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On being person-centered…
…and recovery oriented
Neal Adams MD MPH
Director of Special Projects
California Institute for Mental Health
pleonasm
N
O
U
N
:
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.
E
T
Y
M
O
L
O
G
Y
:
Late Latin pleonasmus, from Greek pleonasmos, from pleonazein,
to be excessive, from ple
Foremost, consumers of health care for M/SU
conditions face a number of obstacles to patientcentered care that generally are not encountered by
consumers of general health care.
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-centered

there is agreement on
 goals
 tasks
 participation

and roles
the relationship with the provider is
experienced as
 collaborative
empathic
 respectful
trusting
 understanding

 encouraging
hopeful
 empowering
carl rogers

congruence


genuineness, honesty with
the client
empathy
 the
ability to feel what the
client feels

respect
 acceptance,
unconditional
positive regard
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
nothing about me…
without me
quality
 right care
 right way
 right time
nothing about me…
without me
quality
person-centered
 right care
 care person needs
 right way
 manner person desires
 right time
 time person desires
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
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…
1. compliant with meds
2. compliant with scheduled appointments
3. compliant with having his blood drawn
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
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 Care
Policy/Financing/Regulation
www.wellink.org.nz
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
Shapers
person
behavior
5
dimensions
time
Consultation
Level
Influences
Person Factors
Professional
Context
Provider Factors
provider
behavior
model of change
Interior
• Thoughts
• Attitudes & feelings
• Subconscious
Individual • Dreams
• Sense of purpose
• Intention
Group
• Purpose
• Values & norms
• Feelings--e. g. safety
& connection
• Alignment of group &
individual intentions
Exterior
• Behaviors
• Skills &
competencies
• Public commitments
• Collaborative
agreements
• Budgets
• Systems
• Structures
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
burden of choice
need to account for stages
of change
 pre-contemplation
 contemplation
 action
 maintenance
lack of information
difficult to manage
not for everyone
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
CONTROL
provider
biomedical
CONTENT
person
biopsychosocial
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
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 personcentered could mean
provider directed
above all else
…do no harm
above all else
…be person-centered
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
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