Assessing the content validity of the revised Health of the Nation Outcome Scales 65+: the HoNOS Older Adults.

AIMS AND METHOD: Recently, the Health of the Nation Outcome Scales 65+ (HoNOS65+) were revised. Twenty-five experts from Australia and New Zealand completed an anonymous web-based survey about the content validity of the revised measure, the HoNOS Older Adults (HoNOS OA). RESULTS: All 12 HoNOS OA scales were rated by most (≥75%) experts as 'important' or 'very important' for determining overall clinical severity among older adults. Ratings of sensitivity to change, comprehensibility and comprehensiveness were more variable, but mostly positive. Experts' comments provided possible explanations. For example, some experts suggested modifying or expanding the glossary examples for some scales (e.g. those measuring problems with relationships and problems with activities of daily living) to be more older adult-specific. CLINICAL IMPLICATIONS: Experts agreed that the HoNOS OA measures important constructs. Training may need to orient experienced raters to the rationale for some revisions. Further psychometric testing of the HoNOS OA is recommended.

Assessing the Content Validity of the Revised Health of the Nation Outcome Scales (HoNOS 2018).

The Health of the Nation Outcome Scales (HoNOS) comprises 12 scales that cover the kinds of problems that may be experienced by working-age adults in contact with specialised mental health services. Drawing on 20 years' experience in clinical practice, a collaborative, international review of the HoNOS was undertaken and a revised measure (known as the HoNOS 2018) was published. In this study, 32 experts from Australia, England and New Zealand completed an anonymous web-based survey to assess the relevance, comprehensiveness and comprehensibility (aspects of content validity) of the HoNOS 2018. The experts rated 11 of the 12 HoNOS 2018 scales as 'important' or 'very important' for determining the overall clinical severity (item-level content validity index or I-CVI ≥ 0.75). Evaluations of the scales' ability to capture change, comprehensiveness and comprehensibility were more variable, but generally positive. Experts' comments provided further insights into this variability; for example, they noted that some scales combine multiple phenomena, which can result in ambiguity in item wording and assessment challenges. Results from this study suggest that the revisions have not altered the importance of the scales. Given the measure's breadth of content, training remains important for ensuring rating fidelity. Inter-rater reliability and utility testing are indicated.

Numerical Modelling of the Dynamic Voltage in HTS Materials under the Action of DC Transport Currents and Different Oscillating Magnetic Fields.

The dynamic voltage is a unique phenomenon of superconducting materials. It arises when the superconductor is carrying a DC transport current and spontaneously in subject to an AC magnetic field. This study excavates the aspects that previous studies have not comprehensively investigated: the dynamic voltage in a DC-carrying superconducting tape exposed to different oscillating AC magnetic fields. First, the fundamental physics of dynamic voltage/flux of superconductors is reviewed and further analysed in detail. We used the superconducting modelling method using the H-formulation merged into the finite-element method (FEM) software, to re-produce the typical dynamic voltage behaviour of a superconducting tape. The modelling was verified by both the analytical and experimental results, in order to precisely prove the reliability of the modelling. Afterwards, the modelling was performed for a DC-carrying superconducting tape under four different oscillating magnetic fields (sine, triangle, sawtooth and square), and their corresponding dynamic voltages and energy losses were analysed and compared. Results show the sinusoidal magnetic field can lead to the optimal combination of reasonable dynamic voltage but relatively lower loss, which is suitable for those superconducting applications requiring dynamic voltage as the energy source, e.g., flux pumps. This article presents novel investigation and analysis of the dynamic voltage in superconducting materials, and both the methodology and results can provide useful information for the future design/analysis of superconducting applications with DC transport currents and AC magnetic fields.

Developing an International Standard Set of Patient-Reported Outcome Measures for Psychotic Disorders.

OBJECTIVE: The objective of this project was to develop a set of patient-reported outcome measures for adolescents and adults who meet criteria for a psychotic disorder. METHODS: A research team and an international consensus working group, including service users, clinicians, and researchers, worked together in an iterative process by using a modified Delphi consensus technique that included videoconferencing calls, online surveys, and focus groups. The research team conducted systematic literature searches to identify outcomes, outcome measures, and risk adjustment factors. After identifying outcomes important to service users, the consensus working group selected outcome measures, risk adjustment factors, and the final set of outcome measures. International stakeholder groups consisting of >100 professionals and service users reviewed and commented on the final set. RESULTS: The consensus working group identified four outcome domains: symptoms, recovery, functioning, and treatment. The domains encompassed 14 outcomes of importance to service users. The research team identified 131 measures from the literature. The consensus working group selected nine measures in an outcome set that takes approximately 35 minutes to complete. CONCLUSIONS: A set of patient-reported outcome measures for use in routine clinical practice was identified. The set is free to service users, is available in at least two languages, and reflects outcomes important to users. Clinicians can use the set to improve clinical decision making, and administrators and researchers can use it to learn from comparing program outcomes.

Health of the Nation Outcome Scales for Infants field trial: concurrent validity.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. A Child and Adolescent Mental Health Information Development Expert Advisory Panel working group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for infants 0-47 months. Prior face validity testing showed that the HoNOSI was considered useful in measuring mental health outcomes. AIMS: To examine the concurrent validity of the HoNOSI. METHOD: Mental health clinicians providing assessment and treatment to infants in routine clinical practice participated in the study. The mental health status of 108 infants were rated by a minimum of 26 clinicians with the HoNOSI, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS) and measures of symptom severity and distress. RESULTS: The HoNOSI was statistically significantly correlated with the PIR-;GAS, rs = -0.73; Clinical Worry, rs = 0.77; and Severity Judgement ratings, rs = 0.85; P < 0.001. A good level of internal consistency was found. Using the COsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria for judging instrument acceptability, the HoNOSI meets the standard for both concurrent validity and internal consistency. CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants. This study provides positive evidence of aspects of validity. These findings, along with those from the prior face validity study, support a controlled release of the HoNOSI accompanied by further research and development.

The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency. AIMS: We aimed to investigate the interrater reliability of the HoNOSI. METHOD: Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes. RESULTS: Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7). CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

Engineering Properties of Superconducting Materials.

Taking a technology from the laboratory to industry is a long and resource-consuming process. Discovered more than a century ago, the phenomenon of superconductivity is testament to this process. Despite the promise of this technology, currently the only major use of superconductors outside the laboratory is in MRI machines. The advent of high-temperature superconductors in 1986 heralded a new dawn. Machines which do not require cooling with liquid helium are a very attractive target. A myriad range of different superconductors were rapidly discovered over the next decade. This process of discovery continues to this day with, most recently, a whole new class, the pnictides, being discovered in 2006. Many different usages have been identified, including in motors, generators, wind turbines, fault current limiters, and high-current low-loss cables. This Special Issue looks at some of the different factors which will help to realise these devices and thereby bring about a superconducting world.

Measurement properties of the Health of the Nation Outcome Scales (HoNOS) family of measures: protocol for a systematic review.

INTRODUCTION: The Health of the Nation Outcome Scales (HoNOS) for adults, and equivalent measures for children and adolescents and older people, are widely used in clinical practice and research contexts to measure mental health and functional outcomes. Additional HoNOS measures have been developed for special populations and applications. Stakeholders require synthesised information about the measurement properties of these measures to assess whether they are fit for use with intended service settings and populations and to establish performance benchmarks. This planned systematic review will critically appraise evidence on the measurement properties of the HoNOS family of measures. METHODS AND ANALYSIS: Journal articles meeting inclusion criteria will be identified via a search of seven electronic databases: MEDLINE via EBSCOhost, PsycINFO via APA PsycNET, Embase via Elsevier, Cumulative Index to Nursing and Allied Health Literature via EBSCOhost, Web of Science via Thomson Reuters, Google Scholar and the Cochrane Library. Variants of 'Health of the Nation Outcome Scales' or 'HoNOS' will be searched as text words. No restrictions will be placed on setting or language of publication. Reference lists of relevant studies and reviews will be scanned for additional eligible studies. Appraisal of reliability, validity, responsiveness and interpretability will be guided by the COnsensus-based Standards for the selection of health Measurement INstruments checklist. Feasibility/utility will be appraised using definitions and criteria derived from previous reviews. For reliability studies, we will also apply the Guidelines for Reporting Reliability and Agreement Studies to assess quality of reporting. Results will be synthesised narratively, separately for each measure, and by subgroup (eg, treatment setting, rater profession/experience or training) where possible. Meta-analyses will be undertaken where data are adequate. ETHICS AND DISSEMINATION: Ethics approval is not required as no primary data will be collected. Outcomes will be disseminated to stakeholders via reports, journal articles and presentations at meetings and conferences. PROSPERO REGISTRATION NUMBER: CRD42017057871.

A systematic review of clinician-rated instruments to assess adults' levels of functioning in specialised public sector mental health services.

BACKGROUND: Functioning is one of the key domains emphasised in the routine assessment of outcomes that has been occurring in specialised public sector mental health services across Australia since 2002, via the National Outcomes and Casemix Collection. For adult consumers (aged 18-64), the 16-item Life Skills Profile (LSP-16) has been the instrument of choice to measure functioning. However, review of the National Outcomes and Casemix Collection protocol has highlighted some limitations to the current approach to measuring functioning. A systematic review was conducted to identify, against a set of pre-determined criteria, the most suitable existing clinician-rated instruments for the routine measurement of functioning for adult consumers. METHOD: We used two existing reviews of functioning measures as our starting point and conducted a search of MEDLINE and PsycINFO to identify articles relating to additional clinician-rated instruments. We evaluated identified instruments using a hierarchical, criterion-based approach. The criteria were as follows: (1) is brief (<50 items) and simple to score, (2) is not made redundant by more recent instruments, (3) relevant version has been scientifically scrutinised, (4) considers functioning in a contemporary way and (5) demonstrates sound psychometric properties. RESULTS: We identified 20 relevant instruments, 5 of which met our criteria: the LSP-16, the Health of the Nation Outcome Scales, the Illness Management and Recovery Scale-Clinician Version, the Multnomah Community Ability Scale and the Personal and Social Performance Scale. CONCLUSION: Further work is required to determine which, if any, of these instruments satisfy further criteria relating to their appropriateness for assessing functioning within relevant service contexts, acceptability to clinicians and consumers, and feasibility in routine practice. This should involve seeking stakeholders' opinions (e.g. about the specific domains of functioning covered by each instrument and the language used in individual items) and testing completion rates in busy service settings.

Power flow analysis and optimal locations of resistive type superconducting fault current limiters.

Based on conventional approaches for the integration of resistive-type superconducting fault current limiters (SFCLs) on electric distribution networks, SFCL models largely rely on the insertion of a step or exponential resistance that is determined by a predefined quenching time. In this paper, we expand the scope of the aforementioned models by considering the actual behaviour of an SFCL in terms of the temperature dynamic power-law dependence between the electrical field and the current density, characteristic of high temperature superconductors. Our results are compared to the step-resistance models for the sake of discussion and clarity of the conclusions. Both SFCL models were integrated into a power system model built based on the UK power standard, to study the impact of these protection strategies on the performance of the overall electricity network. As a representative renewable energy source, a 90 MVA wind farm was considered for the simulations. Three fault conditions were simulated, and the figures for the fault current reduction predicted by both fault current limiting models have been compared in terms of multiple current measuring points and allocation strategies. Consequently, we have shown that the incorporation of the E-J characteristics and thermal properties of the superconductor at the simulation level of electric power systems, is crucial for estimations of reliability and determining the optimal locations of resistive type SFCLs in distributed power networks. Our results may help decision making by distribution network operators regarding investment and promotion of SFCL technologies, as it is possible to determine the maximum number of SFCLs necessary to protect against different fault conditions at multiple locations.

A flux pumping method applied to the magnetization of YBCO superconducting coils: frequency, amplitude and waveform characteristics.

This letter presents a flux pumping method and the results gained when it was used to magnetize a range of different YBCO coils. The pumping device consists of an iron magnetic circuit with eight copper coils which apply a traveling magnetic field to the superconductor. The copper poles are arranged vertically with an air gap length of 1 mm and the iron cores are made of laminated electric steel plates to minimize eddy-current losses. We have used this arrangement to investigate the best possible pumping result when parameters such as frequency, amplitude and waveform are varied. We have successfully pumped current into the superconducting coil up to a value of 90% of I c and achieved a resultant magnetic field of 1.5 T.

Routine outcome measurement in Australia.

Australia has been implementing routine outcome measurement in its specialized public sector mental health services for over a decade. It uses a range of clinician-rated and consumer-rated measures that are administered at set times during episodes of inpatient, ambulatory and community residential episodes of care. Routine outcome measurement is now embedded in service delivery, and data are made available in a variety of ways to different audiences. These data are used by policy-makers and planners to inform decisions about system-wide reforms, by service managers to monitor quality and effectiveness, and by clinicians to guide clinical decision-making and to promote dialogue with consumers. Consumers, carers and the general community can use these data to ensure that services are accountable for the care they deliver. This paper describes the status quo in Australia with respect to routine outcome measurement, discusses the factors that led to its successful implementation, and considers the steps that are necessary for its continued development.

The art and science of using routine outcome measurement in mental health benchmarking.

OBJECTIVE: To report and critique the application of routine outcome measurement data when benchmarking Australian mental health services. METHOD: The experience of the authors as participants and facilitators of benchmarking activities is augmented by a review of the literature regarding mental health benchmarking in Australia. RESULTS: Although the published literature is limited, in practice, routine outcome measures, in particular the Health of the National Outcomes Scales (HoNOS) family of measures, are used in a variety of benchmarking activities. Use in exploring similarities and differences in consumers between services and the outcomes of care are illustrated. This requires the rigour of science in data management and interpretation, supplemented by the art that comes from clinical experience, a desire to reflect on clinical practice and the flexibility to use incomplete data to explore clinical practice. CONCLUSIONS: Routine outcome measurement data can be used in a variety of ways to support mental health benchmarking. With the increasing sophistication of information development in mental health, the opportunity to become involved in benchmarking will continue to increase. The techniques used during benchmarking and the insights gathered may prove useful to support reflection on practice by psychiatrists and other senior mental health clinicians.

A review of social inclusion measures.

BACKGROUND: Social inclusion is crucial to mental health and well-being and is emphasised in Australia's Fourth National Mental Health Plan. There is a recognition that a measure of social inclusion would complement the suite of outcome measures that is currently used in public sector mental health services. This paper is an initial scope of candidate measures of social inclusion and considers their suitability for this purpose. METHODS: We identified potential measures through searches of PsycINFO and Medline and a more general Internet search. We extracted descriptive and evaluative information on each measure identified and compared this information with a set of eight criteria. The criteria related to the measure's inclusion of four domains of social inclusion outlined in Australia's Fourth National Mental Health Plan, its usability within the public mental health sector and its psychometric properties. RESULTS: We identified 10 candidate measures of social inclusion: the Activity and Participation Questionnaire (APQ-6); the Australian Community Participation Questionnaire (ACPQ); the Composite Measure of Social Inclusion (CMSI); the EMILIA Project Questionnaire (EPQ); the Evaluating Social Inclusion Questionnaire (ESIQ); the Inclusion Web (IW); the Social and Community Opportunities Profile (SCOPE); the Social Inclusion Measure (SIM); the Social Inclusion Questionnaire (SIQ); and the Staff Survey of Social Inclusion (SSSI). After comparison with the eight review criteria, we determined that the APQ-6 and the SCOPE-short form show the most potential for further testing. CONCLUSIONS: Social inclusion is too important not to measure. This discussion of individual-level measures of social inclusion provides a springboard for selecting an appropriate measure for use in public sector mental health services. It suggests that there are two primary candidates, but neither of these is quite fit-for-purpose in their current form. Further exploration will reveal whether one of these is suitable, whether another measure might be adapted for the current purpose or whether a new, specifically designed measure needs to be developed.

An exploration of the ability of routine outcome measurement to represent clinically meaningful information regarding individual consumers.

OBJECTIVE: Evidence that feedback on outcome measures can improve consumer outcomes is building but clinician engagement remains inconsistent. Clinicians can interpret and utilize familiar measures but have difficulty in relating to routine outcome measures like the Health of the Nation Outcomes Scales (HoNOS). This paper aims to explore and illustrate how these measures can represent clinically meaningful information regarding individual consumers. METHOD: Exploration of the aspects of individual clinical states and scenarios that can be represented using the HoNOS and Kessler-10 (K-10) will be used to illustrate their utility in clinical practice. RESULTS: Routine outcome measures have the capacity to represent aspects of consumer symptoms, individual functioning and the need for support relevant to clinical care. These measures may be considered using pattern recognition and reflective practice to answer the following questions. Have we adequately assessed the consumer? Is there agreement between the consumer and clinician? Has anything changed? CONCLUSIONS: While it may be difficult to relate to the total scores on outcome measures, information from within such measures, individual items and subscales can be presented in a manner that is clinically meaningful. Where clinicians are familiar with the measures, this ability is already being used. The challenge is to make it 'routine'.

Routine outcome measurement in youth mental health: a comparison of two clinician rated measures, HoNOSCA and HoNOS.

Mental health services engagement in routine outcome measurement has created a demand for a coherent infrastructure. Two clinician instruments for adolescents (HoNOSCA) and adults (HONOS) are used across many countries. However, the increasing emphasis on youth suggests protocols with historically driven age divisions may obscure outcomes. The current study examines these instruments' congruence with regard to youth mental health. Members of national mental health expert panels rated four vignettes before discussing perceived strengths and weaknesses. The instruments were strongly correlated and HoNOSCA resulted in more severe symptom scores. Most subscales and scales correlated as predicted with some important exceptions. 'Problems with family relationships', tracked by HoNOSCA, did not correlate with its HoNOS counterpart. Qualitative feedback indicated using the HoNOSCA scale 'School attendance' for vocational attendance would improve its applicability to young people. The instruments have a strong relationship. While either could be used, HoNOS will underestimate symptom severity in youth. The importance of family relationships for young people suggests that HoNOSCA is preferable. While sited in the Australian context, these findings should be applicable to other countries using these instruments, and should interest services considering the continuity of youth presentations and their outcomes.

Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN).

BACKGROUND: Australia's National Mental Health Strategy has emphasised the quality, effectiveness and efficiency of services, and has promoted the collection of outcomes and casemix data as a means of monitoring these. All public sector mental health services across Australia now routinely report outcomes and casemix data. Since late-2003, the Australian Mental Health Outcomes and Classification Network (AMHOCN) has received, processed, analysed and reported on outcome data at a national level, and played a training and service development role. This paper documents the history of AMHOCN's activities and achievements, with a view to providing lessons for others embarking on similar exercises. METHOD: We conducted a desktop review of relevant documents to summarise the history of AMHOCN. RESULTS: AMHOCN has operated within a framework that has provided an overarching structure to guide its activities but has been flexible enough to allow it to respond to changing priorities. With no precedents to draw upon, it has undertaken activities in an iterative fashion with an element of 'trial and error'. It has taken a multi-pronged approach to ensuring that data are of high quality: developing innovative technical solutions; fostering 'information literacy'; maximising the clinical utility of data at a local level; and producing reports that are meaningful to a range of audiences. CONCLUSION: AMHOCN's efforts have contributed to routine outcome measurement gaining a firm foothold in Australia's public sector mental health services.

A framework for exploring the potential of routine outcome measurement to improve mental health care.

OBJECTIVE: To present a framework for exploring the potential applications of routine outcome measurement (ROM) to improve clinical practice. CONCLUSIONS: ROM is now commonplace in Australian mental health services, but it is fair to say that it has not yet achieved its potential in guiding service quality improvements. The framework described in this paper articulates the key components of ROM, noting that data from standardized outcome measures must be augmented by contextual information from other datasets. It considers the key users of ROM, and suggests the kind of questions that ROM might answer for each user group. It presents the use of ROM as a cycle of understanding the context, prioritization, brainstorming and planning, action and review. It is hoped that this framework might help to maximize the clinical utility of ROM at a number of levels.

Shift climate profiles and correlates in acute psychiatric inpatient units.

PURPOSE: Inpatient psychiatric units are dynamic in nature, potentially creating a different treatment experience for each person, which may be difficult to quantify. Among the goals of this multi-centre service evaluation project was an assessment of shift-to-shift changes in unit-level events and their impact on the social-emotional environment. METHODS: Over 1 year, various nurse-completed logs were used within the 11 participating Australian psychiatric units (n = 5,546 admissions) to record patient- and unit-level events per shift, including ratings of the overall social-emotional climate using a novel shift climate ratings (SCR) scale (n = 8,176 shifts). These were combined with admission-level patient characteristics to investigate shift climate profiles and correlates. RESULTS: Occupancy rates averaged 88% and two-thirds of admissions were involuntary. The psychometric performance of the SCR scale was considered to be satisfactory (e.g., high internal consistency, unidimensional factor structure, and evidence of discriminant and predictive validity). A series of hierarchical regressions revealed considerable variation in SCR total scores, with poorer climates being significantly associated with: day/afternoon shifts; higher occupancy levels; higher proportions of experienced staff, and male, older, or involuntary patients; higher rates of less serious aggressive incidents; reporting of additional staffing demands; and unit location in a stand-alone psychiatric hospital. CONCLUSIONS: The day-to-day social-emotional climate can have important consequences for patient engagement and recovery. Improved understanding of the role played by unit, staff and patient characteristics, together with routine monitoring, should facilitate the development and evaluation of targeted interventions to reduce adverse incidents and improve the overall social-emotional climate.

Benchmarking adult mental health organizations.

OBJECTIVE: This paper describes the adult mental health forums that were conducted as part of the National Mental Health Benchmarking Project (NMHBP). METHOD: Eight adult mental health forums were attended by staff from eight adult mental health services from around the country. The forums provided an avenue for these participants to document their organizations' performances against previously agreed key performance indicators (KPIs), and to compare this performance with that of their peers. The forums also encouraged discussion about appropriate targets. RESULTS: Forum participants found that the inter-organizational range for many of the KPIs was substantial, and they used this to inform practice change within their own organizations. They also found that they could set "alert targets" and "good practice targets" for some KPIs but not others. The discussion that ensued informed participants' understanding of factors that were within the control of their organizations that could be modified to improve service quality. CONCLUSIONS: Benchmarking in adult mental health services is not only possible but also likely to be extremely worthwhile as an exercise in improving service quality. For benchmarking to realize its potential, it requires strong national and local leadership, and a spirit of openness on the part of participating organizations.