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Now that
the GAF scores are being analyzed, several people have asked questions on FORUM and on
Exchange about the GAF performance measure. This page contains links to answers to
those questions by Dr. William Van Stone. Another good source of information is the GAF directive.
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The following quote from the 1999 Review of Outcome Measure for Inclusion in the Report to Congress on Maintaining Capacity to Provide for the Specialized Treatment and Rehabilitation Needs of Disabled Veterans may help clarify the "performance" question.
VISN Director's Performance Measure for Seriously Mentally Ill Veterans, FY 1988: "There will be at least 1 Global Assessment of Functioning (GAF) score reflecting the "current level of functioning" for each veteran patient seen at any VHA mental health inpatient or outpatient setting in FY 1998.
Goals: Fully Successful: 90% of mental health patients have GAF score on record.
Exceptional: 95% of mental health patients have GAF score on record.
A GAF is taken directly from the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV), p. 32, except that VHA only includes scores from 1 to 100, excluding 0 (insufficient information). A mental health outpatient setting is defined as a clinic that has a Decision Support System (DSS) identifier (stop code) in the 500 series with the exception of those clinics with the following telephone mental health DSS identifiers: 526, 527, 528, 542, 545, 546, 530, 537, and 579.
All patients discharged from a psychiatric bed section will have a GAF score recorded by the attending physician a part of the discharge process which will be stored in the [VISTA-ex-DHCP] Mental Health package. All patients remaining on a psychiatric bed section during the Annual Patient Census (September 30) will have a GAF score recorded by the attending physician that will be stored in the VISTA Mental Health Package. All patients seen in a mental health outpatient setting will have a GAF score recorded by a qualified mental health professional that will be stored in the VISTA Mental Health Package.
Data: The VA did not begin collecting GAF data systematically until FY1998 and will not have the software capability to analyze it nationally until early in FY 1999. Thus there are no FY 1996, FY 1997, or FY 1998 data available.
Data Source: Northeast Program Evaluation Center (NEPEC) with information obtained from the Austin Texas database
Status: Software is being developed that will transfer all GAF data from the VISTA Mental Health package to an appropriate Austin database. Depending on what GAF data are obtained for FY 1998, outcome will be measured by comparing early and late GAF score (for each individual) during the year, or comparing FY 1997 score with FY 1998 score (if only one is available). "
Since this was written the software has been written, delivered, and I hope installed, that will move the facility GAFs to Austin. The name and other discussions about GAF, including discussion on training are available to anyone tapping into the G.Mental Health FORUM discussions
This year, the agreement is a 1% increase in GAF scores, which, under the circumstance has no practical meaning .
Essentially the goal for last year was to set procedures in place so that both in and outpatients could be identified and given a GAF rating. This year, the goal is to become as proficient and reliable as possible in doing GAFs locally, obtain the national rollup from Austin to see what the data look like, and see if modifications are needed. If you would like more info, please continue asking.
If only one GAF is used, it should represent the functioning just prior to admission to help establish the need for hospitalization; since the discharge software still asks for two GAFs, it has been and still is a local option how or whether to record a second one even though the software suggests the highest functioning at least for a few months. Most record the functioning at discharge so that they can document improvement as a result of hospitalization. Depending upon the length of stay, mission of the medical center, research interests, and local preference, flexibility in use of the 2nd GAF is preserved.