Assessing Outcomes in Routine Clinical Practice
The focus of the definitions of recovery presented so far has been on outcome measurement in research, including longitudinal outcome studies and studies of treatment effectiveness. However, the drive towards evidence-based practice has fuelled demand for the introduction of routine outcome measures for assessing individual outcomes and for the evaluation of services (Slade, Thornicroft and Glover, 1999; Eagar, Trauer and Mellsop, 2005; Slade et al., 2006; Priebe et al., 2007; Valenstein et al., 2009). Outcome measures for routine use have also often failed to embrace a recovery orientation. A number of authors have proposed domains for outcome measurement. In a systematic review of this literature, Slade (2002)
identified seven categories of patient-level outcome domains: wellbeing, cognition/ emotion, behaviour, physical health, interpersonal, society and satisfaction with service (Slade, 2002). The majority of authors took a medical perspective and focused the staff viewpoint on ameliorating disability. The only review that emphasized the client’s subjective experience came from the consumer-oriented literature, and included domains of wellbeing, recovery (defined in terms of cognition, emotion and functioning), self-help and empowerment – representing a recovery-oriented focus (see Slade, 2002, for the full review).
In Australia, which was at the forefront of introducing mandatory routine outcome measures, a number of existing tools were selected for routine use (Stedman et al., 1997). Two clinician-rated adult mental health outcome measures have been introduced into most Australian states, the Health of a Nation Outcome Scales (HoNOS; Wing et al., 1998) and the Life Skills Profile (LSP-16; Rosen, Hadzi-Pavlovic and Parker, 1989). In addition, one client-rated measure is mandatory, and varies between states. In New South Wales the Kessler-10 (K-10; Andrews and Slade, 2001) is used (Department of Health NSW, 2006). The HoNOS consists of 12 items assessing four domains: symptoms, impairment, behaviour and functioning. The LSP-16 consists of five scales: Self-Care, Non-Turbulence, Social Contact, Communication, and Responsibility. The client-rated K-10 assesses depression and anxiety symptoms.
While assessment should, ideally, contribute something to the clinical process, rather than representing a burden on clinicians and consumers, consumers found that these measures – which are typical of those used elsewhere – were not used to initiate change, and moreover do not assess those things important to them (Happell, 2008). Lakeman (2004) cautioned that, rather than informing recoveryoriented practice, such measures ‘have little, if anything, [to] do with or offer to the recovery process. Indeed, they strip the person’s experience of all meaning and reduce it to predetermined categories’ (p. 212). A recent Australian review of outcome measures for ‘chronic’ mental illness has acknowledged the value of subjective assessments such as quality of life, perceived needs and recovery (Trauer, 2010).
The focus of the definitions of recovery presented so far has been on outcome measurement in research, including longitudinal outcome studies and studies of treatment effectiveness. However, the drive towards evidence-based practice has fuelled demand for the introduction of routine outcome measures for assessing individual outcomes and for the evaluation of services (Slade, Thornicroft and Glover, 1999; Eagar, Trauer and Mellsop, 2005; Slade et al., 2006; Priebe et al., 2007; Valenstein et al., 2009). Outcome measures for routine use have also often failed to embrace a recovery orientation. A number of authors have proposed domains for outcome measurement. In a systematic review of this literature, Slade (2002)
identified seven categories of patient-level outcome domains: wellbeing, cognition/ emotion, behaviour, physical health, interpersonal, society and satisfaction with service (Slade, 2002). The majority of authors took a medical perspective and focused the staff viewpoint on ameliorating disability. The only review that emphasized the client’s subjective experience came from the consumer-oriented literature, and included domains of wellbeing, recovery (defined in terms of cognition, emotion and functioning), self-help and empowerment – representing a recovery-oriented focus (see Slade, 2002, for the full review).
In Australia, which was at the forefront of introducing mandatory routine outcome measures, a number of existing tools were selected for routine use (Stedman et al., 1997). Two clinician-rated adult mental health outcome measures have been introduced into most Australian states, the Health of a Nation Outcome Scales (HoNOS; Wing et al., 1998) and the Life Skills Profile (LSP-16; Rosen, Hadzi-Pavlovic and Parker, 1989). In addition, one client-rated measure is mandatory, and varies between states. In New South Wales the Kessler-10 (K-10; Andrews and Slade, 2001) is used (Department of Health NSW, 2006). The HoNOS consists of 12 items assessing four domains: symptoms, impairment, behaviour and functioning. The LSP-16 consists of five scales: Self-Care, Non-Turbulence, Social Contact, Communication, and Responsibility. The client-rated K-10 assesses depression and anxiety symptoms.
While assessment should, ideally, contribute something to the clinical process, rather than representing a burden on clinicians and consumers, consumers found that these measures – which are typical of those used elsewhere – were not used to initiate change, and moreover do not assess those things important to them (Happell, 2008). Lakeman (2004) cautioned that, rather than informing recoveryoriented practice, such measures ‘have little, if anything, [to] do with or offer to the recovery process. Indeed, they strip the person’s experience of all meaning and reduce it to predetermined categories’ (p. 212). A recent Australian review of outcome measures for ‘chronic’ mental illness has acknowledged the value of subjective assessments such as quality of life, perceived needs and recovery (Trauer, 2010).
