On being person-centered … … and recovery oriented

2. On being person-centered……and recovery oriented Neal Adams MD MPH Director of Special Projects California Institute for Mental Health

3. pleonasm

4. 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.

10. 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

11. 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

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

13. picker 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

14. nothing about me…without me

15. nothing about me…without me

16. 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

17. 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

18. 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

20. You’re the picture of health…and by the way, I’m totally in love with you

21. Experience of Individuals, Families and Communities Microsystems of Care Where care occurs Health Care Organizations External Environment of Care Policy/Financing/Regulation

22. www.wellink.org.nz

23. 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

24. Shapers person behavior provider behavior 5 dimensions Professional Context Person Factors Provider Factors time Consultation Level Influences

25. model of change Interior Exterior Individual Group

26. 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

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

28. 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

29. provider CONTROL bio- psycho- social biomedical CONTENT person

30. 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

31. cultural competence • at the heart of person—centeredness • 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

32. above all else …do no harm

33. above all else …be person-centered

34. 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