Person-centered care planning and service engagement: a study protocol for a randomized controlled trial

Abstract

BackgroundService disengagement is a pervasive challenge the mental health care system faces. Mental health services are of little value should persons with mental illnesses continue to opt out of receiving them. Consumers attribute disengagement from care to an absence of choice in their treatment. In response, the mental health system is adopting a person-centered model, based upon recovery principles, to engage consumers more actively in their care. Person-centered care planning is a promising practice involving collaboration to develop and implement an actionable plan to assist the person in achieving personal recovery goals.Methods/designThis study design combines a parallel-group randomized controlled trial of community mental health organizations with qualitative methods to assess the effectiveness of person-centered care planning. Participants at 14 sites in Delaware and Connecticut will be randomized to treatment as usual or the person-centered care planning intervention. Participants will be in leadership (n = 70) or supervisory or direct care (n = 210) roles. The person-centered care planning intervention involves intensive staff training and 12 months of ongoing technical assistance. Quantitative survey data will be collected at baseline, 6 months and 12 months measuringperson-centered care planning competency and organizational factors. Consumer outcomes (engagement, medication adherence, functioning and consumer satisfaction) will be assessed by Medicaid and state-level data. Qualitative data focused on process factors will include staff and consumer interviews and focus groups. In this intent-to-treat analysis, we will use mixed-effects multivariate regression models to evaluate the differential impact of the person-centered care planning intervention on each consumer and implementation outcome as well as the extent to which clinician assessments of organizational factors are associated with the implementation outcome. Mixed methods will triangulate and strengthen the interpretation of outcomes.DiscussionThe aim of this study is to generate valuable guidance for state systems engaged in scale-up and transformation efforts. Targeted staff selection for training to support sustainability will serve to provide further insight into important intervention implementation strategies. Person-centered care planning has the potential to enhance the impact of all evidence-based and recovery-oriented practices and bring practice into line with the emerging national guidelines in health care reform.Trial registrationThis trial was registered with ClinicalTrials.gov (Identifier: NCT02299492) on 21 November 2014 as New York University Protocol Record PCCP-13-9762, Person-Centered Care Planning and Service Engagement.

Person‐directed care planning in nursing homes: A scoping review

“…Utilising an approach to care planning that attends to individuals’ strengths and capabilities rather than their weaknesses and disabilities is emphasised as foundational to planning care in a way that maximises choice for individuals receiving mental health services (Stanhope, Tondora, Davidson, Choy‐Brown, & Marcus, 2015). Taking a strengths‐based approach has promise for improving uptake and promoting effectiveness of care: “By shifting from an illness and/or deficit focus to a strengths‐based, person‐centred one… fundamentally changes a practice culture that has resulted in many people walking away from the care they need” (Stanhope et al, 2015; p. 2).…”

“…Taking a strengths‐based approach has promise for improving uptake and promoting effectiveness of care: “By shifting from an illness and/or deficit focus to a strengths‐based, person‐centred one… fundamentally changes a practice culture that has resulted in many people walking away from the care they need” (Stanhope et al, 2015; p. 2).…”

“…For mental health services to achieve an individual's personal recovery goals, optimal care planning has been described as “a collaborative process between the service user and all of those people in the person's life whom he or she identifies as supportive of his or her recovery” (Stanhope et al, 2015, p. 2). Similarly, in the context of paediatric rehabilitation, parent‐professional collaboration is recommended (An & Palisano, 2013).…”

“…Self‐direction is a central element of the recovery model of mental healthcare wherein individuals direct their own goals, identify their preferred life paths, and determine which steps to take on that path (Onken, Craig, Ridgway, Ralph, & Cook, 2007). However, adaptive challenges to self‐direction in the care planning process have been identified, including: beliefs that recovery‐oriented practice is not unique or novel, that it is too burdensome for overextended clinicians, that it is not desired by individuals with severe mental illnesses, that it is not evidence‐based or reimbursable, that it devalues provider expertise, and that it is too risky because it increases provider exposure to incidents and liability (Stanhope et al, 2015). …”

“…Furthermore, care planning interventions often are implemented in conjunction with other efforts, making it difficult to determine which changes are affecting outcomes (Stanhope et al, 2015). …”