Case Managers Role
- temporary or permanent functional changes
- physiological, psychological or social problems
- problems functioning in the community
This can be done by observation and if the need for further assessment is indicated a variety of tests are available. The case manager does not necessarily perform these assessments, but rather may be making referrals for them. A medical evaluation should be performed prior to psychological evaluation to rule out underlying medical conditions that can cause behavioral symptoms.
Once all of the information is available an experienced professional should interpret the data to make a diagnosis. They will review the:
- Independent medical evaluation
- personal interview
- review of psychiatric records
- psychological tests
Rancho Los Amigos Levels of Cognitive Functioning
I= Unresponsive to all stimuli
II= Generalized response to stimuli
III= Localized response to stimuli
V= Confused/inappropriate, nonagitated behavior
VI= Confused appropriate behavior
VII= Automatic/appropriate behavior
VIII= Purposeful/appropriate behavior
Axis I: Clinical Disorders
This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia). These may come and go.
Axis II: Developmental Disorders and Personality Disorders
These are lifelong and enduring. Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood. Personality disorders are clinical syndromes which have a more long lasting symptoms and impact the individual’s way of interacting with the world. They include Paranoid, Antisocial, and Borderline Personality Disorders.
Axis III: General Medical Conditions
Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders. These are important even when a problem seems to be mental or behavioral, because sometimes psychological problems are the byproduct of an illness.
Axis IV: Psychosocial and Environmental Problems
Events in a persons life such as; poverty, dysfunctional families, death of a loved one, unemployment, starting a new job, college, that might have some impact on the person’s ability to function and can impact the disorders listed in Axis I and II.
Axis V: Global Assessment of Functioning Scale
The clinician rates the person’s level of functioning both at the present time and the highest level within the previous year. This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.
The rating goes from low scores of 10 (Persistent danger of severely hurting self or others) to 100 (Superior functioning in a wide range of activities).