New Zealand Experiences

Transcription

1 New Zealand Experiences Robyn Shearer Chief Executive Richard Woodcock Service and Information Development Manager

2 What doesn t get measured doesn t get managed

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4 Our journey with Routine Outcome Measurement Ministry of Health funding health agreements Research undertaken HONOs family endorsed Embed HONOs via training A national collection system was also built - PRIMHD

5 Why we did this Improve mental health outcomes for patients Embed principles of recovery into practice Change mental health service culture Improve clinician & patient shared decision making

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8 Individual Team Service National

9 How to use ROM in clinical practice Case Study: How can a team turn data into useful information.

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13 A thought We have to collect these tools anyway so why not try to make use of them?

14 HoNOS as an individual engagement tool patients want to know how they are doing useful for patients to know how they are progressing over time. Patients developing their own plans and goals.

15 Rating the HoNOS

16 Brief narrative Jude is a 40 year women with a 10 year history of depression received support from the local community mental health team over a six month period lives alone, has no children and is unemployed Jude s involvement in treatment decisions is important to her.

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18 Collaborative planning Jude: HoNOS items Collaborative planning Item and rating Nurse Jude (7) Depression 3 ensure Jude has Venlafaxine Jude: HoNOS and items taking as prescribed ensure Jude has a chance to talk through the issues which are affecting her. take Venlafaxine use distraction techniques use sleeping pill if necessary call CATT if unsafe (to organise respite). (2) Self harm 2 monitor Jude s mental state and provide risk assessment with regular home visits. (8H) Sleep 2 ensure Jude has a supply of Zopiclone and taking as prescribed. use distraction techniques (e.g. crochet to keep my hands busy or tearing up old phonebook). use sleeping pill if necessary stay awake and go for a walk in the day set up budgeting appointment with Citizens Advice Bureau.

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20 Collaborative planning Jude: Review - HoNOS items Item and rating Nurse Jude (7) Depression 2 ensure Jude takes Venlafaxine as per prescription ensure Jude can talk with key worker at least weekly. continue Venlafaxine use distraction techniques continue to attend CBT keep journal (CBT homework) call CATT if unsafe (to organise respite) (2) Self harm 2 Monitor mental state regularly. use distraction techniques (e.g. crochet to keep my hands busy or tearing up old phonebook) have a nice haircut (reward). (8D) Stress 2 ensure Jude takes Venlafaxine encourage Jude with the Workwise and gym use. keep going to budgeting register with Workwise for help to look for a job use free gym 2 times a week.

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22 Collaborative planning Jude: Discharge - HoNOS items Item and rating Nurse Jude (7) Depression 1 ensure Jude takes Venlafaxine as per prescription ensure Jude has opportunity to talk with key worker regularly. (8D) Stress 1 ensure 1:1 sessions with Jude continue on 2 weekly basis. (9) Relationships 1 encourage Jude with her social activity plans. continue Venlafaxine use distraction techniques continue to attend CBT keep journal (CBT homework) call CATT if unsafe (to organise respite). use CBT skills go for 3 walks a week keep budgeting keep applying for work (Workwise). go to wellness group go to family dinner on Sundays ring three friends and go for a walk.

23 Clinicians feeding back outcomes information the importance of feedback for all outcomes research evidence that feedback is itself a therapeutic activity.

24 Allocating referrals case weighting based on severity index of severity (based on HoNOS items): sub-clinical = all items <2 mild = at least one item > 1 and all items <3 moderate = one item >=3 severe = at least 2 items >=3 using first 10 items.

25 Allocating referrals aggregating case loads for clinician 1 to 7 clinician 3 has 31 people on his case load clinician 4 has 30 people on her case load clinician 7 has 17 people on his case load.

26 Index of severity last admission or review for current Patients Index of Severity: sub-clinical = all items <2, mild = at least one item > 1 and all items <3, moderate = one item >=3, severe = at least 2 items >=3 using first 10 items.

27 Average number of clinically significant items last admission or review for current service users Average number of HoNOS items in the clinically significant range (scoring 2, 3, or 4).

28 Use of HoNOS HoNOS is not a decision making tool but it is a tool for helping to make good decisions.

29 Purpose of the questions 1 2a 2b 2c 3 Are we the right service? Concordance Change Concerns Priorities Identifying people who could or should be discharged/ Permission to discharge. Encourage fuller, multi-perspective understanding of the person. Identifying positive and negative changes over time. Identifying issues to be addressed. Identifying the plans to address them. Specifying highest priority changes to promote recovery.

30 Using this approach to make more efficient and effective discussions in multi disciplinary teams Completed prior to review One page long Quick to complete Helps to clarify thinking about this person Focuses on identifying solutions

31 Training resources HoNOS training online Feedback scenarios Hemi (HoNOSCA) Outcomes Graph Builder Trainers Forum 4 Service User's Scores Over Time Name: Mr Elroy NHI: 3 Time 1: Admission Time 2: 3 months 2 Time 3: 6 months Scale 1 Other Categories Time 1: None Time 2: None Time 3: None 0 AGR SH AOD COG PHY Del/HAL DEP OTH REL ADL LIV OCC Unable to Rate -1 HoNOS65+ Item

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33 HoNOS e-booklets A new training resource available Find them, and other HoNOS resources at

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