Special Section on the GAF: Selection of Outcome Assessment Instruments for Inpatients With Severe and Persistent Mental Illness

Abstract

The purpose of this article is to describe a procedure to assist in selecting outcome measures for inpatients treated at a state psychiatric hospital. The procedure combines evidence-based criteria from the literature, instruments shown to be sensitive to change in clinical trials, and the perspectives of a multidisciplinary team of researchers, administrators, providers, and patient advocates. Recent efficacy and effectiveness studies were used to identify recurrently used outcome instruments. A computerized search of more than 30 bibliographic databases, such as PsycINFO, MEDLINE, Social SciSearch, and ERIC, was conducted for articles published between 1990 and 2002. Comparisons of the most frequently used instruments were made on seven criteria proposed as best-practice indicators, including sensitivity to change and robust psychometrics. The sample produced 110 measures. Rater-completed instruments were represented more often than patient-completed ones. However, considerable variability across both methods was found on the criteria. The limited resources associated with publicly funded inpatient facilities led to a recommendation to select at least one rater-completed and one patient-completed instrument.

Progress Monitoring Measures: The Interaction of Clinician Initial Motivation with Selection and Maintenance Issues

“…Proposals have been made to adopt a small set of "core measures" to reduce the burden of selection, increase comparability of services, and focus resources on the most promising measures (Hermann & Palmer, 2002). Several frameworks have been created to aid organizations, researchers and clinicians in developing such a core set (Burlingame et al, 2005;Burlingame, Lambert, Reisinger, Neff, & Mosier, 1995;Erbes et al, 2004;Green & Gracely, 1987;Hermann et al, 2006;Hermann et al, 2004;Hermann & Palmer, 2002;Lambert, Ogles, & Masters, 1992;Slade, 2002;Waraich et al, 2010).…”

“…Other commonly cited features included feasibility, appropriate case-mix adjustment, and sensitivity to change. From a researcher perspective, these are key factors to consider in the mental health-care quality assessment (Burlingame et al, 2005;Burlingame et al, 1995;Erbes et al, 2004;Green & Gracely, 1987;Hermann et al, 2006;Hermann et al, 2004;Hermann & Palmer, 2002;Lambert et al, 1992;Slade, 2002;Waraich et al, 2010).…”

Clinical outcomes of a coping with stress training program among patients suffering from schizophrenia and schizoaffective disorder: a pilot study

“…Because of its high sensitivity to change, it has been recommended that this measure be used as an outcome measurement to assess symptom change (e.g. changes associated to therapeutic interventions, such as medication, psychosocial therapy, and hospitalization) among both outpatients and inpatients, rather than for diagnostic purposes (Burlingame et al, 2005(Burlingame et al, , 2006Dingemans et al, 1995;Leucht, Kane, Kissling, Hamann, Etschel, & Engel, 2005;Lukoff et al, 1986).…”

The Hoosier Assurance Plan Instrument for Adults (HAPI-A): The Psychometric Properties of a Level of Functioning Assessment Instrument Designed for Use in a State Managed Care Mental Health Program

“…Several recent studies provide support for the reliability and validity of the GAF and for its usefulness as a measure of overall level of functioning (Burlingame et al, 2005;Greenberg & Rosenheck, 2005;Hilsenroth et al, 2000;Startup, Jackson, & Bendix, 2002;. In general, each of the HAPI-A factors was associated with the GAF scores in the expected direction (i.e., lower functioning on the HAPI-A was associated with lower functioning on the GAF).…”