|
HoNOS
HOW TO USE HoNOS: SOME COMMON QUESTIONS ANSWERED
What is HoNOS?
Is a set of 12 scales, each one measuring a type of problem commonly
presented by patients/clients in mental health care settings. A completed
HoNOS score sheet provides a profile of 12 severity ratings and a total
score. It is a numerical record of a clinical assessment but does not
replace clinical notes or any other records. It is intended that it
becomes an integral part of a minimum data set and a basic component
of CPA.
How are outcomes measured using HoNOS?
By comparing the severity of each problem recorded at the first
rating (Time 1) with the ratings made on a second or subasequent occasion
(Time 2).
How is severity measured?
Severity is measured on a five-point Scale (0,1,2,3,4).
0 = no problem within the period rated
1 = sub-threshold problem
2 = mild but definately present
3 = moderately severe
4 = severe to very severe
Brief examples of each rating point are given for each of the 12 scales
in the Glossary which is used alongside the score sheet.
What period does each assessment cover?
The most severe problems present during the 2 previous weeks or a locally
agreed relevant time period e.g. since last review or during the last
month are rated.
Who fills in HoNOS and when?
HoNOS is recommended for use by qualified mental health care practitioners,
called Raters. However any experienced mental health worker who has
been trained in the use of HoNOS adn achieves similar scores to other
qualified health practitioners can use HoNOS. If HoNOS is completed
as part of a CPA review/ward round, a consensus will be reached on HoNOS
ratings by the team which will include qualified mental health practitioners,
although the person who records the ratings decided will not necessarily
be a qualified practitioner. The scales should be completed by the same
individual or a similar team at each timepoint as this is good practice.
But this is not always possible particularly in acute inpatient settings.
Training helps raters rate similarly, and thus ensures reliability.
When is HoNOS completed?
It is completed directly after a routine assessment/CPA review/ward
round etc.
What questions are asked in the assessment?
HoNOS is not a structured interview. The assessment is made in the ususal
way. More issues may need to be discussed than were once required, and/or
information from other members of the care team, or the carer can be
considered.
Are patient/client's views included in the ratings?
Ratings of every item are made on the basis of clinical judgement, not
patient/client's perceptions.
How is the HoNOS filled in?
Each item is described in the Glossary. Always start at item 1 and work
down through the score sheet. Choose a severity rating for each item
and enter it in the corresponding item box on the score sheet. Suggested
items of background information have their own page of definitions.
How do I know where on the score sheet to rate a particular
problem?
HoNOS items are arranged in a special order so as to avoid rating the
content of any of them twice. All itemns are rated at every rating point.
They are always rated in the order 1 to 12. When one item has been rated,
the contents are not considered when rating items further down the score
sheet. For example, if there is a patient/client who is hallucinating
and aggressive, the severity of 'aggressive behaviour' is rated in Item
1. At Item 6, only the severity/impact of hallucinations is rated. Similarly,
'suicidal behaviour' is rated at Scale 2 and the severity of depressed
mood, if present, at Scale 7. Guidance is provided in the Glossary.
What if two problems are present on the same scale
but of different severity?
This happens quite often because some scales represent a wide range
of problems.
Always rate the most severe problem that has occurred during the chosen
rating period.
What rating is given if a problem like serious violence
or serious suicidal attempt has occurred only once during the period
rated?
Such events are always rated (4), even if they only occur once in the
period
Is the personal information confidential?
Yes, if used, the A4 charts are anonymous. A number unique for each
patient/client is needed to link repeated assessments of the same individual
but only aggregated data are used in reports. The socio-demographic
data are very important for reseach purposes but cannot be used to identify
patients. This information is not needed if self-adhesive score sheets
are put in the notes.
What is the procedure when the same patient/client
is rated more than once?
A fresh score sheet is completed on each occasion. If A4 score sheets
are used, there should be a Chart on the back on which to enter rater's
initials and profession, today's date, the date of the patient/clicne
assessment and the period rated in weeks as a minimum. Information such
as diagnosis is useful for statistical analysis, but is not a requirement.
What information should be used to make the ratings?
Use all available information, including case records and reports from
other informants, e.g. ratings could be made following a CPA review,
taking into account information from any/all members of the multidisciplinary
team.
Why should I rate a second time if I know there will
be no clinical change?
To be able to measure lack of change, i.e. a steady state or changes
other than in clinical condition.
What if there is insufficient information available
to make a rating?
If it is impossible to make an informated estimate of the severity of
an item, enter the rating point '9'. This should be avoided if possible;
if used rating of 9 are not included in the total score.
Where are targets and interventions recorded?
HoNOS does not set targets or specify interventions. It is used to rate
'health outcomes' not 'health care' outcomes so interventions are not
taken into consideration when rating items. Having rated an item at
levels 2-4, this will normally indicate that an intervention is required.
Edited by Gavin Andrews MD, UNSW, Jan 03
© 2003 CRUfAD
|