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| Improving Outcomes through a Person-Centered Approach |
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One would think, or at least hope, that by 2006 any discussion of treatment planning would be tired old news for the behavioral health service delivery system. Yet, in its landmark report, Improving the Quality of Health Care for Mental and Substance-Use Conditions, released in November 2005, the Institute of Medicine (IOM) finds that practice continues to fall short of consumer expectations and quality standards.
One of the IOM"s lead recommendations calls for provider organizations to "have in place policies that implement informed, patient-centered participation and decision-making in treatment, illness self-management and recovery plans." This recommendation raises logical questions for service providers: "How can this be?" and "What can I do to improve this situation?" The answer is straightforward: implement a person-centered planning approach.
The reality is that many providers repeatedly identify planning as the most clinically irrelevant, meaningless, frustrating and mandatory administrative burden that they face, as there are so many competing clinical, regulatory and accreditation standards related to its implementation. Even when part of an organization's quality improvement process, it is not unusual to find that treatment plans are evaluated solely for their administrative compliance rather than their relevance to the individual's recovery.
Yet person-centered planning serves as the basis for building recovery-oriented services and gives providers and consumers a path to follow for goal attainment. It also can improve staff motivation, business process, client outcomes and agency reputation.
There are five principal dimensions of person-centeredness, which place an emphasis on the quality and dynamic in the relationship between provider and consumer. They include:
Understanding needs from a strengths and capacity perspective that recognizes achievements and assets, rather than a deficit or symptom driven perspective.
The ability to see the "consumer-as-person" who is presumed to be competent, and not diminished or dehumanized in any way by his/her diagnosis or help seeking.
Sharing of power, risk and responsibility in decision making.
Recognition of a therapeutic alliance and partnership between the provider and the consumer that enhances motivation for recovery and focuses on integration in the community, not just on symptom reduction and or abstinence.
The ability to view the "provider-as-person," who stimulates hope and optimism, but is not cast into a position of power or undue authority.
Person-centered care does not mean there is no longer any role for the provider to play in the treatment/recovery process. Rather, the provider's role shifts to that of coach, architect, cheerleader, facilitator, mentor and/or shepherd. The provider must partner with the individual to create an individual roadmap to recovery that can guide progress toward goal attainment, identify needed resources, and provide a measure of growth and change.
Similar to other organizational change efforts, the implementation of person-centered planning can involve all levels of an organization. Direct care staff learn the principles of person-centered planning as well as the clinical and administrative competencies associated with its implementation. Supervisors can be involved in assessing processes, forms and paperwork requirements to assure that they support the clinical needs of direct care staff. Compliance officers can assess clinical and administrative changes against relevant local, state and national standards. And all levels of staff can work in partnership with consumers to articulate new standards and expectations for participation and recovery.
Person-centered care helps everyone to focus on the results of care and has proven effective in meeting clinical and administrative requirements, increasing staff satisfaction and creativity and instilling hope in consumers and family members. In short, this approach is good for the clinical and operational bottom line of your organization.
Originally published in the National BH Council News at:
http://www.nccbh.org/SERVICE/Newsletters/NCNEWS/NCNewsJan-Feb06/improving-outcomes.htm
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About The Author:
Diane Grieder and Neal Adams have been awarded a contract by SAMHSA to prepare training curricula and materials for consumers, family members, direct care staff and administrators to help implement the findings of a SAMHSA national consensus panel on person-centered care.
See more about them and their workat:
http://www.txdirector.com/tf488133.tip.html |
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