Using the Health of the Nation Outcome Scales in clinical practice

Abstract

Aims and methodTo describe the implementation of a plan to use a validated outcome measure in the care and treatment of people with severe mental illness within a district general hospital psychiatric service. Multiple techniques were necessary to promote actual change of practice.ResultsA survey of practice found 77% of full Care Programme Approach patients to have recorded Health of the Nation Outcome Scales (HoNOS) scores in their care plans one year after the beginning of the implementation plan.Clinical implicationsIt is possible to incorporate the use of HoNOS in to everyday practice but it takes a lot of time, effort and resources. Mental health services may require a clearer indication from the NHS Executive regarding the use of such outcome scales before committing themselves.

A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures

“…Audits of the extent to which the HoNOS is being used in particular settings have generally lent support to the latter view. Glover and Sinclair-Smith [ 57 ] found that 60% of mental health care provider trusts in Britain had implemented routine outcome measurement (with the majority using the HoNOS), and James and Kehoe [ 58 ] found that 77% of consumers in a UK district service had HoNOS scores recorded in their care plans. The latter finding was supported by Broadbent [ 41 ], who found that the HoNOS was completed for the majority of consumers on an electronic case register in the UK.…”

“…Reports of clinicians' experiences with using the HoNOS have been more mixed. James and Kehoe [ 58 ], Broadbent [ 41 ] and Milne et al [ 59 ] found that UK clinicians were relatively positive about the HoNOS, viewing it as potentially useful, but insisting that its ongoing use would depend on adequate resourcing, infrastructure, training and feeback. By contrast, Gilbody [ 54 ] found that many UK psychiatrists questioned the instrument's usefulness.…”

A research study to identify facilitators and barriers to outcome measure implementation

“…Black and Thompson (1993) found physicians generally understand the need for audit, although Nettleton and Ireland (2000) report that junior doctors had little understanding of the process itself. This suggests that facilitating outcome-measure implementation involves incorporating training not only on how to use the measure but also of wider audit and quality issues (James and Kehoe, 1999;Hughes et al, 2004b, Hughes et al, 2004c. Training may also help health professionals identify how audit may be useful in clinical practice, rather than a meaningless exercise, as some studies suggest (Nettleton and Ireland, 2000).…”

Local initiatives in clinical effectiveness

“…We have subsequently stopped using most of these and have implemented the widespread use of a single measure, HoNOS, initially in all those people subject to 'full CPA'. This again has been costly in implementation, using a cascade system of training staff (James & Kehoe, 1999). A recent audit found that almost 100% of full CPA cases had regular HoNOS scoring performed by their keyworker alongside CPA reviews.…”