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ABSTRACI'. Two methods for obtaining estimates of everyday functioning in elderly patients were described: the Present Functioning Questionnaire (PFQ) and the Functional Rating Scale (FRS). The PFQ obtains information from a collaborative informant with respect to number of reported problems in five areas of everyday functioning: personality; everyday tasks; language skills; memory functioning; and self-care. The FRS integrates assessment information from multidisciplinary sources in eight areas crucial to the establishment of diagnoses in dementia: memory; social/community/ D. Crockett is affiliated with the Division of Psvcholoev. De~artment of Psvchiatry, University of British Columbia. H. occupational; homehobbies; personal care; language skills; problem solving; affect; and orientation. Reliabili studies indicate a high de ee of consistence for both scales. W en the rating of normal f X el erly subjects and patients with suspected malignant memory disorders were compared, the rating scales showed a good level of discriminant validity. These results were interpreted as indicatin that the use of these scales will enhance research into the relationskp of the course of dementing diseases and competency to deal with everyday life.

Use of community services is common among older outpatients with psychotic disorders, but its frequency varies as a function of patient characteristics.

This paper reports the development of a psychological assessment instrument for evaluating the deteriorated elderly patient. The instrument provides information on patient function in eight areas including communication abilities, cognitive status and mood. Analyses were undertaken to determine the psychometric properties of each component of the instrument. Examination of the means and standard deviations indicated that the full range was used for each scale. Examination of interrater reliability yielded values ranging from .92 to .99. Several indices that may be of use in evaluating the significance of change in test scores are also presented. Suggestions are also made for the application of this instrument in both clinical and research settings.

Public job training programs funded by the U.S. Department of Labor (USDOL) are now 40 years old. Since their inception, the programs have evolved from strong federal control to significant local autonomy, from narrowly targeted to broadly available services, and from prescribed training options to significant customer choice. The evolution has been marked by four distinct stages. The 1962 Manpower Development and Training Act (MDTA) provided funding administered by regional offices of USDOL directly to job training providers delivering classroom training in local areas. The first elements of decentralized decision making were introduced by the Comprehensive Employment and Training Act (CETA), which superceded MDTA in 1973. CETA required establishment of local administrative entities, called "prime sponsors," to coordinate programs and competitively finance training providers. MDTA and CETA each targeted job training services to economically disadvantaged workers and youth. CETA was supplanted by the Job Training Partnership Act (JTPA) in 1982. JTPA continued the decentralization trend that CETA had begun by significantly reducing the federal and state role and replacing it with a well-developed performance management system. JTPA was a results-driven job training program, which added dislocated workers as an eligible client group.The Workforce Investment Act (WIA) of 1998 replaced JTPA. WIA retained local administration but created a customer focus to programs with universal access and a greater reliance on market mechanisms. It expanded the array of job training, education, and employment services that could be accessed by customers, and mandated that one-stop centers for employment services be created in every labor market throughout the country. Universal access to programs has welcomed a wide variety of customers into the system, many of whom are served through core and intensive services. The provision of training services changed radically with the introduction of vouchers (individual training accounts) to provide training, and choices limited to training providers certified as eligible by the local WIA administrator. To inform their choice, voucher recipients have access to performance information about potential training providers-including job placement rates-through a system of consumer reports on past performance of job training participants.WIA included a sunset provision, with funding beyond five years after enactment of the original program requiring WIA reauthorization. The Bush administration proposed a number of incremental changes to the current program, the most important of which is the consolidation of all adult programs:x disadvantaged adult, dislocated worker, and the employment service funded under the Wagner-Peyser Act. This change would incorporate the public labor exchange into the basic WIA system.This book looks at federally funded training programs as they exist today. It reviews what job training is and how training programs have been implemented under WIA. More specifically, it ex...

T he evaluation of functional status can be accomplished by three types of assessment: patients' reports, caregivers' reports, and direct observation of performance. Research has shown low rates of agreement between self-reported and actual performance of activities of daily living among elderly hospitalized patients (1). In addition, caregivers' reports of patients' functioning have been noted to be unreliable in some cases (2). For older outpatients with schizophrenia there is often a paucity of available caregivers (3). The direct evaluation of behaviors essential to daily living provides a more objective index of an individual's ability to complete relevant tasks. Behavior-based assessments, however, often evaluate skills targeted for specific populations or skills related to institutional care. Such shortcomings tend to reduce the sensitivity of these measures to detect subtle changes in functioning (4).A performance-based protocol has been developed to assess directly a broad range of functional abilities in older individuals. The Direct Assessment of Functional Status Scale (4) involves the assessment of behavior during simulated daily activity tasks. Unlike other performance-based measures, which tend to provide information regarding primarily basic, lower-level skills and appear most applicable to institution-based care, this scale assesses a wide range of behaviors that are generalizable to outpatients and ambulatory care settings. It covers seven areas having to do with time orientation, communication, transportation, finance, shopping, grooming, and eating. Within each area, specific tasks that simulate real-world activities are performed (e.g., for the dimension of time orientation, the participant is asked to tell time at each of four progressively more difficult clock settings with the use of an analog clock; the participant is also tested on orientation for time and date).Loewenstein and colleagues (4) reported that the Direct Assessment of Functional Status Scale significantly discriminated clinic patients with Alzheimer's disease from normal elderly subjects and from a group of elderly outpatients with major depression. To our knowledge, the measure has not been tested in a group of older patients with schizophrenia. The present study was conducted to compare the functional abilities of middle-aged and elderly patients with schizophrenia with those of normal subjects, by means of the Direct Assessment of Functional Status Scale, and to determine the predictors of functional disability in the patients.

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