Hi Merrie

Hi Merrie,

Oakrise CAMHS has been developing and using an integrated outcomes assessment database(Clinical Outcome and Tracking System(COaTS)). We are using HONOSCA at the moment but only because our state mental health service has begun using a system called OARS(from NSW, Wentworth Area Health I think). Prior to this we were using the SOPISCA(Severity of Psychiatric Illness Scale- Adolescent). We are using FACES-III as a way of tracking family functioning and the Ohio Youth Problem, Functioning and Satisfaction Scales to gather parental and client information about symptoms and satisfaction.

Part of the implementation of all this has been to develop as low-profile a data collection system as possible. Probably 98-100% of our clients complete the initial assessments prior to the first appointment. The data is entered into our database by the clinicians as part of the initial registration of clients. We then have a protocol for follow-up assessments at 6 month intervals whilst the case is open and then a final assessment 6 months after discharge.

We have now been collecting data for 2 years (about 950 initial assessments)and are in the process of analysing some of the instruments used in terms of whether they provide a useful and integrated picture of client issues. The main problem with the whole approach is that we have been getting very low return of follow-up assessments(<100). I am thinking about using the next 12 months to trial a simple 7 question outcome format which can be gathered in 5-10 minutes over the phone. We used this methodology in some research we did on single sessions and it provided excellent data but we have done nothing further in looking at validity and etc.

Obviously most of this stuff should be looked at on a national basis. But, it certainly seems like that process has stalled and in the meantime CAMHS in Tasmania has been getting pressure to adopt the adult database which doesn't assess what we would like and comes with a range of Federal Govt DHAC data collection agendas.

One of the things that I am most pleased about is that we developed and introduced this data collection system as a team of clinicians. All the clinicians are as interested and involved in the design of the data system and it's implementation as the developer(me). We truly 'own' this as a team and I have not worked in any other team where the issue of data collection has been worked on collaborativley by clinicians. Usually IT and management impose a system which is then maintained and implemented incredibly poorly. Interestingly I read some documentation regarding the development of outcomes assessment systems for CAMHS that recommended that clinicians not be involved in the design and delivery phase!! If anything I think that this would be a recipe for corrupt data.

I would be happy to communicate(there doesn't seem to be an email equivalent to "talk"). If you have ICQ or MSN Messanger perhaps we could set up a time to chat about it? Maybe we could identify a group of people in CAMHS and have an online forum about this... not dominated by the existing power heirachy - whoever that is - as this whole area seems to bring out the territorial imperative in most of the people that I have talked to.

Merrie

For clinical outcomes measurement I use:

* HoNOSCA

* CGAS: Child Global Assessment Scale.

This is consistent with our service overall where HoNOS and GAF are used with the Adult Teams.

* GFES: Global Family Environment Scale. I use the GARF: Global Assessment of Relational Functioning from the DSMIV with the GFES. These scales are the ones used in the MHCASC project which ran nationally in 1996 with about 60 trial sites. They didn't use the GARF. I don't think the CGAS/GFES tell you much though. They need to be anchored far better so that you can accurately scale clinical change with them. I heard a few years ago that a Sydney hospital was trialing a Measurement Of Functioning Scale because of the problems they saw with the CGAS. I can't remember details. Others may know.

I use the SDQ: Strengths and Difficulties Questionnaire in my assessments but have not used it as an outcome measure.

I have a consumer survey form which I don't use systematically.

There is a child version of the Brief Psychiatric Rating Scale (BPRS): BPRS-C. I have written to the authors and they will be posting me information. I have seen a copy of the form and it looks very useful. I have used the BPRS with older adolescents and first episode psychosis.

We have been considering using the Achenbach Child Behaviour Checklist

(CBCL) as a standard tool but it is costly resources-wise. I heard recently that there were moves nationally to implement standard use of a cut-down version of the CBCL. This would be useful.

Email me off list and I can send you some stuff.

Regards

Alistair, I would love to know more about FACES3, can you msn me on valpain@hotmail.com

cheers,
Valeri

All

I have been involved in a group looking at this report and providing further advice on how we may be able to progress outcome measures across the states and territories.

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Denise,