Routine outcome measurement in adolescents seeking mental health services: standardization of HoNOSCA in Kenyan sample

Background: The evaluation of treatment outcomes is important for service providers to assess if there is improvement or not. The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) was developed for this use in child and adolescent mental health services. Outcome measurement in routine mental health services is limited. This paper evaluates the psychometric properties of the self and clinician rated versions of the HoNOSCA for routine use in child and adolescent mental health services in Kenya. Methods: Using a prospective design, the clinician- and self-rated versions of the HoNOSCA and the Paediatric Symptom Checklist (PSC) were administered at the Youth Centre at the Kenyatta National Hospital in Nairobi. Initial ratings were obtained from adolescents 12-17 years (n = 201). A sample of 98 paired ratings with 2 follow-ups were examined for measurement of change over time. Results: Our findings showed good reliability with the self-rated version of the HoNOSCA score, correlating well with the self-reported version of the PSC (r = .74, p < .001). Both versions correlated well at follow-up and were sensitive to change. Using factor analysis, the maximum likelihood factoring and Promax rotation resulted in a four-factor structure, which with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.8 explained 54.74% of total variance. Conclusion: The HoNOSCA appears to be of value, and easy to use in routine settings. Our findings suggest further investigation with a larger sample.

Automated summary

This study evaluated the psychometric properties of the HoNOSCA for routine use in child and adolescent mental health services in Kenya. The self-rated version of the HoNOSCA showed good reliability and correlation with the PSC, indicating sensitivity to change. Further investigation with a larger sample is recommended based on the positive findings.