HoNOS-secure: A reliable outcome measure for users of secure and forensic mental health services

The Health of the Nation Outcome Scales for users of secure and forensic services (HoNOS-secure) comprises amended versions of the original 12 HoNOS items, and an additional seven-item security scale. HoNOS-secure tracks clinical outcome, including ongoing security needs. To investigate the interrater reliability of HoNOS-secure, 60 inpatients were rated independently by two clinicians. There were 34 raters in total. Intraclass correlation coefficients (ICCs) for six of the seven security items indicated at least moderate agreement; one item indicated fair reliability. ICCs for all 12 HoNOS items indicated fair to substantial consistency between raters. Cronbach's alphas were .73 for the security scale and .79 for the HoNOS scale, indicating acceptable internal reliability. The security scale and the HoNOS items were measured consistently by different raters, indicating that HoNOS-secure is a reliable outcome measure when used in routine clinical practice.