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Issues in the assessment of client level of functioning in mental health: An introduction

Issues in the assessment of client level of functioning in mental health: An introduction,10.1007/BF02518601,Journal of Behavioral Health Services & R

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Issues in the assessment of client level of functioning in mental health: An introduction   (Citations: 1)
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This special section of the Journal of Mental Health Administration is a collection of papers which deal with the use of level of functioning measures in mental health settings. These papers offer examples of efforts to come to grips with the difficult task of assessing the abilities of clients in the service delivery system. The importance of assessing client functioning rests with the need for adequately documenting the basis for the provision of services, the degree to which the client improves over time and the effectiveness of interventions. In addition to the significant individual contribution each paper makes to our understanding of functional assessment, together the five papers in this section serve two additional purposes. First, the papers illustrate the broad applicability of level of functioning within the mental health system. Functional assessments not only offer a way of characterizing the residual disability which may result from an individual's mental illness but also offer insight regarding the effectiveness of services and a prescription of the interventions which may be required to return the individual to an active position in the community. Functional assessments can also be used to help determine the availability and organization of services. On a less ambitious note, level of functioning information offers a description of those who seek services. One of the simplest values of level of functioning information may be to identify, for public planning and policy-making, who constitutes the chronically mentally ill population. Each of these applications is critically important for meaningful and cost-effective delivery of services. Second, the papers illustrate the broad approaches used in assessing functioning in mental health systems. The divergent needs for information result in very broad interpretations of the standard for level of functioning instruments. Mental health systems have relied on level of functional assessments which are based on single questions, rating the client from one to seven, one to nine, or zero to 90, as well as instruments composed of 80 or more questions covering a dozen or more dimensions. Differences in instrumentation are due not only to differences in the purpose of the assessment but also to more pragmatic concerns such as the system's capacity to develop instrumentation and to collect, analyze and disseminate information in a timely fashion. Among the instruments referred to in this section, readers may be most familiar with the simple oneitem summary measures of functioning. These measures have been used to describe client populations and determine change over time and are sometimes proposed for use in determining the chronic mentally ill population for purposes of P.L. 99-660. A well-kn0wn example of a one-question scale is the Global Assessment Scale.~ For readers who use or have considered using these summary measures, the paper by Pokorny 2 will be of greatest relevance. Pokorny's paper describes summary measures of functioning in state mental health authorities and offers needed recommendations and warnings for their use. These global measures have been found to be very appealing to mental health providers because of
Journal: Journal of Behavioral Health Services & Research - J BEHAV HEALTH SERV RES , vol. 18, no. 2, pp. 77-79, 1991
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    • ...The process is made all the more expensive by the generally agreed need to obtain information from both children and key adults (parents, teachers), and to use face-to-face interviews (American Academy of Child and Adolescent Psychiatry, 1992; 1993; Angold & Costello, 1996; Botvin & Botvin, 1992; Garland, Litrownik, Mitchell, & Levine, 1997; Jensen, 1992; King et al., 1995; Massey, 1991; McClellan & Werry, 1994; Offord et ...

    E. Jane Costello, et al. The Prevalence of Serious Emotional Disturbance: A Re-Analysis of Comm...

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