Assessing Impairment by Sam Goldstein & Jack A. Naglieri

Author:Sam Goldstein & Jack A. Naglieri
Language: eng
Format: epub
Publisher: Springer US, Boston, MA

7.7 Challenges Existing in the Use of Chap. 14

The stated purpose of including all three of these scales is “to provide a broad assessment of the patient with M&BD” (AMA, 2008, p. 355). The goal is to “arrive at a strongly supportable impairment rating” (p. 355). As the approach used in the Mental and Behavioral Disorders chapter is a dramatic departure from what was used previously (especially since numerical psychiatric ratings have not been used since the second edition), its impact and reliability are yet to be determined. Several critical challenges exist that greatly complicate the use of this particular chapter in the guides. Many of these challenges have been discussed in this section. Briefly, there are problems with the conceptualization and definition of impairment associated with mental and behavioral disorders, with the process used to identify certain diagnoses as “ratable” and others as “nonratable,” with the establishment of the very difficult concept of MMI, and with the identification of what information will be used as the foundation for impairment assessment and how that information should be gained. Most importantly, there are significant problems and flaws associated with instrumentation, measurement, statistical analysis, and validity of the tools and methods chosen to derive the actual impairment ratings. It is clear that this chapter, while it provides a methodology that will increase the reliability of impairment ratings, faces major challenges as it currently exists in terms of its validity and usefulness in medicolegal settings.

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