Featured Tool: Multnomah Community Ability Scale (MCAS)

In a study such as the CMHEI, which follows the progress of individuals over 18 months, we were interested in measures which could help us assess functioning over time rather than at a single point in time. The Multnomah Community Ability Scale (MCAS)* seemed to fit our needs. It was developed by a team in Multnomah County, Oregon, to assess impairments and abilities among individuals with severe mental illness living in the community. The measure assesses how the person has been doing, on average, for the past three months. By comparing ratings over time, we can tell whether the person has, in general, improved in functioning, remained more or less the same, or declined. Four subscale scores are produced, in addition to a total score, so that we can look at changes in functioning in specific areas – physical and psychiatric symptoms, daily living skills, interpersonal relations and daily activities, and behavioural problems.

Because the MCAS is not a self-report measure, it is not being used in the consumer or family projects. It is usually completed by a provider familiar with the consumer. In this study, a research assistant completes the MCAS after speaking with the consumer's primary worker, meeting with the consumer and reviewing his/her chart. The MCAS developers have prepared an information package which includes an administration manual, training video and normative data. These data describe average ratings for users of community mental health programs, subdivided into age and sex groupings. In psychometric tests performed by the Oregon team, the MCAS has performed well. In Ontario, several community programs are currently using the MCAS and find that it contributes useful information.

Examples of the 17 items that make up the MCAS are listed here. Each item is rated on a five-point scale. The full scale can be downloaded from the CMHEI website (see Proxy Modules) and the training package can be ordered from Sela Barker at (503) 238 0769.

Sample Items:

• How successfully does your client manage his/her money and control expenditures?
How frequently does your client initiate social contact or respond to others initiation of social contact?
• How extensive is the client's social support network?
• How frequently does your client experience episodes of extreme acting out?

* Barker et al. (1994). A community ability scale for chronically mentally ill consumers: PPart: Reliability and validity, Community Mental Health Journal, 30(4), 363-383.

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