HOW TO..HoNOS and RiO Contents: Background to HoNOS (extract from Trust website) Page 2 How to Rate HoNOS Page 2 The Mental Health Clustering Tool Page 3 How to use HoNOS process flow For teams using RiO and those not yet using RiO Page 4 Appendix 1 HoNOS Score Sheet for teams using RiO Page 5 Appendix 2 HoNOS Supplement Information Sheet for teams not using RiO Page 6 How to use HoNOS and RiO v1.0.doc Page 1 of 6
One global clinical outcomes measurement tool is being introduced across all services. This is the Health of the Nation Outcomes Scales (HoNOS), it is used to measure change in a person s mental health, well being and social functioning. Clinical staff e.g. doctors and nurses, assess a patient s HoNOS score when they are first assessed and again when they are discharged. By comparing these two records, the impact, or outcome, of the care and treatment provided for an individual patient can be measured. Using health outcomes in reflective clinical practice requires a link to be made between three types of information. First, the context of care (setting, diagnosis, demographics like age and gender) must be noted. Second measurements of health status before and after interventions are undertaken. Third, a record of treatment used is made. HoNOS consists of 12 items which measure behaviour, impairment, symptoms, and social functioning. The original tool was designed for working age adults; adapted versions (link to image) are available for use with:- Older Peoples Services (HoNOS65+) Children and Young Adults (HoNOS-CA) Forensic Settings (HoNOS-Secure) For adults with Learning Disabilities (HoNOS-LD) Acquired Brain Injury (HoNOS-ABI) HoNOS is recorded at initial assessment to our services, at CPA review and at discharge from care. By comparing the severity of each scale item outcome measures are generated. How to rate HoNOS Consider a two week period, or condition at discharge Rate the most severe problem in the rating period Use the glossary to define severity rating Rate each scale item in order 1-12 Rate scale 8 with one letter and number Complete rating setting identification and date of last day in rating period. HoNOS records are entered onto an electronic database, HECS2. This system can generate basic reports showing: The amount of records made by each team or service The number of record pairs made suitable for analysing outcomes Average total HoNOS scores Average HoNOS scale scores Typical clinical outcomes by diagnosis The changes in an individual client's HoNOS scores can also be reviewed over time too. How to use HoNOS and RiO v1.0.doc Page 2 of 6
Staff can obtain login accounts by contacting Liz Vernon-Wilson at the Clinical Outcomes Team elizabeth.vernon-wilson@hantspt-sw.nhs.uk Monthly extracts of the data held on HECS are used to develop more tailored clinical outcomes reports. These may include clinical outcomes measured for groups defined by their age, gender, initial symptom severity, or length of stay*. These reports are shared amongst similar teams in each directorate. The information is also used to inform commissioners of our services' impact and to benchmark our activities with our mental health care providers. *Length of stay here is the period between HoNOS admission record and discharge record. For further information about HoNOS please follow the link below to the Trust website: http://www.hampshirepartnership.nhs.uk/departments-and-directories/corporate/medicaldirectorate/outcomes The Mental Health Clustering Tool The MHCT, or Mental Health Clustering Tool, is an extended version of HoNOS/65+ used to help mental health care professionals group service users with similar needs into care clusters. HoNOS and HoNOS65+ form the basis of the tool; additional historical items provide a richer description of service users current problems. Care clusters will be used as the basis for allocating resources in line with changes to how our services are funded known as payment by results. Training will be provided in rating the new items found in the MHCT, clustering service users and capturing this information on RiO as teams begin to implement this practice in 2011. In the meantime, HoNOS (for working age adults) can be recorded as items 1-12 in the Cluster Tool page of outcome measures menu on RiO. HoNOS65+ can be recorded in its own page also found on the outcome measures menu. How to use HoNOS and RiO v1.0.doc Page 3 of 6
For further information For Teams using HoNOS only Admin Team For Teams using HoNOS and RiO How to use HoNOS and RiO v1.0.doc Page 4 of 6
HoNOS 2009/10 Patient Forename: Patient Surname: Date of Birth: NHS number: Postcode: HoNOS Score Sheet Gender: Place sticker here Ward / Team Base Name Service Type (please circle) Inpatients / CMHT/ CRHT/ AOT / EIP/ Day services Consultant Name Rater Name (& Profession) Key NB. Rate preceding fortnight or condition at discharge for acute services. 0 = No problem, 1 = minor problem-requiring no action, 2 = Mild problem but definitely present,3 = Moderate, 4 = Severe, U = Not known (avoid using if possible) Score sheets with more than 2 U unknown scores will be returned Sheets with more than 2 unknown items will be returned Last DATE of rated period here dd/mm/yyyy Rating Setting ID 1) Hospital admission, 2) Hospital review 3) Hospital discharge 4) Community initial assessment 5) Community review 6) Community discharge 7) Outpatients initial assessment 8) Outpatients review 9) Outpatients discharge 10) Crisis team admission 11) Crisis team discharge 12) Liaison assessment 13) other (specify) 1) Overactive, aggressive, disruptive or agitated behaviour 2) Non-accidental self-injury 3) Problem drinking or drug taking 4) Cognitive Problems 5) Physical illness or disability problems 6) Problems with hallucinations and delusions 7) Problems with depressed mood 8) Other mental or behavioural problems () Rate 0 for no problem Specify single most severe disorder A J Not Rated Elsewhere 9) Problems with relationships 10) Problems with activities of daily living 11) Problems with living conditions 12) Problems with occupation and activities Total Primary Diagnosis 1) Dementia, 2) Delirium, 3) Substance misuse -drug 4) Substance misuse -alcohol 5) Schizophrenia/ schizoaffective disorder 6) Bipolar 7) Depression 8) Eating disorders 9) Borderline personality disorder 10) MCI (mild cognitive impairment) A-J 1-11 How to use HoNOS and RiO v1.0.doc Page 5 of 6
HoNOS 2010/11 HoNOS Supplement Information Sheet For use alongside RiO Patient Identification Patient Forename Date of Birth NHS number Postcode Surname Place sticker here Gender Record Date Last date of fortnight rated period here dd/mm/yyyy Ward / Team Base Name Service Type Inpatients PICU CRHT CMHT AOT EIP Other (please state) Consultant Name Rater Name Care pathway setting Admission Review Discharge Transfer Other Rater Profession Nurse MHP Consultant Staff grade Assoc Spec SPR ST 1-3 Psychologist Other (state) Primary Diagnosis (select one) Dementia Delirium Substance Misuse Drug Alcohol Schizophrenia/Schizoaffective disorder Bipolar Depression Eating Disorders Borderline personality disorder MCI Other (please specify) How to use HoNOS and RiO v1.0.doc Page 6 of 6