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HoNOS family of measures

The Health of the Nation Outcome Scale (HoNOS) is a clinician-rated tool

It is used to measure the health and social functioning of people using services. It was developed by the United Kingdom Royal College of Psychiatrists Research Unit.

There are six measures in the HoNOS suite:

  • HoNOS: for adults aged 18 to 64 years.

  • HoNOSCA: for children and adolescents aged 4 to 17 years.

  • HoNOS65+: amended version of the HoNOS for adults aged 65 and over.

  • HoNOS-LD: for adults who have a dual diagnosis, such as mental illness and an intellectual disability.

  • HoNOS-secure: for adults who are being supported by forensic services.

  • HoNOSI: for infants aged 0 to 47 months (for collection from 1 July, 2023. Mandatory collection from 1 July, 2024).

National HoNOS summary reports are sent to Te Whatu Ora districts and some NGOs every three months. The reports provide an overall picture of data quality, what has changed for people using services, and how services perform.

HoNOS training

A range of training options are available to introduce clinicians to the HoNOS family of measures or to refresh their knowledge. Te Pou also offers training for people to become HoNOS outcome trainers within their service.

Changes to HoNOS transfer rules

From 1 July 2021, important collection rules connected to transfers between community and inpatient settings are changing. More information about the changes are available in a clinicians factsheet and a more detailed technical webpage.

HoNOS research

Revision of HoNOS and HoNOS 65+

A range of national and international research activities have been carried out recently in the review of the HoNOS and HoNOS65+ tools. The revised versions are known as HoNOS 2018 and HoNOS OA (older adults) respectively. Te Pou recently supported a content validity review of the HoNOS 2018 and HoNOS OA (older adults).

Further work is required to understand the utility of the revised tool within the New Zealand context, including a review of the acceptability among the broader mental health sector.

New Zealand is also taking part in international work to revise the HoNOS-LD (for adults with learning disabilities). Te Pou will share details once the revision is completed.

Collection protocol

DHBs and some NGOs are required by the Ministry of Health to collect HoNOS information, therefore clinicians need to be trained in HoNOS collection.

Te Pou developed an Information Collection Protocol (ICP) which describes how, when and what outcomes information is collected. In order for the information to be useful, it is essential that the outcomes collection is carried out as directed in the ICP.

The ICP requires that an outcomes collection is completed at the start and end of periods of care, in either inpatient or community settings and at three-monthly intervals, when treatment is more than three months

The National Outcomes Collection: Clinician's Reference Guide outlines everything clinicians need to know to collect and use HoNOS appropriately.

Guides for clinicians

A set of New Zealand guides have been developed as a resource for:

  • clinicians and managers in mental health services
  • site coordinators and data quality personnel
  • outcomes trainers (to assist deliver training in their respective services).

Each guide brings together resources that have previously been available as separate documents. These include the Clinician’s Reference Guide Version 2.1, 2014; the Mental Health Outcomes Information Collection Protocol (ICP) Version 3.0, and the original e-booklets for each of the HoNOS measures.

Each measure in the HoNOS family has a guide available.

Outcomes graph builders

A set of outcomes graph builders for Microsoft Excel 2007 or later have been designed for clinicians who have limited access to IT tools. Each builder is an Excel file that allows you to enter a service user's outcomes data (HoNOS, HoNOS65+, HoNOSCA, HoNOS-secure, HoNOS-LD or Kessler 10+) into a rating form, to generate a graph which can be shown to the service user or used in a team discussion when reviewing the person's care.

Achieving collection compliance

Outcome collection rates are important to improve the quality of data collected. Te Pou provides assistance to ensure DHBs meet Ministry of Health collection targets.

Involving tāngata whai ora and whānau

Often tāngata whai ora and their whānau are not aware that one of the HoNOS family of measures is collected about them. However, involving them in outcomes collection can improve the quality and quantity of data collected.

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