Contents
- Codes
- GAF Summary - Data
- Development Stream
- Dis-functioning and Mal-Behavior Score 10 Items (LSF)
- Social Behavior Benefit Status Score 15 Items (HSF)
- Content
- Timeline – Key Events & Major Milestones
- Signs & Symptoms Screener 9 Items (LSF)
- Severity of Symptoms Qualitative
- Content
- Functionality Comparison
- Excerpts from 2 Articles
20170602-F: Copied as whole into: Assess_GAF_17060204_Results
Result - Functioning/Severity of Symptoms
|
Date |
Eligible Professional |
Result |
Note |
|
2011 AVG |
Alan Vu, MD |
60/65 |
Registered student @ Cypress College, Outcome 4.0 GPA |
|
201201 |
|
|
Non-sleep Able Environment Cascade Begin Catastrophic Losses |
|
20120319 |
HCA: Wilfert, MFT II |
40/NR |
|
|
20120420 |
Ravinder Singh, MD |
30/NR |
|
|
201205 |
“Doctor” Daniels |
|
Temp practitioner Fails to sustain Clozapine |
|
20120518 |
Thymes, MD ER Doctor |
NR |
Not Reported |
|
20120607 |
Bum-Soo Lee, MD |
35/45 |
Western Med Anaheim Prescribes Restoril to compensate for no Clozapine |
|
During 2012 |
Unknown |
|
SSA Declares Lower Functioning & Cannot manage money |
|
2013 May |
DSM Changes |
|
GAF Dropped |
|
During 2014 |
Bum Soo Lee, MD |
|
“You look better” “You are a nice guy” |
|
20160815 |
Self-Score |
70/NR |
|
|
2018 |
Rimal B Bera MD |
|
New doctor does not report GAF, SOFAS or WHODAS |
|
20251015 |
Rimal B Bera MD |
78/NR |
Asked him to report |
Table of GAF Scores for Keith E
Torkelson (2011-2025) – Last Updated and Reviewed: 20260415-W:
05_Daily_Assess_Satisfaction_18081301_OCHCA
GAF (MSG) Adaptation - Impairment Summary (GAF-MSG-Beta 9 Item Screener)
Assessment Considerations
- GAF
- GAF Derivations
- SOFAS
- WAI
- WHODAS
Quantifying Gains and Losses
Impact of Losses
versus Gains
Losses have a greater psychological impact than gains, a concept known as loss aversion, where the pain of losing is often twice as intense as the pleasure of winning. While gains feel good, losses drive stronger emotional responses, often causing people to act conservatively to avoid losses, even at the cost of potential gains.
Development Stream
GAF (MSG) Adaptation
Dis-function Assessment 10 Item Screener
Buster Evaluating Buster
20200406-M: Low Scores are Favorable
Progress setting things Right
Progress setting things right is characterized as a process of continuous, incremental improvement rather than a single, perfect leap. It involves taking "messy action" to correct mistakes, learning from failures, and focusing on consistent forward motion over perfect execution.
Baseline for Corona Scare
As of April 2026, COVID-19 shows low, stable activity with nationwide declines in infections, though it remains a lingering threat with seasonal surges. Over 99% of the U.S. population has some immunity, meaning the virus generally causes less severe illness than at its peak, shifting the focus to protecting high-risk individuals.
Metadata > [ORIGIN]
04_Case_Study_Mikel_Roby_19052901_Notes
I
13_Media_Case_Mikel_Profiling_19081202_Working
V2020
Social Behavior Benefit Inventory
15 Items (Functionality)
HSF = High Scores are Favorable
Buster scores Buster
First Generated: 20190814-W: 20200406-M: Baseline before Corona Threat
Catastrophic Baseline at time of
catastrophic losses
A "catastrophic baseline" at the time of catastrophic losses refers to the new, elevated level of expected losses that insurance companies and risk managers must now use for forecasting, as historical averages are no longer adequate to predict the frequency and severity of modern disaster events.
A Medical Necessity
Medical necessity refers to healthcare services or supplies needed to prevent, diagnose, or treat an illness, injury, or its symptoms, adhering to generally accepted standards of medical practice. It must be clinically appropriate in type, frequency, and duration, and not primarily for the convenience of the patient or provider.
Meaningful Engagements
Meaningful engagement is the respectful, equitable, and active inclusion of individuals—particularly those with lived experience—in decision-making processes, shifting power from institutions to people to improve outcomes. It transforms participation from passive consultation into collaborative, purpose-driven action that values diverse expertise, fosters trust, and builds relationships.
Aside - Impact of Corona Scare
The "corona scare" (COVID-19 pandemic) caused a 25% increase in global prevalence of anxiety and depression, driven by isolation, fear of infection, and financial stress. It profoundly impacted mental health, particularly among women, youth, and healthcare workers, while triggering massive economic disruptions and a shift to virtual communication.
Life-Long-learner
Graduate Programs ...A lifelong learner is an individual who voluntarily and continuously
pursues knowledge for personal or professional growth, driven by curiosity
rather than necessity. This mindset embraces learning as a lifelong journey,
utilizing both formal education and informal experiences to adapt to change.
Aside - 20190812-M: Update in the
face of Mikel
GAF Interpretation
71-80
If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational or school functioning (e.g., temporarily failing behind in schoolwork).
61-70
Some mild symptoms (e.g. depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
Catastrophic
Loss as Indicated by Global Assessment of Functioning (GAF)
A Global Assessment of Functioning (GAF) score of 40 or below indicates severe, catastrophic impairment in functioning, social, or occupational areas. Scores in the 1–30 range suggest severe danger of harm to self/others, inability to communicate, or gross impairment in daily living, often requiring hospitalization.
Catastrophic Loss as Indicated by
Incarceration
Incarceration represents a catastrophic loss, causing profound, long-lasting damage to individuals, families, and communities, often creating "collateral consequences" that extend far beyond the initial sentence. It results in severe mental health deterioration, such as PTSD and depression, economic ruin, broken family bonds, and lost opportunities for housing and employment.
DSM-5
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the U.S. and worldwide, published by the American Psychiatric Association (APA). It provides a common language for diagnosis, outlining criteria for each disorder to improve consistency in clinical practice, research, and insurance. The most current version is the DSM-5-TR (Text Revision), published in 2022, which includes updates and clarifications to the original DSM-5.
SOFAS
The Social and Occupational Functioning Assessment Scale (SOFAS) is a 1-100 clinician-rated scale measuring an individual's level of social, occupational, and school functioning, specifically excluding the severity of psychological symptoms. It was derived from the GAF scale, with higher scores (91–100) indicating superior functioning and lower scores (1–10) indicating severe impairment.
WHODAS
WHODAS-The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is a 12- or 36-item tool used to measure health and disability across six functional domains (cognition, mobility, self-care, getting along, life activities, and participation). It assesses difficulty over the past 30 days, producing a score from 0 to 100.
Retirement of the GAF
The Global Assessment of Functioning (GAF) scale was officially removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), released in 2013. It was replaced due to concerns regarding its conceptual clarity, questionable reliability, and lack of clear guidelines for use in clinical practice.
Workability Assessment Index
The Work Ability Index (WAI) is a validated questionnaire-based tool used to assess an employee's
perceived ability to perform their job, considering health, mental resources,
and job demands. Developed by the
Finnish Institute of Occupational Health, it rates work capacity on a
7–49 point scale, categorizing results from "poor" to
"excellent" to guide occupational health interventions.
What is the hallmark of a mental
health episode?
The primary hallmark of a mental health episode, particularly a psychotic episode, is a loss of contact with reality. During this time, a person's thoughts and perceptions are severely disturbed, making it difficult for them to distinguish what is real from what is not.
Does hospitalization delineate a
mental health episode?
Yes, hospitalization is generally considered a definitive marker of an acute, severe mental health episode. It serves as a clinical threshold indicating that an individual's symptoms have become too severe for outpatient management, posing a safety risk to themselves or others, or resulting in an inability to function.
Reality Testing Intact
Intact reality testing is the psychological ability to accurately distinguish between internal mental experiences (thoughts, feelings, perceptions) and external reality. It involves recognizing hallucinations or delusions as false and maintaining an accurate, logical orientation to the world.
Matrix - Severity of Symptoms –
Tracker
“How are your symptoms”?
Table – Severity of Symptoms for Keith E Torkelson
GAF - NSR = Not Spontaneously Reported
About Moving > “It is up to you”
Wellbutrin PRN trial denied
“How Satisfied Are You” Assessment Results
201606 – Titration off Ativan
“How is your situation”?
20160811-TH:
How is it treatment days?
Treatment days, particularly for cancer or chronic illness, are structured in cycles consisting of active treatment (drugs or therapy) followed by a rest period, designed to manage disease while allowing the body to recover. They can last from a few hours to a full day, often involving procedures like chemo infusions, with side effects, such as fatigue and nausea, that can develop in the days following.
Written by Matt Smith - Medically Reviewed by Smitha Bhandari, MD on January 16, 2025
https://www.webmd.com/mental-health/gaf-scale-facts
https://iaap.org/wp-content/uploads/2020/01/GAF-Scale.pdf
GAF = Global Assessment of
Functioning - Interpret Range 51–60
Moderate symptoms (e.g., flat affect and circumlocutory speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).
Range 71-80
If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g.,
difficulty concentrating after family argument); no more than slight impairment
in social, occupational or school functioning (e.g., temporarily failing behind
in schoolwork).
Aside - SOFAS - Social and
Occupational Functioning Assessment Scale
71-80
Slight impairment in social, occupational, or school
functioning (e.g. infrequent interpersonal conflict, temporarily falling behind
in schoolwork).
51-60
Moderate difficulty in social, occupational, or school
functioning (e.g., few friends, conflicts with peers or co-workers).
41-50
Serious impairment in social, occupational, or school
functioning (e.g., no friends, unable to keep a job)
Work Done > Metadata >
https://housingadvisoryboard.blogspot.com/2019/08/mikel-roby-casestudy-by-msg-and.html
https://www.albany.edu/counseling_center/docs/GAF.pdf
Global Assessment of Functioning
(GAF) Scale. (From DSM-IV-TR, p. 34.)
Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical (or environmental) limitations.
Behavior Inventory – GAF Driven -
Functionality
Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).
20190812-M: Offering GAF = 30 at best
We had high expectations for Mikel.
Associated Documents >
Metadata >
GAF_14010603_Tracker_DAG V2019-Results
20190812-M:
Functionality Comparison
Having a Low Functioning Roommate
To handle a roommate with low functioning abilities, communicate openly, be patient, and set clear expectations while focusing on their well-being. You can try to be more patient with their processing time and communication style, offer support without being patronizing, and address any specific issues directly and calmly using "I" statements. If the situation is unsustainable, you may need to have a broader conversation about the experience or speak to a university or accommodation authority.
ParaSocial_Surveying_Ref2008082102 v2016
The actual process of rating the global assessment of functioning scale . K . Yamauchi
Comprehensive Psychiatry - Volume 42, Issue 5, September 2001, Pages 403–409
http://linkinghub.elsevier.com/retrieve/pii/S0010440X01415586
Copyright © 2003 Elsevier Inc. All rights reserved.
Abstract
GAF & Others
The Global Assessment of Functioning Scale (GAF) was developed for the overall assessment of psychological, social, and occupational functioning. While the advantage of the GAF lies in this comprehensiveness, questions have been raised on whether clinicians rate appropriately. To clarify this issue, the actual process of how clinicians assign GAF scores was investigated. A total of 2,462 inpatients of 19 psychiatric hospitals in Japan were assessed by their primary psychiatrists using the following rating scales: GAF, Brief Psychiatric Rating Scale (BPRS), World Health Organization Psychiatric Disability Assessment Schedule (DAS), and physical Activities of Daily Living (ADL) index.
Aside - Functioning and Severity
of Symptoms
A tree-based model analysis (also referred to as Automatic Interaction Detector [AID] or Classification and Regression Tree [CART]) was used to construct a statistical model with the GAF score as the dependent variable. The statistically best-fitted tree to predict the GAF score is as follows. The first split is based on the “conceptual disorganization” score in the BPRS, followed by splits based on DAS item scores, such as “conversation” and “underactivity.” The tree model obtained suggests that Japanese clinicians judge the level of global functioning by integrating the information on both the severity of psychiatric symptoms and the level of impaired behaviour and social functioning. This logic structure was clinically acceptable and agreed well with the concept of the GAF.
HHS_Measures_GAF_Ref_20090822b V2020
https://www.ncbi.nlm.nih.gov/pubmed/8837160
by P Roy-Byrne - 1996 - Cited by 126
Psychiatr Serv. 1996 Aug;47(8):864-6.
P Roy-Byrne, C Dagadakis, J Unutzer and R Ries
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
The study examined the concurrent validity of the revised Global Assessment of Functioning (GAF) scale, which is highly similar to the Social and Occupational Functioning Assessment Scale (SOFAS) in DSM-IV and which is designed to measure patients' functioning and not their clinical symptoms. Psychiatrists used the revised GAF to rate 337 psychiatric inpatients; the ratings were compared with nurses' ratings of the same sample using Lehman's Quality of Life Scale. Ratings on the revised GAF were most strongly correlated with ratings of clinical symptoms, not functioning. Reliance on the GAF as the only tool to assess patients' functioning may be problematic.
Summary
>As of May 2026, we are
retiring our efforts around Functioning.
We will continue our work on Competency in the face of end-of-life
planning. In the end, we accept the GAF
score that Rimal B. Bera, MD assigned us.
Buster is 67 now and does not
foresee any significant improvement in his GAF and SOFAS. Buster is relatively well off compared to
his 2024-2026 Harvest Retirement cohort.
Buster still drives the car and is satisfied with his current living
arrangement.
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