Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS—LD)

Glossary for HoNOS—LD score sheet{dagger}

ASHOK ROY, FRCPsych

Brooklands, Marston Green, Birmingham, UK

HELEN MATTHEWS, MRCPsych

St David's, Carmarthen, UK

PAUL CLIFFORD, DClinPsy

British Psychological Society, UK

VANESSA FOWLER, MSc

Galahad Substance Misuse Solutions Ltd, Oxted, Surrey, UK

DAVID M. MARTIN, BA

Brooklands, Marston Green, Birmingham, UK

Correspondence: Dr A. Roy, North Warwickshire NHS Trust, Brooklands, Coleshill Road, Marston Green, Birmingham B37 7HL, UK

{dagger} See pp. 61–66, this issue. Back


   INTRODUCTION
 TOP
 INTRODUCTION
 APPENDIX
 
Summary rating instructions:

  1. Complete the front sheet including ICD-10 diagnoses and subjective rating.
  2. Rate each in order from item 1 to 18.
  3. Do not include information rated in an earlier item.
  4. Rate the person over the previous 4 weeks.
  5. Rate the most severe problem that has occurred during the period rated.
  6. All items follow the five-point rating format similar to other HoNOS instruments:

1. Behavioural problems (directed at others)
Include behaviour that is directed to other persons. Do not include behaviour that is directed towards self (Scale 2) or primarily at property or other behaviours (Scale 3). Rate risk as it is currently perceived.

2. Behavioural problems directed towards self (self-injury)
Include all forms of self-injurious behaviour. Do not include behaviour directed towards others (Scale 1), or behaviour primarily directed at property, or other behaviours (Scale 3).

3. Other mental and behavioural problems
This is a global rating to include behavioural problems not described in Scales 1 or 2. Do not include behaviour directed towards others (Scale 1), or self-injurious behaviour (Scale 2). Rate the most prominent behaviours present. Include: A, behaviour destructive to property; B, problems with personal behaviours, for example, spitting, smearing, eating rubbish, self-induced vomiting, continuous eating or drinking, hoarding rubbish, inappropriate sexual behaviour; C, rocking, stereotyped and ritualistic behaviour; D, anxiety, phobias, obsessive or compulsive behaviour; E, others.

4. Attention and concentration
Include problems that may arise from underactivity, overactive behaviour, restlessness, fidgeting or inattention, hyperkinesis or arising from drugs.

5. Memory and orientation
Include recent memory loss and worsening of orientation for time, place and person in addition to previous difficulties.

6. Communication (problems with understanding)
Include all types of responses to verbal, gestural and signed communication, supported if necessary with environmental cues.

7. Communication (problems with expression)
Include all attempts to make needs known and communicate with others (words, gestures, signs). Rate behaviour under Scales 1, 2 and 3.

8. Problems associated with hallucinations and delusions
Include hallucinations and delusions irrespective of diagnosis. Include all manifestations suggestive of hallucinations and delusions (responding to abnormal experiences, e.g. invisible voices when alone).

9. Problems associated with mood changes
Include problems associated with low mood states, elated mood states, mixed moods and mood swings (alternating between unhappiness, weeping and withdrawal on one hand and excitability and irritability on the other).

10. Problems with sleeping
Do not rate intensity of behaviour disturbance — this should be included in Scale 3. Include daytime drowsiness, duration of sleep, frequency of waking and diurnal variation of sleep pattern.

11. Problems with eating and drinking
Include both increase and decrease in weight. Do not rate pica — which should be rated in Scale 3. This scale does not include problems experienced by people who cannot feed themselves (e.g. people with severe physical disability).

12. Physical problems
Include illnesses from any cause that adversely affects mobility, self-care, vision and hearing (e.g. dementia, thyroid dysfunction, tremor affecting dexterity). Do not include relatively stable physical disability (e.g. cerebral palsy, hemiplegia). Behavioural disorders caused by physical problems should be rated under Scales 1, 2 and 3 (e.g. constipation producing aggression).

13. Seizures
Include all types of fits (partial, focal, generalised, mixed, etc.) to rate the short-term effect on the individual's daily life. Rate the effects of the fits. Do not include behavioural problems caused by, or associated with, fits (use Scales 1, 2 and 3).

14. Activities of daily living at home
Include such skills as cooking, cleaning and other household tasks. Do not rate problems with daily living outside the home (Scale 15). Do not rate problems with selfcare (Scale 16). Rate what is seen regardless of cause, for example, disability, motivation etc. Rate performance not potential. Rate the current level achieved with the existing support.

15. Activities of daily living outside the home
Include skills such as budgeting, shopping, mobility and the use of transport, etc. Do not include problems with activities of daily living at home (Scale 14). Do not rate problems with self-care (Scale 16). Rate the current level with the existing support.

16. Level of self-care
Rate the overall level of functioning in activities of self-care such as eating, washing, dressing and toileting. Rate the current level achieved with the existing support. Rate appearance not motivation.

17. Problems with relationships
Include effects of problems with relationships with family, friends and carers (in residential and day/leisure settings). Measure what is occurring regardless of cause, for example, somebody who is known to have good relationships may still display problems.

18. Occupation and activities
Rate the overall level of problems with quality of daytime environment. Take account of frequency and appropriateness of, and engagement with, daytime activities. Consider factors such as lack of qualified staff, equipment and appropriateness with regard to age and clinical condition. Do not rate problems with self-care (Scale 16).


   APPENDIX
 TOP
 INTRODUCTION
 APPENDIX
 
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HoNOS—LD score sheet
 

Received for publication March 29, 2000. Revision received September 19, 2000. Accepted for publication September 19, 2000.


Related articles in BJP:

Highlights of this issue
ELIZABETH WALSH
BJP 2002 180: 0. [Full Text]  

Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS—LD){dagger}
ASHOK ROY, HELEN MATTHEWS, PAUL CLIFFORD, VANESSA FOWLER, and DAVID M. MARTIN
BJP 2002 180: 61-66. [Abstract] [Full Text]  




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