Do Providers Know What They Do Not Know? Understanding How Knowledge Acquisition Relates to Person-Centered Care Practice

Background and Purpose: In recent years, the delivery of person-centered care (PCC) has become integral to quality behavioral health care.  One practice used to promote PCC is person-centered care planning (PCCP). Grounded in the values and approach of mental health recovery, PCCP integrates clients’ values and preferences into treatment decisions, and builds on existing strengths and natural supports to achieve client-defined goals of wellness. 

Although there are manualized approaches to PCCP, studies suggest many providers still struggle with the model’s meaning and practical requirements. Interestingly, research exploring barriers to PCCP adoption found that many providers report they are already doing PCCP and perceive training to be unnecessary. These seemingly contradictory findings require additional exploration, particularly as many measures of PCC and PCCP rely on provider self-reports of practice behavior, without assessing related competencies. Understanding the relationship between knowledge and perceived practice is also essential for effective implementation. Leading implementation theories posit that stages of ‘sense-making’, or knowledge building and mastery, should precede practice integration. This quantitative study, examined perceived barriers to implementation of PCCP and explored the relationship between providers’ knowledge of PCCP and their perceived adoption of this practice. 

Methods: The study recruited a sample of providers (N=224), from 14 community mental health clinics as part of a multi-state NIMH-funded randomized controlled trial. Supervisors (N=81), and direct care staff (N=143) completed a baseline survey as part of the trial.  Knowledge of PCC was measured using the Recovery Knowledge Inventory. Adoption of person-centered practices was measured using the Person-Centered Planning Questionnaire. Providers were also asked to identify barriers to PCCP adoption from a list of common implementation concerns. Multivariate linear regression analyses examined the relationship between knowledge of recovery oriented practice and adoption of PCCP.

Results: Nearly half of respondents (45.79%; N=102) endorsed the barrier that they were already using PCCP in their practice.  Other commonly endorsed implementation barriers included the belief that clients are not motivated enough (36%; N=98) or are too sick (21%; N=59) to engage in PCCP. Self-reported adoption of person-centered practices was negatively associated with knowledge (B= -.328, p<.01), such that higher reports of PCCP adoption predicted lower levels of PCCP-related knowledge when controlling for site and years in mental health.

Conclusion and Implications:  Many providers believed they were already implementing person-centered care planning. Some simultaneously endorsed beliefs contrary to core principles of PCCP, namely that clients are too sick or unmotivated for the practice to succeed.  In addition, perception of PCCP practice was inversely related to recovery knowledge.  Collectively, results suggest that providers may “not know what they do not know” and are not accurately assessing their own abilities to implement PCCP. Therefore, measures that explore only providers’ perceived adoption of person-centered care planning may not reliably indicate genuine uptake of this practice. This demonstrates the challenge of measuring complex, nuanced, concepts such as person centered care with self–report measures, and suggests that both building and assessing knowledge must be a focal point of efforts to implement and evaluate person-centered care practices.