dr peter brann dr nick kowalenko - iceberg...

Dr Peter Brann, Eastern Health Child Youth Mental Health Service, and Monash University, [email protected]

Dr Nick Kowalenko, Clinical Senior Lecturer, University of Sydney, [email protected]

Dr Gordana Culjak, Honorary Associate, University of Sydney, [email protected]

CAMHIDEAP Working Group (Rosemary Dickson; Anne Sved-Williams; Margaret Hoyland; Elisabeth Hoehn; Tim Coombs with support from Sally Merry)

Strengthening Connections with Information, AMHOIC 2017 Conference, 28-30 June 2017

Peter Brann, Nick Kowalenko, Gordana Culjak and CAMHIDEAP

From HoNOSCA to HoNOSI HoNOSCA developed in the UK in the late 1990s.

A snapshot of mental health functioning and symptomatology

Track change for children and adolescents

Brief enough, reliable enough, valid enough for routine use in CAMHS

Used widely internationally and in the public domain

International collaboration on HoNOSCA reliability Discussions commenced on an under 4 year old version between New

Zealand (Dr Sally Merry) and Australia (CAMHIDEAP)

In parallel, CAMHIDEAP undertook reviews of potential infant, pre-schooler measures. Ongoing subtext was development of a HoNOSCA like instrument

2Peter Brann, Nick Kowalenko, Gordana Culjak and CAMHIDEAP

Covering what areas?Problems with:

1 ...disruptive behaviour /under controlled emotional regulation

2 ...activity levels, joint and/or sustained attention

3 …non accidental self-injury

4 ...feeding behaviour

5 ...language or communication skills

6 ...physical illness or disability

3

Problems with:

7 …regulation and integration of sensory processing

8 …sleep9 ...emotional and related symptoms10 ...social reciprocity11 ...contributing to self-care and

environmental exploration12 ...family life and relationships13 ...attending care, education and

socialisation settings

14 ...parent’s/caregiver’s knowledge or understanding about the nature of the infant/child’s difficulties

15 ...lack of information about services or management of the infant’s / child’s difficulties

Peter Brann, Nick Kowalenko, Gordana Culjak and CAMHIDEAP

Further development since last AMHOIC: Face Validity Testing Face Validity Testing across Australia

Representative sample of clinicians

Method: focus groups

Thematic analysis

Focus group recordings were transcribed

Analysed to identify emerging themes

Peter Brann, Nick Kowalenko, Gordana Culjak and CAMHIDEAP 4

Focus Groups Most groups had 4-6 participants

Sample size: n=50 (46 in focus groups plus 6 more; determined by availability)

Composed of:

Psychiatrists

Psychologists

Psychiatric Nurses

Occupational Therapists

Social Workers

who would be using the HoNOSI in routine practice


Face Validity Results: Themes1. Reference to developmental stages

2. Overlaps and crossovers in scales

3. Specialist knowledge

4. Global themes with subthemes of:

a. Structure

b. Length

c. Consistency

d. Clarity – global to the instrument

e. Sources of Information

f. Global Score

5. How to rate

6. Clarity - specific to descriptions or ratings


Focus Groups’ responses:very positive!

“I really like it, I feel it fills a vacuum, actually.”

“Having an infant-specific outcome measure is great.”


Face Validity Results: ThemesTheme 1: Reference to developmental stages

“…what does it look like in a 3 ½ year-old versus a 2 year old”

“…I think you’re right as the rate of change is so enormous – 3 months versus 9 months or one year, so you’ve got to know”

What we did about it:

Hyperlinks to further resources on developmental stages added to the HoNOSI (page 2)


Face Validity Results: ThemesTheme 2: Overlaps and crossovers in scales - an example:

There were recurring comments about Scales 1 and 9:

“Dysregulation should probably come under Scale nine… So just extract the dysregulation symptoms... and put them into the examples for the emotional. The dysregulation is described in the descriptor in a non-aggressive way, and then also in an aggressive way”

What we did about it (example):

Over-controlled emotional regulation moved to scale 9


Face Validity Results: ThemesTheme 3: Specialist knowledge

“I suppose the question is: How much knowledge is assumed about things outside the expertise of the rater, like, so for example, there’s one of the scales that surrounds…speech and things”


Clarified glossary where possible and hyperlink to resources also assists with this


Face Validity Results: ThemesTheme 4: Global themes (relating to the HoNOSI overall) with subthemes of:

a. Structure

b. Length

c. Consistency

d. Clarity – global to the instrument

e. Sources of Information

f. Global Score


Clarified glossary where possible, especially in relation to the ratings and made wording of ratings more consistent


Consistency (example): “It seems like certain specialists have contributed to the development of each of the scales… You get the sense there are slightly different styles, a little bit more detail in one and not the other… Ideally would have the same flow of language and similar level of detail for each scale”

Face Validity Results: ThemesTheme 5: How to rate

“…not sure whether this is now asking me to interact with the infant to see if I would get a different response from the infant to what I observe with their caregiver”


Clarified glossary where possible


Face Validity Results: ThemesTheme 6: Clarity - specific to descriptions or ratings

[Scale 1:] “I had a particular issue with the word settling in here… what they talk about is settling them to sleep, which is actually addressed in a different scale, so you may want to look at another way of expressing because what I think they mean is being able to calm down”

Scale 5, [Rating 2] mildly severe – clarify wording

[Scale 2, Rating 3: ]– appropriate supports - I am not sure what is meant by appropriate supports; is this referring to parental supports, or what sort of supports are appropriate?


Clarified glossary and ratings where possible


Face Validity Results – Further Development

In Summary:

Themes and recommendations from clinicians within focus groups were:

considered

incorporated wherever feasible

New Version: HoNOSI 0.93!!!


15

2017: Field Trial Underway

AMHOCN Website:http://www.amhocn.org/

HoNOSI Field TrialMethods: Next Steps:

HoNOSI Field trial: Qld, NSW, Vic, SA, WA

HoNOSI against 3 other measures (rating infants)

PIRGAS

Clinical Worry

Severity Judgement

Inter-rater Reliability (rating case vignettes)

Further Psychometric testing required

Integration of HoNOSI into the National Outcomes and Casemix Collection protocol via Mental Health Information Strategy Standing Committee (MHISSC)


Thank You Any questions?


dr peter brann dr nick kowalenko - iceberg...

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