On being person-centeredOn being person-centered…………and recovery orientedand recovery oriented

Neal Adams MD MPHNeal Adams MD MPHDirector of Special ProjectsDirector of Special Projects

California Institute for Mental HealthCalifornia Institute for Mental Health

pleonasmpleonasm

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

Foremost, consumers of health care for M/SU Foremost, consumers of health care for M/SU conditions face a number of obstacles to patient-conditions face a number of obstacles to patient-

centered care that generally are not encountered by centered care that generally are not encountered by consumers of general health care. consumers of general health care.

a fuzzy concept…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

person-centeredperson-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

carl rogerscarl rogers

congruence genuineness, honesty with

the client

empathy the ability to feel what the

client feels

respect acceptance, unconditional

positive regard

picker institutepicker institute

respect for person’s 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

quality

right care

right way

right time

nothing about me…nothing about me…without mewithout me

quality

right care

right way

right time

person-centered

care person needs

manner person desires

time person desires

nothing about me…nothing about me…without mewithout me

essential role essential role of treatment planningof 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

exampleexample

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…

1. compliant with meds

2. compliant with scheduled appointments

3. compliant with having his blood drawn

changing the conversationchanging 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

You’re the picture of health…and by the way, I’m totally

in love with you

Experience of Individuals, Families and Communities

Microsystems of Care

Where care occurs

Health Care Organizations

External Environment of CarePolicy/Financing/Regulation

www.wellink.org.nzwww.wellink.org.nz

trainingtraining

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

Professional Context

Shapers

Consultation Level

Influences

5 dimensions

Pro

vid

er

Fa

cto

rs

Pe

rson

Fa

cto

rs

time

provider behavior

person behavior

model of changemodel of change

• 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

Interior Exterior

self directed careself 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

burden of choiceburden of choice

need to account for stages of change pre-contemplation contemplation action maintenance

lack of informationdifficult to manage

not for everyone

evidence based practiceevidence 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

bio-psycho-social

CO

NT

RO

L

biomedicalCONTENT

provider

person

outcomesoutcomes

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

cultural competencecultural competence

at the heart of person—centeredness account for heterogeneity

within and across cultures preference for

participation may varybased on culture there are

instances in which person-centered could mean provider directed

above all elseabove all else

……do no harmdo no harm

above all elseabove all else

……be person-centeredbe person-centered

I get up each day determined to change the I get up each day determined to change the world – and to have one hell of a good time. world – and to have one hell of a good time.

Sometimes this makes planning the day Sometimes this makes planning the day difficult.difficult.

E.B. White