Outcomes measures
Excellent mental health services which support recovery, monitor and measure changes in people’s health, wellbeing and circumstances over time. Measuring outcomes for people using mental health and addiction services supports the best possible service delivery and understanding of how well services are doing. Te Pou helps the workforce focus on recovery by providing tools for, and training on, outcomes measurement and mental health information.
Sharing outcomes information is also a therapeutic activity that is highly valued by people receiving services. People want to know how they’re doing.
Using outcomes information well improves services and ensures they are recovery driven, people focused and culturally responsive. Outcomes information also supports continuous quality improvement and innovation.
Outcomes information can assist:
- service users to use their own outcomes data to reflect on their wellbeing and circumstances, talk to clinicians about their support needs and inform their recovery plans
- clinicians to use outcomes information to support their decision-making in day-to-day practice, monitoring change, better understanding the needs of the service user, and also to begin evaluating the effectiveness of different interventions
- planners and funders to assess population needs for mental health services and assist with allocation of resources
- policy and mental health strategy developments through nationally aggregated data.
The Ministry of Health’s national dataset, PRIMHD (Programme for the Integration of Mental Health Data) collects information from DHBs. This single rich source of information informs positive changes in services.
The Health of the Nations Outcomes Scale (HoNOS) family of measures are the first standard measures of assessment and recovery mandated by the Ministry of Health for collecting mental health outcome information in New Zealand. A number of countries including the United Kingdom, Norway and Australia also use these tools.
The Alcohol and Drug Outcome Measure (ADOM) is a brief outcome measure which consists of 18 questions relevant to New Zealand alcohol and other drug (AOD) services. The tool focuses on a range of substances and can be used in a range of services.
Taku Reo, Taku Mauri Ora - My Voice, My Life is a tangata whaiora/service user self-assessed outcomes measure.
HoNOS family of measures
The HoNOS family of measures consists of:
- HoNOS - designed for adult service users between the age 18 and 65 years
- HoNOSCA - designed for children and adolescent service users between the age of 4 and 17 years
- HoNOS65+ - amended version of the HoNOS designed for adult service users over the age of 65
- HoNOS-LD - designed for adult service users who have a dual diagnosis, such as mental illness and an intellectual disability
- HoNOS-secure - designed for adult service users who are being supported by forensic services
The Ministry of Health requires trained clinicians in all DHBs to collect HoNOS, HoNOS65+ and HoNOSCA. From 1 July 2012 relevant services will also be required to collect HoNOS-LD and HoNOS-secure. Te Pou has developed an Information Collection Protocol which describes how the data is collected.
Non government organisations are increasingly interested in using HoNOS information in their services.
Check out outcomes training for more information about the HoNOS family of measures.
Additional outcomes measures
In addition to the above outcomes measures, there are a number of rating scales which may also have some relevance to the mental health community.
The Adelaide University rating scale website covers much of this material, but here the emphasis is on a number of specific measures.
This list is limited to some of the more useful and popular rating scales used in the New Zealand setting, with the focus on symptom rating scales, functioning rating scales and service user self report scales.
Symptom rating scales
Beck Depression Inventory (BDI) - a highly-regarded validated measure for assessing the severity of depression. It consists of 21 multiple-choice self-report questions, designed for people over 13 years old.
Hamilton Anxiety rating scale - a widely-used clinician-rated, validated measure for assessing anxiety. It consists of 14 questions and can be used for both adults and children.
Positive and Negative Symptom Scale (PANSS) - a reliable, validated measure used to assess the positive and negative symptoms of schizophrenia. It consists of 30 items, clinician-rated on a seven-point scale (where 1=absent and 7= extreme).
Functioning rating scales
Camberwell Assessment of Need (CAN) is a family of questionnaires for assessing the wide range of problems that can be experienced by a mental health service user with severe mental health problems. It was developed in the 1990s (Phelan et al., 1995) and exists in a variety of formats, one of which is the CAN Short Appraisal Schedule, CANSAS.
The Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) is a short (one-page) assessment which summarises whether a person with mental health problems has difficulties in 22 different areas of life, and whether they are currently receiving any effective help with these difficulties. CANSAS is designed to be used in routine clinical work or as an outcome measure in research studies.
The adult CAN was developed and tested for use with adults of working age (16-65) who were in contact with mental health services, and were receiving treatment in hospital, community and NGO settings.
Useful links
- Kings College London - Institute of Psychiatry
Additional reading
- Factor structure in the Camberwell assessment of need
- Reliability of the Camberwell assessment of need
- Comparitive study
- Development and evaluation of a service user rated version of CAN
Service user self report scales
The Kessler 10 (K10) is a short questionnaire used to assess stress, anxiety and depression levels of service users when they enter a service, and ongoing until discharge. The self-report scales can be shared with mental health workers to help with recovery planning.
In some states in Australia clinicians are mandated to ask service users if they would like to fill out the K10. There is a fun Australian DVD called ‘Breaking News with Sarah Tonin.’ It shows service user actors and others discussing how they might use the K10. The DVD is available from the Mental Health Coordinating Council (MHCC).
Client-Directed Outcomes Informed (CDOI) clinical work - tools developed by therapists for service users. They are quick and easy tools which can demonstrate how things are going.
Outcomes Rating Scale (ORS) - can be completed by a service user before a session with their mental health worker. The scale focuses on the previous week and rating four areas of life. The ratings can help decide what to work on - focusing on what is and isn't working in life.
Session Rating Scale (SRS) - the SRS has only four questions. The answers show what a service user thinks about the session they've just had with a mental health worker.
International outcome links
- Australian Mental Health Outcomes and Classification Network
- NSW Mental Health Outcome and Assessment Portal
- Ohio Mental Health Consumer Outcome Initiative
- Victoria (Australia) Mental Health Outcomes
- Scott D Miller’s website for clinical excellence and outcome measurement
