The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle.

Charlotte L Hall,Kapil Sayal,Karen Newell,Chris Hollis,Michael Marriott,Maria Moldavsky,Laurence Baldwin,John Taylor

doi:10.1186/1471-244x-13-270

Abstract

BackgroundRoutine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research).MethodsWith the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013.ResultsThe findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user.ConclusionsThe findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers.

Highlights

Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes
Measures recommended by the Consortium were more likely to be used, with HoNOSCA being the most frequently reported, followed by Children’s Global Assessment Scale (C-GAS)
The Strengths and Difficulties Questionnaire (SDQ) parent and self-reported versions were more likely to be completed than the teacher version, and use of parent and self-reported SDQ had significantly increased since the original audit

Summary

Introduction

Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Outcome measures offer a window on the clinical effectiveness of interventions, providing important information to clinicians, managers, commissioners and service users. The importance of measuring outcomes within Child and Adolescent Mental Health Services (CAMHS) was recognised in England through the government’s NHS Outcomes Framework policy [1] and the National Service Framework (NSF) [2] for children and young. The Consortium originally recommended the use of four outcome measures: the Strengths and Difficulties Questionnaire (SDQ) [3], the Children’s Global Assessment Scale (C-GAS) [4], the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) [5], and the Commission for Health Improvement-Experience of Service Questionnaire (CHI-ESQ) [6]. Measures that are only completed at one time point cannot measure withinindividual change which is an essential feature of outcome measurement, as such the completion of the same measure at follow-up is crucial to meet the criteria of outcome measurement

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