On being person-centered

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On being person-centeredand recovery oriented

• Neal Adams MD MPH
• Director of Special Projects
• California Institute for Mental Health

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pleonasm
NOUN 1a. The use of more words than are required to express an idea redundancy. b. An instance of pleonasm. 2. A superfluous word or phrase.
ETYMOLOGY Late Latin pleonasmus, from Greek pleonasmos, from pleonazein, to be excessive, from ple
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Foremost, consumers of health care for M/SU
conditions face a number of obstacles to
patient-centered care that generally are not
encountered by consumers of general health care.
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a fuzzy concept

• everyone recognizes overall meaning
• different connotation for different people
• core elements of concept is clear
• but unclear on the periphery
• difficult to operationalize in measurable
  elements

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person-centered

• there is agreement on
• goals
• tasks
• participation and roles
• the relationship with the provider is experienced
  as
• collaborative ?empathic
• respectful ?trusting
• understanding ? hopeful
• encouraging ? empowering

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carl rogers

• congruence
• genuineness, honesty with the client
• empathy
• the ability to feel what the client feels
• respect
• acceptance, unconditional positive regard

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picker institute

• respect for persons values
• information/education
• access to services
• emotional support to relieve fear and anxiety
• Involvement of family and friends
• continuity across settings
• physical and emotional comfort
• coordination

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nothing about mewithout me
quality
? right care
? right way
? right time
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nothing about mewithout me
person-centered
? care person needs
? manner person desires
? time person desires
quality
? right care
? right way
? right time
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essential role of treatment planning

• key lever for systems changes at all levels
• making it real
• opportunity to assure that individual recovery--
  oriented life goals direct services
• not about documentation
• all about the process
• frequent point of failure

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example

• Goal
• Stuart will receive the assistance he needs to
  make decisions that best meet his needs and to
  keep his entitlements current
• Objectives
• Stuart will be
• compliant with meds
• compliant with scheduled appointments
• compliant with having his blood drawn

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changing the conversation

• no single treatment approach or setting effective
  for all individuals
• emphasis on program-based care
• easier to target specific communities or problems
• significant number of clients are channeled into
  available programs rather than programs that
  would meet their individual needs

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Youre the picture of healthand by the way, Im
totally in love with you
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Experience of Individuals, Families and
Communities
Microsystems of Care Where care occurs
Health Care Organizations
External Environment of Care Policy/Financing/Regu
lation
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www.wellink.org.nz
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training

• pre/post degree curriculum
• necessary but not sufficient
• move beyond didactic and be competency based
• needs to be integrated with overall systems
  strategy for change strategy
• Medicaid is the boogeyman
• built into supervision and performance
  expectations
• work flow
• business processes

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Shapers
person behavior
provider behavior
5 dimensions
Professional Context
Person Factors
Provider Factors
time
Consultation Level Influences
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model of change
Interior
Exterior
Thoughts Attitudes feelings Subconscious Dreams Sense of purpose Intention Behaviors Skills competencies Public commitments
Purpose Values norms Feelings--e. g. safety connection Alignment of group individual intentions Collaborative agreements Budgets Systems Structures
Individual
Group
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self directed care

• person-centered planning
• putting necessary services and supports in place
• individual budgeting
• control over how the funds are spent
• financial management services
• tracking and monitoring budgets
• supports brokerage
• design and management of self-directed care plans

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burden of choice

• need to account for stages of change
• pre-contemplation
• contemplation
• action
• maintenance
• lack of information
• difficult to manage
• not for everyone

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evidence based practice

• almost by definition is provider and disorder
  centered
• does not account for individual preference or
  choice
• CATIE study
• toolkits
• move to shared decision making

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provider
CONTROL
bio- psycho- social
biomedical
CONTENT
person
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outcomes

• person-centeredness challenges current
  thinking/practice in outcome measurement
• each individual becomes their own measure of
  recovery outcome and success
• goal attainment scaling
• potential oppression of standard social
  indicators

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cultural competence

• at the heart of personcenteredness
• account for heterogeneity within and across
  cultures
• preference for participation may vary
• based on culture there are instances in which
  person-centered could mean provider directed

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• above all else
• do no harm

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• above all else
• be person-centered

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• I get up each day determined to change the world
  and to have one hell of a good time.
• Sometimes this makes planning the day difficult.
• E.B. White