Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): Psychometric properties of the Italian version

The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) assesses mental health and social functioning of people <18 years. We explored the psychometric properties of the HoNOSCA Italian version. Dimensionality was assessed by Exploratory Factor Analysis and validated using Confirmatory Factor Analysis. Internal consistency and reliability of the factorial structure were evaluated. One hundred thirty-four subjects were assessed by HoNOSCA, Clinical Global Impression and Strengths and Difficulties Questionnaire for concurrent validity. Intraclass correlation was computed to evaluate inter-rater reliability using eight vignettes assessed by 35 professionals. Exploratory Factor Analysis identified two correlated subscales and Confirmatory Factor Analysis showed good fit to data. Cronbach's alpha was 0.65. HoNOSCA subscale scores increased with Clinical Global Impression severity and correlated positively with Strengths and Difficulties Questionnaire. Predictive power to discriminate between two Clinical Global Impression groups was good. The minimal difference in total score corresponding to a marked clinical change was 9, the clinically reliable change was 10. This should be considered when using the HoNOSCA as outcome measure. Intraclass correlation coefficient was 0.71 for the total score. The need for a comprehensive assessment for child mental health and behaviour in Italian services can be met by the HoNOSCA if used as cumulative bivariate subscales.