Use of Mandatory National Outcome Measures - MHJHADS · Web viewOutcome Measures can guide treatment decisions in the clinical review process, help people recognise their own improvement,

CHHS17/074

Canberra Hospital and Health ServicesClinical ProcedureUse of Mandatory National Outcome Measures in Mental Health Service Delivery AreasContents

Contents....................................................................................................................................2

Purpose.....................................................................................................................................3

Scope........................................................................................................................................ 3

Section 1 – Background.............................................................................................................3

Section 2 – Mandatory Requirements......................................................................................4

Section 3 – Outcome Measures Collection...............................................................................5

Section 4 – Essential Training....................................................................................................6

Implementation........................................................................................................................ 6

Related Policies, Procedures, Guidelines and Legislation.........................................................7

References................................................................................................................................ 7

Definition of Terms...................................................................................................................8

Search Terms............................................................................................................................ 9

Attachments..............................................................................................................................9

Appendix A: Data to be collected at each Collection Occasion within each Mental Health Service Setting, for people in each Age Group....................................................................10

Appendix B: Proposed Future Collection Requirements (from 2018)................................12

Doc Number Version Issued Review Date Area Responsible PageCHHS17/074 1 02/05/2017 01/05/2020 MHJHADS 2 of 12

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS17/074

Purpose

To improve the quality of mental health services provided by ACT Health by: outlining the mandatory requirements for the collection of mental health Outcomes Measures to assist in assessing whether change has occurred for a person as a result of mental health care. The use of Outcome Measures can track a person’s recovery journey over time, identifying areas where clinical interventions are required, using a standardised method.

Scope

All Mental Health, Justice Health, Alcohol and Drug Service (MHJHADS) staff working in Mental Health clinical service delivery settings, including consultation liaison to other CHHS wards.

The Alcohol and Drug Service and Justice Health Primary Health Services are outside of scope for this procedure.

Section 1 – Background

Outcome Measures provide an opportunity for clinicians and people accessing mental health services to help map the journey of recovery over time in line with the National Outcome and Casemix Collection (NOCC) Protocol (for further information refer to the Australian Mental Health Outcomes and Classification Network (AMHOCN) website.

The collection of Outcome Measures is recognised internationally as assisting in the implementation of robust evidence based clinical practice. Outcome Measures can guide treatment decisions in the clinical review process, help people recognise their own improvement, and benefit the clinician’s professional practice. The use of standardised mental health measures are designed to support the assessment, monitoring and review of mental health care in a consistent manner both at an individual level and across the ACT.

Clinical Utility of Outcome MeasuresSeveral studies have shown that the use of Outcome Measures and providing ongoing feedback regarding outcomes can result in improvements in both client engagement and outcome, particularly when feedback is received by both the clinician and the person, and frequently rather than once (Knaup, Koesters, Schoefer, Becker & Pushcner, 2009; Lambert, Harmon, Slade, Whipple & Hawkins, 2005; Miller, Duncan, Brown, Sorrell & Chalk, 2006). The strength of these benefits rely on clinicians who are willing to provide regular and routine feedback to people.



CHHS17/074

In summary, Outcome Measures: Enhance evidence based practice and clinical accountability Complement a clinician’s biopsychosocial assessment of the person Assist in the development of goals and form part of the person’s recovery plan Provide information about whether predicted outcomes are being realised Assist in improving mental health outcomes by identifying any issues and formulating a

plan to address those issues Provide a common language with which to evaluate outcomes Can be used to engage people in the development of their Recovery Plan Identify strengths of the person Enhance the development of the therapeutic relationship Are an indicator that clinicians can review as part of clinical handover and transfer of

care Can enhance conversation with people, their families/carers/nominated persons, the

multidisciplinary team, and other service providers Can help explore differences in perspectives between the clinician and the person Guide a clinician’s professional practice and development Provide a database for benchmarking analysis at the clinical and planning levels

Back to Table of Contents

Section 2 – Mandatory Requirements

It is a mandatory requirement that Outcome Measures are completed at the entry and discharge of each episode of care and at least every three months while in a community or residential setting, and every 35 days in an inpatient setting. These are the minimum requirements, however Outcome Measures can be utilised at any time that is clinically warranted and useful for clinical care.

It is mandatory that all clinicians offer self report measures as an invitation to participate in assessments, treatment planning, reviews and discharge. Completion of self-report Outcome Measures is voluntary.

Appendix A provides an overview of the mandatory measures to be applied to clinical work for Child and Adolescent, Adult and Older Persons Mental Health Services. These include staff rated measures and consumer self-rated questionnaires. These measures and questionnaires can be found in the MHJHADS Electronic Client Record (refer to the Mental Health, Justice Health and Alcohol & Drug Services Electronic Clinical Record Access and Use Procedure).

Appendix B provides information on other measures that clinicians may utilise but are not otherwise currently part of mandatory collection at the time of publication of this document.




CHHS17/074

Section 3 – Outcome Measures Collection

The Outcome Measures that have been endorsed for use in mental health clinical service delivery areas can be found in Appendix A. These are also located on the MHJHADS Electronic Clinical Record.

Procedure 1. The primary clinician working with a person in each service setting is required to

complete the mandatory Outcome Measures for and with the person, in line with the National Outcome and Casemix Collection (NOCC) Standards (refer to Appendix A) and the requirements of the Indpendent Hospital Pricing Authority (IHPA) (refer to Appendix C – Phase of Care). Completion of the self report can be declined by the person.

2. Clinicians will provide each person with an explanation of the purpose of the Outcome Measures. This orientation to the Outcome Measures is best clinicial practice and is a standard requirement. Routine and regular feedback is also to be provided to the person regarding the results of the Outcome Measures and progression of recovery by the primary clinician.

3. Outcome Measures are to be completed at the beginning and end of each episode of care and every 3 months for review in a community setting and every 35 days in an inpatient setting. Clinicians will be prompted to provide Outcome Measures by the MHJHADS electronic clinical record system in line with the NOCC Standards.

4. An episode of care is commenced at the first contact with the person. The point of transfer of primary care from one mental health setting to another is considered a new episode of care and will require revised Outcome Measures. There are three types of setting identified: Inpatient, Community (Ambulatory) and Community Residential. For example, discharge from an inpatient facility (Inaptient Setting) to a community team (Community setting) (and vice versa) require a new episodes of care. A clinician may determine that Outcome Measures are more appropriate to complete at full assessment rather than following a single triage contact, as further information can be obtained at the assessment. A person’s movement between teams of the same setting is considered a transfer: the episode continues and outcome measures are collected in line with the protocol for that setting. Review and discharge Outcome Measures are only required to be completed if the episode of care is longer than two weeks.

5. When completing Outcome Measures, clinicians are to ensure that people and their family and support systems participate in this process, where possible.

6. The results of a person’s Outcome Measures will be discussed routinely at multidisciplinary and clinical review meetings to support treatment decisions.



CHHS17/074

7. Directors and Managers are to ensure that all staff are familiar with the collection and utilisation of Outcome Measures through training, orientation, multidisciplinary team and clinical review discussion, and performance management.


Section 4 – Essential Training

Each team will have an identified ‘NOCC Champion’ who will be responsible for training and assisting new and existing staff with meeting the requirements for completion of the Outcome Measures. The NOCC Champion will be a senior clinician who has undergone ‘Train the Trainer’ NOCC training and/or completed relevant e-learning.

All clinicians working in mental health services will be required to complete the following e-learning via the AMHOCN website on the use of NOCC measures and the clinical utility of using Outcome Measures: Outcome Measures Training for Public Mental Health Services

o Note: Clinicians are to choose either Child and Adolescent, Adult, Child and Adolescent, or Older Adult depending on their work site. Clinicians will be required to complete additional modules if they work across different age groups.

Clinical Utility of Outcome Measures Training

The clinician will submit their certificate of completion to MHJHADS Service Development (with their Manager in copy) for recording on the clinician’s Capabiliti record.

Re-CredentialingClinicians will be required to complete a retraining module every two years to ensure the administration of the measures is being maintained: Retraining in Outcome Measures for Public Mental Health Services

o Note: Clinicians are to choose either Child and Adolescent, Adult, or Older Adult depending on their work site. Clinicians will be required to complete additional modules if they work across different age groups.

The clinician will submit their retraining certificate of completion to MHJHADS Service Development (with their Manager in copy) for recording on the clinician’s Capabiliti record.


Implementation

This procedure will be implemented throughout Mental Health Services in MHJHADS, overseen by Managers and championed by senior clinicians. Expectations will be communicated at staff meetings and Multidiciplinary Team and Clinical Review meetings. The procedures will be incorporated into the essential education sessions on NOCC. The completion of the required Outcome Measures will be reported in monthly Outcome



CHHS17/074

Measures reports to track adherence. The required Outcome Measures and review timeframes will be designed into the electronic clinical record system.


Related Policies, Procedures, Guidelines and Legislation

Policies and Procedures MHJHADS Electronic Clinical Record Access and Use Procedure

Guidelines National Standards for Mental Health Services 2010 National Safety and Quality Health Services Standards 2012 Mental Health National Outcome and Casemix Collection Standards Standards of Practice for ACT Allied Health Professionals Fourth National Mental Health Plan 2009-2014 Fifth National Mental Health Plan (draft) ACT Charter of Rights for People who experience mental health issues Mental Health Statement of Rights and Responsibilities 2012 Australian Charter of Healthcare Rights 2008

Legislation Mental Health Act 2015 Human Rights Act 2004 Children and Young Persons Act 2008 Carers Recognition Act 2010 Health Records (Privacy and Access) Act 1997


References

1. Australian Mental Health Outcomes and Classification Network (2016). [http://amhocn.org/]

2. Knaup, Koesters, Schoefer, Becker, & Pushcner (2009). Effect of feedback on treatment outcome in a specialist mental healthcare: Meta-analysis. British Journal of Psychiatry, 195, 15-22.

3. Lambert, Harmon, Slade, Whipple, & Hawkins (2005). Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions.

4. Journal of Clinical Psychology, 61(2), 165-174.5. Miller, Duncan, Brown, Sorrell & Chalk (2006). Using formal client feedback to improve

retention and outcome: Making ongoing, real-time assessment feasible. Journal of Brief Therapy, 5(1), 5-22.


Definition of Terms



http://amhocn.org/

CHHS17/074

AMHOCN – Australian Mental Health Outcomes and Classification Network.

People – the terms ‘person’ or ‘people’ have been used as a generic term which applies to people accessing MHJHADS who may otherwise be known as clients, patients and consumers.

Mental Health Electronic Clinical Record – The electronic clinical record system currently in use by MHJHADS is Mental Health Assessment Generation and Information Collection (MHAGIC).. From 2017, the electronic clinical record system will be updated to MAJIC ER.

NOCC- National Outcomes and Casemix Collection.

Outcome Measures – staff rated and self report questionnaires that are included in the NOCC protocol. The Outcome Measures required are defined below.

Children and Adolescents (18 years and under)HoNOSCA - Health of the Nations Outcome Scale for Children and Adolescents CGAS - Children’s Global Assessment Scale FIHS - Factors Influencing Health Status SDQ - Strengths and Difficulties QuestionnairePhase of Care (IHPA requirement)Principal and Additional Diagnoses Mental Health Legal Status

Adults (18-65 yrs)HoNOS - Health of Nations Outcome Scale LSP – 16 Life Skills Profile Consumer self-report BASIS 32 - Behaviour And Symptom Identification Scale Principal and Additional Diagnoses Phase of Care (IHPA RequirementMental Health legal Status

Older Persons (65yrs and over)HoNOS 65 + - Health of the Nation Outcome Scale LSP – 16 Life Skills Profile RUG – ADL Resource Utilisation Group – Activities of Daily Living Consumer Self Report – BASIS 32 Behaviour And Symptom Identification Scale Principal and additional Diagnoses Phase of Care (IHPA Requirement)Mental Health Legal Status

Consumer and Carer Measures (proposed from 2018. Refer to Appendix B)Your Experience of Service (YES) Carer Experience of Service (CES)Doc Number Version Issued Review Date Area Responsible PageCHHS17/074 1 02/05/2017 01/05/2020 MHJHADS 8 of 12


CHHS17/074

Living in the Community Questionnaire (LCQ)


Search Terms

National Outcomes and Casemix Collection, NOCC, Outcome Measures, HONOS, SDQ, Basis 32, LSP-16, Focus of Care, CGAS, FIHS, Phase of Care, YES, CES, LCQ.


Attachments

Appendix A: Data to be collected at each Collection Occasion within each Mental Health Service Setting, for people in each Age Group

Appendix B: Proposed Future Collection Requirements (from 2018)

Disclaimer: This document has been developed by ACT Health, MHJHADS specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved By07/03/2017 all



CHHS17/074

Appendix A: Data to be collected at each Collection Occasion within each Mental Health Service Setting, for people in each Age Group

Mental Health Service Setting Collection Occasion

Inpatient Residential CommunityA R D A R D A R D

Children and Adolescents HoNOSCA (1) M M M M M M M M M CGAS M M O M M O M M O FIHS O M M O M M O M M Parent/Consumer Self Report M M M M M M M M M Principal and Additional Diagnoses O M M O M M O M M Mental Health Legal Status O M M O M M O M MAdults HoNOS (1) M M M M M M M M M LSP-16 O O O M M M O M M Consumer self report (BASIS 32,) M M M M M M M M M Principal and Additional Diagnoses O M M O M M O M M Focus of Care/Phase of Care O O O O O O O M M Mental Health Legal Status O M M O M M O M MOlder Persons HoNOS 65+ (1) M M M M M M M M M LSP-16 O O O M M M O M M RUG-ADL M M O M M O O O O Consumer self –report (BASIS 32) M M M M M M M M M Principal and Additional Diagnoses O M M O M M O M M Focus of Care/Phase of Care O O O O M O O M M Mental Health Legal Status O M M O M M O M M



CHHS17/074

Abbreviations and SymbolsA Admission to Mental Health Care M Collection of data on this occasion is mandatory

R Review of Mental Health Care O No collection requirements apply but may be done at the discretion of the clinical manager.

D Discharge from Mental Health Care

Notes:(1) Discharge ratings for the HoNOS, HoNOS65+ and HoNOSCA are not required for

a) inpatient episodes less than 3 days durationb) community episode less than 14 daysc) Transfer of care out of community setting into an inpatient setting

(2) Discharge ratings for the SDQ are not required for any episode of less than 21 days duration because the rating period at discharge (previous month would overlap significantly with the period rated at admission.

(3) The classification of self-report measures as mandatory is intended only to indicate the expectation that people will be invited to complete self-report measures at the specified Collection Occasions, not that such measures will always be appropriate.

(4) The LSP – 16 is not included as a measure for use in inpatient settings as, in its current form, it requires ratings to be based on the person’s functioning over the previous three months. This is difficult for the majority of inpatient episodes which are relatively brief.

(5) Restriction of the Focus of Care/Phase of Care only to community care episodes for adults and older persons is based on experience in the Mental Health-CASC study which found it to be of limited value in inpatient and community residential settings and with children/ adolescents.

(6) Consultation/Liaison services to complete outcome measures as per the community setting (A) at time of assessment.



CHHS17/074

Appendix B: Proposed Future Collection Requirements (from 2018)

At the time of publication of this document, the below Outcome Measures were not yet mandatory for collection. However, under the proposed Fifth National Mental Health Plan three Outcome Measures have been recommended to be included for regular collection and reporting. These measures are self reported by the consumer (two) and carer (one). They are: Your Experience of Service (YES) – consumer completed survey Carer Experience of Service (CES) – carer completed questionnaire Living in the Community Questionnaire (LCQ) – consumer completed

These measures cover a range of domains in the draft Fifth National Mental Health Plan related to consumer and carer outcomes of mental health service contact and the services provided. Further details of these Outcome Measures are available via the AMHOCN website.

Clinicians will be made aware of any changes to mandatory Outcome Measures collection requirements via their Managers.



Documents

Use of Mandatory National Outcome Measures - MHJHADS · Web viewOutcome Measures can guide treatment decisions in the clinical review process, help people recognise their own improvement,