The introduction of outcome measures is part of a national initiative attempting to measure whether a change has occurred for a consumer as a result of mental health care. Using a range of clinician-rated and consumer-rated measures, collectively known as the National Outcomes and Casemix Collection, the consumer and the clinician can map the journey of recovery over time. The information collected can also be used to help mental health services plan for improvements in service delivery.
Frequently Asked Questions
The regular assessment of outcomes has been an aim of the National Mental Health Strategy since it was first agreed by all Australian Health Ministers in 1992 and has been highlighted in subsequent National Mental Health Plans. Implementation of the selected measures comprising the National Outcomes and Casemix Collection (NOCC) in public sector mental health services commenced under the Second National Mental Health Plan (1998 – 2003) and has continued with nearly all state and territory mental health services now involved in the routine collection and use of consumer outcomes data.
Some of the frequently asked questions and answers about the NOCC suite are listed below. AMHOCN is happy to respond to any queries you may have about the use of the outcome measures. Submit your question via the form below.
AMHOCN has also created Online Forums that provide an opportunity for people to discuss issues that relate to the use of the NOCC measures being collected and used across the main population groups in mental health services.
The measures that comprise the National Outcomes and Casemix Collection (NOCC) are:
- Health of the Nation Outcome Scales (HoNOS);
- Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA);
- Health of the Nation Outcome Scales 65+ (HoNOS65+);
- Life Skills Profile 16 (LSP-16);
- Resource Utilisation Groups – Activities of Daily Living Scale (RUG-ADL);
- Children’s Global Assessment Scale (CGAS);
- Mental Health Inventory (MHI);
- Behaviour and Symptom Identification Scale 32 (BASIS-32®);
- Kessler-10 Plus (K-10+);
- Strengths and Difficulties Questionnaire (SDQ)
- Factors Influencing Health Status (FIHS); and
- Focus of Care (FOC).
The reporting requirements for the provision of the NOCC dataset by States and Territories to the Australian Government are outlined in The Mental Health National Outcomes and Casemix Collection: Technical specification of State and Territory reporting requirements.
The document provides details about the:
data content of all items included in the Mental Health National Outcomes and Casemix Collection;
business rules to be followed in the reporting of those data items (i.e. what data are required when); and
extract format to be used when preparing data files for submission to the Australian Government.
Outcome measures contribute to the development of clinical practice, aiming to improve the quality of care for consumers of Australia’s public sector mental health services. Outcome measures can assist consumers in considering options for their care and treatment and support the development of a therapeutic relationship between the clinician and the consumer. The measures can also be used by clinicians to monitor the progress of the consumer, evaluate the effectiveness of treatments and thereby provide information that will assist decisions about clinical practices. The outcome measures can also be used by team leaders and service managers to better understand the needs of their consumers, to plan for the allocation of resources and to identify where service improvements are required.
By using a range of outcome measures, consumers and clinicians can work together to map the journey of recovery over time.
No. The consumer does not have to be present. The Health of the Nation Outcome Scales (HoNOS) - including also the family of measures the HoNOS65+ and the HoNOSCA - is not a clinical interview. Mental health staff gather information from all sources available to them to complete the measure including: collateral information from key informants, review of the medical records, previous HoNOS ratings, as well as interview and observation. There are occasions when some information is not readily available; but be that as it is, mental health staff are still undertaking an assessment and making clinical decisions regarding the best approach to initial or ongoing management of the consumer based on that assessment. Given this clinical process, the HoNOS can still provide a summary of the clinician’s assessment based on the best available information. As a result, the reality is that the HoNOS, and other members of the HoNOS family, can be completed during telephone triage and discharge processes, including lost to care and other occasions when the consumer is not present.
Scale 11 Problems with living conditions This scale requires a knowledge of the patient’s usual domestic environment during the period rated, whether at home or in some other residential setting. If this information is not available (usually because someone is in an acute setting who has not previously been in contact with services), rate 9 (not known). Where a patient is in a longer term placement such as a long stay rehabilitation setting, if the plan of care is for that person to remain in that setting for at least 6 months then it is that environment that should be rated. Consider the overall level of performance this patient could reasonably be expected to achieve given appropriate help in an appropriate domestic environment. Take into account the balance of skills and disabilities. How far does the environment restrict, or support, the patient’s optimal performance and quality of life? Do staff know (as they should) what the patient’s capacities are? The rating must be realistic, taking into account the overall problem level during the period, ratings on scales 1-10, and information on the following points: • are the basics provided for – heat, light, food, money, clothes, security and dignity? If the basic level conditions are not met, rate 4; • consider the quality and training of staff relationships with staff or with relatives or friends at home; degree of opportunity and encouragement to improve motivation and maximise skills, including: interpersonal problems; provision for privacy and indoor recreation; problems with other residents; helpfulness of neighbours. Is the atmosphere welcoming! Are there opportunities to demonstrate and use skills: e.g. to cook, manage money, exercise talents and choice, and maintain individuality? If full autonomy has been achieved, i.e. the residential environment does not restrict optimum performance overall, rate 0; • a less full but adequate regime is rated 1. Between these poles, an overall judgement is required as to how far the environment restricts achievable autonomy during the period – 2 indicates moderate restriction and 3 substantial.
Scale 12 Problems with occupation and activities The principles considered at scale 11 also apply to the outside environment. This scale requires a knowledge of the patient’s usual day time environment during the period rated, whether at home or in some other residential setting. If this information is not available (usually because someone is in an acute setting who has not previously been in contact with services), rate 9 (not known). Where a patient is in a longer term placement such as a long stay rehab setting, if the plan of care is for that person to remain in that setting for at least 6 months then it is the environment around that placement that should be rated. Consider arrangements for encouraging activities such as: shopping; using local transport; amenities such as libraries; understanding local geography; possible physical risks in some areas; use of recreational facilities. Take into account accessibility, hours of availability, and suitability of the occupational environment provided for this patient at day hospital, drop-in or day centre, sheltered workshop, etc. Are specific (e.g. educational) courses available to correct deficits or provide new skills and interests? Is a sheltered outside space available if the patient is vulnerable in public (e.g. because of odd mannerisms, talking to self, etc.)? For how long is the patient unoccupied during the day? Do staff know what the patient’s capacities are? The rating is based on an overall assessment of the extent to which the daytime environment brings out the best abilities of the patient during the period rated, whatever the level of disability rated at scale 10. This requires a judgement as to how far changing the environment is likely to improve performance and quality of life and whether any lack of motivation can be overcome. • If the level of autonomy in daytime activities is not restricted, rate 0. A less full but adequate regime is rated 1. • If minimal conditions for daytime activities are not met (with the patient severely neglected and/or with virtually nothing constructive to do), rate 4. • Between these poles, a judgement is required as to how far the environment restricts achievable autonomy – 2 indicates moderate restriction and 3 substantial.