In Search of a Standardised, Comprehensive Assessment of Functioning
Lutchman, Raksha, Thompson, Andrew, Tait, Hemaima, Savage, Anne-Louise, Aitchison, Rachael, Ruru, Ripene, Mellsop, Graham, New Zealand Journal of Occupational Therapy
As part of a national programme to provide mechanisms for quality improvement in the mental health sector, New Zealand has established the MH-Smart Programme. The programme aims to introduce the routine use of standardised assessments that, with repeated use, can reflect consumer changes, outcomes or results. This paper describes the process and rationale for assessing the suitability of measures of functioning. No ideal measure was found, but a provisional recommendation has emerged.
Functional skills, assessment, mental health, outcome measures
Lutchman, R., Thompson, A., Tait, H., Savage, A., Aitchison, R., Ruru, R. & Mellsop, G., (2007). In search of a standardised, comprehensive assessment of functioning. New Zealand Journal of Occupational Therapy 54(1) 33-38
The New Zealand Ministry of Health piloted the routine use of outcome measures in the Casemix and Outcomes Study (CAOS) in July 2002 (Gaines et al. 2003; Eagar, Trauer & Mellsop, 2005), carried out under the Mental Health Research and Development Strategy. This has been succeeded by a programme MH-Smart, which seeks to nationally implement the routine use of standardised assessment measures. In common language these measures are frequently referred to as outcome scales (Mellsop & Wilson, 2006). Increasingly, outcome measurement is being recognised as an important area for service delivery and a part of Government policy. Using such measures can facilitate clinician/consumer discussion or partnership and consumer recovery planning, as well as team and service level quality improvement activities and national benchmarking activities. MH-Smart seeks ultimately to have five standardised measures of assessment (outcome scales).
These are likely to be:
* The Health Of Nations Outcome Scale (HoNOS) Family (CRU, 1996; Wing et al, 1998), reflecting particularly clinical presentation issues.
* A measure of functioning.
* A consumer rated outcome measure.
* A culturally informed (Maori) outcome measure
* A standardised outcome measure for drug and alcohol services.
The term 'functionality' is defined by the World Health Organisation (WHO, ICIDH-2, 2001) as an 'umbrella' term to cover an individuals' activities and participation. The MH-Smart Programme sought through tender, recommendation for measure(s) of functionality that could be routinely used in the New Zealand context of adult mental health services. The Waikato DHB team won the tender and provided the ministry with the recommendation. This brief report describes the process of reviewing the available measures.
In addition, the Ministry of Health required the recommendation process to examine the cultural acceptability of the instruments, their consistency with the recovery philosophy and compatibility with the HoNOS family at the same time as determining any overlap. The selected measures had to address wellness, medication management, personal cares, family/social involvement and activity. Each of the instruments were rated on whether they measured performance (which describes what an individual does in his/her environment) or capacity/potential (which describes an individual's ability to execute a task or action), or both.
A national and international literature search on outcome measures and measures of adult functionality was conducted. Sources for the literature review were obtained from key word searches conducted on MEDLINE, PSYCHINFO, CINAHL, AMED and other relevant databases, as well as from citation lists, texts and other pertinent policy documents. Key informants from the MH Smart Team were consulted along with other mental health service providers.
Starting with scales already known to be used in New Zealand, a template of content areas, potential outcome domains and indicators which the concept of functionality should cover was developed in a systematic manner. …