Does a web-based feedback training program result in improved reliability in clinicians' ratings of the Global Assessment of Functioning (GAF) Scale?

The Global Assessment of Functioning (GAF) Scale is used in routine clinical practice and research to estimate symptom and functional severity and longitudinal change. Concerns about poor interrater reliability have been raised, and the present study evaluated the effect of a Web-based GAF training program designed to improve interrater reliability in routine clinical practice. Clinicians rated up to 20 vignettes online, and received deviation scores as immediate feedback (i.e., own scores compared with expert raters) after each rating. Growth curves of absolute SD scores across the vignettes were modeled. A linear mixed effects model, using the clinician's deviation scores from expert raters as the dependent variable, indicated an improvement in reliability during training. Moderation by content of scale (symptoms; functioning), scale range (average; extreme), previous experience with GAF rating, profession, and postgraduate training were assessed. Training reduced deviation scores for inexperienced GAF raters, for individuals in clinical professions other than nursing and medicine, and for individuals with no postgraduate specialization. In addition, training was most beneficial for cases with average severity of symptoms compared with cases with extreme severity. The results support the use of Web-based training with feedback routines as a means to improve the reliability of GAF ratings performed by clinicians in mental health practice. These results especially pertain to clinicians in mental health practice who do not have a masters or doctoral degree.

Factor analysis of the Achievement of Therapeutic Objectives Scale (ATOS) in short-term dynamic psychotherapy and cognitive therapy.

This study examined the factor structure of the Achievement of Therapeutic Objectives Scale (ATOS; McCullough, Larsen, et al., 2003) in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT). The ATOS is a process scale that has shown promise as a measure of patients' achievements of treatment objectives in STDP and CT and is conceptualized as comprising 7 subscales hypothesized to cluster according to 3 main treatment objectives (defense restructuring, affect restructuring, and restructuring of sense of self and others). However, the factor structure of the ATOS has not been examined empirically previously. Data were derived from ratings of videotaped therapy sessions from a randomized controlled trial, comparing STDP and CT for patients with Cluster C personality disorders. The model fit of a 2- and 3-factor solution was examined in the combined patient sample, as well as in each treatment separately, utilizing structural equation modeling. Both a 2- and 3-factor model provided acceptable fit to the data. The results add to the psychometric soundness of the ATOS as an innovative observer-based instrument for examining process in STDP and CT.