<?xml version="1.0" ?>
<tei>
	<teiHeader>
		<fileDesc xml:id="0"/>
	</teiHeader>
	<text xml:lang="en">

		<p>For purposes of both treatment planning and program evaluation, it<lb/> is important to
			be able to take into account the patient&apos;s level of<lb/> functioning in daily life.
			Most mental health services have established<lb/> procedures for obtaining diagnosis,
			mental status, and relevant history<lb/> information. However, the patient&apos;s
			adjustment to his or her role in the<lb/> community is typically less systematically
			examined. The purpose of<lb/> this paper is to describe one such measure, to report
			reliability and<lb/> validity data, and to compare its properties with those of a more
			general<lb/> measure of severity of disturbance.<lb/></p>

		<p>A global rating scale is well suited for measuring level of functioning<lb/>
			<ref type="biblio">(Newman, 1980)</ref>. A global scale integrates ratings of different
			patient<lb/> characteristics resulting in a single multidimensional measure. Global<lb/>
			ratings are easy to make and can be useful for service planning and<lb/> evaluation
			research <ref type="biblio">(Krowinski &amp; Fitt, 1980; Mintz, Luborsky &amp;
				Chris-<lb/>toph, 1979; Newman, 1980)</ref>. The advantages of a global rating of
			overall<lb/> impairment associated with psychiatric disturbance are highlighted by<lb/>
			Luborsky&apos;s introduction of the Health Sickness Rating Scale (HSRS)<lb/>
			<ref type="biblio">(Luborsky, 1962; Luborsky &amp; Bachrach, 1974)</ref>, later revised
			as the<lb/> Global Assessment Scale (GAS) <ref type="biblio">(Endicott, Spitzer, Fleiss,
				&amp; Cohen,<lb/> 1976)</ref>.<lb/></p>

		<p>A compliment to the GAS would be a measure of the individual&apos;s<lb/> functioning in
			his or her natural environment. Specifically, a simple<lb/> measure is needed for adult
			psychiatric patients which would assess<lb/> their functioning in each of the several
			domains in which most adults<lb/> operate, e.g., personal self-care, cognitive/affective
			functioning, social/<lb/> familial relationships, and vocational/educational
			functioning. An indi-<lb/>vidual with a reasonable level of role functioning should be
			able to<lb/> maintain intimate relationships (including marriage, parenting, and<lb/>
			friendship), productivity, self-esteem, and integration into the
			commu-<lb/>nity.<lb/></p>

		<p>It was expected that independent evaluations of severity of psychi-<lb/>atric disorder,
			degree of experienced distress, and role functioning<lb/> would yield different types of
			information. While there may be close<lb/> relationships among these factors, the
			relationships have not been well<lb/> understood. Specifically, the independent
			evaluation of level of role<lb/> functioning would help identify how some persons can
			function rea-<lb/>sonably well in their environment even though they have an active<lb/>
			diagnosis of schizophrenia and are under a great deal of personal<lb/> distress, whereas
			others may function poorly in the absence of diagnosis<lb/> or distress.<lb/></p>

		<p>The Role Functioning Scale (RFS) was found to be particularly suited<lb/> to this type of
			assessment. It was originally devised as an instrument<lb/> for program evaluation in
			state mental health in Georgia <ref type="biblio">(McPheeters,<lb/> 1984; Newman,
				1980)</ref>. In a comparison with other adjustment measures<lb/> relative to the
			NIMH criteria for mental health treatment outcome<lb/> measures <ref type="biblio"
				>(NIMH, 1986)</ref>, the RFS emerged as the top ranked scale on<lb/> six of the
			twelve criteria and received the second highest ranking on<lb/> four of the remaining
			criteria <ref type="biblio">(Green &amp; Gracely, 1987)</ref>. <ref type="biblio">Green
				and<lb/> Gracely (1987)</ref> concluded that the RFS was the preferred scale in
			refer-<lb/>ence to the NIMH task force&apos;s priorities and was judged as
			particularly<lb/> outstanding in psychometric criteria and more relevant to
			chronically<lb/> mentally ill patients than the other scales. Although extensively
			uti-<lb/>lized, evaluation of the psychometric properties of the RFS has not been<lb/>
			conducted <ref type="biblio">(Green &amp; Gracely, 1987; Stribling, 1983)</ref>. This
			paper will<lb/> describe the RFS and provide reliability and validity data on one<lb/>
			sample.<lb/></p>

		<p>It was hypothesized that, first, RFS is a reliable, stable measure of a<lb/>
			patient&apos;s level of functioning, regardless of diagnosis. Second, it was<lb/>
			hypothesized that RFS scores will discriminate between psychiatrically<lb/> disturbed
			and well subjects. Third, it was hypothesized that RFS scores<lb/> will be related to
			scores on measures of level of disturbance, self-esteem,<lb/> and specific role
			performance.<lb/></p>

		<head>METHOD<lb/></head>

		<head>Subjects<lb/></head>

		<p>The women in the study were primarily African-American (93%), urban, low-income<lb/> (70%
			in Hollingshead&apos;s lowest Category V), primarily single parents (75%), all of
			whom<lb/> had at least one child under five years old. Included in the sample were 1) 79
			women<lb/> who were receiving outpatient treatment and/or had been hospitalized within
			the<lb/> previous six months for either schizophrenia or severe depression, and 2) 33
			women who<lb/> had no history of psychiatric disturbance who were comparable on
			demographic factors.<lb/> The disturbed women would probably be comparable to other
			samples of inner city,<lb/> community mental health center patients.<lb/></p>

		<p>Eligibility for the disturbed group was determined by a psychiatrist-assigned
			current<lb/> diagnosis of schizophrenia or mood disorder based on an unstructured
			diagnostic inter-<lb/>view guided by DSM-III criteria. Two experienced psychologists
			independently and<lb/> blindly reviewed 30 randomly selected case records and confirmed
			the diagnosis in 83%<lb/> of the cases. In all of the remaining cases, at least one of
			the psychologists confirmed the<lb/> original diagnosis. Women were eliminated from the
			sample if there was any evidence<lb/> of current or past alcohol or drug abuse. The well
			women were recruited from well-baby<lb/> clinics in the same neighborhoods as the mental
			health centers. Screening determined<lb/> that they had no history of having experienced
			or sought treatment for psychiatric<lb/> disturbance, drug or alcohol abuse. Smaller
			subgroups of the sample were used for each<lb/> analysis, depending on the availability
			of data on the measures needed for each<lb/> statistical test.<lb/></p>

		<head>Measures<lb/></head>

		<p>The Role Functioning Scale. The RFS is comprised of four single rating scales for<lb/>
			evaluating the functioning of individuals in specified areas of everyday life (see <ref
				type="table">Table<lb/> 1</ref>). The four role functions assessed are: (1) Working:
			productivity (RFS1), (2) Indepen-<lb/>dent living and self care (RFS2), (3) Immediate
			social network relationships (RFS3), and<lb/> (4) Extended social network relationships
			(RFS4).<lb/></p>

		<p>The values on each of the four scales range from one, which represents a very
			minimal<lb/> level of role functioning, to seven, the hypothetically optimal level of
			role functioning.<lb/> Each of the seven points on the scales is accompanied by a
			behaviorally defined<lb/> description.<lb/></p>

		<p>Trained interviewers can complete the scale in a few minutes following a standard<lb/>
			intake interview. The evaluation focuses on the patient&apos;s functioning during a
			specified<lb/> time period, in this case the week prior to the evaluation. The four role
			scores totalled<lb/> represent a Global Role Functioning Index with scores ranging from
			4 to 28.<lb/></p>

		<p>Global Personal Distress Scale. 1 The Global Personal Distress Scale is an estimate
			of<lb/> a patient&apos;s subjective feelings of &apos;~pain&quot; or personal
			dissatisfaction with himself or<lb/> herself. This quality was hypothesized to be
			independent of the level of role functioning,<lb/> yet an important factor for use in
			evaluating the effectiveness of mental health pro-<lb/>grams. For example, one can
			maintain a clean, adequately functioning home, yet suffer<lb/> from considerable
			depression. Ratings range from 1 (constant and pervasive awareness<lb/> of painful
			symptoms) to 7 (no apparent or reported personal distress).<lb/></p>

		<p>Global Assessment Scale (GAS; <ref type="biblio">Endicott et al., 1976</ref>). The GAS is
			a single rating<lb/> scale used to measure the impairment associated with emotional
			disturbance. Scores<lb/> range from 0 to 10 (needs constant supervision for severe
			dysfunction) to 90 to 100 (no<lb/> symptoms, superior functioning), with behavioral
			descriptions for each 10-point inter-<lb/>val. The GAS is widely used and has been
			reported to have good reliability and validity,<lb/> including correlations with
			measures of overall severity of illness and relationship to<lb/> rehospitalization <ref
				type="biblio">(Endicott et al., 1976)</ref>. Interrater reliability on a randomly
			selected<lb/> 20% of the present sample was .87 for the 10-point interval.<lb/></p>

		<p>Home Observation for Measurement of the Environment (HOME Inventory, <ref type="biblio"
				>Bradley &amp;<lb/> Caldwell, 1978</ref>). The quality of child rearing environment
			provided by the mother was<lb/> measured with the HOME Inventory. Two versions of the
			instrument were used, one for<lb/> birth to three year olds (45 items) and one for older
			children (55 items). The total scale<lb/> scores were used here, with higher scores
			indicating better quality childrearing. Pre-<lb/>vious reports indicated interrater
			reliability at .90, internal consistency for the total<lb/> scale at .88, and
			correlations with various cognitive measures as high as .72 <ref type="biblio">(Bradley
				&amp;<lb/> Caldwell, 1978; Elardo, Bradley, &amp; Caldwell, 1977)</ref>. In the
			present study, interrater<lb/> reliability, checked on a randomly selected 25% of the
			sample, was .87 for the total<lb/> scale.<lb/></p>

		<p>Self-Esteem (Rosenberg Self-Esteem Scale; <ref type="biblio">Rosenberg &amp; Pearlin,
				1978</ref>). The Self-<lb/>Esteem Scale consists of ten items to which respondents
			indicate the extent to which<lb/> they agree or disagree. Answers are grouped into six
			subscales, with final scores<lb/> ranging from zero to six. High scores indicate low
			self-esteem. Adequate test-retest<lb/> reliability (r = .85 for two weeks) and
			convergent, discriminant, and predictive validity<lb/> have been established<ref
				type="biblio"> (Robinson &amp; Shaver, 1973; Silbert &amp; Tippet,
			1965)</ref>.<lb/></p>

		<p>Behavioral Indices. In order to test the validity of the individual subscales of the<lb/>
			RFS, some independent measures of behavior were obtained. A ~%ignificant
			other,&quot;<lb/> usually a spouse or mate, mother, or sibling, was identified by each
			subject. A social<lb/> worker, blind to other information on the subject, interviewed
			the significant other and<lb/> obtained information on the subject&apos;s work history,
			educational status, marital rela-<lb/>tionship history, quality of care as a homemaker,
			household status (i.e., who the subject<lb/> lived with and frequency of changes), and
			police contacts. Information on social services<lb/> received by the woman was obtained,
			with consent, from county social service agencies.<lb/></p>

		<head>Procedure<lb/></head>

		<p>Four bachelors or masters level social workers, blind to the diagnostic status of
			the<lb/> women, evaluated the women on each of the interview and observation based
			measures<lb/> (RFS, GAS, and HOME), administered the Self-Esteem Scale, and obtained
			consent to<lb/> obtain information from independent sources. The questionnaires were
			orally adminis-<lb/>tered to avoid any problem with poor reading ability. All measures
			were completed in<lb/> the subjects&apos; homes in two to three sessions. A randomly
			selected subset of the women<lb/> (N = 32) were interviewed again one year later and the
			RFS was completed again. The<lb/> interviewer was blind to both the previous data on the
			family and the diagnostic status<lb/> of the woman.<lb/></p>

		<head>RES UL TS<lb/></head>

		<head>Reliability<lb/></head>

		<p>Interitem Reliability. The interitem reliability of the four Role Func-<lb/>tioning
			Scales was computed on all 112 subjects to test whether these<lb/> scores covaried
			together within subjects and between scales in produc-<lb/>ing the Global Role
			Functioning Index score. The results show that this<lb/> is, in fact, what happens
			[between measures F (3,333) = 13.01, p &lt; .001;<lb/> Cronbach&apos;s alpha --0.918].
			That is, differences in scores between sub-<lb/>scales and within subjects are similar
			in pattern across all scales for all<lb/> subjects. Similar patterns of changes in
			subscale scores are seen across<lb/> subjects for each Global Role Functioning Index
			score. These results<lb/> indicate that each scale score is composed of the same general
			factors<lb/> across subjects based on the final score computed.<lb/></p>

		<p>Test-Retest Reliability. Test-retest reliability was determined by<lb/> comparing scores
			on the RFS administered twice to a randomly selected<lb/> subsample of 32 women with a
			one-year interval between the repeated<lb/></p>

		<figure type="table">TABLE 1<lb/> Role Functioning Scale<lb/> Score:<lb/> Working<lb/>
			Productivity<lb/> Rate the client primarily in<lb/> the most appropriate expected<lb/>
			role (i.e. homemaker, student,<lb/> wage earner).<lb/> Productivity severely
			limited;<lb/> often unable to work or adapt<lb/> to school or homemaking;<lb/> virtually
			no skills or attempts<lb/> to be productive.<lb/> Occasional attempts at<lb/>
			productivity unsuccessfully;<lb/> productive only with constant<lb/> supervision in
			sheltered work,<lb/> home or special classes.<lb/> Limited productivity; often<lb/> with
			restricted skills/abilities<lb/> for homemaking, school,<lb/> independent employment (e.
			g.<lb/> requires highly structured<lb/> routine).<lb/> Independent Living,<lb/> Self
			Care<lb/> (Management of household,<lb/> eating, sleeping, hygiene<lb/> care)<lb/>
			Lacking self-care skills<lb/> approaching life endangering<lb/> threat; often
			involves<lb/> multiple and lengthy hospital<lb/> services; not physically able<lb/> to
			participate in running a<lb/> household.<lb/> Marked limitations in
			self-<lb/>care/independent living; often<lb/> involving constant<lb/> supervision in or
			out of<lb/> protective environment<lb/> (e.g.<lb/> frequent utilization of crisis<lb/>
			services).<lb/> Limited self-care/independent<lb/> living skills; often relying on<lb/>
			mental/physical health care;<lb/> limited participation in<lb/> running household.<lb/>
			Immediate Social Network<lb/> Relationships<lb/> (Close friends, Spouse,<lb/>
			Family)<lb/> Severely deviant behaviors<lb/> within immediate social<lb/> networkds
			(i.e. often with<lb/> imminent physical aggression<lb/> or abuse to others or
			severely<lb/> withdrawn from clsoe friends,<lb/> spouse, family; often rejected<lb/> by
			immediate social network).<lb/> Marked limitations in<lb/> immediate interpersonal<lb/>
			relationships<lb/> (e.g. excessive<lb/> dependency or destructive<lb/> communication or
			behaviors).<lb/> Limited interpersonally; often<lb/> no significant participation/<lb/>
			communication with<lb/> immediate social network.<lb/> Extended Social Network<lb/>
			Relationships<lb/> (Neighborhood, community<lb/> church, clubs, agencies,<lb/>
			recreational activities).<lb/> Severely deviant behaviors<lb/> within extended
			social<lb/> networks<lb/> (i.e. overtly<lb/> disruptive, often leading to<lb/> rejection
			by extended social<lb/> networks).<lb/> Often totally isolated from<lb/> extended social
			networks,<lb/> refusing community<lb/> involvement or belligerent to<lb/> helpers,
			neighbors, etc.<lb/> Limited range of successful<lb/> and appropriate interactions<lb/>
			in extended social networks<lb/> (i.e. often restricts community<lb/> involvement to
			minimal<lb/> survival level interactions).<lb/> Marginal productivity (e.g.<lb/>
			productive in shelte~&apos;ed work<lb/> or minimally productive in<lb/> independent
			work; fluctuates<lb/> at home, in school; frequent<lb/> job changes.)<lb/> Moderately
			functional in<lb/> independent employment, at<lb/> home or in school. (Consider<lb/>
			very spotty work history or<lb/> fluctuations in home, in<lb/> school with extended
			periods<lb/> of success).<lb/> Adequate functioning in<lb/> independent employment,<lb/>
			home or school; often not<lb/> applying all available skills/<lb/> abilities.<lb/>
			Optimally performs<lb/> homemaking, school tasks or<lb/> employment-related
			functions<lb/> with ease and efficiency.<lb/> Marginally self sufficient;<lb/> often
			uses REGULAR<lb/> assistance to maintain self-<lb/>care/independent functioning;<lb/>
			minimally participates in<lb/> running household.<lb/> Moderately self-sufficient;
			i.e.<lb/> living independently with<lb/> ROUTINE assistance<lb/> (e.g.<lb/> home visits
			by nurses, other<lb/> helping persons, in private or<lb/> se~f-help residences).<lb/>
			Adequate independent living<lb/> &amp; self-care with MINIMAL<lb/> support<lb/> (e.g.
			some<lb/> transportation, shopping<lb/> assistance with neighbors,<lb/> friends, other
			helping<lb/> persons).<lb/> Optimal care of health/<lb/> hygiene; independently<lb/>
			manages to meet personal<lb/> needs and household tasks.<lb/> Marginal functioning
			with<lb/> immediate social network (i. e.<lb/> relationships are often<lb/> minimal and
			fluctuate in<lb/> quality).<lb/> Moderately affective<lb/> continuing and close<lb/>
			relationship with at least one<lb/> other person.<lb/> Adequate personal<lb/>
			relationship with one or more<lb/> immediate member of social<lb/> network (e. g. friend
			or<lb/> family).<lb/> Positive relationships with<lb/> spouse o1&quot; family and
			friends;<lb/> assertively contributes to<lb/> these relationships.<lb/> Marginally
			effective<lb/> interactions; often in a<lb/> structured environment; may<lb/> receive
			multiple public<lb/> system support in accord with<lb/> multiple needs.<lb/> Moderately
			affective and<lb/> independent in community<lb/> interactions; may receive<lb/> some
			public support in accord<lb/> with need.<lb/> Adequately interacts in<lb/> neighborhood
			or with at least<lb/> one community or other<lb/> organization or recreational<lb/>
			activity.<lb/> Positively interacts in<lb/> community; church or clubs,<lb/>
			recreational activities,<lb/> hobbies or personal interests,<lb/> often with other
			participants.<lb/></figure>

		<p>administration. Intraclass correlation coefficients <ref type="biblio">(Winer,
				1971)</ref> were<lb/> computed for each subscale score. Correlations for the four
			scale scores<lb/> and the Global RFS index ranged from .85 to .92. The correlation
			for<lb/> GAS was .94. In contrast, the test-retest correlation for the Global<lb/>
			Personal Distress Scale was .68.<lb/></p>

		<p>Interrater Reliability. RFS and Global Personal Distress scores from<lb/> a second rater
			were available for 52 subjects. The second rater scored<lb/> the RFS from reading case
			notes and from having observed the mother<lb/> while interviews were being conducted.
			The correlations ranged from<lb/> .64 to .82 for the four RFS Scale scores and the
			Global RFS Index and<lb/> was .21 for Global Personal Distress.<lb/></p>

		<head>Validity<lb/></head>

		<p>Criterion-Group Validity. Psychiatric patients were predicted to<lb/> score lower than
			well controls. Scores from the Global RFS Index for<lb/> well women versus depressed or
			schizophrenic women (N = 112) were<lb/> submitted to a one-way analysis of variance. The
			results show that the<lb/> well women scored significantly higher than those with
			disorders [F<lb/> (1,110) = 58.44, p &lt; .001].<lb/></p>

		<p>In addition, a discriminant function analysis using the four RFS Scale<lb/> scores as
			predictors and diagnostic status (well or disturbed) as out-<lb/>comes (assuming equal
			numbers in the two groups) showed an average<lb/> prediction accuracy of 78.8% (72.8%
			for disturbed; 93.1% for well) (see<lb/>
			<ref type="table">Table 2</ref>). A discriminant analysis of the Global RFS Index alone
			on the<lb/> same outcomes yielded an average hit rate of 77.9% (73.2% for
			dis-<lb/>turbed, 89.7% for well) (see <ref type="table">Table 3</ref>). Comparing the
			two sets of results<lb/> suggests that the simple sum of the RFS, the Global RFS Index,
			is about<lb/> the same as the best weighted sum in predicting diagnostic status. A<lb/>
			further comparison is provided by a separate discriminant analysis of<lb/> GAS alone on
			the same outcomes. GAS yielded an average hit rate of<lb/> 70.3% (63.3% for disturbed
			and 87.5% for well) (See <ref type="table">Table 3</ref>). Cross-<lb/>validation
			analysis using randomly selected subsets of subjects pro-<lb/>duced the same results,
			thereby reducing the likelihood of these results<lb/> being due to chance. The accuracy
			of these scales as predictors supports<lb/> the validity of Role Functioning scores in
			distinguishing among the<lb/> criteria for well or disturbed groups.<lb/></p>

		<p>Further criterion group validity was demonstrated by examining the<lb/> breakdown of
			scores on each of the four Role Functioning Scale Scores<lb/> for each diagnostic
			category. For this purpose, RFS scores were clus-<lb/></p>

		<figure type="table">TABLE 2<lb/> Discriminant Analysis of Well vs. Disturbed Mothers<lb/>
			Using RFS1-RFS4 as Predictors<lb/> Discriminant Function<lb/> Variable<lb/>
			Coefficient<lb/> RFS 1 Working<lb/> RFS 2 Independent Living<lb/> RFS 3 Immediate Social
			Network<lb/> RFS 4 Extended Social Network<lb/> .03<lb/> .49<lb/> .37<lb/> .33<lb/>
			Results for the Discriminant Function<lb/> Canonical<lb/> Chi-<lb/>Function<lb/>
			Eigenvalue<lb/> Correlation<lb/> Squared<lb/> p<lb/> 1<lb/> .425<lb/> .546<lb/>
			37.51<lb/> .001<lb/> Classification Results<lb/> Predicted Group<lb/> Actual Group<lb/>
			No. of Cases<lb/> Disturbed<lb/> Well<lb/> Disturbed<lb/> 79<lb/> 58 (72.8%)<lb/> 21
			(27.2%)<lb/> Well<lb/> 33<lb/> 2 (6.9%)<lb/> 31 (93.1%)<lb/></figure>

		<p>tered as less than or equal to 3 (severely to moderately limited), 4 to 5<lb/> (marginal
			to moderate functioning), and 6 to 7 (adequate to optimal<lb/> functioning). All of the
			scales discriminated well across subject groups,<lb/> with the limited functioning range
			having higher percentages of schizo-<lb/>phrenics than depressed patients and no well
			control women. Also<lb/> noted was that more schizophrenics and depressives functioned
			ade-<lb/>quately in the Independent Living domain and Immediate Social Net-<lb/>work
			than in the other two domains.<lb/></p>

		<p>Construct Validity. The RFS and, specifically, the Global Role Func-<lb/>tioning Index
			are supposed to be indicative of general level of function-<lb/>ing. Furthermore,
			general level of functioning is hypothesized to be<lb/> related to the constructs of
			level of disturbance and self-esteem. In<lb/> particular, Global RFS Index scores should
			be significantly related to<lb/> less severe disturbance on GAS scores and higher
			self-esteem. Correla-<lb/>tional analyses of the data (N = 112) support these
			hypotheses. As the<lb/></p>

		<figure type="table">TABLE 3<lb/> Discriminant Analysis of Well vs. Disturbed Mothers<lb/>
			Using RFS5 and GAS as Predictors<lb/> Results for Discriminant Function<lb/>
			Canonical<lb/> Eigenvalue<lb/> Correlation<lb/> Chi-Squared<lb/> p<lb/> Global RFS
			Index<lb/> .349<lb/> .509<lb/> 32.50<lb/> .001<lb/> GAS<lb/> .269<lb/> .461<lb/>
			25.86<lb/> .001<lb/> Classification Results for Global RFS Index<lb/> Predicted
			Group<lb/> Actual Group<lb/> No. of Cases<lb/> Disturbed<lb/> Well<lb/> Disturbed<lb/>
			79<lb/> 58 (63.3%)<lb/> 21 (36.7%)<lb/> Well<lb/> 33<lb/> 3 (12.5%)<lb/> 30 (87.5%)<lb/>
			Classification Results for GAS<lb/> Predicted Group<lb/> Actual Group<lb/> No. of
			Cases<lb/> Disturbed<lb/> Well<lb/> Disturbed<lb/> 79<lb/> 51 (63.3%)<lb/> 28
			(36.7%)<lb/> Well<lb/> 33<lb/> 2 (12.5%)<lb/> 31 (87.5%)<lb/></figure>

		<p>Global RFS Index scores increase, there are corresponding increases in<lb/> higher
			self-esteem (r = .40, p &lt; .001), and a decrease in severity of<lb/> disturbance (r =
			.84, p &lt; .001).<lb/></p>

		<p>Of special interest in the present study was the parenting ability of<lb/> the women, as
			measured with the HOME <ref type="biblio">(Bradley &amp; Caldwell, 1978)</ref>.<lb/> In
			order to test the relationship between HOME (Infant and Child<lb/> Scales) and RFS
			scores, scores on the two measures were correlated.<lb/> The RFS Scale, Immediate Social
			Network Relationships, was signifi-<lb/>cantly correlated with both the Infant HOME
			Inventory Score (r = .50)<lb/> and the Child HOME Inventory (r = .69); all but one of
			the correlations<lb/> with other RFS scales were also significant, ranging from .28 to
			.59.<lb/></p>

		<p>Construct validity of the RFS was further tested by comparing scores<lb/> on the separate
			scales with independent measures of the behaviors the<lb/> scales were intended to
			measure. Information indicating actual func-<lb/>tioning in several areas of life was
			compared to three of the RFS scale<lb/> scores. (No independent sources of information
			were available for Ex-<lb/>tended Social Network Relationship). For Working:
			Productivity, scores<lb/> were compared to data on whether or not the individual either:
			(1) had<lb/> paid employment, (2) was enrolled as a student, or (3) was maintaining<lb/>
			a home with primary responsibility for homemaking. For Independent<lb/> Living, Self
			Care, scores were compared to data on whether ~i~not the<lb/> individual either: (1)
			lived in her own household (i.e., not with parents<lb/> or other extended family), or
			(2) received regular assistance from a<lb/> visiting nurse or other social service
			provider to assist with daily<lb/> routines. For Immediate Social Network Relationships,
			scores were<lb/> compared to data on whether or not the individual either: (1) had
			been<lb/> reported to Protective Services for abuse or neglect; (2) had police<lb/>
			contacts due to physical aggression with a friend or family member; or<lb/> (3) had more
			than one change in marital/mate relationship status. In<lb/> each case, women who met
			criteria for at least one of the indices,<lb/> relative to those who met none of the
			criteria, scored significantly<lb/> higher on the relevant RFS scale.<lb/></p>

		<head>DIS CUSSION<lb/></head>

		<p>The findings reported here provide preliminary psychometric data in<lb/> support of the
			usefulness of the Role Functioning Scale in assessing the<lb/> levels of an
			individual&apos;s functioning in his or her natural environment.<lb/> The measure was
			found to have very high internal consistency and the<lb/> subscales and total score have
			adequate test-retest reliability. In fact,<lb/> scores were remarkably stable over a one
			year time period, the stability<lb/> comparable to that of the more established GAS. In
			addition, scores<lb/> derived from this measure were found to be significantly related
			to a<lb/> number of relevant dependent variables. Schizophrenic and depressed<lb/> women
			scored lower than well women. Lower scores also corresponded<lb/> with more severe
			global impairment (GAS) and lower self-esteem. The<lb/> scales showed the expected
			relationships to independent measures of<lb/> the target behaviors.<lb/></p>

		<p>As expected, scores on the Role Functioning Scale were highly inter-<lb/>related with
			diagnostic status and global impairment. Nonetheless, the<lb/> Scale performs slightly
			better than the GAS and provides unique infor-<lb/>mation. The subscale scores provide
			information on the relative level of<lb/> functioning in each of four distinct areas of
			life. This more precise<lb/> assessment suggests which particular aspects of an
			individual&apos;s overall<lb/> situation may need the most immediate attention in
			treatment. The<lb/> RFS thus lends itself to treatment planning by the clinician and
			offers<lb/> specific information not available with the GAS. For example, many of<lb/>
			the emotionally disturbed women functioned well in the independent<lb/> living domain
			(29% of the schizophrenics and 68% of the depressives).<lb/> This finding reflects the
			fact that most disturbed women manage to<lb/> maintain a household, even in an era of
			brief hospitalizations and<lb/> scarce community resources.<lb/></p>

		<p>The present study supports the predicted distinction between per-<lb/>sonal distress and
			other aspects of role functioning. Personal distress<lb/> was found to be less stable
			over time and less reliably measured.<lb/></p>

		<p>Finally, although the present group of disturbed women is probably<lb/> typical of female
			psychiatric patients at urban, community mental<lb/> health centers, future studies with
			the Role Functioning Scale need to<lb/> test its psychometric properties on a broader
			variety of samples, includ-<lb/>ing men and middle SES patients. Also needed is more
			information on<lb/> the validity of each of the subscales. The usefulness of the measure
			will<lb/> be demonstrated by the extent to which it helps clinicians in treatment<lb/>
			planning, predicts relevant aspects of functioning in community living<lb/> activities
			and is a sensitive measure of change.</p>


	</text>
</tei>