NIMH Funded RCT Finds Comprehensive Training Strategy Yields Significant Improvement in Delivery of Person-Centered Care Planning
Associate Professor Victoria Stanhope’s National Institute of Mental Health funded randomized controlled trial on Person-Centered Care Planning (PCCP) and Service Engagement found that PCCP delivered by an implementation strategy using a train-the-trainer model resulted in significant and sustained improvement in provider delivery of person-centered care in Community Mental Health Clinics (CMHCs).
“PCCP is a recovery-oriented, manualized intervention that aligns care to people’s personal life goals and ensures they are making decisions about their own treatment,” said Dr. Stanhope. “While many state mental health systems have embraced the principle of person-centered care, they have struggled to implement it in real-world mental health clinics, with limited resources and competing demands. We have developed an implementation strategy using gold-standard training techniques that makes PCCP practical to implement and that results in increased delivery of person-centered care.”
Notably, Dr. Stanhope and colleagues assessed the extent to which providers in the study applied PCCP principles in their service plans with a new, objective measure of person-centered care rather than relying on providers’ self-reported behaviors. A previous paper in Community Mental Health Journal, co-authored by Dr. Stanhope, suggested that individuals have difficulty assessing their level of PCCP implementation pointing to the need for an objective measure.
In a paper published online first in Psychiatric Services, Dr. Stanhope and co investigators Drs. Mimi Choy-Brown, Nathaniel Williams, and Steven C. Marcus reported on the study, which randomized 14 CMHCs from Connecticut and Delaware to either receive comprehensive PCCP training (experimental condition) or deliver service planning as usual without training (control condition). There were 34 provider teams in the experimental condition and 26 in the control condition, each of which had the same supervisor throughout the full period of study.
The clinical supervisors of the 34 teams in the experimental condition received two days of intensive in-person training from PCCP experts to prepare them to train their own direct care teams. Then, over the next 12 months, both the clinical supervisors and members of their direct care teams received one-hour technical assistance calls per month with the trainers. During the calls, supervisors received support in training their teams, and team members took turns presenting service plans for trainer and peer feedback on how well they were aligned with PCCP.
A new measure of person-centered care, The PCCP Assessment Measure (PCCP-AM), was administered via chart review to service plans in both the control and experimental conditions at baseline, 12 months, and 18 months. The measure, originally developed by the experts who designed PCCP and further refined by Dr. Stanhope’s research team, operationalizes the delivery of person-centered care according to PCCP principles, which are assessed across key service plan domains. Analyses controlling for service user and program characteristics revealed that at 12 months, providers in the experimental arm showed significant improvements in delivering person-centered care compared with the control arm. That effect was even more pronounced at 18 months.
“With this rigorous implementation strategy, which gives agencies an embedded PCCP training mechanism that can sustain the practice, we impacted the quality of services being delivered to service users,” said Dr. Stanhope, who recently presented the study at the inaugural meeting of an NYU-Wide Implementation Science Working Group convened by the Office of Research Development in NYU’s Office of the Vice Provost for Research. “When we looked at the service plans of people whose providers were in the intervention arm, they were much more person-centered; they map onto people’s personal life goals, they utilize strengths and natural supports, they focus on connecting people with community resources. We hoped to see providers in the intervention arm writing service plans that are more meaningful for service users and that is what we got.”
This latest paper is one of many to come out of the PCCP and Service Engagement study, on which Dr. Stanhope partnered with researchers from more than a half-dozen academic institutions. Among other significant findings is that electronic health records can be either a barrier or an enhancement to the implementation of PCCP. Those designed with pre-populated domains within their service planning templates preclude the entry of unique information and are thus antithetical to PCCP, with its goal of providing consumer choice and ownership of the treatment process. On the other hand, the same paper found that “a well-designed EHR can become a key strategy for the delivery of person-centered care by having the functionality to reflect individual goals, actions, and natural supports.”
“The electronic health record should be a reflection of clinical practice,” Dr. Stanhope observed, “but instead, it's actually shaping and driving clinical practice.” Because it is so determinative of clinical practice, Dr. Stanhope has made research on the impact of EHR on person-centered care the focus of her current research.
Dr. Stanhope said her passion for facilitating implementation of PCCP comes from her commitment to mental health recovery. “Recovery places an emphasis on therapeutic relationships, demanding that providers collaborate closely with each service user to discover their unique path to healing, and that’s what PCCP does.” She noted that the shift from the medical model of treating people with severe mental illnesses towards personal recovery came from service users themselves. They demanded that mental health services have to start seeing the person first and attending to their goals and aspirations, and not just their symptoms. It's a really powerful movement and it's very social work aligned but not always embedded into the curriculum. One of my key contributions within social work has been to increase knowledge about mental health recovery.”