A pragmatic mixed-methods review of changing “case-complexity” of referrals to an intensive support service

Abstract

Purpose “Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation. Design/methodology/approach Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis. Findings Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence. Research limitations/implications Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources. Originality/value The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population.

An investigation into the factor structure of the Health of the Nation Outcome Scales for People with Learning Disabilities

“…The HoNOS-LD is one of several scales recommended for use in English intellectual disability services (e.g. NHS England 2017) and has been used in several clinical studies, as an outcome measure for hospital wards (Hillier et al 2010), for therapy evaluations (Skelly et al 2018) and as a means of managing caseload complexity (Clifford and Kemp 2020). Published studies have either used the total score for the HoNOS-LD (e.g.…”

“…Published studies have either used the total score for the HoNOS-LD (e.g. Skelly et al 2018;Clifford and Kemp 2020) or studies have used clusters of scores based on clinical opinion or face validity as suggested by Harris et al 2018(e.g. Hillier et al 2010.…”

“…2010), for therapy evaluations (Skelly et al . 2018) and as a means of managing caseload complexity (Clifford and Kemp 2020). Published studies have either used the total score for the HoNOS‐LD (e.g.…”

“…Skelly et al . 2018; Clifford and Kemp 2020) or studies have used clusters of scores based on clinical opinion or face validity as suggested by Harris et al . 2018 (e.g.…”

A short-term “behavioural support” service for autistic adults without an intellectual disability: a pilot evaluation

“…This included extracting key information and codes on discharge outcomes. Health of the Nation Outcome Scales (HoNOS) were collected for all accepted referrals as an additional indicator of case-complexity at point of referral (Clifford and Kemp, 2020). Thematic analysis (Braun and Clarke, 2006) was used as the qualitative methodology for examining and extracting key information from referral documents and casenotes, using elements of Robinson's (2022) tabular approach for investigating brief texts.…”