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Person-centered care has been identified by the Institute of Medicine as critical to enhancing the quality of health and mental health services. Person-Centered Care Planning (PCCP) is a practice that has been utilized in mental health services to maximize choice and treatment engagement. A key function of PCCP is the creation of an actionable service plan developed through a process of equal partnership between providers and individuals receiving services. Despite the service plan’s central role in service delivery, few measures exist to assess the person-centeredness of service plans. In this paper, we describe the early stage development of the Person-Centered Care Planning Assessment Measure (PCCP-AM), a tool designed to measure fidelity to PCCP.
Methods
The PCCP-AM was developed as part of a NIMH funded multi-site randomized control trial of PCCP. After completing an extensive review of existing training materials, PCCP literature, input from national experts, and two existing unvalidated PCCP measures, the research team aggregated a pool of 29 items reflecting the components of a person-centered service plan. These items captured PCCP components in order to blindly rate the degree to which a service plan aligned with them. This preliminary 29-item measure was subsequently piloted by six independent researchers over the course of six months with a sample of de-identified service plans developed using PCCP. Two iterations of pilot testing and feedback along with analyses of Cronbach’s alpha scores were used to further refine the tool items.
Results
Cronbach’s alpha scores ranged from .76-.80 and assisted with the revision of the measure to include 24 items comprising the components of a person-centered service plan. These items spanned five domains and included: Assessment, Goals, Objectives, Natural Supports/Self-Directed Actions, and Professional/Billable Services. Items within these domains were assessed for the extent to which they emphasized the principles of PCCP including collaborative decision making, person-first language, goals written in the person’s own words, and the incorporation of strengths, self-directed actions and natural supports. Individual items measured the degree to which these principles were incorporated within each domain using an anchored 6-point Likert scale with “1” indicating “strongly disagree” and “6” indicating “strongly agree.” The last two items in the measure were global and assessed the overall recovery orientation and rigor of the plan. The final 24-item PCCP-AM was assessed for inter-rater reliability, resulting in a good intra-class correlation coefficient of .80.
Conclusion and Implications
Results of the pilot test indicate that the PCCP-AM demonstrates good inter-rater reliability across assessors. Further psychometric testing of the PCCP-AM will include factor analyses of the responses collected using the PCCP-AM to assess service plans from the larger trial. Seventy-five chart reviews at each of the 14 sites will be assessed using the PCCP-AM. This measure has potential for researchers, in providing a fidelity measure for implementation of person-centered care, and for clinicians by serving as a training guide and a “check-list” for practitioners adopting PCCP within their agencies.