Treatment Planning for Person-Centered Care

Shared Decision Making for Whole Health

Neal Adams, Diane M. Grieder

• Publisher: Academic Press
• Year: 2013
• ISBN:
  9780123947970
• Edition: 2
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Treatment Planning for Person-Centered Care, second edition, guides therapists in how to engage clients in building and enacting collaborative treatment plans that result in better outcomes. Suitable as a reference tool and a text for training programs, the book provides practical guidance on how to organize and conduct the recovery plan meeting, prepare and engage individuals in the treatment planning process, help with goal setting, use the plan in daily practice, and evaluate and improve the results. Case examples throughout help clarify information applied in practice, and sample documents illustrate assessment, objective planning, and program evaluation.

• Presents evidence basis that person-centered care works
• Suggests practical implementation advice
• Case studies translate principles into practice
• Addresses entire treatment process from assessment & treatment to outcome evaluation
• Assists in building the skills necessary to provide quality, person-centered, culturally competent care in a changing service delivery system
• Utilizes sample documents, showing examples of how to write a plan, etc.
• Helps you to improve the quality of services and outcomes, while maintain optimum reimbursement

Section II

Getting Started

Outline

Introduction

Chapter 2 Assessment

Chapter 3 Understanding Needs

Introduction

We are now prepared to launch into the more technical details about the role of person-centered planning on the road to wellness. Section I, Land of Opportunity, described key features of the current health care environment and the terrain which our journey to whole health and recovery must cover. The environment is one that clearly fosters and promotes person-centered care and the important role of person-centered planning in helping individuals to fulfill their wellness vision—but it is not without mountains to climb and rivers to forge.

Section II will deal with the specifics of engaging the individual in a process of shared decision making and mapping out their personal journey.

Chapter 2 is focused on gathering information and assessment. It addresses the importance of finding a balance between collecting data and building a healing partnership. In it we find that information about the particulars of the journey is essential, but equally important is the bonhomie and collaboration between the person served and the provider as fellow travelers.

Chapter 3 examines the importance of understanding and integration of all the information gathered. It discusses the transition from collecting data to providing important understanding insights and knowledge; this begins to identify opportunities for success as potential barriers to achieving whole health. This will become the fuel that sustains the trip. We may know where we want to go, but without understanding, we do not have a good idea about how to get there.

These two linked steps are essential to setting the compass—together they begin to lay out the individual’s route, to define the purpose of the journey, as well as identify the destination.

Chapter 2

Assessment

Abstract

Chapter 2 examines the first step in creating a person-centered plan: the process of assessment. Topics include organizing the steps, the importance of engagement and building a relationship, and consideration of the ongoing nature of assessment and strategies for gathering relevant clinical information/data including the use of standardized instruments and assessment domains. Special attention is given to the importance of strengths-based approaches, consideration of co-occurring disorders, cultural factors, levels of care and stages of change as part of the assessment. The use of motivational interviewing and other tools and strategies for engagement and data gathering is also discussed.

Keywords

shared decision making; health care reform; person-centered plan(ning); person-centeredness; whole health; integrated care (treatment); health and wellness; Wagner chronic care model; medical necessity; peer support; trauma-informed care; DSM-5™; integrated summary; goals; objectives; interventions; reassessment/evaluation; progress notes; transition/discharge planning; stage of change; outcomes; shared-care planning

Knowing is half the battle.

G.I. Joe

I Stating the Case

Ostensibly, the purpose of an assessment is to gather information; this is the essential first step in shared decision making and creating a person-centered plan. It has been said that any plan is only as good as the assessment. There are many books and references that consider the challenges and issues in assessment for mental health and addiction recovery services at a level of detail that is beyond the scope of this book—it is a rich and complex topic worthy of its own book and exploration. However, taking some time to understand the process of assessment is a worthwhile investment for success in providing person-centered recovery-oriented services. Identifying the unique attributes and needs of individuals and families is the essence of being person-centered.

The Process of Assessment

Providers have a responsibility to fully understand the individual and family, their strengths, abilities and past successes, along with their hopes, dreams, needs and problems in seeking help. Only this knowledge prepares the provider to promote shared decision making and help create a responsive, efficacious plan, which is consistent with the expressed values, culture and wishes of those receiving services.

But assessment is more than the mere gathering of information; it is the initiation of building a trusting, helping, healing relationship, and the forging of an alliance upon which to build a plan responsive to the individual’s and family’s needs. In terms of the road trip metaphor, this is the point of “getting started” on the journey and gathering the needed provisions in order to begin the trip. While there is no question that the accuracy and quality of information that we gather is important, how the information is gathered is perhaps even more critical. In many instances, it is easy to confuse the process of assessment with the requirements of paperwork and forms, but ultimately assessment is primarily about building a relationship. While forms and documentation need to be completed, it may be better to pursue a natural conversation rather than follow a linear approach to completing these forms.

This is akin to the metaphor of the road map. Following a decision to travel and the choice of destination, preparations begin, the route is laid out and the intermediate stops are selected. Simply beginning a journey without a destination should be avoided, to prevent heading in the wrong direction and having to double back. Without following these basic steps, reaching the destination is unlikely. Assessment is the “getting started phase,” identifying what we need to bring with us, choosing the provisions, gathering the essentials and packing for the trip. In the process of creating an individual plan, information is the fuel that propels us.

Before continuing with the discussion on assessment, it may be helpful to clarify the terminology. The words “triage,” “screening” and “assessment” are often used interchangeably, resulting in some degree of confusion. While they are related processes, they also represent distinct clinical functions.

Triage A process of assigning priorities for access to treatment based on urgency and risk, typically but not necessarily used in emergency or crisis situations.

Screening A cursory of the preliminary assessment process for determining the need and appropriateness of services, often used in the initial determination of eligibility, level of care, and so on.

Assessment An in-depth gathering of data and information, typically conducted at the initiation of treatment, needed to understand an individual’s or family’s needs as a prerequisite for developing a plan of care.

This chapter will focus on assessment.

Establishing a Relationship

Too often, initiating an assessment begins by asking and focusing on what is wrong. In a recovery-oriented, person-centered approach, the challenge is to think about more positive, inviting, as well as affirming ways of responding to and engaging individuals and families seeking help. The need to accept and “meet the person on their own terms” is an often recited phrase, but its real meaning needs to be examined in response to an individual’s or family’s request for assistance. Sometimes simply asking the neutral and inviting question “How can I be of help?” begins to realign some of the inherent and at times undermining power differentials in the relationship between the provider and the person seeking services. This helps to set the stage for a more positive and productive course. There are times when this process is framed as one of alliance building or engagement. While this may at one level be accurate, the importance of the tone, quality and experience of the relationship cannot be overestimated. Treating people with dignity and respect, and as experts in their own lives, should always be our standard of practice and guiding rule, regardless of the circumstance.

The importance of a strengths-based approach to assessment cannot be overstated. An immediate focus on problems and shortcomings all too often leads to feelings of shame, blame and failure. This does not promote openness or support engagement and partnership; it does not set the stage for a successful recovery endeavor. A deficit-based approach emphasizes a negative perspective and often leaves the individual and family feeling that they are the problem. Instead, there is an opportunity to be empowering and collaborative even in the process of gathering assessment information. In a strengths-based and person-centered approach, the focus should be on possibility and response rather than the identification of all of the problem areas¹; this helps to build trust, cooperation and meaningful involvement by the individual and family.

Another approach is to actually begin to build the helping alliance with some form of an orientation to how services are provided and the process of assessment and treatment planning, rather than immediately engage in data gathering and assessment. There are multiple levels of orientation to consider: orientation to the larger concept of mental health and addiction, orientation to the planning process, orientation to the service organization and available services, and/or orientation to a particular program. Depending on the needs, experience, knowledge and sophistication of the individual and family, all four levels of orientation might be indicated. Although providers are themselves generally very familiar with the mental health and addiction services process, many of the individuals and families seeking help are not. For many people, each new experience in seeking services promotes anxiety and uncertainty. Both children and adults will frequently carry fears and misconceptions, not knowing what to expect. Beginning with an explanation or overview of the whole process can help reduce anxieties, begin to build the alliance and support the assessment.

Organizing the Steps

Figure 2.1 begins to show a hierarchy for the multiple sequential steps that lead to the creation of a plan. Each step in the pyramid builds upon the preceding one. Like the metaphor of building a house, creating the foundation is the essential first task. Each successive step must not only be completed in order, but must be done properly if the final result is to succeed. Skipping a step or jumping ahead will typically not work well. Perhaps not surprisingly, assessment is the first level of the pyramid. It is metaphorically as well as practically f...