Numbers, Circles and Dots –
Why, What Does it Mean?
Margaret Martin
MH-OAT Coordinator
Hunter New England Mental Health
New South Wales
Australia
Australia
New South Wales Map
HNE Health = Size of England
HNE Mental Health: Six Acute Inpatient Units
• Newcastle: 96 beds (includes Intensive
Care, Substance Use & Older Person units)
• Maitland:
26 beds
• Taree:
20 beds
• Tamworth: 25 beds
• Armidale:
8 beds
• C&A:
12 beds
HNE Mental Health Units
Non-Acute
• Newcastle:
• Morisset:
Older Person
• Newcastle:
• Morisset:
• Taree:
• Tamworth:
20 beds
130 beds
18 beds
27 beds
16 beds
15 beds
HNE Community Mental Health Services
•
•
•
•
18 Community Mental Health Services
Struggle with electronic health record system
Outcome Measures last priority
Prefer one to one training
Circles and Dots
• Inpatient staff circle numbers on a form
• Community staff feel it is an administrative
task to dot the numbers electronically – want
to report this as a separate task from their
clinical work
• Lack of comprehension - why and what does it
mean
How to Approach the Challenge
• How do I stimulate clinician interest and
commitment to collecting quality data?
• How to promote relevance and applicability?
Send Detailed reports:
Who looks at them?
Who understands them?
HNE Health Distance Map
Distance map
provides a guide
when planning trips
e.g. Armidale to
Tenterfield 195 klms
Generating Interest
• Describe client profile by HoNOS scores
• Ask clinicians:
– To estimate the total score given
– Do you discuss the ratings with consumer/ other
clinicians
– Does the service profile
accurately reflect your service
Feedback Questions
How to Calculate HoNOS Total Score (in NSW)
HONOS_ HONOS_ HONOS_ HONOS_ HONOS_ HONOS_ HONOS_ HONOS_ HONOS_ HONOS_ HONOS_ HONOS_
1
2
3
4
5
6
7
8
8a
9
10
11
HONOS_
12
Total
Score
0
0
2
0
0
0
0
0X
0
0
4
4
2
0
0
2
0
0
0
0
9X
1
0
4
4
3
0
0
2
0
1
0
0
9X
0
0
4
4
3
0
0
0
0
0
0
0
0X
0
0
2
2
0
0
0
0
1
0
0
0
0X
1
1
9
9
3
0
0
0
1
0
0
0
0X
1
0
9
9
2
0
0
2
0
0
0
0
0X
0
0
0
0
2
0
0
2
0
0
0
0
0X
1
0
0
4
3
0
0
2
0
0
0
0
0X
1
0
0
0
3
0
0
2
0
0
0
0
0X
1
9
9
9
3
0
0
2
0
0
0
0
0X
1
0
0
0
3
0
0
0
0
0
0
0
0X
1
0
0
0
1
9
9
9
9
9
9
9
9X
9
9
9
9
0
0
0
0
0
0
0
0
0X
1
0
0
1
1
0
0
2
0
0
0
0
0X
1
0
0
4
3
0
0
2
0
0
0
0
0X
1
0
0
4
3
Medium Stay Unit: June 2011 and April 2015
Ocuppational
Residential
ADL's
Relationships
Other
Depression
Psychosis
Physical
Cognitive
Substance
Self Harm
Disrup/Aggress
Neuropsychiatry Similar to Older Person?
100
90
80
70
60
50
40
Older Person
Neurpsychiatry
30
20
10
0
Occupational
Residential
ADL's
Relationships
Other
Depression
Psychosis
Physical
Cognitive
Substance
Self Harm
Disrup/Aggress
Changes in Older Person Unit Profile
100
90
80
70
60
50
2009_May: Boronia
-12 Reviews
40
30
2015_Sep: Mater
19 Reviews
20
10
0
Consumer Self Report
•
•
•
•
States had choice of tool
NSW selected Kessler 10
Calculate score – not on form
Score is 10 to 50 with four bands
to measure levels of anxiety and depression:
•
•
•
•
No feelings of distress
Mild
Moderate
Severe
Adult Acute Unit K10 Scores
Admission K10 (288 completed)
180
153
160
140
120
100
80
68
60
40
32
35
Score 20-24
Score 25-29
20
0
Score 10-19
Score 30-50
Discharge K10 (111 completed)
60
57
50
40
30
26
20
16
12
10
0
Score 10-19
Score 20-24
Score 25-29
Score 30-50
Client K10 Scores
Client: K 10 Total Scores
(Client refused Sept Admission)
60
50
49
49
44
40
30
20
20
17
10
0
April Admiss
April Disch
Oct Dish
K10 Score April Discharge (HoNOS Total Score 2)
Total Score 49/50 5 = All of the Time/ 4 = Most of the Time
5
4
3
April
Disch
2
1
Worthless
Extreme
Sad
Life Effort
Depressed
Extreme
Restless
Restless
Hopeless
Extreme
Nervous
0
Nervous
April Disch
Tired
March Admiss
Ask Staff
• Look at the K10 and score
• Discuss scores/ changes in scores with client
• Consider completing the HoNOS with the
client
• Discuss HoNOS changes with client
Where to from here?
•
•
•
•
Implementing major change is difficult
Embedding clinical utility into practice ongoing
Sending information by email has minimal effect
Staff do not look for
information or guides:
– Just ignore the issue
– Ring/email for help
Attitudes