On the Meaning of Change in a Clinician's Routine Measure of Outcome: HoNOSCA

Brann, Peter; Coleman, Grahame J

doi:10.3109/00048674.2010.513037

Cited by 27 publications

(25 citation statements)

References 37 publications

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“…A larger proportion of HTRYP than previously reported (Bebbington et al., ) suffered from more than one disorder. Those HTRYP treated in the IP improved statistically and clinically over time (TP1–TP3; Bird, Canino, Rubio‐Stipec, & Ribera, ; Brann & Coleman, ; Schorre & Vandik, ), when compared to the CMHT YP and other UK CAMHS (Garralda, Yates, & Higginson, ; McArdle & Gillet, ; The CAMHS Clinical Academic Group, ) and with less medication and fewer admissions. Also, while small numbers precludes firm conclusions, the reported educational and accommodation gains were encouraging, the continuing gains between discharge and follow‐up suggest the possibility that the intervention represented a ‘turning point effect’ towards a more resilient path (Rutter, ).…”

Section: Discussionmentioning

confidence: 99%

Innovations in Practice: A case control and follow‐up study of ‘hard to reach’ young people who suffered from multiple complex mental disorders

Camilleri

Newbury‐Birch

McArdle

et al. 2016

Child Adoles Ment Health

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Background: Innovations Project (IP) was a new multidisciplinary team based within an inner city, walk-in health centre, North East England (throughout 2011). The aim was to describe the social and mental disorders of the hard to reach young people (HTRYP) from the IP and compare with a matched sample who attended a Community Mental Health Team (CMHT) and follow-up both samples 24 months after discharge. Methods: A retrospective review of clinical case notes of YP who attended the IP and CMHT. A 24-month (postdischarge) follow-up evaluation of the mental state and social function of the YP in both groups using Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and Children's Global Assessment Scale (CGAS). Results: Thirty-six referrals were accepted over a one-year period by the IP, 31 met criteria for the HTRYP, 15 were offered individually tailored therapy. The HTRYP who were more deprived compared to the CMHT matched sample (n = 115), experienced a higher median number of mental disorders (n = 3 compared to CMHT n = 1), higher severity scores and lower levels of social function (HTRYP HoNOSCA mean: 19.1 (95% CI 15.9-22.2) and CMHT mean: 11.2 (95% CI 2.0-23.0) p = <.001, and HTRYP CGAS mean: 51.0 (95% CI 46.0-56.2) and CMHT mean: 58.9 (95% CI 52.9-64.8), p = .05). The HTRYP made significantly greater improvement compared to CMHTYP; (HoNOSCA p = <.001 and CGAS p = <.002) at discharge. A total of 13 HTRYP and 9 CMHT YP attended the follow-up review at 24 months. There was substantial variability in terms of social function between the YP within each sample. Conclusions: The term 'HTR' describes a state that may be often temporary, as opposed to lifelong. A bespoke service offering a developmental theoretical framework, regular reviews and an individualised care plan, was able to engage and had the potential to reduce morbidity suffered by HTRYP. Key Practitioner Messages• Hard to reach young people (HTRYP) presented with more disadvantage and psychopathology than those young people (YP) attending standard Community Mental Health Teams (CMHT).• HTRYP may benefit from a flexible, individualised, resource intense service that includes an outreach capability to maximise engagement, assessment and intervention planning. The HTRYP who engaged with IP received a package of care with low use of medication and low admission rates to inpatient beds compared with those YP attending regular CMHT.• For some HTRYP at 2-year follow-up, the absence of unstable accommodation together with positive change in both mental state and social function at follow-up review could be considered as positive outcomes in contrast to the poor prognosis that is usually associated with the term 'hard to reach'.• Perhaps the term 'hard to reach' would be more appropriate as a descriptor of an aspect of current circumstances for some individuals with complex mental disorders rather than a descriptor of both poor engagement with services and poor longer term prognosis.• Despite multiple attempts by the Innovations P...

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Section: Discussionmentioning

confidence: 99%

Innovations in Practice: A case control and follow‐up study of ‘hard to reach’ young people who suffered from multiple complex mental disorders

Camilleri

Newbury‐Birch

McArdle

et al. 2016

Child Adoles Ment Health

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“…Specifically, outcome measures are quantitative indicators used at two or more points in time: baseline, post-intervention, discharge, or follow-ups [ 2 , 3 ]. Routine outcome measurement, whereby the same outcome measure is used frequently at a number of time points, has been adopted in child and adolescent mental health services in Australia, New Zealand, Denmark, United Kingdom and Norway [ 4 ]. This push has been driven by an increasing emphasis on monitoring the quality and effectiveness of services [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Routine outcome measurement reported at the service level enables decision making around funding of services, particularly at a government level where health resources are limited and need to be distributed to achieve the best outcomes [ 4 ]. It is also essential as a component of ongoing service-level quality improvement.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of mental health outcome measures for young people aged 12 to 25 years

Kwan

Rickwood

2015

BMC Psychiatry

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BackgroundMental health outcome measures are used to monitor the quality and effectiveness of mental health services. There is also a growing expectation for implementation of routine measurement and measures being used by clinicians as a feedback monitoring system to improve client outcomes. The recent focus in Australia and elsewhere targeting mental health services to young people aged 12–25 years has meant that outcome measures relevant to this age range are now needed. This is a shift from the traditional divide of child and adolescent services versus adult services with a transitioning age at 18 years. This systematic review is the first to examine mental health outcome measures that are appropriate for the 12 to 25 year age range.MethodsMEDLINE and PsychINFO databases were systematically searched to identify studies using mental health outcome measures with young people aged 12 to 25 years. The search strategy complied with the relevant sections of the PRISMA statement.ResultsA total of 184 published articles were identified, covering 29 different outcome measures. The measures were organised into domains that consisted of eight measures of cognition and emotion, nine functioning measures, six quality of life measures, and six multidimensional mental health measures. No measures were designed specifically for young people aged 12 to 25 years and only two had been used by clinicians as a feedback monitoring system. Five measures had been used across the whole 12 to 25 year age range, in a range of mental health settings and were deemed most appropriate for this age group.ConclusionsWith changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years. In particular, multidimensional measures that are clinically meaningful need to be developed to ensure quality and effectiveness in youth mental health. Additionally, outcome measures can be clinically useful when designed to be used within routine feedback monitoring systems.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0664-x) contains supplementary material, which is available to authorized users.

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“…The HoNOSCA is a brief, clinician‐completed measure (Department of Health and Ageing, ) that has been found to be sensitive to change as a result of treatment interventions (Brann & Coleman, ; Garralda, Yates, & Higginson, ; Gowers et al., ; Tiffin & Rolling, ). The HoNOSCA measure was used in this study as it is routinely employed to gather child and adolescent mental health client clinical outcomes within LRH CAMHS.…”

Section: Methodsmentioning

confidence: 99%

Clinical change after the implementation of the Choice and Partnership Approach within an Australian Child and Adolescent Mental Health Service

Naughton

Carroll

Basu

et al. 2017

Child Adoles Ment Health

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Background: The Choice and Partnership Approach (CAPA) model has been implemented widely into Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom and similar health systems in Australia and New Zealand. This study investigated whether the implementation of the CAPA model was related to changes in client clinical outcomes and response times within a regional Australian CAMHS. Method: Multiple measures of time, clinical diagnosis, contact and outcomes were collected at intake and discharge for 33 clients prior to and 77 following the implementation of CAPA. Results: A two-tailed t-test showed that the significantly reduced waiting time was associated with the timing of CAPA implementation. The Health of the Nation Outcome Scales for Children and Adolescents information subscale showed a significant post-CAPA implementation improvement. A chi-square test for independence showed that the CAPA model group had significantly more initial clinical appointments. Conclusions: After the implementation of CAPA, the flow of young people through the service improved, with children and adolescents being seen in a more timely manner. The findings highlighted that the greater client throughput did not negatively impact upon clinical outcomes. Further prospective research with the completion of multi-informant outcome measures is recommended. Key Practitioner Message• Utilising the CAPA model, CAMHS may improve access to and flow through the service without increasing clinical demands.• The CAPA model may lead to young people being seen significantly faster than previously.• One of the six HoNOSCA measures (Information) demonstrated a larger pre-post change for the CAPA cohort than for the comparison group.

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On the Meaning of Change in a Clinician's Routine Measure of Outcome: HoNOSCA

Abstract: From a number of perspectives, change in HoNOSCA total and scale scores is valid. However, several clinical dilemmas must be faced in deciding which approach should be used. The implications of these choices may affect clinicians, patients, carers and managers in understanding change.

Cited by 27 publications

References 37 publications

Innovations in Practice: A case control and follow‐up study of ‘hard to reach’ young people who suffered from multiple complex mental disorders

Innovations in Practice: A case control and follow‐up study of ‘hard to reach’ young people who suffered from multiple complex mental disorders

A systematic review of mental health outcome measures for young people aged 12 to 25 years

Clinical change after the implementation of the Choice and Partnership Approach within an Australian Child and Adolescent Mental Health Service

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