Mental Health Outcomes Information Collection Protocol
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Key concepts underpinning the Mental Health Outcomes Information Collection Protocol
The Mental Health Outcomes Information Collection Protocol is based on a number of key concepts.
- Service setting
- Episode of care
- Period of care
- Collection occasion
- Age group
- Mental health service team
- Admission date
- Collection occasion date
- Reason for collection
- Focus of care
- Identifying the status of the collection
Service setting
The service setting denotes the setting in which the mental health service is provided. This can either be inpatient or community.
Episode of care
The concept of episodes is widely used throughout the health system as a method to describe the activities of health services. An episode of mental health care for the purposes of outcomes collection is used to refer to a period of contact between a service user and mental health service within the same setting, and has discrete start and end points. It is defined as a more or less continuous period of contact within a mental health service setting.
By definition, a service user may only be the subject of one such episode of mental health care at any given time. Where a person might be considered as receiving treatment in more than one service setting simultaneously, inpatient care will take precedence over community care. The diagram below illustrates this.
Community care with intervening inpatient admission
Period of care
The period of care is the interval within an episode of care between one collection occasion and the next.
Period of care within a community episode of care
Collection occasion
A collection occasion is defined as an occasion during an episode of mental health care when the outcome measures and case complexity information set are collected in accordance with the collection protocol.
Collection occasions generally occur at the following times.
New episode
Commencing within a service setting. The new episode of mental health care begins when the service user commences treatment with a mental health service setting. This may be marked by an objective event like service user admission to an inpatient unit. In the community, a new episode would be recorded if:
- a service user currently receiving no MHS care is admitted into a mental health service, or
- when a service user moves between settings and begins a new episode of care.
The beginning of a new episode acts as a ‘trigger' for a specific set of information to be collected.
NB: If an assessment of a new service user in the community determines that no further MHS care will be provided, then an assessment only collection occasion is required.
Review - three month (standard 91 days)
This collection occasion refers to the point at which the service user has been under three months' of continuous care within the same service setting, either since the episode commenced, or since the last review was completed within the current episode.
Review other (ad hoc)
This collection occasion identifies other situations which may trigger a review earlier than the 91 day standard review occasion. These may include when a service user:
- moves to another MHS team within the same service setting
- changes case manager
- declines treatment or support
- requests a review
- injures themselves or another person
- receives compulsory assessment or treatment.
DHBs may choose to generate local rules about when to complete ad hoc reviews.
Ad hoc collections will not reset the standard three month review process, unless the ad hoc review occurs within the required timeframe for a three month review (refer RFC 05), where they may be considered as the planned three month review.
Community episode, ad hoc review, followed by three month review
End of episode
Within a mental health service setting. End of episode occurs when no further treatment or care is planned in the current service setting. This includes discharge from an inpatient team, and/or when the service user no longer requires treatment or care from a community team. Regardless of the reason, the end of an episode acts as a ‘trigger' for a specific set of clinical data to be collected. A change in mental health service setting marks the end of one episode and the beginning of another.
Age group
The outcome measures to be reported at a particular collection occasion depend on the broad age group to which the service user is assigned (child and youth, adult or older person). The exception is for children under the age of four years, who are currently not in scope for the collection of outcome measures.
Generally, throughout mental health services, adults are defined as persons between the age of 18 and 64 years inclusive, older people are defined as persons aged 65 years and older and children and youth are defined as persons under the age of 18 years.
However, clinical or organisational factors sometimes require that a service user be assigned to a different age group to that which they would be assigned on the basis of their biological age. For example, a person aged 60 years who was being cared for in an inpatient psychogeriatric unit may be assigned to the older people age group. Similarly, a 15 year old in full time employment/living alone or similar, admitted to a general mental health unit, may be assigned to the adult group.
Mental health service team
Identifying the service user's primary mental health service team is important when tracking a service user's movement within an episode of care and essential for comparing service user data within each team.
Admission date
In inpatient settings, this is the actual date of admission. In community settings, this is the date that the service user was first seen by the service.
Collection occasion date
- At start of episode - this is the date assessment and outcome measure was actually collected.
- At review of episode - this is the date assessment and outcome measure was actually collected.
- At end of episode - this is the date the episode actually ended (i.e. this is the date of discharge in inpatient settings, or the date of last contact/discharge from community settings).
The collection occasion date should be distinguished from the date of completion of any of the individual standard measures.
Reason for collection
Application of the Mental Health Outcomes Information Collection Protocol requires that the defined collection occasion be mapped to a range of key events (such as admission to an inpatient unit or community team, review and discharge) which may occur within the context of an episode of mental health care.
Understanding the nature of the events triggering new episode, end of episode and review is necessary for subsequent informed analysis. For example, it will be desirable to separately analyse the differential outcomes of new service users admitted to community services from those who are admitted to community services following discharge from an inpatient service.
These considerations will be captured within the data item reason for collection (RFC). An explanation for each RFC is outlined below.
Assessment only (RFC 01)
This collection occasion is utilised in the community setting only, and applies in the following situations.
- A person is seen for a maximum of two face-to-face occasions for the purpose of assessment only and the outcome of the assessment was that the person received no further intervention by the health care agency (DHB). Services also delivered ‘on behalf of' the service user are not counted as face to face contacts.
- A person is a shared care service user who is being reviewed and whose previous contact with the mental health community service occurred more than 91 days previously. The measures will be collected by the community team worker. Assessment only collections are required to be completed within one week of assessment.
Outcomes episode start collection occasions
New referral (RFC 02)
This applies in any case where a person is admitted into care in a mental health service setting which does not involve their transfer from care from another mental health service setting within the same DHB mental health service. It includes self-referrals, referrals from family members or other caregivers, referrals from private medical practitioners, including GPs and private psychiatrists. New Referral collections are required to be completed within two weeks of assessment in the community, or within 24 hours in an inpatient setting.
Transfer (admission) from other setting (RFC 03)
This category principally refers to the start of an episode when transfers between mental health service settings occur, for example, community to inpatient, or, inpatient to community within the same health care agency (DHB).
It does not include transfers from acute psychiatric inpatient units to specialised, high acuity inpatient facilities and transfers from specialised, high acuity inpatient facilities to acute psychiatric inpatient units within the same hospital.
It does not include cases where a person in community mental health care has responsibility for their care taken over by a second service team providing more intensive community mental health care for several days or weeks.
Complete referral documentation, including the appropriate standard measures, may be made available to the admitting unit at the time the transfer takes place. The staff member responsible for the completion of the first comprehensive clinical assessment is responsible for ensuring that the standard measures are collected and recorded as required. Information provided by the referring service may be used to inform the comprehensive admission assessment.
Transfer (admission) from other setting collections are required to be completed within two weeks of assessment in the community, or within 24 hours in an inpatient setting.
Episode start other (RFC 04)
The decision to ascertain and record information in response to an admission not classifiable under the preceding alternatives should be treated as an episode start other. This may include transfers from other mental health service settings outside the admitting DHB, including from private psychiatric hospitals. Episode start other collections can be completed as required.
Outcomes episode review collection occasions
Review - three month (RFC 05)
This is the standard mandatory review to be conducted at intervals of 13 weeks (91 days) in all DHB mental health service settings. This interval of 13 weeks is identified as the routine clinical review interval and is also the standard interval for the collection of outcomes and casemix information.
Review - three month collections are required to be completed within two weeks (14 days) either side of the due review date.
Review - other (RFC 06)
The decision to ascertain and record information at a clinical review conducted in response to any other event not classifiable under the preceding alternatives needs to be addressed by local policies. This can include any of the reviews identified in the National Mental Health Standards 2001, Standard 16.11.
Review - other collections can be completed as required.
Outcomes episode end collection occasions
No further care (RFC 07)
This category refers to occasions where a person is discharged from a mental health service setting without referral for further treatment in any mental health service setting in any DHB. Included under this category are instances where a person is referred to a private medical practitioner, or is simply discharged to their usual residence.
The clinical staff member responsible for the discharge of the service user is responsible for ensuring that the standard measures to be collected at discharge are completed and recorded as required. This includes both clinician-rated and the associated individual data items.
No further care collections are required to be completed within one week of episode end in the community, and within three days in an inpatient setting.
Transfer (discharge) to other setting (RFC 08)
This category principally refers to the end of an episode when transfers between service settings occur, for example, community to inpatient, or, inpatient to community.
It does not include cases where a service user already in community mental health care has responsibility for their care taken over by a second service team providing more intensive community mental health care for several days or weeks. It also does not include transfers from general acute psychiatric inpatient units to specialised high-acuity inpatient facilities and vice versa.
The clinical staff member responsible for the discharge and referral of the service user should complete the required clinician-rated measures and period of care data.
Transfer (discharge) to other setting collections are required to be completed within one week of episode end in the community, or three days in an inpatient setting.
Lost to care (including AWOL and discharged at own risk) (RFC 09)
In inpatient psychiatric care settings this category refers to the case where a service user has left care against advice, has been discharged at their own risk, or has otherwise been "lost to care". The need for ongoing care may be probable but not clear because the person cannot be contacted.
The clinical staff member responsible for the discharge of the service user lost to care should complete the required clinician-rated measures and period of care data items.
In a community mental health care setting, this category refers to cases where a service user in need of ongoing care either has been discharged at their own risk due to their having refused such care, or their current whereabouts are unknown and there is no reasonable expectation that they will be located within 13 weeks of their last service contact.
The clinical staff member responsible for the discharge of the service user lost to care should complete the required clinician-rated measures and data items relating to the preceding period of care. Standard measures should be completed where the responsible staff member was able to validly ascertain the service user's clinical status at the time. If this is information is not available then valid ratings cannot be made.
Lost to care collections are required to be completed within one week of episode end in the community, or three days in an inpatient setting.
Deceased (RFC 10)
The clinical staff member responsible for the discharge of the deceased service user should not complete the required clinician-rated measures but only complete the individual data items identifying the collection occasion and the period of care data.
Note that this category is not to be used where the client is determined to have been "lost to care" and it is subsequently determined that they have died. However, if the service user is lost to care and dies within three days of being "lost to care" - that should be recorded as (RFC10).
Deceased collections are required to be completed within one week of episode end (HoNOS/HoNOS65+/HoNOSCA is not required to be collected for this RFC).
Brief episode of care (RFC 11)
A very brief episode of inpatient psychiatric mental health care is defined as a length of stay of three days (72 hours) or less.
A very brief episode of community mental health care is defined as one during which contacts, including either face-to-face or by telephone, have taken place over a period less than 14 days.
Whilst standard measures are not required to be completed, individual data items identifying the collection occasion and the preceding period of care are.
Brief episode of care collections are required to be completed within one week of episode end in the community and three days in an inpatient setting (HoNOS/HoNOS65+/HoNOSCA is not required to be collected for this RFC).
Episode end other (RFC 12)
This category is set aside for instances where the DHB mental health service's policy indicates that there is a definite clinical or administrative need to consider other clinical events not classifiable under the preceding alternatives as constituting the discharge of a service user from an episode of care.
This category includes the discharge of a service user from any mental health service setting in one DHB to any setting in another DHB, for example, transfer from an inpatient unit in one DHB to an inpatient unit in another DHB.
Episode end other collections are required to be completed within one week of episode end in the community or three days in an inpatient setting.
Focus of care
The focus of care identifies the principal clinical intent of the care provided during the period of care preceding the collection occasion. It is a global clinical judgment based on the intensity and purpose of the services provided during the period of care. It has implications for the kinds of outcomes that might be expected.
The domain of the focus of care covers four alternatives - acute, functional gain, intensive extended and maintenance - defined as follows.
Acute: The primary goal is the short-term reduction in severity of symptoms and/or personal distress associated with the recent onset or exacerbation of a psychiatric disorder.
Functional gain: The primary goal is to improve personal, social or occupational functioning or promote psychosocial adaptation in a service user with impairment arising from a psychiatric disorder.
Intensive extended: The primary goal is the prevention or minimisation of further deterioration and the reduction of risk of harm in a service user who has a stable pattern of severe symptoms, frequent relapses, and/or a severe inability to function independently, and is judged to require care over an indefinite period.
Maintenance: The primary goal is to maintain the level of functioning, minimise deterioration or prevent relapse where the service user has stabilised and functions relatively independently.
Identifying the status of the collection
Completion date
The date the measure was actually completed.
Collection status
The status of the data recorded and, if missing information is recorded, the reason for the non-completion of the measure. Collection of this information will facilitate the monitoring of adherence to the data collection protocol.
01 - Complete or partially complete
07 - Not completed for reasons not elsewhere classified
08 - Not completed due to protocol exclusion
09 - Not stated/missing
Mode of administration
An indicator of the procedure or method used in the ascertainment and recording of the standard measure. For clinician-rated measures it enables ratings completed in the context of a comprehensive clinical assessment to be distinguished from those which were not. Collection of this information will also facilitate the monitoring of adherence to the information collection protocol.
01 - Clinical rating completed following clinical assessment
02 - Clinical rating completed without clinical assessment (for example, service user unable to be located)
08 - Not applicable (collection not required due to protocol exclusion or not collected for other reasons)
09 - Not stated/missing
Outcome measure
HoNOS - An instrument developed in the United Kingdom, rated by clinicians to measure change across 12 domains for people using adult mental health services.
HoNOS65+ - A modified version of HoNOS for people aged 65 years and above.
HoNOSCA - The child and adolescent equivalent of the HoNOS, 15 domains.
HoNOS LD - Designed for adult service users who have a dual diagnosis (such as mental illness and an intellectual disability).
HoNOS Secure - Designed for adult service users who are being supported by forensic services.
The HoNOS suite of measures are rated, using the relevant glossary, based on the last two weeks of a service users presentation at all collection occasions except end of episode in an inpatient setting, where the rating period is three days.
Measures are not required to be collected if the episode end reason for collection is either 10 - Deceased or 11 - Brief episode of care.
Detailed rating rules and glossaries can be viewed for each measure in the appendices.
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Page last updated: 29 September 2008