Wisconsin:
Leading the Way to Person-Centered
Planning in Community-Based Health
Diane Grieder, M.Ed
Gerald Theis, LCSW
Citation:
Grieder D & Theis G (2008). Wisconsin: Leading the Way
to Person-Centered Planning in
Community-Based Health International
Journal of Psychosocial Rehabilitation. 12 (2), 111-114
Introduction
A person-centered approach is reshaping practice
throughout behavioral healthcare with its emphasis on the individual
who has
strengths, talents, and interests rather than a person as a case or a
diagnostic label. Person-Centered Planning (PCP) incorporates the
person’s
right to fully participate in all aspects of their recovery planning;
their
right to make decisions and choices about their treatment, while
ensuring
important aspects of their culture also be documented in the service
plan
itself. This collaborative process empowers and provides an opportunity
through
a psychosocial rehabilitative model for the person to inherently find
their own
path to recovery.
It
is now widely recognized that people with mental illness can
participate actively in their own treatment and can become the most
important agents of change for themselves. Person-Centered Planning
skills,
along with Evidence-based Practice (EBP) interventions, such as
Wellness Management
and Recovery, ranging from greater knowledge of psychiatric illness
and its treatment to coping skills and relapse prevention strategies,
play a critical role in people's recovery from mental illness.
It
is anticipated that EBP will be a key
intervention in PCP recovery outcomes. For example, Wellness Management
and
Recovery (WMR) aims to empower consumers with severe mental illness to
manage
their wellness, define their own recovery goals, and make informed
treatment
decisions by teaching consumers the necessary knowledge and skills. WMR
strongly emphasizes that consumers determine and pursue personal goals
and
implement action strategies (objectives)
in their daily living to achieve them. The program employs
interventions to help consumers improve their ability to overcome
the effects of mental illness on social and role functioning.
PCP encourages
people receiving services and their
supporters to focus on goals aimed at increased functionality and
community
integration rather than solely on reduction of symptoms and decreased
use of
hospitalization. It helps people to focus on increasing the quality of
their
lives and look to a better future with more meaningful activities and
social
relations. The barriers to success resulting from the person’s
disability are
identified and the plan is an effort to explain to everyone concerned
how those
barriers will be overcome while enhancing the person’s chances of
successfully
achieving the agreed upon goal.
In the State
of Wisconsin, under the
Bureau of Mental Health & Substance Abuse, the State has been
awarded a one
year grant (the “CMS Real Choice Award”) to bring recovery based;
Person-Centered
Planning (PCP) to Wisconsin’s
community -based mental health programs beginning in 2008. A precursor
to this
grant was a previously awarded grant to implement recovery-based
Evidence-based
Practices (EBP) under a new statue called, Comprehensive Community
Services,
(CCS), and technical assistance, as requested by Alice Mirk, (Chief,
Integrated
Services Section, Bureau of Mental Health & Substance Abuse
Services,
Wisconsin Department of Health & Family Services from NTAC
(National Technical
Assistance Collaborative) which is part of NASMHPD (National
Association of
Mental Health Program Directors).
In 2004, Wisconsin
created a new statute called Comprehensive Community Services (CCS) to
administer a comprehensive service array for persons with severe mental
illness. The statute establishes a scope of psychosocial rehabilitation
services with standards for certification and criteria for determining
need
under Medicaid rules. The emphasis is on recovery, measured by
decreases in
dysfunctional symptoms and increases in level of health, well being,
stability,
self-determination, and self-efficacy.
Five counties initially applied for CCS
and implemented
the components of CCS. These same five counties were then selected by
the
Bureau to be offered two full-day s and three months of on-going
technical
assistance via follow-up phone calls on person-centered planning (PCP)
as part
of the NTAC consultation. Each of these counties use the Mental Health
Functional Screen in their programs and agreed to use the SAMHSA
Recovery
Oriented Systems Inventory (ROSI) for surveying consumer satisfaction,
prior to
and after applying the PCP approach.
The Division of
Quality Assurance and the Division of
Health Care Financing also participated in these training sessions to
ensure
that PCP would be integrated into the regulatory and reimbursement
environment
in Wisconsin. PCP is one of the
new criteria in the proposed Center for Medicaid and Medicare Services
(CMMS)
rule on psychosocial rehabilitation (Notice of Proposed Rule Making:
Coverage
for Rehabilitative Services 42 CFR Parts 440 and 441). PCP is
considered
critical to the advancement of system transformation.
A
national behavioral health-consulting group, Alipar Inc, facilitated
these
training sessions and follow-up calls. The owner of AliPar, Inc.
co-authored
the book “Treatment Planning for Person-Centered Care: The Road to
Mental
Health and Addiction Recovery.” In preparation for the bi-weekly
teleconferences, each county team took turns preparing an Assessment, a
Narrative Summary and a Person-Centered Plan of a consumer actively
engaged in
their mental health program. The documents were e-mailed to each of the
other
counties prior to the scheduled teleconference. The focus of the
teleconference
was on the use of PCP with its emphasis on the person’s assessed
strengths,
central theme of the person and their stages of change. The focus on
the
person-centered plan was on the use of the person’s own goals,
strengths,
objectives, and interventions applied by the providers. This process
proved to
be beneficial in the development of new skill sets. As a whole, the
group
determined defining objectives (as
opposed to goals and interventions) was the most difficult part in the
formation of the person-centered plan.
Since
the Division of Quality Assurance and the Division of Health Care
Financing
participation in these training sessions, these entities were able to
monitor
and then later facilitate the progress made to ensure that PCP was
being fully
integrated into recovery planning and outcomes for these state
regulated
programs in Wisconsin. The monthly follow up
teleconferences allowed for ongoing collaboration with each county
technical
training team. Through this process, each county team worked together
building
new skill sets while gaining a strategic advantage in this era of
transformation. This process created an opportunity for each county to
collectively apply their own unique circumstances towards a common goal.
Together,
these two approaches PCP and EBP are expected to enhance the service
array and
enhance a person-centered approach currently being offered by these
five
existing community-based mental health programs. Each of these counties
will be
at a strategic advantage towards demonstrating a recovery-oriented,
evidence-based, person-centered model of delivery.
As
a result of the PCP training these counties have already achieved the
following
objectives:
-Appreciation for the
need for
practice change (and just how difficult that is to
do) in terms of conducting person-centered treatment
planning
-Preparation for state and/or
federal audits which focus on meeting
medical necessity criteria for services
-Identification of
emerging new
frameworks that will guide and develop the person-centered plan
-Understanding of the
importance of
a strengths-based assessment process
-Defining the key
elements of a
recovery plan
-Understanding how to
apply a
stages of change framework to engagement and person-centered planning
-Apply when indicated, Evidence-based
Practice as a key intervention within the recovery/service plan
This
group of providers agreed that the potential effect of PCP initiatives
on their
consumer’s with mental illness was significant. Although the
benefits of learning how to plan to manage one's illness and make
progress toward recovery are compelling, all agreed that recovery is
hard work. The switch from being a passive recipient of care
to an active partner is very challenging for many consumers. Providers
note:
- Results of the training and the follow-up technical
training phone calls were: Significant increases in PCP
skills were documented.
- County learning was given strong
support by state staff.
- Consumer concerns are being
addressed through the development of training to address their specific
issues.
- County clinical and supervisory
staff has additional skill development needs but are committed to the
PCP
process and are eager to refine their ability to engage consumers in
PCP.
The
State is hopeful that knowledge about PCP will be
widely circulated and used in a variety of mental health specialties as
providers begin to appreciate the need for practice change in the era
of
transformation. Those providers will be encouraged to expand these
newly
developed skill sets as they are tested and proven to be effective with
the
newly empowered consumers.
As providers focus on
the individual who has
strengths, talents, interest rather than theperson as a case or a
diagnostic label our mental health recovery process
will become a journey of healing and transformation for both providers
and consumers.
Consumer ownership of their recovery plan
allows providers to view the situation from the consumer’s perspective
who is
now perceived as a capable human being who is full of strengths and
resources
and the treatment approach is geared toward empowering consumer to
achieve a
desired future and meaningful life. This collaborative process results
in a
recovery-oriented plan that is directed by consumers and produced in
partnership with providers.
By focusing in on the
wisdom of consumers, providers will
transition into a consumer- driven process that will assist consumers
to
enhance their resiliency and hope to the ravages of their illnesses.At
the end of the
day, providers who implement PCP will address consumer’s unique
recovery needs
by mapping their road to Recovery,
Resilience and Wellness.
