School of Health & Technology-MIT_WPU

Rehabilitation Psychology

Shamim Mohammad, M.Phil., PhD.

 MI-Multifaceted Problem
• Mental illness (MI) is “characterized by sustained,
abnormal alterations in thinking, mood, or behavior
associated with distress and impaired functioning”
(Reeves et. al, 2011)
• Mental disorders are more disabling than any other group of
illnesses, including cancer and heart disease (MI is the 3rd or
4th most costly condition)
• Many mental and physical health disorders co-exist
(called co-morbidity)
 Multidimensional Impact
• Mental disorders are disabling and can affect all aspects
of life:
• Physical health
• Parenting
• Work
• Finances
• Care giving
• Relationships with family and friends
• Common daily activities
Introduction
How to assess severity of psychotic symptoms, depression, anxiety, substance
misuse, and cognitive impairment in people with psychiatric disability?
Why?
Severity of the condition determines location of treatment (inpatient versus
outpatient), the nature and approach to treatment (psychotherapy, medication
or both), the level of clinical expertise required to provide the treatment, and
the need for other support services such as accommodation, employment or
training
Ongoing assessment and monitoring
Useful for key decisions for degree of support required, early intervention to
avert relapse, timing new initiatives (job), and negotiating continuance or
termination of an intervention
Without monitoring- difficult to know whether progress is being achieved,
especially when it is slow or variable.
Self-report versus practitioner-rated measures
Approaches to the assessment of symptoms have been developed in two
broad formats:
• (i) self-report measures and
• (ii) Practitioner rated
• Self-report measures take less time, little training, and less expensive.
• The information being collected is obtained directly (i.e. without rater
interpretation).
• It captures subjective experiences (QoL and satisfaction).
Client
• Must be able to read and understand what is being asked of them.
• Care must be taken to paraphrasing of questions
 Different Measures
Scale Domain Assessed Structure Cost
Measures of Depressive Symptoms
Calgary Depression Depression in people Structured interview No cost
Scale for Schizophrenia (CDSS) with schizophrenia (9 items)
Hamilton Rating Scale for Depression Severity of depression Structured interview No cost
(HAM-D) (17 items)
Depression, Anxiety, Stress Scale Depression, anxiety, stress Self-report (21- or No cost
(DASS) 42-item versions)
Non Specific Measures of Psychiatric Symptoms
Behavior and Symptom Relations to self/others Depression/ Self-report or Site license
Identification Scale (BASIS-32) anxiety, Daily living/role functioning practitioner interview must be
Impulsive/addictive behavior (32 items) purchased
Psychosis
Kessler-10 or Kessler-6 Psychological distress Self-report No cost
(10 or 6 items)
Clinical Global Illness severity Practitioner interview No cost
Impressions (CGI) Scale Improvement (3 items)
Efficacy of medication
Scale Domain Assessed Structure Cost
Measures of Cognitive Functioning
Brief Assessment Verbal memory, Working memory Motor speed, Practitioner Must be
of Cognition in Semantic fluency Letter fluency, Executive administered purchased
Schizophrenia (BACS) function, Attention and motor speed
Substance misuse: brief screening measures suitable for repeated use

Drug Check cost Recent Substance Quantity/frequency of No cost

Use (RSU) use in the last 3 months
Problem List (PL) Functional impact from (12 items) No info
most problematic substance
in the last 3 months
Alcohol Use Disorders Alcohol use and related Self-report (10 items) No cost
Identification Test (AUDIT) problems

Substance misuse: assessment of consumption

Timeline followback Consumption occasions
and amounts over recent
weeks/months
Opiate Treatment Index Substance use, injecting/
(OTI) sexual practices, social
Self-report/interview No cost
Self-report in interview No cost
(11 substance types,
 Introduction
•Deficits in functioning (i.e. disability) can continue to
accumulate.
•Limitations in functioning can represent a significant
component of illness burden.
• Conditions such as schizophrenia have a pervasive
impact across a wide range of life domains.
•Initial assessment and ongoing monitoring of deficits in
functioning using standardized measures should be a
major focus of rehabilitation workers.
 Assessment of functioning
• Functioning is a broad and complex construct
• It encompasses a number of related domains (role,
relationships, leisure, self-care, and physical and
psychological health)
• Related factors that can affect functioning such as the
impact of medication side-effects.
• There is currently no single scale available to assess all of
these constructs
• Range of measures that could be considered for monitoring
and evaluation purposes
 Functioning and Disability Measures
Measure Domain assessed Administration Cost
Assessment of Impairment Behavior, Impairment, Symptoms, Social Functioning 12 items/scales. Completed based on No cost
Health of the Nation client’s interview, client observation,
Outcomes Scales (HoNOS) and information from carers

Assessment of functioning Withdrawal, Self-care, Compliance Antisocial 16 items, Completed based on No cost
Life Skills Profile behavior client observation and information
(LSP-16) from carers and others
Multidimensional Scale Work, Education, Residential Each domain is rated on 3 domains (rated on 3 aspects) No cost
of Independent 3 aspects: role, support and performance Semi-structured interview with client
Functioning (MSIF
Multnomah Community Functioning, Adjustment to living 17 items Practitioner version Copyright
Ability Scale (MCAS) Social competence, Behavioral problems Client version (self-report) Fee for use

Independent Living Personal hygiene, Appearance and clothing, Care of 103 items practitioner Copyright
Skills Survey (ILSS) personal possessions, Food preparation, Care of version Fee for use
health and safety, Money management, 51 items self-report
Transportation, Leisure and recreation, Job seeking,
version
Job maintenance, Eating behaviors, Social
interactions
Measure Domain assessed Administration Cost

Assessment of insight Insight into illness 8 items No cost,

Birchwood Insight Completed by client no
Scale (BSI) permissi
on
needed
Assessment of side- Extrapyramidal 51 items No cost
effects side-effects Completed by client
Liverpool University Autonomic side-effects
Neuroleptic Side-Effect Psychic side-effects
Rating Scale Anticholinergic side-effects
(LUNSERS Allergic reactions
Prolactin-related
side-effects
Miscellaneous side-effects
 Assessment of Quality of Life (QoL)
Measure Domain Assessed Administration Cost

WHOQOL-BREF Physical, Psychological Self-report or semi structured, No cost

Social relationships, Environment interview with
client (26 items)
Quality of Life Housing, Housing environment Self-report by client (100 No cost
Self-Assessment Household and self-care items)
Inventory (Skantze Knowledge and education, Leisure, Physical
et al ., 1992 ) health, Contacts, Work, Inner experience,
Community service, Dependence
Wisconsin Quality Life satisfaction, Occupational activities Three versions: No cost
of Life Index Psychological wellbeing, Physical health - consumer (42 items)
(W-QLI) (Becker Social relations, Finances, Activities of daily - carers/family
et al ., 1993 ) living, Symptoms, Patient ’ s own goals (28 items)
- practitioner (68 items)
Quality of Life Intrapsychic foundations, Interpersonal Semi-structured interview No cost
Scale (QLS) relations, Instrumental role category with client
(Heinrichs et al ., Common objectives and activities (21 items)
1984 )
 Assessment of Satisfaction
Measure Domain Assessed Administration Cost
Satisfaction with Work, Leisure Interview with client No cost
Daily Occupations Domestic tasks, Self-care (9 items)
(SDO) (Eklund, 2004 )
Inpatient Evaluation of Staff–patient alliance Self-report or with No cost
Satisfaction Treatment, Hospital assistance from carer/
Questionnaire environment practitioner (22 items)
(IESQ) (Meehan et al .,
2002 )
Verona Service Overall satisfaction Self-report or with Permission
Satisfaction Scale Professionals’ skills and assistance from Required
– European Version behavior practitioner (54 items)
(Ruggeri et al .,2000 ) Information, Access,
Efficacy
 Assessment of Satisfaction
Measure Domain Assessed Administration Cost
Satisfaction with Work, Leisure Interview with client No cost
Daily Occupations Domestic tasks, Self-care (9 items)
(SDO) (Eklund, 2004 )
Inpatient Evaluation of Staff–patient alliance Self-report or with No cost
Satisfaction Treatment, Hospital assistance from carer/
Questionnaire environment practitioner (22 items)
(IESQ) (Meehan et al .,
2002 )
Verona Service Overall satisfaction Self-report or with Permission
Satisfaction Scale Professionals’ skills and assistance from Required
– European Version behaviour practitioner (54 items)
(Ruggeri et al .,2000 ) Information, Access,
Efficacy
 Health of the Nation Outcome Scales
HoNOS developed in the UK by Wingvand associates as a measure of
illness severity. It comprise 12 separate scales
• Behavioral problems (aggression, self-harm and substance use)
• Impairment (cognitive and physical)
• Symptomatic problems (hallucinations/delusions, depression and
other symptoms)
• Social problems (relationships, daily living, housing and work)
• Each scale is rated from 0 (‘no problem’) to 4 (‘severe to very severe
problem’).
• The total score (12 scales) ranges from 0 to 48 where higher scores represent
greater overall severity. The rating period is usually the previous 2 weeks.
• Validated in Canada, UK, and Australia
 Assessment of Daily Functioning
• Schizophrenia can have a major impact on one’s ability to perform basic
self-care activities.
• Understanding the challenges of the clients may have in meeting the
basic necessities of life
(cooking, cleaning, shopping, managing finances, meeting healthcare
needs, etc.)
• These make key components of rehabilitation assessment. A wide
range of measures is now available to assess these areas of functioning
• The focus is on those applicable to those with severe disability.
• Some are self-rated by the client whereas others are completed by the
rehabilitation worker.
 The Life Skills Profile (LSP)
• Developed in Australia as a multidimensional measure of functioning and disability
(PwS)
• Now applied psychotic and organic conditions
• Rated by a practitioner by observations
• Three versions the LSP-39 (original version), the LSP-20 and LSP-16.
• The original 39-item version was found to be rather lengthy -two briefer versions
• The LSP-16 was developed as a measure of outcome for the Mental Health
Classification and Service Costs
• The 16-item version used to monitor client outcomes in Australian mental health
services
• Has four subscales (withdrawal, self-care, compliance and antisocial behavior)
• Scored 0–3 where ‘0’ -low levels of dysfunction and ‘3’ means high levels
 Multidimensional Scale of Independent Functioning
The MSIF rates functional disability in psychiatric patients
Administered by a mental health professional (semi-structured interview)
The interview guide is available from the authors of the scale
Provides level of person ’ s day-to-day activities in three domains
• Work (competitive, supported, dependent care, volunteer)
• Education (college, vocational or certificate school, rehab training program)
• Residential (where the person is living, what responsibilities the person has).
• Seven-point Likert scale (1 = normal functioning to 7 = total disability).
• Score is obtained for each domain (work, education, residential) and for each
dimension (role, support and performance).
Finally, a global rating (total scale score) can be obtained for overall functioning.
Liverpool University Neuroleptic Side Effects Rating Scale
• The LUNSERS was developed in the UK by Day and colleagues (1995) to monitor
medication-induced side-effects.
• Designed to be completed by clients (rather than clinical staff), includes 51 side-
effects of which 41 are recognized side effects and 10 are false side-effects (known
as ‘red herrings’).
• The red herring side-effects (such as chilblains, hair loss, runny nose, etc.) are used
to identify individuals who may be over-rating their side-effects.
• All 51 side-effects are rated on a five-point scale ranging from ‘not at all’ to ‘very
much’
• The 41 recognized side-effects can be collapsed into seven domains.
• Extrapyramidal – parkinsonian type side-effects
• Autonomic – includes uncontrollable side-effects
• Psychic – relates to the functioning of mind and emotion
• Anticholinergic – side-effects affecting the choline system
• Allergic reactions – such as skin rashes
• Prolactin – related to hormones such as prolactin
• Miscellaneous – side-effects without a clear category
Reference
1. Manual of psychosocial rehabilitation by Robert King
2. Reeves, et al. (2011, September 2). Mental illness surveillance among
adults in the United States. Morbidity and Mortality Weekly Report.
Centers for Disease Control and Prevention. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1.htm?s_cid
=su6003a1_w.
3. Melek, Steve and Norris, Doug. (2008, July). Chronic conditions and
comorbid psychological disorders. Milliman Research Report. Retrieved
from http://publications.milliman.com/research/health-
rr/pdfs/chronic-conditions-and-comorbid-RR07-01-08.pdf.