Global Assessment of Relational Functioning Scale (GARF): I. Background and Rationale

The Committee on the Family of the Group for the Advancement of Psychiatry has introduced the Global Assessment of Relational Functioning (GARF), a scale that describes and quantifies the relational context within which patients live and problems occur. The GARF is intended to serve as a device that alerts clinicians to pay attention to the evaluation not only of individuals but also of relational functioning. In this article, we describe from a historical perspective the scientific and political context within which this scale was developed. The GARF is analogous to Axis V of the DSM GAF scale (Global Assessment of Functioning) that is used to assess individual functioning. The GARF is a composite derivative of three major dimensionalized constructs, namely, joint problem solving, organization, and emotional climate. We provide five clinical vignettes to illustrate the process of arriving at GARF ratings. Finally, we discuss caveats and limitations for use of the GARF at present, and make recommendations for research projects and training methods that may enhance the value of this instrument in the future.     

Global Assessment of Relational Functioning Scale (GARF): II. Reliability and Validity in a Sample of Families of Bipolar Patients

The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73 ) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.     

Don't Take Out This Appendix! Generalizability of the Global Assessment of Relational Functioning Scale

This study investigated the generalizability of the Global Assessment of Relational Functioning (GARF) Scale. Found in an appendix of the Diagnostic and Statistical Manual of Mental Disorders under "Criteria Sets for Axes Provided for Future Study," the GARF Scale provides a global rating of a relational unit (family or couple). Thirty-two raters assigned GARF ratings to five relational units. Generalizability analyses indicate extremely high dependability of GARF scores across raters. Higher generalizability coefficients were found for raters who had formal education in family systems theory. Overall, these results are an encouraging step towards adopting the GARF for widespread use.     

Concurrent validity of the Global Assessment of Functioning Scale for clients with schizophrenia

Although the Global Assessment of Functioning (GAF) scale is a widely utilized instrument, little data on construct validity is available about its use with clients having schizophrenia. This study compared point-specific GAF scores with concurrent ratings of symptomatology and social and occupational impairments using the Functional Assessment Rating Scale (Ward & Dow, 1994). A linear multiple regression analysis of empirical data from investigations of clients' global functioning showed that increased work and school-related problems, danger to others, and psychotic symptoms predicted lower GAF scores. In general, GAF scores seem to reflect the construct of global psychological, social, and occupational functioning that the scale was designed to measure.     

Clinical Validity of a Dimensional Assessment of Self- and Interpersonal Functioning in Adolescent Inpatients

The Social Cognition and Object Relations Scale–Global Version (SCORS–G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS–G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS–G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS–G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS–G with adolescents.     

Construct validity of the Global Assessment of Functioning Scale for clients with anxiety disorder

The Global Assessment of Functioning Scale is a widely used although poorly researched measurement of overall mental health or illness. This study investigated construct validity for clients with anxiety disorder. Analysis suggests that current suicidality was the most significant predictor of ratings. Current homicidality, work/school problems, and inability to care for oneself were not significantly correlated with scale ratings.     

评价中心结构效度的多元概化理论分析研究

评价中心技术是现代人事测评的一种主要形式,主要通过多种模拟任务来测评高级管理人才。然而,少有研究能证明它具有理想的结构效度。该研究运用多质多法分析了某金融企业一次真实的评价中心测评项目,发现测评的结构效度并不理想。接着,通过多元概化理论的分析,探讨了结构效度不理想的原因,并指出了评价中心任务与所测维度之间的关系,以及对各维度的测量信度。最后,根据分析结果,探讨了优化评价中心结构效度和提升整体测量信度的途径。     

Functioning in the Real World: Using Storytelling to Improve Validity in the Assessment of Executive Functions

Real-world contexts differ in the clarity of expectations for desired responses, as do assessment procedures, ranging along a continuum from maximal conditions that provide well-defined expectations to typical conditions that provide ill-defined expectations. Executive functions guide effective social interactions, but relations between them have not been studied with measures that are matched in the clarity of response expectations. In predicting teacher-rated social competence (SC) from kindergarteners' performance on tasks of executive functions (EFs), we found better model–data fit indexes when both measures were similar in the clarity of response expectations for the child. The maximal EF measure, the Developmental Neuropsychological Assessment, presents well-defined response expectations, and the typical EF measure, 5 scales from the Thematic Apperception Test (TAT), presents ill-defined response expectations (i.e., Abstraction, Perceptual Integration, Cognitive-Experiential Integration, and Associative Thinking). To assess SC under maximal and typical conditions, we used 2 teacher-rated questionnaires, with items, respectively, that emphasize well-defined and ill-defined expectations: the Behavior Rating Inventory: Behavioral Regulation Index and the Social Skills Improvement System: Social Competence Scale. Findings suggest that matching clarity of expectations improves generalization across measures and highlight the usefulness of the TAT to measure EF.     

Validity of the Finnish version of the Parental Burnout Assessment (PBA)

The aim of the present study was to validate the Finnish version of the Parental Burnout Assessment (PBA) using data from 1,688 Finnish parents (91% mothers) living in Finland with at least one child living at home. Confirmatory factor analyses supported the theoretical four-factor structure of the PBA – emotional exhaustion in one’s parental role, contrast with previous parental self, feelings of being fed up with one’s parental role, and emotional distancing from one’s children. Internal consistency for the total scale was excellent (Cronbach’s alpha ≥ 0.90) and for the subscales from acceptable (alpha ≥ 0.70) to excellent. The results further demonstrated strict factorial invariance of PBA across genders and educational status groups. Finally, the PBA and its four subscales correlated as expected with the three criteria variables (depressive symptoms, sleep disruptions, and self-esteem), the latent factors of all three criteria variables being still clearly unique and separate constructions from parental burnout factors.     

Reliability and Validity of a Short Version of the General Functioning Subscale of the McMaster Family Assessment Device

The General Functioning 12‐item subscale (GF12) of The McMaster Family Assessment Device (FAD) has been validated as a single index measure to assess family functioning. This study reports on the reliability and validity of using only the six positive items from the General Functioning subscale (GF6+). Existing data from two Western Australian studies, the Raine Study (RS) and the Western Australian Child Health Survey (WACHS), was used to analyze the psychometric properties of the GF6+ subscale. The results demonstrated that the GF6+ subscale had virtually equivalent psychometric properties and was able to identify almost all of the same families who had healthy or unhealthy levels of functioning as the full GF12 subscale. In consideration of the constraints faced by large‐scale population‐based surveys, the findings of this study support the use of a GF6+ subscale from the FAD, as a quick and effective tool to assess the overall functioning of families.     

Family Assessment Measure (FAM) and Process Model of Family Functioning

This paper provides an overview of twenty years' work in the development of the Family Assessment Measure (FAM), based on the Process Model of Family Functioning. The Process Model describes a conceptual framework for conducting family assessments according to seven key dimensions: task accomplishment, role performance, communication, affective expression, involvement, control, values and norms. The FAM provides measures of these dimensions at three levels: whole family system (general scale, fifty items), various dyadic relationships (dyadic scale, forty-two items) and individual functioning (self-rating scale, forty-two items). In addition, the general scale includes social desirability and defensiveness response style measures. Brief FAMs (fourteen items) are available for each scale as well. The measurement properties of FAM have been evaluated in a variety of clinical and non-clinical settings. Reliability estimates are very good in most contexts. FAM's validity has been supported using a number of techniques. Overall, the weight of the evidence is that FAM's effectively and efficiently assess family functioning and provide strong explanatory and predictive utility. This empirical evidence reinforces experiences of clinicians, indicating that FAM provides a rich source of information on family functioning.     

The Implicit Relational Assessment Procedure (IRAP ) and the Malleability of Ageist Attitudes

The Psychological Record - The current study examined the malleability of implicit attitudes using the Implicit Relational Assessment Procedure (IRAP). In Experiment 1, “similar” and...     

Convergent Validity of the Defense Mechanisms Manual and the Defensive Functioning Scale

This report, describing a peculiar reaction of two psychiatric patients to the Rorschach test, tries to relate this phenomenon to some other Rorschach phenomena, already known and previously described.     

The Relationship Between the Child and Adolescent Functional Assessment Scale (CAFAS) and Indicators of Functioning

We investigated the relationship between scores on the Child and Adolescent Functional Assessment Scale (CAFAS) and several indicators of functioning assessed in the national evaluation of the demonstration grants funded by the Center for Mental Health Services System of Care Initiative. The sample included 3187 youths, ranging in age from 4 to 23, with serious emotional disturbance (SED) who were evaluated at intake. At 6 month post-intake, 873 of these youths were re-evaluated. As predicted, higher CAFAS scores were associated with previous psychiatric hospitalization, more serious psychiatric diagnoses, and more restrictive living arrangements. Youths in residential inpatient settings were significantly more impaired than youths living in their own home or in regular foster care. Below average school performance, poor attendance, and contact with law enforcement personnel were also associated with greater impairment. Youth's total CAFAS scores decreased significantly from intake to 6 months. These results indicate that the CAFAS is a measure of functioning which has both statistical and clinical significance.     

A Team Format for the Global Assessment Scale: Reliability and Validity on an Inpatient Unit

The Global Assessment Scale (GAS) is a 100-point rating instrument which purports to measure psychological adjustment on a continuum from self-actualization to severe regression. Its reliability and validity were examined on the admitting ward of a state hospital where GAS ratings are assigned to patients by computing a mean of the individual ratings assigned by a team of clinicians. Results showed such team GAS ratings to have good reliability. As for validity, team GAS predicted the outcomes of court hearings at two stages of the civil commitment process and showed construct validity in its relevant correlations with the Psychotic Inpatient Profile. A predicted association between team GAS and a ward atmosphere measure was not obtained. Taken as a whole, the results support the use of team GaS ratings in inpatient settings.     

Extending the Validity of the Personality Assessment Inventory's (PAI) Level of Care Index (LOCI) in Multiple Psychiatric Settings

The purpose of this study was to extend the validity and clinical application of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in 2 independent psychiatric samples. In Study 1 (N = 201), the LOCI effectively differentiated level of care (inpatients from outpatients), and was also meaningfully associated with risk factors for psychiatric admission (e.g., suicidal ideation, self-harming behavior, previous psychiatric admission, etc.), even after controlling for other demographic variables (range of Cohen's ds = 0.57–1.00). Likewise, the LOCI also incremented other risk indicators (suicide and violence history) and relevant PAI indexes (i.e., Mean Clinical Elevation, and Suicide and Violence Potential) in predicting level of care, and explained an additional 6% to 12% of variance in the target variable. Diagnostic efficiency analyses indicated LOCI scores in the range of 15 to 18 optimize positive and negative predictive power, and classification rate. In Study 2 (N = 96), the LOCI was found to be significantly higher in those with a recent psychiatric admission within the past 6 months (d = 0.64), as compared to those without an admission. Similarly, those who were admitted for suicide risk had significantly higher mean LOCI scores as compared to those who did not (d = 0.70). The clinical implications of these findings and potential application of the LOCI are discussed.     

自编《中小学生非智力因素教师评价量表》的信、效度研究

通过自行编制的《中小学生非智力因素教师评价量表》,以天津市4所中、小学校的4个年级365名学生为被试考察了该量表的质量。研究结果表明：(1)《中小学生非智力因素教师评价量表》具有较高的信度;(2)《中小学生非智力因素教师评价量表》所构想的非智力因素结构模型是完全可以接受的,即有较好的结构效度。     

When Laddering and the Downward Arrow Can Be Used as Adjuncts to Inference Chaining in REBT Assessment

This paper looks at the ways in which laddering in Personal Construct Therapy and the downward arrow in Cognitive Therapy can be used as adjunctive techniques to inference chaining in locating a client's critical A or emotional core. We describe their use through a number of case examples and annotations. We conclude that these two methods require skilled use if they are to be successfully integrated into inference chaining and are offered as part of REBT's interest in theoretically consistent eclecticism. The use of inference chaining in Rational Emotive Behaviour Therapy (REBT), the downward arrow in Cognitive Therapy (CT) and laddering in Personal Construct Therapy (PCT) are techniques which aim to help therapists and clients gain rapid insight into the latters' core beliefs and values about themselves, others and the world. This article will show how each technique reveals underlying beliefs and then, from the REBT viewpoint, in what circumstances laddering or the downward arrow might be used as an adjunct to inference chaining in the assessment stage of therapy.     

The Abbreviated Character Strengths Test (ACST): A Preliminary Assessment of Test Validity

The 24-item Abbreviated Character Strengths Test (ACST) was developed to efficiently measure character strengths (Peterson, Park, &; Castro, 2011 Peterson, C., Park, N., &; Castro, C. A. (2011). Assessment for the US Army Comprehensive Soldier Fitness program: The Global Assessment Tool. American Psychologist, 66, 10–18.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). However, its validity for this purpose has not yet been sufficiently established. Using confirmatory factor analysis to test a series of structural models, only a modified bifactor model showed reasonably acceptable fit. Further analyses of this model failed to demonstrate measurement invariance between male and female respondents. Relationships between ACST dimension and Big Five personality trait scores were generally weak-to-moderate, and support for hypotheses regarding each ACST virtue's expected correspondence with specific Big Five dimensions was mixed. Finally, scores on ACST dimensions accounted for a combined 12% of the variance in satisfaction with life scores, after controlling for socially desirability. Although an abbreviated measure of character strengths represents a practical need, considerable improvements to the ACST are needed for it to adequately meet this purpose.