Global assessment of functioning following assertive community treatment in Edmonton, Alberta: A longitudinal study

Objective: To examine longitudinal the efforts of Assertive Community Treat ment (ACT) or Global Assessment of Functioning (GAF) scores in Edmonton, Al berta. Methods: We acquired GAF scores for all clients at initial registration in the ACT program and at subsequent 18- and 36-month time points while in ACT . We analyzed both the entire ACT cohort and separate diagnostic groups. Results: We obtained baseline and follow-up GAF scores for 411 clients, of whom the largest diagnostic group suffered from schizophrenia (n = 189), fo llowed by bipolar disorder (n = 98). Collapsed across all groups, GAF score s significantly improved at both 18 (P < 0.0001) and 36 months (P < 0.0001) . By group, at 18-month follow-up, significant improvements were seen in pa tients with delusional disorder (P < 0.05), dysthymia (P < 0.05), schizoaff ective disorder (P < 0.05), and schizophrenia (P < 0.001). This was also se en at 36-month follow-up. with the addition of significant improvements in those with bipolar disorder (P < 0.05). Those patients with major affective disorder or psychosis not otherwise specified (NOS) did not show significa nt improvements over time. Regardless of diagnosis, those clients with base line GAF scores of <less than or equal to> 40 significantly improved at bot h 18-month (P < 0.0001) and 36-month (P < 0.0001) follow-up, while those wi th baseline GAF scores above 40 did not show significant improvement. Conclusions: GAF scores improved at 18- and 36-month follow-up from enrolme nt in an ACT program. Groups with different diagnoses and levels of functio ning at time of enrolment may not benefit to the same degree.