An audit on admission outcome measures in a national child and adolescent mental healthinpatient unit

Abstract

BACKGROUND: Young people with severe or complex mental health symptoms may require observation and treatment in a mental health inpatient setting. The National Institute for Health and Care Excellence (NICE) guidance recommends that “all healthcare and Child and Adolescent Mental Health Services (CAMHS) professionals should routinely use, and record in the notes, appropriate outcome measures”. These may take the form of self-/clinician-reported questionnaires and screening items.

AIMS: To analyse the use of pre- and post-admission outcome measures for admissions to a national child and adolescent mental health inpatient unit (Young People’s Unit – YPU, Mount Carmel Hospital, Malta) and to suggest recommendations for implementation to improve the completion rate of pre- and post-admission outcome measures.

METHODOLOGY: A retrospective case note analysis was carried out on all YPU admissions, between the 1st of January 2022 and the 31st of December 2022, to analyse the completion of pre- and post-admission outcome measures. Outcome measures included the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), the 6-item Kutcher Adolescent Depression Scale (KADS-6), the Moods and Feelings Questionnaire (MFQ), the Tool for Assessment of Suicide Risk - Adolescent (TASR-A), and the Children’s Global Assessment Scale (CGAS). Demographic data were also recorded. These outcome measures (usually filled in by on-call doctors) were selected as they were the ones assigned in the ward for completion during patient admissions.

RESULTS: Out of all admissions (n = 83), the MFQ was the lowest completed with a 0% completion rate, both for the pre- and post-admission phases. During the pre-admission phase the KADS-6 was completed the most (n = 22, 26.5%), followed by the TASR-A (n = 18, 21.7%), the HoNOSCA (n = 12, 14.5%), and the CGAS (n = 7, 8.4%). During the post-admission phase, the KADS-6 (n = 13, 15.66%) and the HoNOSCA (n = 13, 15.66%) were completed the most, followed by the TASR-A (n = 12, 14.50%) and the CGAS (n = 10, 12.04%).

CONCLUSION: This audit study showed that more awareness is required about the importance of outcome measures. The authors recommend educational sessions with professional staff members to emphasise the importance of outcome measures, and a re-audit study. They also recommend a qualitative study with staff members to elicit possible causes related to the low rate of completion of outcome measures.