Reliable and clinically significant change based on the Health of the Nation Outcome Scales

Boon, Albert; Boer, Sjoukje Berdina Beike de; Dorp, Melissa van; Nijssen, Yolanda

doi:10.1016/j.psychres.2019.112587

Cited by 8 publications

(6 citation statements)

References 33 publications

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“…The findings of the quantitative analysis of the functioning of the child at baseline of the study highlights the severity of the impact of maltreatment on the study group. Consistent with Boon et al ( 99 ) who studied outcomes for clients ( n = 12,547; d = 0.5) of 10 child mental health facilities in The Netherlands, an effect size of 0.60 (cohen's d ) was found in this study with a similar treatment length. The cohort used in this study did exhibit more severe symptomology at baseline as measured on all HoNOSCA Scales except for Poor School Attendance, with four items in the Clinically Significant Range (Over-activity, attention and concentration; Emotional and Related Symptoms; Peer relationships and Family Life and Relationships) compared with Norwegian [ n = 153; ( 81 )].…”

Section: Discussionsupporting

confidence: 91%

Australian Maltreated Infants and Young Children Can Achieve Positive Relational Health With Neurodevelopmentally- and Trauma-Informed Interventions Provided Within Relationally-Positive and Stable Environments

Cox¹,

Frederico

Mosse³

et al. 2021

Front. Psychiatry

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Background: Childhood maltreatment such as abuse, neglect and family violence has a profound impact on children's psychological and relational functioning and their lifelong trajectory, with associated adverse physical and mental health outcomes, higher mortality rates and reduced socioeconomic opportunities. The aim of the study was to explore the impact of neurodevelopmentally- and trauma-informed interventions on the relational health of children who have experienced maltreatment.Context: The study was conducted at Berry Street Take Two, an Australian therapeutic service. Take Two provides services to Victorian children aged 0-18 years, to address the impact of the trauma they have experienced from maltreatment. Take Two clinicians use relational and ecological frameworks, neurodevelopmental research and evidence-informed approaches to repair family relationships and develop networks of caring adults that focus on meeting the child's needs. Take Two uses the NMT approach as a framework for clinical intervention-planning and is site-certified in the use of the NMT Clinical Practice tools.Method: The mixed methods study had two components. A cross sectional study of baseline and repeat clinical measure data (HoNOSCA and SDQ) with a cohort of children aged 2–11 years (n = 91), who were clients of Berry Street Take Two between 2014 and 2019, was conducted utilizing SPSS. The quantitative data analysis was supplemented by three case studies of Berry Street Take Two clients, which explored the process of intervention, including intervention type, timing and dosage. The case studies drew on the full case record for each child to illustrate the impact of NMT-informed interventions on the relational health, psychological and behavioral functioning of children.Results: The study found that Take Two intervention was associated with improved relational health, measured by the NMT metric and supported by significant positive changes on the SDQ and HoNOSCA with medium effect sizes (cohen's d). The case study analysis highlighted the importance of intervention addressing individual, family and systems elements to bring about positive change.Conclusions: This study illustrates the value of neurodevelopmental trauma-informed interventions in positively impacting on the relational health and current functioning of maltreated children and the potential to reduce the lifelong impact of maltreatment.

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Section: Discussionsupporting

confidence: 91%

Australian Maltreated Infants and Young Children Can Achieve Positive Relational Health With Neurodevelopmentally- and Trauma-Informed Interventions Provided Within Relationally-Positive and Stable Environments

Cox¹,

Frederico

Mosse³

et al. 2021

Front. Psychiatry

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“…Our findings, especially the cut-off scores and benchmark values, reciprocally corroborate and validate previous results, obtained in different clinical samples, with other statistical methods (Boon et al, 2019;De Beurs et al, 2018;Parabiaghi et al, 2005Parabiaghi et al, , 2011Parabiaghi et al, , 2014. The percentage of change for improvement (treatment response) and deterioration determined in our analysis are in accordance with generally accepted thresholds (Duff, 2012;Evans et al, 1998;Schennach-Wolff et al, 2010).…”

Section: Discussionsupporting

confidence: 91%

“…This is attributable to several factors, mainly the methodological and statistical intricacy of comparing heterogeneous groups across multiple domains (Gift et al, 1980; Zimmerman et al, 2018). The interpretation of change in the HoNOS sum score can be arduous, due to the construction of the scale, where each item measures a separate issue (Boon et al, 2019; Egger et al, 2015; Harris et al, 2018; Parabiaghi et al, 2014). Clinical change may, therefore, be captured by a single item, with sub-threshold changes in other items potentially cancelling this out (MacDonald, 2009).…”

Section: Introductionmentioning

confidence: 99%

Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Egger

Bobes

Theodoridou

et al. 2020

Aust N Z J Psychiatry

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Objective: The Health of the Nation Outcome Scales was developed as an overall measure of mental health, applicable to the complete range of psychiatric disorders. Meanwhile, it is a benchmark tool for service providers and is also used for the allocation of costs and funding. The ability of the Health of the Nation Outcome Scales to assess and differentiate the severity of psychiatric disorders is largely unknown, as it is the interpretation of a change in score. We aim to establish Health of the Nation Outcome Scales cut-off and benchmark values for severity and improvement – respectively change, using equipercentile linking to the Clinical Global Impression scales. Methods: In a clinical sample of 30,616 individuals with a psychiatric disorder, we used a multivariate regression analysis to determine the correlation between the scales and possible confounders. We used an equipercentile linking analysis of the Clinical Global Impressions severity scale with the Health of the Nation Outcome Scales sum score to establish cut-off values for severity. The linking of the Health of the Nation Outcome Scales sum score difference and the percentage of change to the Clinical Global Impression improvement scale determined benchmark values for change (i.e. improvement or deterioration). Results: The Health of the Nation Outcome Scales and Clinical Global Impression scales showed a Spearman correlation of 0.38 ( p < 0.000). Clinical Global Impression–Severity: ‘borderline-ill’ corresponded to Health of the Nation Outcome Scales score 3–5; ‘mildly ill’ to 6–10; ‘moderately ill’ to 11–16; ‘markedly ill’ to 17–25; ‘severely ill’ to 26–35; and ‘extremely ill’ to a score ⩾36. The Spearman correlation between the percentage change of the Health of the Nation Outcome Scales was 0.39 ( p > 0.000); Clinical Global Impression–Improvement: ‘minimally improved’ corresponded to Health of the Nation Outcome Scales reduction of 4 points or 9%; ‘much-improved’ to 12 points or 48%; ‘very-much-improved’ to ⩾20 points or ⩾90%. Clinical Global Impression–Improvement: ‘minimally worse’ corresponded to an increase of 6 points or 25%; ‘much-worse’ to 12 points or 54%; and finally, ‘very-much-worse’ to >18 points or ⩾82%. Conclusion: Our results allow for the comparison of severity and response to treatment of patients with a psychiatric disorder, independent of diagnosis.

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“…Note that clinical significance for HoNOSCA was analysed on item level, because a criterion for clinical significance for the total score is lacking. Moreover, the reporting of separate items may better reflect important clinical change (Brann and Coleman, 2010; Boon et al ., 2019). To get an impression of the overall change in symptoms on HoNOSCA, we examined change in the number of clinically significant items between start- and end-of-treatment, using a paired sample t -test.…”

Section: Methodsmentioning

confidence: 99%

Sociodemographic and clinical characteristics in child and youth mental health; comparison of routine outcome measurements of an Australian and Dutch outpatient cohort

Roest

Siebelink

Ewijk

et al. 2021

Epidemiol Psychiatr Sci

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Routine outcome measurement (ROM) data offer unique opportunities to study treatment outcomes in clinical practice, and can help to assess the real-world impact of mental health services for children and adolescents (youth). This is illustrated by studies using naturalistic data from specialist child and adolescent mental healthcare services (CAMHS), showing the proportion of patients with reliable improvement, recovery or deterioration (Burgess et al., 2015; Wolpert et al., 2016), and revealing specific subgroups of patients with greater risk of poor outcome (Garralda et al., 2000; Lundh et al., 2013; Murphy et al., 2015; Edbrooke-Childs et al., 2017). Naturalistic data are therefore undeniably necessary in addition to data derived from randomised clinical trials, which often have limited generalisability due to strict selection criteria (Rothwell, 2005; Van Noorden et al., 2014).

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Reliable and clinically significant change based on the Health of the Nation Outcome Scales

Cited by 8 publications

References 33 publications

Australian Maltreated Infants and Young Children Can Achieve Positive Relational Health With Neurodevelopmentally- and Trauma-Informed Interventions Provided Within Relationally-Positive and Stable Environments

Australian Maltreated Infants and Young Children Can Achieve Positive Relational Health With Neurodevelopmentally- and Trauma-Informed Interventions Provided Within Relationally-Positive and Stable Environments

Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Sociodemographic and clinical characteristics in child and youth mental health; comparison of routine outcome measurements of an Australian and Dutch outpatient cohort

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