Good Treatment
- A valid diagnosis was made and confirmed with appropriate measures.
- Proven treatments were correctly applied and accepted by the individual.
- The whole response was measured and evaluated using appropriate outcome measures.
Define Outcome
The effect on a patient’s health status that is attributable to an intervention by a health professional or health service
Why measure outcomes? 4
- Allows the CLIENT to monitor his or her own progress.
- Allows the CLINICIAN to monitor the client’s progress
- Allows the CLINICIAN to monitor his or her own PERFORMANCE as a clinician
- Helps with DECISION MAKING regarding which treatments are effective and should be supported and which treatments are less effective and in need for review.
Outcome Measurement 5 TYPES
- Clinical Judgement
- Mental State Examination
- Objective questionnaires
- Clinician rated
- Self-report
Criteria for selecting Objective Questionnaires
- Applicability (relevance, useful for clinician in determining treatment and outcomes, will it give aggregated data on the trmt overall)
- Acceptability (brief, user friendly)
- Practicality (time taken to administer, computer or paper, cost to administer, materials, easy to score and interpret, minimal training needed)
- Reliability (if two clinicians were to give the instrument to someone they would get the same data. also reliable in two settings)
- Validity (measures what it wants to measure)
- Sensitivity to Change (detects changes in a client, in specific ways. Picks up what the intervention is aiming to change).
Kessler Psychological Distress Scale (K10)
GP’s use the K10 in their Mental Health Care Plans.
K10 is a 10-item (5-point Likert) self-report questionnaire intended to yield a global measure of “psychological distress”.
The maximum score is 50 indicating severe distress and the minimum score is 10 indicating no distress.
K10 scoring
Scores range from 10 to 50 <20 well 20-24 mild mental disorder 25-30 moderate mental disorder >30 severe mental disorder
Depression Anxiety and Stress
Scale (DASS)
Depression, Anxiety, Stress
DASS 42, DASS 21
4-point severity/frequency scale over the past week
Scores are summed for the relevant scale items.
Dimensional approach, not just categories.
DASS measures (Depression Scale)
DASS – Depression Scale Dysphoria Hopelessness Devaluation of life Self-deprecation Lack of interest/involvement Anhedonia Inertia Sample item – In the past week... I couldn't seem to experience any positive feeling at all
DASS - Anxiety
Autonomic arousal
Skeletal muscle effects
Situational anxiety
Subjective experience of anxious affect
Sample item – In the past week… I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical
DASS-Stress
Difficulty relaxing Nervous arousal Being easily upset/agitated Irritable/over-reactive Impatient
The Outcome Rating Scale (ORS)
The Session Rating Scale (SRS)
ORS
Individual, interpersonal and social functioning. Short and brief and they put themselves on a continuum line. There is a children’s version (CORS)
SRS
Quality of the relational bond, agreement regarding treatment goals and methods and approach. Assesses
Specific Psychological Tests
- Depression
Eg. Beck Depression Inventory - Anxiety
Eg. Beck Anxiety Inventory
Spence Children’s Anxiety Scale - Post-traumatic Stress Disorder
Posttraumatic Stress Disorder Checklist - Substance Use Disorders
Alcohol, Smoking and Substance Involvement
Screening Test (ASSIST)
Outcome Measurement (OM)
OM is not an administrative, statistical or research undertaking, it addresses the vital question of clinical effectiveness.
Inputs, throughputs and outputs give no information as to clinical effectivenss.
OM requires openness and transparency in clinical practice and empowers consumers. Strong consumer focus.
Outcome Measurement (OM) Complexities
- Mental Illness is episodic.
- Outcomes may not be related to the service received.
- Outcomes should not be viewed in isolation but over time and in context with other relevant clinical information.
- Clinician rated.
- Consumer rated
Principles underpinning the
National OM protocol 1. The Mental Health sector is divided into three types of service
a. Acute Inpatient (admitted overnight)
b. Community Residential (staffed 24 hours)
c. Ambulatory (community treatment teams)
Principles underpinning the
National OM protocol 2.
There are two fundamental business rules:
a. One episode at a time
b. A change of setting = a new episode
Principles underpinning the
National OM protocol 3. Outcome Measurement collection occasions:
a. ‘intake’
b. ‘discharge’
c. ‘91-day review’ (formerly ‘ISP review’)
d. discretionary review’ (formerly ‘review other’)
Principles underpinning the
National OM protocol 4.
Different measures are collected for different age groups (CAMHS, Adult, Aged)
Use of OM data
Clinical application of individual OM data
- Facilitates dialogue between clinicians, consumers and carers
- Assists decision making on treatment and care
- Application of aggregate (team/service level) OM data (Victoria aims to collect OMs regularly)
- Information is used to improve services for consumers
Overview of Measures
Adults
The Behavioural and Symptom Identification Scale (BASIS-32)
- Health of a Nation Outcome Scale (HoNOS) (focus on symptoms)
- Life-Skills Profile (LSP-16) (ability vs disability last 3 months)
- Focus of Care (FOC) (clinician rating scale on what is the primary focus of care for this patient).
HoNOS (1993)
Developed by Royal College of Psychiatrists’ Research Unit (CRU) in 1993.
- 12 scales measuring behaviour, impairment, symptoms and social functioning.
- Most widely used routine clinical outcome measure in English speaking mental health services
- Several Versions: HoNOS (Working age adults) HoNOS65+ (Older adults) HoNOSCA (Children and Adolescents) HoNOS-secure HoNOS-LD (Learning Disabilities) HoNOS-ABI (Acquired Brain Injury)
HoNOS Scales
Problems associated with:
- Aggressive and disruptive behaviour
- Suicidal thoughts and self injurious behaviour
- Drug and alcohol use
- Physical disability
- Mood disturbance
- Hallucinations and delusions
- Other mental and behavioural problems
- Social relationships
- Housing
- Wider social environment
HoNOS Sample Items (1993)
Domain: Overactive, aggressive, disruptive or agitated behaviour
Include such behaviour due to any cause, eg, drugs, alcohol, dementia, psychosis, depression, etc.
Do not include bizarre behaviour, rated at Scale 6.
0 No problems of this kind during the period rated.
1 Irritability, quarrels, restlessness etc. Not requiring action.
2 Includes aggressive gestures, pushing or pestering others; threats or verbal aggression; lesser damage to property (eg, broken cup or window); marked over-activity or agitation.
3 Physically aggressive to others or animals (short of rating 4); threatening manner; more serious over-activity or destruction of property.
4 At least one serious physical attack on others or on animals; destruction of property (e.g., fire-setting); serious intimidation or obscene behaviour.
