The Impact of Person Centered Care Planning On Service Engagement

Purpose:  Within mental health care, the emphasis on recovery and evidence based practice have focused attention on structuring care around client needs and preferences. Person centered care planning (PCCP) is one promising practice that has emerged to orient care around personal life goals. PCCP consists of:   identification of personal-life goals; assessment of behavioral health problems; development of service plans to integrate life goals and behavioral health goals; and keeping the focus on life goals during therapeutic sessions. Although person centered care planning is beginning to be implemented as part of routine mental health care throughout the country, there is still limited research on its effectiveness as an intervention. This multisite community based randomized trial examined whether PCCP improves service engagement and medication adherence.       

Methods:  Ten geographically diverse community mental health centers (CMHCs) were selected based on their participation in the National Council on Community Behavioral Healthcare’s Enhanced Access and Retention Quality Improvement Initiative. Five CMHCs were randomized to the experimental condition of PCCP and five were randomized to the control condition of treatment as usual. Within the five experimental CMHCs, 177 clients participated and in the control CMHCs, 190 clients participated. The experimental condition received initial virtual training in PCCP and monthly meetings for further coaching and monitoring to ensure fidelity. Monthly, over an 11 month period, medication adherence was measured by clinician report and service engagement was measured by number of client no-shows. Models examined changes in medication adherence over time among clients in control versus experimental conditions and the relative effect of the intervention on the odds of having a no-show appointment.

Results:  The intervention had a positive impact on medication adherence over time. The slope for overall adherence in the experimental condition showed a significant increase in clinician report of medication adherence (B=0.022, p<.01), indicating a 2 percent increase in medication adherence per month among clients. The control condition showed no significant change in rate of medication adherence over the 11 month time period (B=0.004, p=0.25) and by the end of the study had a lower rate of medication adherence than the experimental condition. CMHCs in the experimental condition also had reduced appointment no-shows (OR=.74, p<.01), as compared with those CMHCs in the control condition.

Implications:  Overall, the study found that person centered care planning was associated with greater engagement in services and higher rates of adherence. While, self determination within mental health care has increasingly become an ethical imperative, this study provides evidence that interventions which give clients a greater sense of ownership of and choice within their treatment can promote service engagement and improved client outcomes.  More rigorous testing of person centered care planning on a broader array of outcomes and an exploration of how the intervention effects provider-client interactions has considerable potential to contribute to the evidence base for recovery-oriented practices.