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

Purpose This study aims to examine 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). Design/methodology/approach 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 was also noted in relation to aggression within services. Findings 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 was observed on patient-reported outcome measures (CORE-OM and PREOM). Practical implications 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. Originality/value Research into this area is limited and yet the HoNOS is a widely implemented tool, without consideration of the core value of this measure.