We are currently trying to find new measures to evaluate our program. We currently use the new Beck Youth Inventories, the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Children's Depression Inventory (CDI), the Revised Childrens Manifest Anxiety Scale (RCMAS) and the parenting style questionnaire based on PPP program. Our respondents/observers include teachers, parents, children and case workers/nurses. I was wondering if anyone can suggest measures which might prove more sensitive and child friendly for measuring behavioral/emotional change.

I understand that the HoNOS-CA is gaining more and more popularity in Australian child and adolescent mental health services. I can give you contact details of services in Victoria that are using it if you are interested.

I think it would be a good idea for your team to look at the reports by Nurcombe and Bickman on this very issue. As services we seem to be 'falling' towards the HONOSCA and the CBCL because 'other' people are using them. Yet there are some serious problems with using them as ongoing measures of clinical outcome. Also, it sounds like you are looking for assessments that are more relevant for your young people to complete. Nurcome and Bickman cover this ground very thoroughly.

try Goodman's (1997?) Strengths & Difficulties Questionnaire, 25 items only and free; has sound inter-correlation with CBCL, also I suggest you measure obstacles to Participation using Kazdin, Holland etc (1997) Barriers to Participation scale as treatment non-response is not just a failure of ttreatment but an effect of success in overcoming berriers to participation,

If you are interested the SDQ forms are at this web-site: http://www.youthinmind.uklinux.net/

I have been running social skills groups for children aged 8-12 years and have trialled using the strengths and difficulties questionairre by Robert goodman. It is free and there is a Goodman has done a fairly large study comparing the use of this to the CBCL. Advantages being Goodmans is much shorter at 25 items and is free to use. It is available from his research articles in the Journal of child Psychology and Psychiatry (97 ). There is also a self report form being developed but I think this is for 11- 16 yrs.

Can you also send me a copy of the groups using HONOS-CA.

This is the first post ive done so excuse me if i fail the tech challenge.

Re HoNOSCA in Victoria

While it is true that it has been gaing momentum, I do think it is important that people realise that the big issue is the context in which the outcome measure is implemented and utilised. This holds ture for all instrumetns. The contextual and pragmatic elements of routine outcome measurement isoften under estimated and then the instrumetn becomes devalued through lack of effective use of the reuslts. That said:
In Vic, you could talk to Tom Callaly at Geelong CAMHS. They participated in the MH CASC trial (casemix) and have continued. They ahve worked hard at integrating the information system and outcome measures into a impressive database. There experince is more adult than CAMHS but CAMHS is working with it there.

JOhn MAtthai at MHSKY (Royal CHildrens Hospital) has also been doing reserach around the inpatient service there with HoNSOCA. Grampains CMAHS (BAllarat) has been using HoNOSCA and the SDQ and I thnk can describe very well the challenges for a rural service in bootstrapping itself into outcomes and data collection. They will all underplay their work but ignore that. I thnk they have some good lessons to share.

At Maroondah, we have approx 5 years experience now with HoNOSCA and 2 1/2 with the Strength and Difficluties Questionaire. The service committed itself to becoming informed by its outcomes some tme back. I think the strength of what we ahve done at MAroondah is that this is a whoel of service routine approach and we ahve concentretd on pragmatics as well as reliability and validity. We published the first article in Aust NZ J PSychiatry mid last year on HoNSOCA and that contains relaibility and validity data. I presented at the Chidl PSychiatry Traing Program late last year on an overview of HoNOSCA. This covers the usaul suspects: reliability , validity, pargmatics, uses made of it , clinicians perceptions of it etc. I'm happy to forward that (powerpoint presentaion)if its not taken out of context. Or if there is a better way of sharing that, let me know. W At Maroondah we have HoNOSCA incorporated into our complete case managmetn, intake allocation, case review, and discharge process.

It's not perfect but i think we have learned an awful lot about outcome measure in the real clinical world.In summary, Honosca is a good outcome measure if the criteria are brief, useful, inexpensive, sensitive to change, reliable and vlaid enough. Sure it does not capture everything or all perspectives but unfrotuantlye routine outcome mesures are not like clothes (ie one size does not fit all- equally well). We laso use the SDQ as we are working towards a system where we ahve clinician , carer/parent, child input. we'll extend this to teacher once we have the rest settled. In a normal clinical CAMHS there is only so much that should be introduced at once.

The reason why HonOSCA appears as an appendix in the BIckman, Nurcombe report is that the reserach had only started to appear (combined iwth the treaditional USA-UK divide). The SDQ reserach was missed for simialr reasons. We are also enged in a community school based norming of the SDQ for Victoria with Deakin University, but another day for that.

As there has been considerable interest with respect to this issue, we could put your PowerPoint presentation on line at the AICAFMHA website. Its obviously up to you whether you feel comfortable doing that.

If you are OK about this then email it to me and I will put it up on line.

Good luck with the PhD.

Could you send me the reference for the ANZ publication. We have data on the Honosca and the Ohio scales over the last two years that I am working into a paper.

One thought about all of these posts is that there are a lot of us doing very similar things but there doesn't seem to be any central coordination. If you think about it we are generating an enormous amount of good clinical data which could be coordinated to answer some basic and more advanced questions in this area. Question is why aren't we coordinating ourselves?

One problem is that coordinated research costs money - but luckily not much - if the basic data collection is being done routinely. Perhaps a few interested people could get together and nut out some important research questions that require a longitudinal, comparative outcomes monitoring design (I already have several in mind!) and put in a collaborative research application to NH&MRC or even to State Mental Health Branches? Historically NH&MRC have not been good at funding service based research but this appears to be turning around a bit following the recommendations of the Wills Report, which the Feds are supporting.

Just to let you know that Prof Michael Sawyer has brought together a national group to look at the issue of outcome meausures in child and adolescent mental health.

Nick Kowalenko and myself (both AICAFMHA Board members) are on this group. I will raise with the group at the next meeting how some of the deliberations from that committee can be communicated. Previously Beverely Raphael had suggested that AICAFMHA may be an appropriate body to act as a clearing house for some of this information.

Regards

A Queensland group has been meeting to discuss outcome measures for child and youth MS services. We would be keen to be involved on a national level, I'm sure.