Global Assessment Of Relational Functioning Research Articles

Developing an alternative approach to the measurement of B2B relationship health

PurposePsychotherapy is often used to treat dysfunctional inter-personal relationships, but it is rarely used to treat dysfunctional B2B relationships. Yet many of the variables found in inter-personal relationships are also found in B2B relationships and both types of relationships have similar fail rates. The authors take a multi-disciplinary approach by adapting an instrument from marriage therapy into a new measure called the Business Relationship Health Index (BRHI). In the process we re-evaluate the drivers of B2B relationships.Design/methodology/approachThe authors apply the Global Assessment of Relational Functioning (GARF) psychiatric system to B2B relationships. The GARF instrument incorporates three components: interaction/problem solving, organization/structure and emotional climate. Using US panel data of 500 B2B relationships based in the USA, the authors use partial least squares analysis and develop a structural equation model to test the validity and reliability of the BRHI with some well-known relationship measures including, satisfaction, trust, commitment and performance.FindingsThe findings support a strong link between the BRHI (emotion, interaction and organization) and relationship performance. The proposed measure shows a strong link between BRHI and relationship performance (R2 = 0.54).Originality/valueThe GARF instrument has never been applied to a B2B context. BRHI is a holistic instrument used for assessing the specific relational characteristics of B2B relationships. The BRHI can benefit relationship stakeholders when used as a diagnostic tool to prioritize B2B investment strategies. Managers can use BRHI to determine the extent to which the relationship is healthy or needs repair, re-evaluation, re-commitment, or repositioning.

Psychosocial functioning, quality of life and clinical correlates of comorbid alcohol and drug dependence syndromes in people with schizophrenia across Europe

Little is known about the correlates of comorbid drug and alcohol dependence in people with schizophrenia outside the USA. We tested hypotheses that dependence on alcohol/drugs would be associated with more severe symptoms, and poorer psychosocial functioning and quality of life. The EuroSC Cohort study (N=1204), based in France, Germany and the UK, used semi-structured clinical interviews for diagnoses, and standardized tools to assess correlates. We used mixed models to compare outcomes between past-year comorbid dependence on alcohol/drugs, controlling for covariates and modelling both subject and country-level effects. Participants dependent on alcohol or drugs had fewer negative symptoms on PANSS than their non-dependent counterparts. However, those dependent on alcohol scored higher on PANSS general psychopathology than those who were not, or dependent only on drugs. People with schizophrenia dependent on drugs had poorer quality of life, more extrapyramidal side effects, and scored worse on Global Assessment of Functioning (GAF) than those without dependence. People with alcohol dependence reported more reasons for non-compliance with medication, and poorer functioning on GAF, though not on Global Assessment of Relational Functioning. In people with schizophrenia, comorbid dependence on alcohol or drugs is associated with impaired clinical and psychosocial adjustment, and poorer quality of life.

Effects of a Brief Intervention for Substance Use on Tobacco Smoking and Family Relationship Functioning in Schizophrenia and Related Psychoses: A Randomised Controlled Trial

Surveys indicate that substance use is prevalent in populations with schizophrenia. Family members may be able to support brief interventions (BI).We conducted a randomised controlled trial with 6-month follow-up among adult patients with schizophrenia and related psychoses who were referred to two hospitals in southern Thailand. Patients with psychosis were screened using the Alcohol Smoking and Substance Involvement Screening Test (ASSIST). 169 participants (all at moderate substance risk on the ASSIST) were randomised to receive simple advice (the clinics' treatment-as-usual, TAU condition), or single-session brief intervention (BI), or a single-session BI with family support (BI-FS).Given observed substance use, the primary outcome was the ASSIST tobacco smoking involvement score (SIS). Secondary outcomes were cigarettes smoked per day, change motivation (Taking Steps from the Stages of Change and Treatment Eagerness Scale), and DSM-IV Axis V Global Assessment of Relational Functioning (GARF).At follow-up, BI-FS participants reported a lower SIS (mean difference, −2.82, 95% confidence interval [CI] −4.84 to −0.81; Glass' effect size [Δ]=0.57, 95% CI 0.19 to 0.95), smoked fewer cigarettes per day (mean difference −3.10, 95% CI −5.45 to −0.74; Δ=0.56, 95% CI 0.18 to 0.94), had greater change motivation (mean difference 3.05, 95% CI 0.54 to 5.57; Δ=0.41, 95% CI 0.03 to 0.79) and GARF (mean difference 6.75, 95% CI 1.57 to 11.93; Δ=0.54, 95% CI 0.16 to 0.92). The BI-FS group also had better relational functioning in comparison to those receiving BI only (mean difference 5.44, 95% CI 0.20 to 10.67; Δ=0.46, 95% CI 0.08 to 0.84).In schizophrenia and related psychoses, a brief intervention supported by a family member reduces smoking involvement, cigarette smoking intensity, and increases change motivation and relational functioning.

Problematic parent-infant relationships in two-parent families: prevalence and risk factors in a Brazilian neighborhood.

Although the quality of parent-child relationships is known to be associated with the offspring's mental health, little is known about the prevalence of problematic relationships in this scenario. This cross-sectional study aims to investigate the prevalence and risk factors of different types of early parent-infant relationships in a Brazilian population group. During 1 year, all families (n = 230) from an urban community of Porto Alegre, southern Brazil, with 4-month-old infants born in public hospitals were identified, and 148 were fully investigated by two family therapists. This study describes data on the 116 infants with two-parent families. Demographic, obstetric, and relational variables were collected through questionnaires and scales (Parent-Infant Relationship Global Assessment Scale, Global Assessment of Relational Functioning, and Self-Report Questionnaire). Prevalence ratios were calculated, and Poisson regression with robust variance was performed to adjust for covariates. Almost 10% of mothers and 12% of fathers showed at least a significantly perturbed relationship with their 4-month-old infants. Inadequate mother-infant bonding coincided with evidence of paternal mental disorder, poor maternal social network, and discontinuation of breastfeeding at 4 months. A problematic father-infant relationship was associated with a dysfunctional couple relationship and with low infant birth weight. There is a high prevalence of early parent-child relationship problems, suggesting a need for health system interventions. Parent-infant relational problems are prevalent very early in life and more associated with other relational problems than with socioeconomic burden.

Reliability and Validity of the Global Assessment of Relational Functioning (GARF) in a Psychiatric Family Therapy Clinic

The reliability and validity of the Diagnostic and Statistical Manual of Mental Disorders-IV Global Assessment of Relational Functioning (GARF) was evaluated in consenting participants presenting to a family therapy training clinic. The purpose of this study was to (a) assess whether the GARF could be administered quickly in a marriage and family therapy training clinic, (b) assess the inter-rater and internal reliability of GARF ratings of intake sessions, (c) examine the relationship of GARF ratings to established measures of relationship functioning, and (d) compare GARF ratings to a measure of depressive symptoms. Study participants completed the General Functioning Subscale of the Family Assessment Device (GFS/FAD), the Quality of Marriage Index (QMI), and the Center for Epidemiologic Studies-Depression Scale (CES-D). After intake sessions were conducted with study participants, GARF ratings were made by an American Association for Marriage and Family Therapy Approved Supervisor or Supervisor-in-Training, a therapist trainee, and two observing trainees who had observed the session from behind a one-way mirror. Cronbach's coefficient alphas and the average intraclass correlation coefficients were both .82 when ratings of the supervisor and two observers were compared and .78 and .79, respectively, when ratings of the supervisor, two observers, and therapist were evaluated. There was significant agreement between GARF ratings made by the supervisor and therapist (but not observers) and scores on the GFS/FAD, QMI, and CES-D. Results suggest that GARF ratings can be made quickly and reliably, especially among raters with greater clinical experience, and are related to measures of relational functioning and depression. Implications for research and marriage and family therapy training are discussed.

Relational diagnosis--A brief historical overview: Comment on the special section.

Various mental health disciplines have attempted to bring the significance of relational interaction and dysfunction to the attention of the entire field. Over the past 20 years, these efforts have been initiated and developed both independently and collaboratively, and although progress has been made, results have been incremental and insufficient. The inclusion of the Global Assessment of Relational Functioning (GARF) as an option on Axis IV of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) was a milestone but fell short of recognition as a major disorder on Axis I. This article summarizes and provides a background for the historical efforts that have occurred and suggests possibilities for greater prominence of relational disorders in DSM-V. Renewed interest by coalitions of researchers and practitioners in recent years indicates a positive prognosis for greater acceptance of a classification of couple and family dysfunction in the mental health professions.

Couples' relationships and breastfeeding: is there an association?

One hundred fifty-three Brazilian families with 4-month-old infants--51 cases (breastfeeding had ceased) and 102 controls (breastfeeding maintained)--were recruited to verify if a problematic couple relationship is associated with early breastfeeding termination. The relationships of the 118 cohabiting couples were assessed by clinical interviews and the Global Assessment of Relational Functioning and Beavers-Timberlawn scales, examining marital and parental functions, parents' satisfaction with the quality of care each partner provided to their infants, mothers' opinions of paternal breastfeeding support, and interviewers' assessments of paternal breastfeeding support and involvement in the infants' care. The quality of a couple relationship was not associated with the interruption of breastfeeding before 4 months postpartum. However, a good couple relationship was associated with more paternal breastfeeding support (P < .01) and involvement in the infant's care (P < .0001).

Using Tape Measures in Family Therapy: An Exploration of the Global Assessment of Relational Functioning

In the current climate of evidence‐based clinical practice, there is an urgent need to give family therapy research more prominence, and to demystify it for the practitioner. We were curious to discover how a family assessment instrument would behave with families we saw in our clinical practice. This paper describes our first attempt to apply a family measure, the Global Assessment of Relational Functioning, with 51 families in which the referred child presented with a confirmed or suspected diagnosis of AD/HD. The GARF, a one‐point measure, assesses three dimensions of family functioning: problem‐solving skills, organisational characteristics and emotional climate. We illustrate the use of the measure with the description of two families who rated at the opposite ends of the scale. The potential value and the limitations of the GARF as a family assessment are discussed.

Validity of the Global Assessment of Relational Functioning (GARF) When Used By Community-Based Therapists

Construct validity of the Global Assessment of Relational Functioning (GARF) was assessed using a health services research approach, a mode of study that captures the naturalistic practice of health service providers. A sample of 395 couple/family cases with GARF scores assigned pre- and post-therapy by 222 community-based marriage and family therapists yielded these results: 1) pretreatment GARF scores were negatively correlated with severity of client problems; 2) GARF change scores were positively correlated with client reported changes in functioning; 3) GARF change scores were positively correlated with therapist-reported client change; 4) GARF change scores were positively correlated with client satisfaction; 5) pretreatment GARF scores were negatively correlated with number of therapy sessions; and 6) pretreatment GARF scores and client diagnoses showed no relationship. Given these results the GARF appears to have construct validity in community settings, and is a promising brief assessment tool for relational functioning.

INTERRATER RELIABILITY AND VALIDITY OF THE GLOBAL ASSESSMENT OF RELATIONAL FUNCTIONING (GARF) SCALE IN A CLINICAL SETTING: A PRELIMINARY STUDY

The purpose of this study was to estimate the reliability and construct validity of the Global Assessment of Relational Functioning (GARF) Scale. The GARF Scale, a preliminary tool for assessing relationship functioning, was designed to be easily administered in a variety of settings. In this study, 29 therapist interns and six American Association for Marriage and Family Therapy clinical supervisors, working in an on-site university-based clinic, independently rated 94 client families using the GARF Scale. Scores were compared, and a correlation of .54 was obtained. Validity was estimated by using assessment of risk and number of sessions attended.

Global assessment of relational functioning scale (GARF): II. Reliability and validity in a sample of families of bipolar patients.

The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.

Global Assessment of Relational Functioning scale (GARF): I. Background and rationale. Group for the Advancement of Psychiatry Committee on the Family.

The Committee on the Family of the Group for the Advancement of Psychiatry has introduced the Global Assessment of Relational Functioning (GARF), a scale that describes and quantifies the relational context within which patients live and problems occur. The GARF is intended to serve as a device that alerts clinicians to pay attention to the evaluation not only of individuals but also of relational functioning. In this article, we describe from a historicals perspective the scientific and political context within which this scale was developed. The GARF is analogous to Axis V of the DSM GAF scale (Global Assessment of Functioning) that is used to assess individual functioning. The GARF is a composite derivative of three major dimensionalized constructs, namely, joint problem solving, organization, and emotional climate. We provide five clinical vignettes to illustrate the process of arriving at GARF ratings. Finally, we discuss caveats and limitations for use of the GARF at present, and make recommendations for research projects and training methods that may enhance the value of this instrument in the future.