On the meaning of change in a clinician's routine measure of outcome: HoNOSCA.
OBJECTIVE
With the advent of routine outcomes across Australia and New Zealand, clinicians, managers, parents and children will be interested in change on these measures. This paper presents a number of approaches and the implications.


METHODS
Health of the Nations Outcome Scales for Children and Adolescents (HoNOSCA) collected during clinical practice for 911 patients were examined for changes over time, clinical significance, treatment status, effect size, and reliable and clinically significant change.


RESULTS
Statistically significant changes in symptom severity were found related to treatment status and to changes in the number of clinically significant scales. An effect size of almost one standard deviation was noted and the proportion of patients who improved was examined. While the reliable change index was calculated, there are clinical complications with this approach. The impact of the capacity to change on specific scales illustrates a critical issue in describing outcomes.


CONCLUSIONS
From a number of perspectives, change in HoNOSCA total and scale scores is valid. However, several clinical dilemmas must be faced in deciding which approach should be used. The implications of these choices may affect clinicians, patients, carers and managers in understanding change.
Eastern Health CAMHS, Box Hill, Victoria, Australia. peter.brann@easternhealth.org.au
Peter
P
Brann
Grahame
G
Coleman
D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D008605:Mental Health Services / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D012720:Severity of Illness Index