MODULE 2: PERSON AND FAMILY CENTERED SERVICES
Person Centered Treatment ServicesI. Summary/Background
Individuals have the RIGHT to have their Individual Plan of Service developed through a person-centered planning process regardless of age, disability or residential setting. The Individual Plan of Service may include a treatment plan, support plan or both. In the past, Medicaid or other regulatory standards have governed the process of treatment or support plan development. These standards drove the planning process through requirements on the types of assessments to be completed and the professionals to be involved. Person-centered planning departs from this approach in that the individual will direct the planning process with a focus on what he/she wants and needs. Professionally trained staff will play a role in the planning and delivery of treatment and may play a role in the planning and delivery of supports. However, the development of the treatment or support plan, including the identification of possible services and professionals, is based upon the expressed needs and desires of the individual.
Multi-County Counseling, Inc. , advocates for and supports a family approach to service delivery for individuals, children, and their families. This approach recognizes the importance of the family system and the fact that supports and services will impact the entire system. Therefore, in the case of minors, the child/family will be the focus of service planning and family members are integral to the planning process and its success. The wants and needs of the child/family will be considered in the planning and evaluation of supports, services and/or treatment.
Managed care strategies will play an important role in planning for and delivery of supports, services and/or treatment. Person-centered planning fits well with these strategies. Both strategies attempt to ensure that individuals are provided with the most appropriate services necessary to achieve the desired outcomes.
The literature defines the values, principals and essential elements of the person-centered planning process and it provides illustrations to its application.
II. Values and Principles Underlying Person-Centered Planning
Person-centered planning is a highly individualized process designed to respond to the expressed needs/desires of the individual.
A. Each individual has strengths, and the ability to express preferences and to make choices.
B. The individual's choices and preferences shall always be considered if not always granted.
C. Professionally trained staff will participate in the planning and delivery of treatment and
may participate in the planning and delivery of supports. Their involvement occurs if the
individual has expressed or demonstrated a need that could be met by professional
intervention.
D. Treatment and supports identified through the process shall be provided in environments
that promote maximum independence, community connections and quality of life.
E. A person's cultural background shall be recognized and valued in the decision-making
process.
III. Practice Guidelines
A. Essential Elements
1. The individual shall be given ongoing opportunities to express his/her needs or desired
outcomes. This would include:
a. Making accommodations for communication to maximize ability for expression;
b. The identification of outcomes of value for the individual; and
c. Expectations of the service delivery system.
2. Potential support and/or treatment options to meet the expressed needs of the individual are
identified and discussed with the individual.
3. The individual shall be given ongoing opportunities to express his/her preferences and
to make choices. This would include:
a. Choices and options shall be clearly explained.
b. To the extent possible, the individual shall be given the opportunity for experiencing
the options available prior to making a choice/decision. This is particularly critical
for those persons who have limited life experiences in the community with respect
to housing, work and other domains.
c. Individuals who have court-appointed legal guardians shall participate in person-centered
planning to the maximum extent possible and shall have authority not otherwise
specifically delegated to the guardian.
d. Parents and significant family members of minors are integral to and shall participate in the
planning process unless:
i. The minor is in the care and custody of the state of Oklahoma Department of Human
Services - Child Welfare Division or the Office of Juvenile Affairs wherein either case
thecaseworker will have discretion as to the participation [if any] of the parent(s);
ii. The minor is emancipated; or,
4. Individuals are provided with opportunities to provide feedback on how they feel about the
service, support and/or treatment they are receiving and their progress toward attaining
valued outcomes.
B. Illustrations of Individual Needs
Person-centered planning processes begin when the individual or parent/custodian/guardian makes a request to Multi-County Counseling, Inc. , for treatment services. The first step is to find out from the individual the reason for his/her request for assistance. During this process, individual needs and valued outcomes are identified rather than requests for a specific type of service. Since person-centered planning is an individualized process, how Multi-County Counseling, Inc., proceeds will depend upon what the individual requests.
This guideline includes elements/strategies that can be used by the treatment professional representing Multi-County Counseling, Inc. , depending upon what the individual wants and needs. Three possible situations are:
- The individual expresses a need which would be considered urgent or emergent [a crisis
When an individual is in an urgent/emergent situation, the goal is to get the individual's crisis situation stabilized. Following stabilization, the individual and Multi-County Counseling, Inc., will explore further needs for assistance and if required, proceed to a more in-depth planning process as outlined below. It is in this type of situation where an individual's opportunity to make choices may be limited.
- The individual expresses a need or makes a request for a support, service and/or treatment in a single life domain and/or of a short duration. Examples of a life domain could be any of the following:
c. Finances; d. Role performance / Work;
e. School; f. Socio-legal and safety;
g. Medical / Physical; h. Family relationships;
i. Feeling/Mood/Affect j. Thinking / Mental Processes
k. Substance Use / Abuse l. Communication; etc.,
[Refer also to the Client Assessment Record (CAR)]
IV. Assurances & Indicators of Person-Centered Planning Implementation
It is the responsibility of Multi-County Counseling, Inc. , to assure that the Individual Plan of Service is developed utilizing a person-centered planning process. Below are examples of systemic and individual level indicators which would demonstrate that person-centered planning has occurred. The methods of gathering information or evidence may vary and include the review of administrative documents, clinical policy and guidelines, case record review and interviews/focus groups with individuals and their families.
A. Systemic indicators would include, but not be limited to:
1. Multi-County Counseling, Inc., has a policy or practice guideline which delineates
how person-centered planning will be implemented;
2. Evidence that Multi-County Counseling, Inc., informs individuals of their right to
person-centered planning and associated appeal mechanisms, investigates complaints
in this area, and documents outcomes;
- Evidence that Multi-County Counseling, Inc.'s quality improvement system actively
4. Multi-County Counseling, Inc.'s staff development plan includes efforts to ensure that staff involved in managing, planning and delivering support and/or treatment services are trained in the philosophy and methods of person-centered planning.
B. Individual indicators could include but not be limited to:
1. Evidence the individual was provided with information of his/her right to person-
centered planning;
2. Evidence that the individual chose whether or not other persons should be involved
and those identified were involved in the planning process and in the implementation
of the Individual Plan of Service;
3. Evidence that the individual chose the places and times to meet, convenient to the
individual and to the people he/she wanted present;
4. Evidence that the individual had choice in the selection of treatment or support
services and staff;
5. Evidence that the individual's preferences and choices were considered, or a
description of the dispute/appeal process and the resulting outcome; and
6. Evidence that the progress made toward the valued outcomes identified by the
individual was reviewed and discussed for the purpose of modifying the strategies
and techniques employed to achieve these outcomes.
V. Dispute Resolution/Appeal Mechanisms
1. If in the judgment of the responsible treatment professional representing Multi-County Counseling, Inc., an individual requests (for instance) inpatient treatment, or a specific mental health support or service for which appropriate alternatives for the individual exist that will meet the needs of the individual in the least restrictive environment and manner, Multi-County Counseling, Inc., should:
a. Identify and discuss the underlying reasons for the request or preference;
b. Identify and discuss alternatives with the individual; and,
c. Negotiate toward a mutually acceptable support, service and/or treatment.
In the event that a mutually acceptable alternative cannot be reached, the person representing Multi-County Counseling, Inc., should:
a. Document the individual's preference, the support, service and/or treatment Multi-
County Counseling, Inc., is offering, and the reason(s) for not accepting that
preference;
b. Inform the individual of their right to appeal the decision as permitted in the
Grievance Procedure.
This would include:
i. His/her right to contact the Multi-County Counseling, Inc., Grievance Coordinator
and/or the Oklahoma Department of Mental Health and Substance Abuse Services,
Consumer Advocate, by telephoning the Office of Consumer Advocacy at (405)
573-6605 or toll-free 1(866) 699-6605 regarding their request for a specific mental
health support or service;
ii. His/her right to request a second opinion via referral for an assessment with an
inpatient triage specialist, if the service being requested is, for instance, inpatient
treatment; and,
iii. His/her right to a Fair Hearing, if a recipient of Medicaid coverage.
2. If in the judgment of Multi-County Counseling, Inc., an individual's choice or preference for
the inclusion or exclusion of a planning participant, meeting location, or specific provider
poses an issue of health or safety or exceeds reasonable expectations of the level of care,
Multi-County Counseling, Inc., should discuss and identify the individual's underlying reason
for that specific choice or preference and negotiate toward a mutually acceptable alternative(s) that meet(s) the outcomes intended.
3. If an individual is not satisfied with his/her Individual Plan of Service, the individual may
request a review and/or revision to the treatment professional responsible for implementing the plan and/or the Clinical Supervisor. The review shall be completed within 72 hours and shall be carried out in a manner approved by the appropriate governing/certifying body. In addition, the individual always has access to the appeal processes as defined in the Grievance Policy.
4. If the individual believes that the opportunity for person-centered planning is not being
provided as specified in the manner above, it is the responsibility of Multi-County Counseling, Inc., to inform the individual of his/her right to consult with the Multi-County Counseling, Inc., Grievance Coordinator and/or the Oklahoma Department of Mental Health and Substance Abuse Services, Consumer Advocate, by telephoning the Office of Consumer Advocacy at (405)573-6605.
5. When there is a disagreement between an individual and the legal guardian or responsible
parent, MULTI-COUNTY COUNSELING, INC., staff should attempt to mediate
between the two parties in order to provide an outcome which is acceptable to both parties.
Adapted from the Michigan Best Practice Guidelines as published by:
Martha A. Churchill, Attorney
108 E. Main St., Milan, MI 48160
Phone: (734) 439-4055. Fax: 439-4056
Family-Centered Services
FACTS Q / A
What Is/Are Family-Centered Services?
Family-Centered Services refers to principles, which if followed, lead to partnership and collaboration between families and professionals to ensure the best possible supports and services for a individuals in need of mental health and/or substance abuse treatment services, and for the entire family.
What Are The Key Characteristics of Family-Centered Planning?
1. Recognition that the family is the constant in a child's, adolescent's, spouse's, or other family
member's life, while the service system and support persons fluctuate.
2. Family and professional collaboration in all settings (home, community, treatment center, school), especially in the areas including but not limited to: Care giving, service planning, program development, program implementation, program evaluation, program evolution, and policy formulation.
3. The exchange of complete and unbiased information between families and professionals in supportive manner at all times.
4. Recognition and honoring of cultural diversity, strengths, and individuality within and across all families: including, ethnic, racial, spiritual, social, economic, educational, and geographic diversity.
5. Recognition and respect for different methods of coping.
6. Implementation of comprehensive policies and programs that provide developmental, educational, emotional, environmental, and financial supports which meet the diverse needs of families.
7. Encourage family-to-family support and networking.
8. Ensure that all service and support systems for individuals and their families are flexible, accessible, and comprehensive in responding to diverse family identified needs.
9. Appreciation of families as families and the individuals within families as individuals, recognizing that they possess a wide range of strengths, concerns, emotions, and aspirations beyond their need(s) for specialized services and supports.
What Are the Limitations of Person & Family-Centered Planning (PCP/FCP)?
1. Belief that only certain families or individuals can use or will benefit from PCP/FCP,
2. Lack of training in understanding and honoring cultural diversity,
3. Tendency for professionals to be seen in [and often fancy themselves to be] the role of
expert,
4. Lack of open and effective communication,
5. Traditional model of service delivery is entrenched,
6. Moves slowly if the individual's is not clear or is unsure about his/her needs,
7. Requires considerable investment of time and research to develop the supports and create the
opportunities the person needs,
8. Family members and/or professionals often define people in clinical terms or even negative
terms,
9. Often done in isolation from other complementary systems change efforts, and
10. Lack of understanding that PCP/FCP is not a quick fix or a cure all for people's difficulties.
What are the Values and Guiding Principles of PCP/FCP?
The following values are the benchmarks of the mental health and substance abuse service delivery system:
Family Centered: A family-centered service delivery system crosses disciplines and settings, views the family as the unit of attention, and organizes the services and supports in a collaborative fashion and in accordance with the wishes, strengths, and needs of the entire family. The individual who is the focus of the treatment [child, adolescent, other family member] is viewed as a part of the whole family system. The individual and his/her family have access to discussions related to their plans, an opportunity to voice their preferences and ultimately feel that they own the plan. Services and supports are designed to improve access, utilization, and satisfaction of families. The individual and his/her family have a legitimate say in all aspects of their services and supports.
Least restrictive environments: Services are provided within the family’s own community whenever possible, and individuals who are the focus of treatment are supported to remain with their families in their home and community rather than being placed in institutional care.
Individualized and tailored care: The plan for services is based on each individual's and family’s unique needs and characteristics, and are flexibly and creatively designed to respond to those needs.
Strength-based: Strength-based services utilize a family’s existing competencies and abilities to shape and implement the plan of service [also known as the treatment plan]. Strengths are maximized and generalized to areas where families want help to reach their goals.
Culturally competent: Providers embody the capacity to accept, respect and give attention to cultural differences; to understand the knowledge, values, beliefs and customs belonging to particular cultural communities. Services are provided within the context of cultural competency.
Family-Centered Services....It's A Process, Not A Method Or Content
A Family-Centered Approach is a PROCESS for delivering services to families that will fit many different "content areas,". It is not a set of particular practices but rather a "philosophy" in which families are recognized as having unique concerns, strengths and values. A Family-Centered Approach represents a paradigm shift away from deficit-based, medical models that discover, diagnose and treat "problems" in families to an ecological model. The ecological model which is the theoretical foundation for a Family-Centered Approach, is described below. It views families from the perspective of "a half-full cup" rather than half empty. This approach builds and promotes the strengths that families already have. The key components of a Family-Centered Approach are:
Creating partnerships and helping relationships. Families are supported and the opportunity for successful treatment outcomes are increased through the helping and partnership relationships.
Building the community environment. Families gain information, resources and support through their connections to the community environment.