HoNOSCA in an adolescent psychiatric inpatient unit: an exploration of outcome measures

Routine Outcome Measures (ROM) are important tools, increasingly used to assess both patient progress and service-provider efficacy. The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a clinician- and patient-rated ROM which summarises a patient's global functioning within behaviour, impairment, symptoms and social domains. Recent literature suggests that consistent disparity exists between the patients' self-ratings and the clinicians' ratings on HoNOSCA. We analysed HoNOSCA data for our own adolescent inpatient unit and report similar findings. Studies have also shown significant differences in both physical and mental health outcomes based on the patient-clinician dynamic and effective communication. We thus investigated the predictive utility of the two HoNOSCA scores, and the disparity between them, with respect to other outcomes measures (CGAS, length of stay and improvement on HoNOSCA). HoNOSCA disparity scores were significantly associated with both patient- and clinician-rated HoNOSCA improvement scores. Moreover, higher admission HoNOSCA scores were associated with greater HoNOSCA improvement scores, for both patient and clinician ratings. We report admission and discharge HoNOSCA scores comparable to other child and adolescent psychiatric inpatient facilities.