Utilizing an Objective Measure to Examine Differences in Person-Centered Care Among White and African American Service Users in Community Mental Health Clinics

Background:

Significant mental health disparities exist among minority racial and ethnic groups, partly due to poor quality of care and lack of access to individualized mental health services (Institute of Medicine, 2006). Person-centered care, which is care that is responsive to individual values, needs and preferences, is a key aspect of service quality. Despite the widespread endorsement, person-centered care has been hard to operationalize and measure with provider self-report overestimating their delivery of person-centered care. This quantitative study used an objective measure of person-centered care (PCCP-AM) anchored in mental health recovery principles to examine differences between African American and White service users’ in the extent to which they received person-centered care

Methods:

This study was part of an NIMH-funded cluster randomized controlled trial of Person-Centered Care and Service Engagement (Stanhope et al., 2015). 798 unique service user service plans were evaluated using the PCCP Assessment Measure (PCCP-AM). The 10-item PCCP-AM tool assesses whether the service plan includes service user strength, life goals, natural supports, self-directed actions, and the promotion of community integration. PCCP-AM scores range from 1 to 10, with higher scores indicating greater person-centeredness. Each item was coded from 0 to 1, indicating “not competent” or “competent.” Bivariate analyses and logistic regression were conducted to examine the association between race and person-centered care, controlling for substance use disorder, psychotic disorder, gender, and study condition.

Results:

Overall White service users did not receive more person-centered care than AA service users. The total sum of PCCP-AM scores did not vary by race (coefficient =-0.58, p=0.14) when controlling for substance use disorder, psychotic disorder, gender, and study condition. However, the objective measure was able to discern differences in services plans when

examined item by item. Service plans for White service users were more likely to be competent in PCCP on three items: the plan/plan update actively incorporate the person’s identified strengths(OR=1.70, p=0.02); interventions are specified clearly in terms of its purpose and duration and who is responsible for implementing the intervention(OR=1.54, p=0.02); the narrative/interpretive summary includes: strength, interests and life roles and priorities, individual’s stage of change/recovery, available supports or resources, cultural factors and a clinical hypothesis/understanding/core theme about what drives the individual’s experience of illness and recovery(OR=1.92, p=0.01).

Conclusions:

While overall, the objective measures did not discern overall differences in receipt of PCC among White and African American service users varied by race on specific aspects of person-centered care. Providers were more likely to incorporate service user’s strengths, life roles, culture, and supports and develop individualized treatment when working with White service users. These findings suggest that more targeted training is needed to address disparities in the delivery of some aspects of person-centered care. The disparity in person-centeredness was found across study conditions, suggesting an additional adaptation or enhanced fidelity monitoring may be needed. Providers need to increase their self-awareness of their own bias towards racial/ethnic minority groups and the impact on the quality of care.