Uses of an empirically derived client typology based on level of functioning: Twelve years of the CCAR

  • Richard H. Ellis
  • John H. Wackwitz
  • Mark Foster


The Colorado Client Assessment Record (CCAR) is a problem checklist and level of functioning rating instrument used to describe admissions to a public mental health system. A brief, non-technical summary of recent research and administrative applications involving this instrument is presented. A stable factor structure, generalizable to several diverse client populations, is reported. Scaling procedures for measuring these procedures and a client typology based on this scaling are described. The client typology is differentially related to the types of services received and the costs of treatment episodes. The typology is also used to understand differences in case mixes and lengths of stay at two state hospitals.


  1. 1.
    Overall, J, Gorham, D: The brief psychiatric rating scale.Psychological Reports 1962; 10: 799–812.CrossRefGoogle Scholar
  2. 2.
    Luborsky, L: The health-sickness rating scale: sample cases and rating forms.Bulletin of The Menninger Clinic 1975; 35:444–480.Google Scholar
  3. 3.
    Ellis RH, Wilson NZ, Foster M: Statewide treatment outcome assessment in Colorado: the Colorado client assessment record (CCAR).Community Mental Health Journal 1984; 20:72–89.PubMedCrossRefGoogle Scholar
  4. 4.
    Glover RW, Wilson NZ:Definitions of Chronic, Critical and Serious. Denver, CO: Colorado Division of Mental Health, 1987.Google Scholar
  5. 5.
    Ellis RH: An empirical method for determining who is chronically mentally ill.Proceedings of the Annual WICHE Management Information Systems Conference, Boulder, CO: Western Interstate Conference on Higher Education, 1989.Google Scholar
  6. 6.
    Ellis RH:Bed Allocation in Colorado State Hospitals, Denver, CO: Colorado Division of Mental Health, 1984.Google Scholar
  7. 7.
    Reihman J, Wolford K, Knapp W, et al.: Treatment outcomes in a day treatment program.International Journal of Partial Hospitalization, 1983; 2:17–31.PubMedGoogle Scholar
  8. 8.
    Pokorny LJ:Feasibility Assessment: The Inclusion of a Level of Functioning Measure in the Minimum Dataset of the Mental Health Statistics Improvement Program, Washington, DC: U.S. Department of Health and Human Services, 1986.Google Scholar
  9. 9.
    Shern DL:Innovative Community Programs and Types of Mentally Ill Individuals, Denver, CO: Colorado Division of Mental Health, 1986.Google Scholar
  10. 10.
    Shern DL:The Special Population Study of the Chronically Mentally Ill: Descriptive Analyses of Client Psycho-social Characteristics, Migration Patterns and Geographic Distribution Denver, CO: Denver Department of Health & Hospitals, 1983.Google Scholar
  11. 11.
    Stahler GJ: The factor structure of the Colorado level of functioning measure.Journal of Clinical Psychology 1981; 43:696–699.Google Scholar
  12. 12.
    Stahler GJ, Rapaport, H: Do therapists bias their ratings of patient functioning under peer review?Community Mental Health Journal 1986; 22:265–274.PubMedCrossRefGoogle Scholar
  13. 13.
    Wackwitz, JH, Foster, F, Ellis, RH:Factor Analysis and Scaling of the Colorado Client Assessment Record (CCAR), Denver, CO: Colorado Division of Mental Health, 1990.Google Scholar
  14. 14.
    Wackwitz, JH, Foster, F, Ellis, RH:Factorial Invariance and Sensitivity to Group Differences of the Colorado Client Assessment Record (CCAR), Denver, CO: Colorado Division of Mental Health, 1990.Google Scholar
  15. 15.
    Wackwitz, JH, Foster F, Ellis, RH:An Empirically-Based Typology of Mentally Ill Persons, Denver, CO: Colorado Division of Mental Health, 1990.Google Scholar
  16. 16.
    Eysenck HJ: Superfactors P, E, & N in comprehensive factor space.Multivariate Behavioral Research 1978; 13:475–481.CrossRefGoogle Scholar
  17. 17.
    Wackwitz, JH, Horn, JL: On obtaining the best of factor scores within an ideal simple structure.Multivariate Behavioral Research 1971; 6:389–408.CrossRefGoogle Scholar
  18. 18.
    SPSS-X User’s Guide (3rd ed.). Chicago, IL: SPSS Inc., 1988.Google Scholar

Copyright information

© Association of Mental Health Administrators 1991

Authors and Affiliations

  • Richard H. Ellis
    • 1
  • John H. Wackwitz
    • 2
  • Mark Foster
    • 3
  1. 1.Decision Support ServicesColorado Division of Mental HealthDenver
  2. 2.Rural Crisis GrantColorado Division of Mental HealthUSA
  3. 3.Treatment Outcome GrantColorado Division of Mental HealthUSA

Personalised recommendations