Session: Delivering Person-Centered Care in Mental Health Clinics: Results from a Multi-Site Randomized Controlled Trial (Society for Social Work and Research 24th Annual Conference - Reducing Racial and Economic Inequality)

Person-centered care has been identified as a critical ingredient in enhancing the quality of health and mental health care. The Institute of Medicine identified person-centered care as one of six principles to guide health care reform and this approach is now a priority for state and federal health policies, including the Affordable Care Act. Within mental health, person-centered care has also been driven by the mental health recovery movement as a way to empower service users to make decisions about their care based on their values, preferences and needs. There is a growing evidence base demonstrating that person-centered care improves treatment engagement, medication adherence, well-being and clinical outcomes.

While there is widespread endorsement of person-centered care, providers still struggle to translate the approach to their clinical practice. One innovative practice is Person-Centered Care Planning (PCCP), a manualized process for developing an individualized and collaborative service plan. By focusing on service planning, a process that is common across mental health programs, PCCP has the potential to enhance a broad array of evidence-based practices. Providers collaborate with service users to develop customized plans that identify life goals and potential barriers to achieving them. Providers elicit and empathize with people's subjective experiences and regard them holistically rather than as patients. Utilizing strengths and natural supports, providers and service users create measurable objectives linked to personal life goals.

This symposium presents results from a NIMH funded multi-site randomized controlled trial of PCCP. Set within community mental health clinics, the study was conducted in 14 research sites across two states over a five-year period. The study utilized a hybrid design to assess the effectiveness of PCCP and the role of organizational factors in the implementation of PCCP. The fourteen sites were randomized either to PCCP with providers receiving a year-long training or to treatment-as-usual. Data was derived from provider surveys, chart reviews, and focus groups with providers and service users.

The papers in this symposium focus on the implementation of PCCP illustrating how quantitative, qualitative and mixed methods utilizing multilevel data can investigate multiple aspects of a large-scale practice innovation effort. Paper #1 reports on the primary implementation outcome, fidelity to PCCP using an objective chart review tool to assess the person-centeredness of the service plans. Looking across time and condition, the study will test whether training in PCCP predicted increased fidelity to person-centered care. Paper #2 uses qualitative methods to understand the implementation process from the provider perspective. The paper explores how providers view person-centered care and how organizational context shaped the implementation process. Paper #3 uses mixed methods to explore if there are differences in PCCP fidelity according to diagnosis, by comparing service plans of people with and without co-occurring disorders and conducting focus groups with providers. Paper #4 uses quantitative methods to examine the role of the electronic health record in the implementation of PCCP. By comparing clinics with and without electronic health records in the experimental condition, the study assesses whether EHR use had an effect on PCCP fidelity.