Models, Principles and Values of Person /Family-Centered Planning

In the past 30 years, an extensive body of literature has emerged from the health literature advocating a patient or person-centered approach to treatment and services.

Yet despite popularity of the concept there is little consensus and broad interpretation as to its meaning and translation into action. Development of the concept of person-centeredness is intimately linked to perceived limitations in the conventional way of providing health and mental health services; often labeled the biomedical model'[1]

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But what does person-centered mean?  How can it be applied?  The general health literature suggests that there are five principle dimensions of person-centeredness. Taken together they place an emphasis on the quality and dynamic in the relationship between provider and the person served.  They include:

Understanding needs from a broad biopsychosocial perspective rather than a deficit or symptom driven perspective
The ability to see the “consumer-as-person” and not diminished or dehumanized in any way by his/her help seeking
The sharing of power and responsibility in decision making

The recognition of a therapeutic alliance and partnership between the provider and the consumer
The ability to view the provider-as-person and not cast him/her into a position of power or undue authority.

While these dimensions begin to describe the concept, they do not particularly emphasize the essential experience of the person seeking help as the ultimate arbiter of person-centeredness:  person/family-centeredness is really determined by the needs and expectations of each consumer and whether or not those needs and expectations are met.

Studies in medicine have used a two-pronged approach to evaluate quality of care issues related to patient participation and shared decision making.  First, the patient is asked about their preferences regarding participation in developing a care plan and then later asked if those expectations were met to their satisfaction[2].  The provider can set the stage for person-centeredness, but the person receiving help has the leading role.

In the mental health field, where a fundamental paradigm shift about treatment models is well underway, the last remaining elements of a “medical model” are being cast off and replaced by a framework of recovery, wellness and resilience.  Central to this approach are the principles of hope, empowerment and self-determination as each person/family articulates their individual vision and begins to map out their own unique roadmap to recovery.

  Although there remains some ambiguity about the meaning of recovery and resilience, there is an emerging consensus that a commitment to creating and actually using person/family-centered treatment plans in everyday practice[3]is perhaps the most powerful and effective approach to ensuring recovery-oriented services    Notions of recovery/resiliency and wellness and person-centeredness are closely if not inexorably linked.

There is much to suggest that a focus on treatment planning has the potential to play an essential role in making the concept and experience of recovery and resilience real for consumers and family members.

The President’s New Freedom Commission on Mental Health Report of July 2003 captures an image of how the current US mental health system needs to change as well as calls for a shift to recovery/resiliency oriented system.  In describing how that changed system might look and function, the Report makes explicit the central role of a plan of care.

In a transformed mental health system, a diagnosis of a serious mental illness or a serious emotional disturbance will set in motion a well-planned, coordinated array of services and treatments defined in a single plan of care….The plan of care will be at the core of the consumer -centered, recovery-oriented mental health system.

The plan will include treatment, supports, and other assistance to enable consumers to better integrate into their communities; it will allow consumers to realize improved mental health and quality of life.[4]

It is perhaps worthwhile to note that many of the person-centered values and principles relevant to practice in the mental health and addictive disorders fields have their roots in the tradition of rehabilitation sciences and practice.

For example, the Developmental Disabilities field has been undergoing a quiet revolution over the past 10 to 15 years in which the role of the individual receiving services—along with the role of the provider and family–has been radically transformed.  It was long ago understood that focusing on strengths, fostering independence and promoting self-determination could help people to realize their hopes and dreams even in the face of substantial challenges.

The critical change occurred with a shift in the relationship between the individual and the provider from a service-focused to a person-centered approach.

This is not typically the case in current day-to-day mental health practice.  The 2003 President’s New Freedom Commission on Mental Health report stated that:

Nearly every consumer of mental health services…expressed the need to fully participate in his or her plan for recovery.

In doing so, the Commission strongly implied that meaningful and satisfying participation has not always been the case in mental health service delivery systems.

Consumers do not consistently receive or experience person/family-centered responses to their request for help in tier recovery journey.  Instead consumers have often suffered the impacts of provider-driven fragmented and complex systems that have not provided hope nor the opportunity for individuals and families to control of their own lives.

[1] Mead, N., Bower, P., Patient-centeredness: a conceptual framework and review of the empirical literature, Social Science ; Medicine 51 (2000) 1087±1110.
[2] Degner, L.F., Sloan, J.A., Decision Making During Serious Illness:  What Role Do Patients Really Want To Play?, J Clin Epidemic-Vd ol. 45. No. 9, pp. 941-950. 1992.

[3] There are many terms that can be used to refer to a plan including recovery plan, service plan, individual plan treatment plan, etc.  For the purposed of this paper and discussion, the term treatment plan will be used.  These plans are to be distinguished from other individual and recovery oriented plans, such as the WRAP (Wellness and Recovery Action Plan) promoted by Mary Ellen Copeland and others.

Treatment plans refer to those planning processes and documents that mental health service providers are required to create to satisfy external oversight requirements and standards of care and are also used in the documentation of medical necessity for the purposes of billing and justifying service provision.

They should be a compliment to personal action and recovery plans developed by an individual to help with goals identification, self management, crisis prevention management, and clarification of treatment preferences and choices.