| Background - | | | | the patient is weak or non-existent, the best we can |
| One aspect of the mental health Access and | | | | hope for is blind compliance and not engagement. |
| Retention Initiative involves using transaction data to | | | | While transitioning to a true person centered |
| identify non-engaged patients. These patients may be | | | | approach takes a significant commitment of time, |
| defined as those having diagnoses including | | | | training and process support, what follows are some |
| schizophrenia, schizoaffective disorder or bi-polar | | | | key questions that can be asked about current |
| disorder and who, during the pre-pilot period missed | | | | practice that can help focus some immediate |
| 30% or more of their scheduled individual therapy | | | | transition efforts. |
| appointments and/ or medication management | | | | 1. Does the current clinical assessment identify |
| follow-up appointments. Once these patients are | | | | meaningful patient strengths, preferences and |
| identified, their provider staff will be identified and will | | | | personal goals, and do the patient and all staff |
| pilot one or more strategies intended to improve | | | | currently working with the patient know what these |
| patient engagement. | | | | are? |
| The purpose of this article is to outline some | | | | 2. Does the assessment conclude with identified |
| potential 'engagement improvement' strategies as a | | | | needs that are meaningful to the patient's personal |
| basis for pilot staff "self assessment" (i.e. where do | | | | goals and reasons for seeking treatment, and do |
| individual pilot staff stand with regard to current use | | | | they make sense to the patient. |
| of the strategies), "strategy selection" (i.e. which | | | | 3. Can the patient, without significant prompting, |
| strategies do the pilot staff believe might improve | | | | articulate the current goal(s) and objectives in his/her |
| retention among their identified pilot cases) and | | | | service plan? |
| "identification of training/ support" for strategy | | | | 4. Is there one integrated service plan, with relatively |
| implementation. Since the no-show / cancellation rates | | | | few current goals and objectives? (multiple plans and |
| for the selected 'non-engaged' pilot patients will have | | | | numerous goals/objectives are confusing to the |
| occurred in the context of current practice, site | | | | patient and staff) |
| teams are encouraged to pilot strategies not | | | | 5. Can all staff that work with the patient know and |
| currently in use or not consistently in use. | | | | articulate the current goal(s), objectives, and relevant |
| Person Centered Approach Engagement Strategy - | | | | patient strengths in the service plan (at least those |
| Of the strategies routinely discussed for improving | | | | that pertain to the intervention they are providing -- |
| the attendance of mental health patients (including | | | | including group interventions)? |
| those suffering with schizophrenia, schizoaffective | | | | 6. Do the patient's current service plan goals reflect |
| disorder or bi-polar disorder), the person centered | | | | (sound like) things the patient wants as opposed to |
| approach is probably the one most likely to generate | | | | things others (e.g. the provider) want for the patient? |
| a lasting change in patient level of engagement. | | | | 7. Are the current objectives in the service plan |
| However, it also involves the broadest and most | | | | meaningful, measurable changes in the patient's skills, |
| significant change in practice for providers who do | | | | functional capabilities, symptoms, etc that clearly |
| not currently embrace and use the approach. Also, | | | | relate to ultimate achievement of a goal of |
| since a meaningful person centered approach begins | | | | importance to a patient? |
| with the assessment and service plan, it is difficult to | | | | 8. Does the patient believe the objectives in the |
| implement 'mid stream' for patients already in service | | | | service plan are achievable in a reasonable amount of |
| for some time, unless there is willingness to revisit | | | | time? |
| the assessment and plan. | | | | 9. Where possible are the objectives stated in |
| While many provider organizations claim to embrace a | | | | positive (hopeful) language as opposed to using the |
| person centered approach, a review of actual case | | | | "dead man standard" (i.e. if a person died he/she |
| records often does not support this. Many providers | | | | would accomplish the objectives)? |
| confuse Person Centeredness with "treating the | | | | 10. Does the service plan mention specifically what |
| patient respectfully" or "listing patient strengths" in | | | | patient strengths can be employed to help achieve a |
| the assessment. To gain a good understanding of the | | | | goal and associated objective(s)? |
| "Person Centered Approach" to actual practice, you | | | | 11. Does the service plan articulate the interventions |
| are referred to the book, "Treatment Planning for | | | | (not just services) that are planned to help the |
| Person -- Centered Care" by Doctors Neal Adams | | | | patient achieve the objectives? |
| and Diane M. Grieder. | | | | 12. Do the patient and staff clearly understand how |
| In a nutshell, the Person Centered Approach is | | | | the interventions and services planned will help |
| ultimately about producing better outcomes and not | | | | achieve the objectives? |
| about "being respectful" which is something that | | | | Providers are generally familiar with the "Golden |
| should be a 'given' in any orientation to service. | | | | Thread" concept as it relates to documentation |
| Particularly germane to the topic of 'engagement' is | | | | linkage and medical necessity. Person Centeredness, |
| the impact of person centered care on patient | | | | involved making that Golden Thread obvious and |
| motivation. Ultimately, if the mental health treatment | | | | meaningful in the everyday patient-provider |
| plan and the services provided offer little of inherent | | | | relationship. While the above questions by no means |
| value to the patient, why would we expect | | | | reflect the entire person centered process, they can |
| engagement? If, in a patient's experience, the | | | | be objectively applied to help assess the current level |
| connection between what goes on in treatment or | | | | of person centered practice. |
| rehabilitative sessions and something of real value to | | | | |