediations are stable. Thom does not like the facility he is residing in. He is maintaining, but in becoming increasingly agitated. His case manager is visiting him daily and researching other housing options. Thom said he is “coping okay” but wants to move out as soon as possible. He is not capable of working at this point in time.
  • Case #15-Frances, GAF Score: 9-19
    • Frances is a 51 year-old Hispanic/Native American female with Schizophrenia – paranoid type. From 1967, she was hospitalized 19 times over ten years. When she decompensates, she becomes psychotic and very assaultive. She currently lives in a congregate care facility. Historically, her placement has been in jeopardy with her frequent disruptions. Her medications were adjusted again 2 months ago and she has been more aggressive and recently assaulted her roommate with her dinner tray and had to be restrained.
  • Case #16-Alice, GAF Score: 27-47
    • Alice is an 85 year-old African American woman who lives in an older adult housing complex. She has been diagnosed with Delusional Disorder – persecutory type. Alice has always struggled with medication noncompliance. Her delusions historically have been fixed on people poisoning her food. Alice is becoming increasingly more agitated, is isolating, and her weight has noticeably dropped again over the past two weeks.
  • Case #17-Colin, GAF Score: 35-55
    • Colin is a 31 year-old Caucasian male. He lived with his family until he was 26 years old. There was a long history of domestic violence in his home growing up. Five months after he moved out, his mother passed away. Colin has a history of substance abuse and schizophrenia. He has been medication compliant for the last several years and is currently in substance abuse treatment, though he is early in his recovery process. Colin struggles with his hygiene issues and has been unable to hold a job. He spends some time with his father but really wants to develop more peer relationships and a normal social life
  • Case #18-Kim, GAF Score: 20-40
    • Kim is a 31 year old Caucasian female with Major Depression. She has a history of heavy alcohol abuse and has been in inpatient chemical dependency treatment programs. Her family of origin has a long history of mental illness and chemical dependency on both sides. She is currently in a co-dependent relationship with an abusive boyfriend. Kim’s mother tries to support her, but is regularly involved in heavy alcohol use. Kim is on the verge of losing another job and is expressing suicidal ideation, but has agreed to a “no harm” contract.
  • Case #19-Sam, GAF Score: 40-60
    • Sam is a 42 year old Caucasian male with Schizophrenia, paranoid type. He has had a history of disappearing for months at a time since his late teens. He has several assault charges for Domestic Violence with a series of girlfriends. He was on probation and was released 2 months ago after completing all of the court requirements. Sam is currently in recovery and is actively participating in AA meetings. Sam is stabilizing with his compliance to his medication regimen. He continues to maintain contact with his ex-probation officer and several staff at the state psychiatric hospital. He is trying to get a job but has not had any response back at this point.
• GAF Quick Guide [Excel Version]
  • ~ https://dl.dropboxusercontent.com/u/80421698/QuickGuide-GeneralAssesmentFunction.xls
• GAF Quick Guide [.pdf Version]
  • ~ https://dl.dropboxusercontent.com/u/80421698/GAF-QuickReference.pdf
• Compiled By:
  • Rigel Arcayan
  • blindcaveman.wordpress.com