Desperately seeking outcomes: quantifying the effectiveness of community mental healthcare using Health of the Nation Outcome Scales

Laugharne, Richard; Eaves, Scott; Mascas, Alin; Psatha, Kiki; Dinnis, Gill; Trower, Jonathan K.; Shankar, Rohit

doi:10.1192/bjo.2018.3

Cited by 9 publications

(10 citation statements)

References 10 publications

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“…HoNOS is a widely used and clinicianreported mental health outcome instrument comprised of 12 items/subscales, which cover symptom severity, functioning, social and environmental measures. 8 The HoNOS score is then combined with additional risk-based scales to group patients into 'clusters' using the Mental Health Clustering Tool. 9 The 21 clusters are divided into three superclasses (psychosis, non-psychosis and organic), which are a measure of combined symptomaticfunctional-social-environmental severity.…”

Section: Honos Datamentioning

confidence: 99%

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Hong

Sheriff

Smith

et al. 2021

Evid Based Mental Health

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BackgroundThe effects of COVID-19 on the shift to remote consultations remain to be properly investigated.ObjectiveTo quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak.MethodsWe used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python.FindingsMental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18–21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients.Conclusions and clinical implicationsThe rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.

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Section: Honos Datamentioning

confidence: 99%

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Hong

Sheriff

Smith

et al. 2021

Evid Based Mental Health

View full text Add to dashboard Cite

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“…1 One reason identified for not routinely using standard outcome measures was the lack of appropriate instruments. 2 In 1998, Wing and colleagues 3 developed the Health of the Nation Outcome Scales (HoNOS), an instrument covering symptoms, functioning, relationships and environmental issues 4,5 that could be used routinely in the National Health Service (UK) to measure progress towards the target set by the Department of Health in the UK 'to improve significantly the health and social functioning of mentally ill people'. 6 Since then, the HoNOS and its adaptations for children and adolescents (HoNOSCA) and for those over 65 years of age (HoNOS65+) have been officially adopted in England, Australia, New Zealand 7 and in other European countries.…”

Section: Introductionmentioning

confidence: 99%

Health of the Nation Outcome Scales for Infants field trial: concurrent validity

et al. 2021

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Background A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. A Child and Adolescent Mental Health Information Development Expert Advisory Panel working group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for infants 0–47 months. Prior face validity testing showed that the HoNOSI was considered useful in measuring mental health outcomes. Aims To examine the concurrent validity of the HoNOSI. Method Mental health clinicians providing assessment and treatment to infants in routine clinical practice participated in the study. The mental health status of 108 infants were rated by a minimum of 26 clinicians with the HoNOSI, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS) and measures of symptom severity and distress. Results The HoNOSI was statistically significantly correlated with the PIR–;GAS, rs = −0.73; Clinical Worry, rs = 0.77; and Severity Judgement ratings, rs = 0.85; P < 0.001. A good level of internal consistency was found. Using the COsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria for judging instrument acceptability, the HoNOSI meets the standard for both concurrent validity and internal consistency. Conclusions There has been a clear need for a routine outcome measure for use with infants. This study provides positive evidence of aspects of validity. These findings, along with those from the prior face validity study, support a controlled release of the HoNOSI accompanied by further research and development.

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“…12 The HoNOSCA has been widely used. 4,[13][14][15][16][17][18][19] It was designed to be brief, have a similar structure to the HoNOS and provide a broad, quantitative measure of severity to measure a range of behavioural, symptomatic, social and impairment domains in children and adolescents and it has been found to have sound psychometric properties. 11,20,21 In Australia, the National Outcomes and Casemix Collection (NOCC) was introduced 'to provide a suite of measures that support clinical practice and comparisons across services and different consumer populations'.…”

mentioning

confidence: 99%

“… 1 One reason identified for not routinely using standard outcome measures was the lack of appropriate instruments. 2 In 1998, Wing et al 3 developed the Health of the Nation Outcome Scales (HoNOS), an instrument covering symptoms, functioning, relationships and environmental issues, 4 , 5 which could be used routinely in the UK National Health Service to measure progress toward the target set by the UK Department of Health ‘to improve significantly the health and social functioning of mentally ill people’. 6 Since then, the HoNOS and its adaptations for children and adolescents (HoNOSCA) and for those aged >65 years (HoNOS65+), have been officially adopted in England, Australia, New Zealand and other European countries.…”

mentioning

confidence: 99%

“… 12 The HoNOSCA has been widely used. 4 , 13 – 19 It was designed to be brief, have a similar structure to the HoNOS and provide a broad, quantitative measure of severity to measure a range of behavioural, symptomatic, social and impairment domains in children and adolescents and it has been found to have sound psychometric properties. 11 , 20 , 21 …”

mentioning

confidence: 99%

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The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants

et al. 2021

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Background A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency. Aims We aimed to investigate the interrater reliability of the HoNOSI. Method Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes. Results Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7). Conclusions There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

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Desperately seeking outcomes: quantifying the effectiveness of community mental healthcare using Health of the Nation Outcome Scales

Cited by 9 publications

References 10 publications

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

Health of the Nation Outcome Scales for Infants field trial: concurrent validity

The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants

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