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A review and update of the Health of the Nation Outcome Scales (HoNOS)

  • Mick James (a1), Jon Painter (a2), Bill Buckingham (a3) and Malcolm W. Stewart (a4)
Abstract
Aims and method

The Health of the Nation Outcome Scales (HoNOS) and its older adults’ version (HoNOS 65+) have been used widely for 20 years, but their glossaries have not been revised to reflect clinicians' experiences or changes in service delivery. The Royal College of Psychiatrists convened an international advisory board, with UK, Australian and New Zealand expertise, to identify desirable amendments. The aim was to improve rater experience by removing ambiguity and inconsistency in the glossary rather than more radical revision.

Results

Changes proposed to the HoNOS are reported. HoNOS 65+ changes will be reported separately. Based on the views and experience of the countries involved, a series of amendments were identified.

Clinical implications

While effective clinician training remains critically important, these revisions aim to improve intra- and interrater reliability and improve validity. Next steps will depend on feedback from HoNOS users. Reliability and validity testing will depend on funding.

Declaration of interest

None.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Mick James via (Emma.George@rcpsych.ac.uk)
References
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A review and update of the Health of the Nation Outcome Scales (HoNOS)

  • Mick James (a1), Jon Painter (a2), Bill Buckingham (a3) and Malcolm W. Stewart (a4)
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eLetters

Misuse & Limitations of HONOS

Frederick Souza Faria, Worcestershire health & Care NHS Trust
23 May 2018

This is timely and important review of Health of Nation Outcome Scales (HONOS) as the instrument is used in each patient assessed by secondary care psychiatric services in the NHS organisation I work for and probably reflects practice across the UK. However the interpretation of the questions varies from assessor to assessor who belong to various disciplines. The level of training undertaken by staff too seems variable. Hence the plea for clarity and guidance with individual questions is extremely relevant to produce valid and reliable information.

The scale is used to control access and discharge from services as the scores result in "care clusters". Hence certain clusters which include patients with common mental health problems or have been stable for some time are excluded from secondary care services. In practise, scores generated from the scale trumps clinical judgement and in my view it is important to clarify what the instrument should and should not be used for. The scale does not quite capture "complexity" and co-morbidity. This includes personality disorder or difficulties which influence the service offered to patient as well as response.

In addition secondary care are receiving increasing referrals of patients with Developmental Disorders including Adult Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) with co-morbid psychiatric syndromes. It would be helpful to clarify if poor concentration could be scored under cognitive problems and impulsiveness under other mental and behavioural problems. Patients with ASD have life long problems with relationships, complex social functioning and occupational activities and clarity on scoring would be invaluable.

HONOS has stood the test of time but the scale needs refining and proper use closely monitored.

Conflict of interest.

I do work for the NHS and am required to use the scale in each patient I manage.
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Conflict of interest: I work for the NHS and have to use the scale in every patient I manage.

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