Collection protocol =================== This section describes the protocol to be used to guide the collection of outcomes and casemix data. It focuses on what data is to be collected and when it is to be collected. The NOCC protocol defines the minimum requirements and should not be interpreted as confining participating States and Territories to those requirements. Additionally, local services may elect to collect additional measures or to increase the frequency of ratings. Implementing the protocol within service delivery agencies requires consideration of how the required data collection will be integrated within agency-level clinical processes and broader information requirements. Local systems vary with different business processes, data collection forms and so forth that reflect differences in service delivery structures. Resolving these issues is beyond the scope of the current document but will need to be addressed by all States and Territories. It is important to minimise the burden of collection, where possible, while preserving episodes of care as the fundamental building block of NOCC. The collection protocol as defined in this version builds on the experience of NOCC implementation since 2003. In particular, a wide range of users was consulted throughout the course of the *NOCC Strategic Directions 2014-2024* project which has led to some revision of the protocol as implemented in earlier versions of the *NOCC Technical Specifications*. Data requirements at each Collection Occasion --------------------------------------------- 9.1.1. Design of the protocol needs to accommodate both the outcomes and casemix development objectives of the agreed information development strategy. These are not identical. Simply put, casemix requirements need key data to be collected only once during each episode to allow the episode to be adequately described and classified. From the casemix perspective, the only issue is to ensure that the information is collected at the most appropriate point within the overall episode of care. For example, assessment on the HoNOS at *Admission* would suffice for casemix purposes because it is the best measure of the level of severity of the condition presented by the consumer to the treatment system. 9.1.2. In comparison, measurement of consumer outcomes by definition presumes a comparison over time and requires data to be collected on at least two occasions in order to allow assessment of change in the consumer’s health status. 9.1.3. The national protocol takes all these issues into account and requires that: - clinical measures that are to be used for outcomes evaluation and casemix purposes be collected at the *Admission*, *Review* and *Discharge Collection Occasions* within episodes to allow change in the consumer’s clinical status to be assessed; and - items required only for casemix purposes be collected at points which are consistent with the MH-CASC classification to allow the classification to be further developed. In general, the decision about whether to collect these at episode start or episode end is based on using the *Collection Occasion* that best describes the consumer during the overall episode of care. 9.1.4. As noted earlier, there were several recommendations from the *NOCC Strategic Directions 2014-2024* project regarding revisions to the NOCC collection protocol, particularly with respect to the data requirements at closure of mental health care episodes in ambulatory settings. .. _9.1.5: 9.1.5. The NOCC data requirements at **discharge from ambulatory care** are dependent on the **reason for collection** based on two broad considerations: #. Whether the care of the consumer is transferred from the ambulatory service to an inpatient or residential service of the same *Mental Health Service Organisation*; or #. Whether the duration of the ambulatory episode of mental health care was brief, as defined as an episode of care 14 days or less in duration (i.e., the number of days from admission to and discharge from the NOCC Ambulatory episode). 9.1.6. With respect to these two kinds of ambulatory discharge (i.e., transfer to bed- based care or brief episodes of care): #. the NOCC clinician and consumer-rated measures (i.e., the HoNOS/CA/65+, LSP-16, FIHS, the SDQ, BASIS-32/K-10/MHI-38) are not collected; and #. Mental Health Legal Status and Principal and Additional Diagnoses pertaining to the ambulatory episode are to be reported. 9.1.7. Regardless of whether the NOCC ambulatory episode of mental health care is closed either as a transfer or a brief episode as described in `9.1.5 <9.1.5_>`_, a NOCC Discharge Collection Occasion must be recorded. 9.1.8. For both consumers and providers, the transition of treatment from ambulatory to bed-based care is a critical point in the delivery of services and therefore it is important to gain an understanding of the status of consumers and the outcomes of services provided. Where ambulatory discharge results in transfer to bed based care (i.e., an inpatient or community residential service of that *Mental Health Service Organisation*), wherever possible, the common clinician and consumer measure ratings for the admission NOCC in the inpatient unit or the residential care setting should be linked to the consumers’ discharge from the ambulatory episode. :numref:`figure-data-ep-setting-age-group` brings together these considerations and provides summary details of the various measures to be reported at the three *Collection Occasions* during each episode of mental health care. .. _figure-data-ep-setting-age-group: .. figure:: data-ep-setting-age-group.png :alt: Data to be reported at each Collection Occasion within each Episode Service Setting, for consumers in each Age Group Data to be reported at each Collection Occasion within each Episode Service Setting, for consumers in each Age Group .. rubric:: Notes #. This table identifies the national reporting requirements and is not intended to restrict a State or Territory from the collection of additional data at specific collection occasions. #. Discharge ratings for the clinician and consumer-rated measures (i.e., the HoNOS/CA/65+,LSP-16, FIHS, the SDQ, BASIS-32/K10/MHI-38) **are not required** by the ambulatory service or the consumer respectively, when the reason for the closure of the ambulatory episode is transfer to a bed-based treatment service setting of that organisation (i.e., psychiatric inpatient or community residential service). Where possible, the clinician and consumer measure ratings for the admission NOCC in the inpatient unit or the community residential care setting are reported as the consumer’s discharge ratings from the ambulatory episode. Details are required, however, regarding Principal and Additional Diagnoses and Mental Health Legal Status relevant to the ambulatory episode of care. #. Discharge ratings for the clinician and consumer-rated measures (i.e., the HoNOS/CA/65+, LSP-16, FIHS, the SDQ, BASIS-32/K10/MHI-38) **are not required** for brief ambulatory episodes. Brief ambulatory episodes are those where the number of days between admission to and discharge from the episode of care is 14 days or less duration. Details are required, however, regarding Principal and Additional Diagnoses and Mental Health Legal Status relevant to the ambulatory episode of care. #. Discharge ratings for the HoNOS, HoNOS65+ and HoNOSCA **are not required** for inpatient episodes of 3 days or less duration. #. Discharge ratings for the SDQ **are not required** for any episode of less than 21 days duration because the rating period used at discharge (previous month) would overlap significantly with the period rated at admission. #. The classification of consumer rated measures as mandatory is intended only to indicate the expectation that consumers **will be offered** to complete self-report measures at the specified *Collection Occasions*. There are circumstances where offering such measures will not be appropriate and special considerations applying to the collection of consumer rated measures are described in `Special considerations applying to the collection of consumer self-report and parent measures `_. #. The K10L3D is a variation of the K10 designed for use in inpatient settings where the episode is of less than 3 days duration. Rating periods for the clinical and consumer self-report measures and data items -------------------------------------------------------------------------------- Completion of each of the clinical measures and data items is based on a period of observation that is specific to each scale or item, and may vary according to the *Collection Occasion*. :numref:`table-rating-periods` identifies the usual rating periods and their exceptions for all clinical data. It should be noted that this Table refers only to the rating period and not to other criteria such as those relevant to the closure of Ambulatory Episodes as a result of transfer to an inpatient/residential setting or brief duration. .. _table-rating-periods: .. csv-table:: Rating periods for each of the clinical and consumer self-report measures and data items :file: rating-periods.csv :delim: tab :header-rows: 1 .. rubric:: Notes #. The K10L3D is a variation of the K10 designed for use in inpatient settings where the episode is of less than 3 days duration. Special issues in interpreting the protocol at service delivery level --------------------------------------------------------------------- 9.3.1. The standard protocol is designed to fit most clinical situations without there being an expectation that the fit will be perfect. Based on experience to date, it is expected that implementation of the protocol for the majority of cases should be relatively straightforward once information systems are in place and clinician training in use of the instruments has been completed. 9.3.2. However, there is a range of special issues that will need to be resolved within each jurisdiction where application of the standard protocol is more complex. Most of these concern clarifying the interface between episodes in complex sequences of care and interpreting the two business rules which act as triggers to data collection (one episode at a time, change of setting = new episode). 9.3.3. It is beyond the scope of the current document to provide detailed guidelines on all potential complexities arising in the translation of the standard protocol to the many service delivery environments in which mental health services operate in Australia. However, a summary of the approach recommended to the main issues is provided in :numref:`table-special-issues` as a basis for further discussion within States and Territories and development of workforce training programs. .. _table-special-issues: .. csv-table:: Recommended approach to special issues in interpreting the protocol at service delivery level :file: special-issues.csv :delim: tab :header-rows: 1 :widths: 15, 20, 30 .. _spec-considerations: Special considerations applying to the collection of consumer self-report and parent measures --------------------------------------------------------------------------------------------- 9.4.1. In general, all consumers should be asked to complete self–report measures at the *Collection Occasions* indicated in :numref:`figure-data-ep-setting-age-group`. However, due to the nature and severity of their mental health or other problems, it is likely that some consumers should never be asked to complete self–report measures, others may not be able to complete the self–report measures at the scheduled occasion, whilst still others may sometimes find completion of the self–report measures to be difficult or stressful. Suggested criteria for defining the reasons why the collection of self–report measures would be contraindicated are outlined below. 9.4.2. In all cases, clinical judgement as to the appropriateness of inviting the consumer to complete the measures should be the determining factor at any given *Collection Occasion*. Where collection of consumer self–report measures is contraindicated, the reasons should be recorded. 9.4.3. Similar considerations also apply in relation to the parent version of the SDQ. **General exclusions** 9.4.4. Some persons may not be able to complete the measures at any time and should not be asked to do so. A definitive list of circumstances in which a general exclusion applies is beyond the scope of this document but broadly it would include situations where: - the person’s cognitive functioning is insufficient to enable understanding of the task as a result of an organic mental disorder or an intellectual disability; - cultural, language and/or literacy issues make the measures inappropriate. [#]_ **Temporary contraindications** 9.4.5. Under certain conditions, a consumer (or in the case of the SDQ a parent) may not be able to complete the measure at a specific *Collection Occasion*. Circumstances where it may be appropriate to refrain from inviting the person to complete the measure include: - where the consumer’s current clinical state is of sufficient severity to make it unlikely that their responses to a self–report questionnaire could be obtained, or that if their responses were obtained it would be unlikely that they were a reasonable indication of person’s feelings and thoughts about their current emotional and behavioural problems and wellbeing; - where an invitation to complete the measures is likely to be experienced as distressing or require a level of concentration and effort the person feels unable to give; or - where consumers or parents in crisis are too distressed to complete the measure. 9.4.6. It is suggested that in these circumstances consumers and parents need not be invited to complete the measures. At all other times, an attempt should be made to obtain their responses. 9.4.7. In many cases, the severity of the person’s clinical state and the degree of family distress experienced will diminish with appropriate treatment and care. It is suggested that, if within a period of up to seven days following the *Collection Occasion* in an ambulatory care setting the consumer (or parent) is likely to be able to complete the measure then their responses should be sought at that time. Otherwise, no further attempt to administer the measure at that *Collection Occasion* should be made. **Special issues related to the Strengths and Difficulties Questionnaire versions** 9.4.8. The SDQ has six versions currently specified for NOCC reporting: [#]_ - Parent-report for children aged 04-10 on admission to a mental health care episode; - Parent-report for children aged 04-10 on follow up contact (review and discharge); - Parent-report for children and adolescents aged 11-17 on admission to a mental health care episode; - Parent Report Measure for Youth aged 11-17 on follow up contact (review and discharge); - Youth self-report measure (11-17) on admission to a mental health care episode; and - Youth self-report measure (11-17) on follow up contact (review and discharge). 9.4.9. Generally, the ‘admission’ versions are administered on admission and rated over the standard rating period of six months and the ‘follow up’ versions are administered on review and discharge and rated over a one month period. However, for referral from another setting, to prevent duplication and undue burden on consumers and parents, the following guide is suggested: .. csv-table:: :file: admission-versions.csv :delim: tab :header-rows: 0 9.4.10. The ‘admission’ versions are to be used on admission of a consumer who is a new referral – that is, they are not currently under the active care of the Mental Health Service Organisation. Future development of the protocol ---------------------------------- The original version of the National Outcomes and Casemix Collection was prepared from the research and development undertaken in the first decade of the National Mental Health Strategy and the experiences by jurisdictions in introducing standard outcome measurement into routine clinical practice. Recognising that the NOCC protocol has been in place for 10 years, in 2013 the MHISSC commissioned the *NOCC Strategic Directions 2014-2024 project*. The Final Report from that project contained 25 recommendations, several of which were implemented through earlier versions of the NOCC Technical Specifications. The remaining recommendations require further research and development work and consultation within the mental health sector, and taking into consideration the evolving information requirements of the mental health sector. .. [#] Substantial development work is required in the future to address cultural issues in the use and interpretation of self-report outcome measures. .. [#] An additional four versions are available for use by Teachers but these are not included in the national protocol. Details of these versions however are provided in the document *Mental Health National Outcomes and Casemix Collection: Overview of clinician rated and self-report measures, Version 2.1.* Australian Institute of Health and Welfare, Canberra, 2021.