Service evaluation of the need for care and clinical risk management procedures using the Health of the Nation Outcome Scale (HoNOS) secure
| DOI | https://doi.org/10.1108/JFP-11-2018-0047 |
| Pages | 61-70 |
| Date | 31 January 2019 |
| Published date | 31 January 2019 |
| Author | Kim Liddiard,Sara Louise Morgan,Charlotte Hill,Andrew Simmonds |
| Subject Matter | Health & social care |
Service evaluation of the need for care
and clinical risk management procedures
using the Health of the Nation Outcome
Scale (HoNOS) secure
Kim Liddiard, Sara Louise Morgan, Charlotte Hill and Andrew Simmonds
Abstract
Purpose –The purpose of this paper is to explore whether the current forensic mental health inpatient
population within a medium secure unit is more or less complex (i.e. clinical and risk presentations) than
former years using the Health of the Nation Outcome Scale (HoNOS) secure. Additionally, the use of the
HoNOS secure as a service-wide measure is discussed in terms of its usefulness. Clinical implications and
recommendations are offered for the continued use of the HoNOS secure in services more widely.
Design/methodology/approach –A retrospective case review of completed HoNOS secure assessments
for 130 patients over three time intervals 2012, 2015 and 2018 was used. A multivariate analysis was
performed on the data using SPSS version 25.
Findings –The findings revealed that contrary to clinical opinion, inpatients’clinical and risk presentations
had not changed significantly overtime.
Research limitations/implications –The study shows the benefits of using the HoNOS secure at a
service-wide level to explore and understand similarities and differences in inpatient admissions over time. It
also highlights the usefulness of the HoNOS secure for considering different ward characteristics and the
needs of patients residing in these environments.
Originality/value –Although much research exists surrounding the individual use of the HoNOS
secure in relation to outcomes, there is limited research focusing on use of the HoNOS secure at the service
level. The paper therefore provides evidence of the utility and value of the HoNOS secure as a service-level
outcome measure.
Keywords HoNOS secure, Medium secure, Need for care, Risk management, Service evaluation,
Outcome measure
Paper type Research paper
Introduction
The Health of the Nation Outcome Scale (HoNOS) is an outcome measure that was developed
by Bebbington et al. (1999) and Wing et al. (1998) in order to provide a routine measure of
individuals with mental health problems within the general population. It comprises 12 items that
measure behaviour, impairment, symptoms and social functioning.
Since the development of the first HoNOS, subsequent tools have been designed to monitor
outcomes within specific areas of healthcare, one being the development of the HoNOS secure
(Dickens et al., 2007) for forensic settings. The HoNOS secure incorporates an additional seven
security items to measure the need for clinical risk management procedures, alongside the
existing HoNOS items measuring an individual’s need for care.
The Royal College of Psychiatry (RCPsych, 2016) sets standards for low and medium secure
mental health services and one requirement is regular monitoring of patient outcomes. Given that
Received 20 November 2018
Revised 22 January 2019
Accepted 22 January 2019
Kim Liddiard,
Sara Louise Morgan,
Charlotte Hill and Andrew
Simmonds are all based at the
Caswell Clinic, Abertawe Bro
Morgannwg University Health
Board, Bridgend, UK.
DOI 10.1108/JFP-11-2018-0047 VOL. 21 NO. 1 2019, pp. 61-70, © Emerald Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAG E 61
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