Routine outcome measurement in a child and adolescent mental health service: an evaluation of HoNOSCA

Objective: This paper evaluates a range of properties for a clinician-based instrument designed for routine use in a child and adolescent mental healt h service (CAMHS). Method: The Health of the Nation Outcome Scales for Children and Adolescent s (HoNOSCA) is a new outcome measure with great promise. Case vignettes wer e used to examine interrater reliability. HoNOSCA was implemented for routi ne outpatient use by multidisciplinary staff with a return rate of 84%. The 305 ratings obtained at assessment were analysed by age, gender and diagno sis. A sample of 145 paired ratings with a 3-month interval were examined f or the measurement of change over time. Results: Interrater reliability of the total score indicates moderate relia bility if absolute scores are used and good reliability if the total score is used for relative comparisons. Most scales have good to very good reliab ility. The scales discriminated between age and gender in the expected way. HoNOSCA correlated with clinicians' views of change and was sensitive to c hange over a 3-month period. The total score seemed a proxy for severity. Conclusion: Routine outcome instruments must be explored in settings where they will be used and with realistic training. HoNOSCA appears to be of val ue in routine outcome measurement and although questions remain about relia bility and validity, the results strongly support further investigation.