Examining forensic service effectiveness within an NHS Trust: Outcomes and considerations for practice

Abstract

The current study examines whole service effectiveness using a secure version of the Health of the Nation Outcome Scales (HoNOS-Secure), further supplemented in some services by the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) and the Patient Reported Experience and Outcome Measure (PREOM). The utility of these measures were considered across the full remit of forensic services within a single NHS Trust. A total of 1,038 service users were included (male, n = 876), with the majority of these presenting with HoNOS-Secure ratings. It was predicted that there would be differences pre and post therapy indicated using these measures, that there would be further differences in relation to period of contact with services, and an association also noted in relation to aggression within services. Results indicated that HoNOS-Secure scores decreased following treatment and as a function of time spent in secure care, however no statistically significant improvement or deterioration were observed on patient-reported outcome measures (CORE-OM and PREOM). The paper concludes with a comparative examination evaluating potential arguments regarding why low levels of distress are observed within forensic populations, and why discrepancies exist between clinician-rated and patient-reported routine outcome measures.