Health of the Nation Outcome Scales for Children and Adolescents

Varied symptoms and problems: (Hanssen-Bauer et al., 2007; n = 169 raters, rating 20 one page clinical vignettes of outpatients with mean age = 10.6 (4.26) years, age range = 4-17, male = 10; mean HoNOSCA total score = 18.34)

• SEM for entire group = 3.51 points

Varied symptoms and problems: (Hanssen-Bauer et al., 2007; n = 3 raters, rating 20 one page clinical vignettes of outpatients with mean age = 10.6 (4.26) years, age range = 4-17, male = 10; mean HoNOSCA total score = 20.05 and sample of 30 consecutively referred patients at intake with mean age = 8.84 (2.24) years, age range = 4.1-12.5, male = 19 ; mean HoNOSCA total score = 18.67)

• SEM for HoNOSCA total score of 30 outpatients at intake = 2.59
• SEM for HoNOSCA total score of 20 clinical vignettes = 2.93 points

Inpatient Psychiatric Treatment: (Boon et al., 2019; n = 12,547, male = 7,700; mean age at admission = 11.35 (3.57) years, range = 6-18 years)

• Mildly severe: (n = 2,079, calculated by initial total score of 1-31, mean (SD) = 6.86 (3.31) 
  • Cutoff point calculated to be 4, meaning if score increases by 4 they are classified as “deteriorated”, if the score decreases by 4 they are classified as “improved”, and if score stages within -3 and +3 of initial value then it is classified as “no reliable change”
• Moderately severe (n = 3,821, calculated by initial total score of 3-34, mean (SD) = 9.47 (3.20)
  • Cutoff point calculated to be 4, meaning if score increases by 4 they are classified as “deteriorated”, if the score decreases by 4 they are classified as “improved”, and if score stages within -3 and +3 of initial value than it is classified as “no reliable change”
• Very severe (n = 6,345, calculated by initial total score of 6-51, mean (SD) = 16.23 (5.47)
  • Cutoff point calculated to be 7, meaning if score increases by 7 they are classified as “deteriorated”, if the score decreases by 7 they are classified as “improved”, and if score stages within -6 and +6 of initial value than it is classified as “no reliable change”

Eating disorders (Anorexia Nervosa): (Gowers et al., 2002; n = 96 in-patients with mean age = 15.05 years (range = 13-18), female = 69; mean HoNOSCA scores over time; clinician-rated and self-report (HoNOSCA-SR) versions)

Mean clinician-rated and self-report HoNOSCA scores over time for in-patient cases in treatment for 18 weeks (n = 18)

Inpatient Psychiatric Treatment: (Boon et al., 2019; n = 12,547)

• Mean total score at admission = 12.37 (5.86)
• Mean total score at discharge = 8.84 (6.21)
• Moderate effect size of 0.59

Inpatient Psychiatric Treatment: (Harnett et al., 2005; n = 51 adolescent patients; mean age = 15.05 years (range = 12-17); female = 41%; HoNOSCA completed at intake and at 3- and 6-months following admission)

• Mean score at admission = 15.86 (5.45, range = 5-28)

Eating disorders (Anorexia Nervosa): (Gowers et al., 2002; n = 54 out-patients with mean age = 15.6 years, all female; mean HoNOSCA scores over time; clinician-rated and self-report (HoNOSCA-SR) versions)

Mean clinician-rated and self-report HoNOSCA scores over time for out-patient cases in treatment for 18 weeks (n = 17)

Outpatient/Day Patient Psychiatric Treatment: (Garralda et al., 2000; n = 203; children attending two or more times)

Scores on HoNOSCA in children attending two or more times

*Clinical score = total score without the information subgroup.

Outpatient Psychiatric Treatment for Adolescents: (Mathiassen et al., 2012; n = 132, mean age = 11.5 (2.4) years; male = 72; children/adolescents treated at three outpatient child and adolescent mental health services (CAMHS) in northern Norway; score on HoNOSCA)

• Mean score at intake = 12.35 (5.29, n = 128)
• Mean score at assessment = 11.11 (4.41, n = 118)
• Mean score at follow-up = 7.91 (4.34, n = 97)

Outpatient/Day Patient Psychiatric Treatment: (Wyl et al., 2017, n = 1,533; mean age = 12.06 (3.70) years, age range = 4.01-17.98; German translation (HoNOSCA-D))

• Mean total score = 12.41 (5.76)

Eating disorders (Anorexia Nervosa): (Gowers et. al 2022, n = 24; Inpatient treatment test-retest reliability determined within 1 week of admission)

• Acceptable test-retest reliability for total score (ICC = 0.806)

Inpatient Psychiatric Treatment: (Boon et al., 2019; sample of n = 397 patients; HoNOSCA completed twice within ten days during treatment)

•  Acceptable test-retest reliability for total score: (ICC = 0.812)

Inpatient Psychiatric Treatment: (Harnett et. al, 2005, n = 51; calculated from initial HoNOSCA score and subsequent score provided 2-4 weeks later)

• Acceptable test-retest reliability for total score (ICC = 0.80)

Outpatient/Day Patient Psychiatric Treatment: (Garralda et al., 2000; n = 53, cases for which clinicians had considered there had been no global clinical change over the 6-month period—test-retest reliability of initial (mean age (SD) = 11.58 (4.45)) years and 6-month follow-up (10.77 (3.74) HoNOSCA scores.

• Questionable test-retest reliability between initial and 6-month follow-up scores (r = 0.69)

Inpatient Psychiatric Treatment: (Hunt and Wheatley, 2009; n = 24, female = 16, age range = 13-18 years, mean age for males = 15 years, 8 months, mean age for females = 17 years, 0 months; all participants in secure unit presented with disturbed and challenging behavior and met criteria for detention; Pearson correlation for the total HoNOSCA scores between clinical psychologist and assistant psychologist used to analyze interrater reliability)

• Excellent interrater reliability for total score (ICC = 0.92)

Inpatient Psychiatric Treatment: (Harnett et. al, 2005; interrater reliability between two trained psychologists)

• Excellent interrater reliability (ICC = 0.96)

Outpatient/Day Patient Psychiatric Treatment: (Garralda et al., 2000; n = 15; Case Vignettes rated by three trained raters)

• Excellent interrater relatiability for psychiatric symptoms (ICC = 0.82)
• Adequate interrater reliability for physical and social imairment (ICC = 0.42-0.61)
• Poor interrater reliability for knowledge about difficulties (ICC = 0.27)
• Poor interrater reliability for knowledge about services (ICC = 0.03)

Varied symptoms and problems: (Hanssen-Bauer et al., 2007; n = 169 clinician-raters, each rating 20 one page clinical vignettes of patients with mean age = 10.6 (4.26) years, age range = 4-17, male = 10; mean HoNOSCA total score = 18.34)

• Excellent interrater reliability (ICC = 0.81)

Varied symptoms and problems: (Hanssen-Bauer et al., 2007; n = 3 clinician-raters, each rating 20 one page clinical vignettes of patients with mean age = 10.6 (4.26) years, age range = 4-17, male = 10; mean HoNOSCA total score = 20.05 and sample of 30 consecutively referred patients at intake with mean age = 8.84 (2.24) years, age range = 4.1-12.5, male = 19 ; mean HoNOSCA total score = 18.67)

• Excellent interrater reliability for 20 clinical vignettes (ICC = 0.88)
• Adequate interrater reliability for 30 patients at intake (ICC = 0.74)

Inpatient Psychiatric Treatment: (Harnett et. al, 2005)

• Poor internal consistency (Cronbach’s alpha = 0.45)

Outpatient/Day Patient Psychiatric Treatment: (Wyl et al., 2017)

• Poor internal consistency for total score (Cronbach’s alpha = 0.63) 

Concurrent Validity

Eating disorders (Anorexia Nervosa): (Gowers et al., 2002)

• Excellent concurrent validity between the HoNOSCA-SR and the Strengths and Difficulties Questionnaire (r = 0.66, p < 0.001, n = 39)

Inpatient Psychiatric Treatment: (Hunt and Wheatley, 2009)

• Adequate concurrent validity between HoNOSCA and Breif Psychiatric Rating Scale (r = 0.57, p < 0.01)
• Adequate concurrent validity between HoNOSCA and Beck Depression Inventory (r = 0.42, p < 0.05)
• Adequate concurrent validity between HoNOSCA and Children’s Global Assessment Scale/Global Assessment Scale (r = -0.35, p < 0.05)

Inpatient Psychiatric Treatment: (Harnett et. al, 2005)

• Adequate concurrent validity between HoNOSCA score at admission and mean number of critical incidents patients were involved in each per month (r = 0.34, p < 0.05)

Eating disorders (Anorexia Nervosa): (Gowers et al., 2002; self-report (HoNOSCA-SR) version)

• Excellent concurrent validity of the HoNOSCA-SR with the Eating Disorder Inventory–2  (r = 0.629, p < 0.001, n = 53)
• Adequate concurrent validity of the HoNOSCA-SR with the Morgan-Russell severity schedule total score (r = -0.32, p = 0.018, n = 54)

Outpatient/Day Patient Psychiatric Treatment: (Yates et al., 1999; n = 248; male = 166; HoNOSCA clinical score equals sum of the 13 clinical features only)

• Adequate concurrent validity between HoNOSCA clinical score and the Strengths and Difficulties Questionnaire (r = 0.397, p < 0.01)

Convergent Validity

Eating disorders (Anorexia Nervosa): (Gowers et al., 2002; in-patient group, n = 18; self-report (HoNOSCA-SR) version)

• Poor convergent validity between clinician rated HoNOSCA and HoNOSA-SR at presentation (r = 0.27)
• Adequate convergent validity between clinician rated HoNOSCA and HoNOSA-SR at discharge (r = 0.58)

Inpatient Psychiatric Treatment: (Harnett et. al, 2005)

• Adequate convergent validity between total HoNOSCA and Paddington Complexity Scale (PCS) (r = 0.46)
• Poor to Excellent convergent validity between items of HoNOSCA at intake and mean PCS scores at intake: 
  • Excellent for overactivity/aggression (r = 0.66)
  • Poor for scholastic/language problems (r = 0.26)
  • Poor for psychotic symptoms: (r = 0.25)
  • Adequate for peer relationships: (r = 0.33)
  • Adequate for self-care and relationship problems: (r = 0.33)

Eating disorders (Anorexia Nervosa): (Gowers et al., 2002; out-patient group, n = 17; self-report (HoNOSCA-SR) version)

• Adequate convergent validity between clinician rated HoNOSCA and HoNOSA-SR at presentation (r = 0.58)
• Excellent convergent validity between clinician rated HoNOSCA and HoNOSA-SR at discharge (r = 0.72)

Varied symptoms and problems: (Hanssen-Bauer et al., 2007; n = 3 clinician raters, each rating 20 one page clinical vignettes of patients with mean age = 10.6 (4.26) years, age range = 4-17, male = 10; mean HoNOSCA total score = 20.05)

• Convergent Validity between mean scores of HoNOSCA and Children’s Global Assessment scale (CGAS)(Hanssen-Bauer et. al, 2007, n = 30)
  • Excellent convergent validity between the mean of all raters for the HoNOSCA total score and Children’s Global Assessment scale (CGAS) (r = 0.84)
  • Excellent convergent validity between mean of all raters for the  HoNOSCA total score and Global Assessment of Psychosocial Disability (GAPD) (r = 0.82)

Outpatient/Day Patient Psychiatric Treatment: (Garralda et. al 2000; n = 203, age range = 3 – 17 years; mean change between assessment and 6-month follow-up)

• Adequate convergent validity between change in HoNOSCA and change in clinical rated CGAS scores (r = 0.51)
• Adequate convergent validity between change in HoNOSCA and change in Behaviour Checklist (BCL) scores (r = 0.40)
• Adequate convergent validity between change in HoNOSCA and change in Strength and Difficulties Questionnaire (SDQ) (r = 0.32)
• Poor convergent validity between change in HoNOSCA and change in maternal psychopathology as measured by the General Health Questionnaire (GHQ) (r = 0.16)
• Poor convergent validity between change in HoNOSCA score and number of treatment sessions attended (r = 0.18)
• Adequate convergent validity between initial HoNOSCA score and number of treatment sessions attended at clinics (r =0.31)

Outpatient/Day Patient Psychiatric Treatment: (Wyl et al., 2017)

• Adequate convergent validity between HoNOSCA-D total score and total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) Parent Report (r = 0.32)
  • Adequate convergent validity between HoNOSCA-D item peer relationships and SDQ peer relationship problems (r = 0.49)
  • Adequate convergent validity between HoNOSCA-D item disruptive, antisocial, or aggressive behavior and SDQ conduct problems (r = 0.45), hyperactivity (r = 0.32), and total difficulties score (r = 0.32)
  • Adequate convergent validity between HoNOSCA-D item overactivity, attention, or concentration and SDQ hyperactivity (r = 0.42)
  • Adequate convergent validity between HoNOSCA-D item emotional and related symptoms and SDQ emotional problems (r = 0.31)

“HoNOSCA also produced results with apparent face validity. Thus, the mean score for in-patients was 15.51 (7.19) compared with a mean score for out-patients of 11.18 (5.30), a statistically significant difference (t = -8.03, d.f. = 1141, p < 0.001, two-tailed). Difference between means = 4.33 (95% CI = 3.28-5.40).” Gowers et al. (1999) concluded that the HoNOSCA “…has satisfactory face validity.”

Inpatient Psychiatric Treatment: (Boon et al., 2019)

• All groups underwent significant change between admission and discharge.

Changes between admission and discharge groups based on severity at admission

*Cohen’s d

Inpatient Psychiatric Treatment: (Harnett et. al, 2005; changes in HoNOSCA score assessed at 3- and 6-months following intake; positive change scores indicate improved functioning; one-tail tests)

• Significant, positive difference between intake and 3-month follow-up (n = 45, 47% female)
  • Mean change score = 1.51, t(44) = 2.23, p < 0.05
• Positive difference in scores between intake and 6-month follow-up approached significance (n = 25, 60% female)
  • Mean change score = 1.92, t(24) = 1.67, p = 0.06

Outpatient/Day Patient Psychiatric Treatment: (Garralda et. al 2000; n = 203, age range = 3-17 years; mean change between assessment and 6-month follow-up)

• Significant positive change in HoNOSCA score of 3.61 (4.7), p <0.001 at 6-month follow-up.
• Significant positive correlation between initial case severity and change in HoNOSCA score over treatment time (r = 0.468, p < 0.001, n = 215).
• Significant positive correlation between change in HoNOSCA scores and complexity of diagnosis as measured by Paddington complexity scale for patients diagnosed with mood disorders (r = .039, n = 26) and conduct disorders (r = 0.33, n = 57)

Outpatient Psychiatric Treatment for Adolsecents: (Mathiassen et al., 2012, n = 132)

• Participants with highest initial HoNOSCA scores showed greater improvement across the intake session, start of treatment, and after six months of treatment
• Change in HoNOSCA scores at the 3 time points showed significant variance in intercepts (29.12, p < 0.01) but not slopes (2.30, p = 0.06) across participants, and both covaried negatively and significantly. 
• Small effect size between intake and start of treatment was non-significant (r = 0.12)
• Moderate effect size between the start of treatment and 6 months post treatment (r = 0.34)