Transitioning to Person-Centered Care: A Qualitative Study of Provider Perspectives

Background and Purpose: The concept of person-centered care (PCC) first emerged in the 1960s as a model to treat patients as unique individuals with a right to make their own decisions about their care. Since then a body of empirical evidence has emerged demonstrating that person-centered care improves treatment engagement and clinical outcomes across healthcare settings. Despite its widespread integration into healthcare guidelines and policies, PCC lacks a consistent definition leading to difficulty in translating and evaluating PCC approaches. This study aimed to answer two research questions: 1) How do community mental health providers understand person-centered care? 2) How do community mental health providers experience the transition from traditional to a person-centered model of care?

Methods: This study was embedded within a larger NIMH-funded hybrid RCT of Person-Centered Care Planning (PCCP) set within community mental health clinics. Focus groups were conducted across seven clinics in the experimental condition which had received in-person training and technical assistance in PCCP over a 12-month period. The sample included supervisors and direct care providers (N=104) who participated in the focus groups (N=15). The majority of providers who participated were female (N=82, 78.8%) and white (N=59, 56.7%), with an average age of 44.37 (SD=11.43). Focus groups were transcribed verbatim and entered into Atlas-TI for analysis. Three researchers inductively interpreted the data, consensually produced an initial codebook, and identified higher level themes emerging directly from the data.

Results: Thematic analysis revealed that providers’ perspectives on delivering PCC can be understood in terms of dialectical tensions. Emerging from the primary tension of transitioning from a traditional model of care to a person-centered model, four dynamic tensions were identified: autonomy vs. compliance, freedom vs. structure, strengths vs. symptoms, and individualized vs. one-size-fits-all. Providers described how PCC focuses on the autonomy of individuals, whereas traditional models focused more on compliance with treatment. Providers found that PCC encouraged individuals to set personal goals, but tensions emerged in trying to support these goals while also providing structure in developing attainable goals. They also described the tensions involved in moving away from symptom-focused service planning to planning that focuses on the strengths and preferences of the individual. Finally, providers understood PCC to be individualized rather than a one-size-fits-all approach but perceived this to be at odds with the wider healthcare delivery system that at times seemed inflexible to the needs of individuals.

Conclusions and Implications:  This study highlights the tensions that community mental health providers must navigate when transitioning to a person-centered approach to care. While providers understood that person-centered care focused on strengths, was unique to the individual personal goals and gave people greater autonomy, many were working within systems that continued to be organized by the values and principles of the traditional medical model of care. This study articulated the elements of clinical practice that reflect a person-centered care approach but also highlights the need to align organizational procedures and external policies to facilitate rather than hinder person-centered care.