Ethical Quandaries for Psychologists in Workers’ Compensation Settings: the GAF Gaffe

Abstract

Psychologists working within the forensic realm of workers’ compensation (WC) evaluative settings can be confronted with a host of unique, ethical quandaries worthy of discussion. The ethical challenges presented by the use of one specific assessment instrument, the Global Assessment of Function Scale (GAF), a clinician-rated, single, numeric scale used as a global assessment of an individual’s psychological, social, and occupational functioning, in WC settings are explored. Reliability and validity of the GAF are discussed in order to evaluate whether its use as a single indicator of psychiatric permanent disability for WC determinations is psychometrically, and subsequently ethically, justified. The present analysis demonstrates that psychologists working in evaluative contexts in WC settings may be putting themselves in ethically precarious situations in their legally mandated use of the GAF to evaluate permanent disability relating to alleged psychiatric injuries. The dearth of psychometric support to justify the use of the GAF to determine psychiatric impairment suggests that the current practice is ethically, psychometrically, and clinically problematic. The authors provide recommendations for more robust assessment procedures.