UCSD Performance-Based Skills Assessment: Development of a new measure of everyday functioning for severely mentally ill adults

Instruments to assess everyday functioning have utilized self-report, proxy report, clinician ratings, or direct observation of performance. Each of t hese methods has strengths and weaknesses. In this article we argue for the inclusion of performance-based measures of functional capacity in studies of severely mentally ill persons and describe a new measure, the UCSD Perfo rmance-Based Skills Assessment (UPSA). We administered the UPSA to 50 middl e-aged and older outpatients with schizophrenia or schizoaffective disorder , and 20 normal comparison subjects. Participants' performance in five doma ins of functioning (Household Chores; Communication; Finance; Transportatio n; and Planning Recreational Activities) was assessed in standardized role- play situations. Administration of the UPSA required an average of 30 minut es to complete, Interrater reliability of ratings was excellent. Patients' performance was significantly more impaired than that of normal subjects. A mong patients, the UPSA performance correlated significantly with severity of negative symptoms and of cognitive impairment but not with that of posit ive or depressive symptoms. The UPSA scores correlated highly with those on another performance-based measure. We believe that UPSA would be useful fo r assessing everyday functioning in severely mentally ill adults.