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HoNOS-secure version 2b is the latest version of what
was previously known as HoNOS-MDO*. It is specifically
designed for use in health and social care settings such as secure
psychiatric, prison health care and related forensic services,
including those based in the community. Parts of the original
HoNOS can be hard to interpret in secure settings, and this scale
meets that need.
In 2002, Dr Philip Sugarman and Lorraine
Walker developed the first version of HoNOS-secure within St
Andrew’s Group of Hospitals. (St Andrew’s Group of Hospitals
is now known as St Andrew’s Healthcare). The ‘MDO scale’ was
developed into 7 security scales so that the completed score sheet
provided a profile of 19 severity ratings, a total HoNOS score and
a separate security score. The title was changed from ‘MDO’
(Mentally Disordered Offenders) to ‘secure’ to include all users of
HoNOS-secure version 2 was developed
in late 2004 by simplifying the original instructions and making
some changes to the wording of the security scales (based on
detailed feedback from users and a review of rating
reliability). The aim was to create a more ‘user friendly’
tool. In version 2b, developed February 2007, the scales
are unchanged but the instructions have been simplified based on
feedback received at training sessions.
The 7 security rating scales are:
Like the previous versions, HoNOS-secure
version 2b is not a risk assessment tool. It allows
the outcome of clinical risk assessment to be rated in terms of
need for care and need for clinical risk management procedures.
*HoNOS-MDO consisted of an amended version of
the 12 original HoNOS scales and a single ‘MDO scale’ that set out
the overall need for level of secure care. It was piloted by
the Kent Forensic Psychiatric Service across Regional Secure Units
in the South Thames Region. Results showed a very high
inter-rater reliability and also good reliability in using HoNOS
and HoNOS-MDO interchangeably in those settings.
Training for staff external to St Andrew’s Healthcare was first
introduced in November 2004. 159 clinicians from across the
UK have been trained as HoNOS-secure Trainers and 27 have been
trained as HoNOS-secure Raters (Rampton Hospital). On-site training
has been provided for Rampton Hospital, West Midlands Trust and
Affinity Healthcare (Cheadle Hospital).
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