Study design
The Health of the Nation Outcomes Scales for Children and Adolescents (HoNOSCA) is a questionnaire that assesses the behaviours, impairments, symptoms, and social functioning of children and adolescents with mental health problems in children and adolescents. The 13 scales of the instrument, which is completed by a mental health professional, were developed in the early 1990s in Great Britain first for adults (Health of the Nation Outcome Scales, HoNOS) (Wing et al., 1998, 2000). The aim was to develop a practicable instrument for differentiated assessment of the severity and social functioning of person with mental health disorders that in particular could be used as a reliable instrument to measure treatment outcome effectiveness. The research team of Gowers and colleagues then developed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) as a second generation HoNOS instrument, for use with children and adolescents (Gowers et al., 1999). It is since used routinely to measure outcome effectiveness in Great Britain, Australia, and New Zealand, and sporadically in other countries. The HoNOSCA has also been in use in Switzerland for quite a long time. The psychiatric clinic for children and adolescents at the University Psychiatric Clinics in Basel decided in 2002 to use the HoNOSCA routinely at the inpatient facilities as a quality assurance instrument.

In 2003 the HoNOSCA was translated into German, and the German-language version authorized by the authors of the original, English-language version. This first German version was tested for some years at the psychiatric clinic for children and adolescents at the University Psychiatric Clinics in Basel. Criticisms of /problems with the translation were gathered at rating training courses and other internal meetings at the clinic. In 2009 the criticisms were inspected. At the same time, the German version was adapted following the already authorized German translation of the HoNOS, the HoNOS-D. The revised version was then back-translated by a native speaker in 2010 and sent to the authors of the original English-language version, who gave their permission for the translation in April 2011. The HoNOSCA-D was completed in May 2011. This entire procedure was done following the recommendations of the World Health Organization for translation and adaptation of outcome measures (Sartorius & Kuyken, 1994).

The Canton St. Gallen Psychiatric Services for Children and Adolescents has been using outcome questionnaires since May 2009 on two wards and since the middle of 2010 with all patients at the start of an assessment or treatment and at the end of treatment. In addition to the HoNOSCA-D, another outcome instrument, the Strength and Difficulties Questionnaire (SDQ), is used.

The Strength and Difficulties Questionnaire (SDQ) is used as a self-completion questionnaire. This questionnaire has been used regularly for a number of years at the outpatient clinic of the Psychiatric Services for Children and Adolescents. The questionnaire contains 25 items on psychological attributes to measure children’s and adolescents’ behavioural difficulties and strengths. There are informant-rated versions for parents and teachers and a self-report version for young people aged around 11-16. There are five scales, with five items each: hyperactivity/inattention, emotional problems, conduct problems, peer relationship problems, and prosocial behaviour. For the German version a validation is available (Klasen et al., 2003).
All data that were collected at the Canton St. Gallen Psychiatric Services for Children and Adolescents between 2009 and March 2011 were included in this evaluation. Data at admission are available for 900 children and adolescents; of these data at discharge are available for 200 children and adolescents. 

Statistics
Also available to us are the following data from the statistics sheets: date of birth, sex, diagnosis, patient’s guardian, patient’s schooling and employment, parents’ occupational status, parents’ educational attainment, discharge diagnosis, main type of treatment, special services, decision to discharge, stay after discharge, recommended further treatment.

Selection of raters
The HoNOSCA is rated by the treating physician or psychologist. Raters are given regular training to assure interrater reliability.

Co-Project leader
Dr. Suzanne Erb, Kinder- und Jugendpsychiatrische Kliniken St. Gallen

Team
Lea Sà de Araujo