3-DIMENSIONS MENTAL-HEALTH PROFESSIONALS EMPHASIZE WHEN JUDGING LEVELS OF FUNCTIONING OF THE SEVERELY MENTALLY-DISABLED IN THE COMMUNITY

Ratings of the level of functioning of severely disabled clients colle cted from staff Of mental health agencies, while attractive as outcome measures, lack specificity and, at times, consistency. Three multidim ensional scaling (MDS) studies were conducted to identify the dimensio ns staff emphasize when they compare clients as to their level of func tioning. Analogues of clients were created to serve as stimuli, dissim ilarity judgment's of pairs of stimuli were collected, and an individu al differences MDS model was applied in each study to distinguish clie nt variance from the judges' perspectives. Ratings along specified dim ensions also were collected and compared to the MDS solutions. One dim ension emerged as pre-eminent, but it corresponded to many of the pre- selected dimensions, such as competence with daily living tasks, clari ty of thinking, appearance and manner, and overall functioning. The ot her two dimensions were belligerence and openness to psychological int ervention or distress with one's problems. Differences among judges we re sizable; nevertheless, considerable support for emphasizing these t hree dimensions was found upon reviewing the contents of other assessm ents of functioning. Concentrating on these three dimensions of functi oning may promote greater agreement among raters, highlight where func tional improvements occur, and expand the coverage of functional diffe rences without markedly increasing the costs of assessment.