Archive for ‘Person-Centeredness’

February 16, 2011

Circling Person-Centeredness

by Richard Edwards

For those in the field of supporting people with disabilities, you undoubtedly know about Person-Centered Thinking as a movement, and as an approach to providing individualized support services. For those outside of the field, you can read about it here, here and here. But what I want to write about is not so much person-centeredness, as a concept, but how we have tried to enforce it in NC.

For many services that include goal or plan development in NC, a six-hour training course in person-centered thinking is a standard requirement. Recently, the state initiated an additional six hours of training for specific services to persons with mental health issues (children and adults). The reason given–that state personnel had reviewed many person-centered plans that were not, in fact, person centered, and so, they were doubling the training requirement.

This is, I believe, completely wrong-headed. Let me count the ways.

1. Person-centeredness is not, in my experience, knowledge-based; but rather, culture-based. We seem to believe that new staff aren’t “getting it” in six hours, so we’ll make it twelve, which completely ignores the fact that person-centeredness is more about how you relate to people–something that can be explained in a few words, such as “Nothing about me without me,” or, “Do unto others as you would have them do unto you.”  I’m not in any way suggesting this should be sufficient…clearly, it isn’t.

But what you cannot achieve, in any training, is an approach that has to be practiced and reinforced repeatedly over time, because it is contrary to the traditional ways that people with disabilities have been viewed–as helpless, as unable to contribute, as needing to be told what’s best for them. No one comes to this field as a blank slate–these kinds of dehumanizing messages still permeate society. There are, sure, light-bulb moments that can be created in a training setting, but by and large, I’ve found that the person-centered approach is something that has to be integrated into one’s worldview through practice and supervision, not through seminars. Even 12 hour ones.

2. State systems are typically not person-centered. This may come as a shock, given the emphasis, but most of the really important decisions about services and supports are made before a provider ever meets a person seeking services. What services are available? Who can provide it? In what quantity? At what locations? For what diagnoses? By which provider agencies? Using what interventions? Targeting what issues? All of these questions have often already been answered, and then providers are told to be person-centered, when the service system itself reinforces the misguided notion that the professionals know best.

There are some exceptions to this–there is a self-directing option in NCs waiver service array to persons with intellectual and/or developmental disabilities, but this is only available if you have a low annual budget, and only if you have one of the finite number of slots in the program. The really great thing about this program, however, is that it gives the individual and her/his family the opportunity to design a system of supports that meet the needs of the individual, rather than choose from a menu that may or may not fit–resulting in over-serving or under-serving the individual. You can read more about self-directed services at the Center for Medicaid & Medicare Services here, and the World Institute for Disability, here.

3. The state system is not person-centered, part II. There are assessment tools for developing truly person-centered plans, such as Essential Lifestyle Planning and the Personal Outcome Measures. My personal preference is for the Personal Outcome Measures assessment tool, but the truth is, public funding in NC does not cover the cost of developing truly person-centered plans. The amount of time it takes to interview the individual and the person and/or people that know her/him best are not reimbursed adequately, and so of course the process gets short shrift. This isn’t acceptable, but is a much more rational explanation for “cookie cutter” goal plans than assuming the training time needs to be doubled.

(By the by, the cost of doubling the training for person-centered thinking is wholly the responsibility of the provider. There was no rate increase, no cost adjustment, no attempt whatsoever on the part of the state to subsidize this training.)

4. We’re still not measuring person-centeredness. It is what is measured that gets attention, and again, we are confusing process with outcome. We assume that process (12 hours of training) assures an outcome (person-centered goals and plans). That assumption is false. If the state really cares about person-centeredness–it should measure person-centeredness, not training time. The Council on Quality & Leadership (for whom I work part-time, full disclosure) has developed a new accreditation model that focuses on person-centeredness, almost exclusively, because that’s how you get at what really matters to people.

Think about that for a moment…person-centeredness is about getting at what really matters to people. And my angle is that prerequisite trainings as the ones mentioned can only circle around person-centeredness, because the person is typically only present in the abstract. More talking about people isn’t what’s needed. More talking to people is.

But that’s just my angle. What’s yours?