Person-Centered Care and the Therapeutic Alliance

Person-centered care has been gaining prominence in behavioral health care, and service planning has shifted towards “person-centered care planning” (PCCP), where individuals, in partnership with providers, identify life goals and interventions. A strong therapeutic alliance has been identified as key to a person-centered approach, but little is known about how the therapeutic relationship influences person-centered processes and outcomes. Using an explanatory sequential mixed methods design, this study investigated: (1) the association between the therapeutic alliance and PCCP, and (2) how the therapeutic relationship influences the process and outcomes of PCCP. Quantitative analyses found that a strong working alliance predicted greater personcenteredness. Qualitative analyses revealed two central themes: (1) the importance of connection, continuity, and calibration of the relationship to set the right conditions for PCCP, and (2) PCCP as a vehicle for engagement. Findings demonstrated that the therapeutic alliance is inextricably linked to the PCCP process, each influencing the other.     

Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics

Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ²(17)?=?47.64, p?<?.0001 and explaining 30% (Nagelkerke R²) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B?=?.90, p?=?.008, OR?2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.

     

Sorting it out: Eliciting consumer priorities for recovery in supportive housing

This study aims to understand participant priorities in their personal recovery journey and their perspectives of recovery domains. A card-sort data-gathering technique was employed to elicit priorities in recovery from consumers in supportive housing programs serving adults who were formerly homeless with severe mental illnesses in New York City. Participants (N = 38) were asked to sort 12 cards printed with recovery domains in order of importance and describe the meaning attached to each domain. Mental health (95%), physical health (89%), and housing (92%) were the domains most frequently included and prioritized in the top three rankings. Family (76%) and partner (74%) were also frequently included and endorsed as most important second only to mental health. Housing was prioritized yet rated most important less often (58%). Work, school, hobbies, program, friends, and neighborhood were less frequently endorsed. “Card-sort talk” revealed critical understanding of participants’ priorities and their reasons for endorsing other domains less frequently. Most important to participants was regaining functional independence through improved mental and physical health and access to housing. With underlying principles of efficiency and empowerment, card sort is a promising engagement technique for providers to elicit consumer priorities in their own recovery.     

Unpacking Clinical Supervision in Transitional and Permanent Supportive Housing: Scrutiny or Support?

Behavioral health organizations use clinical supervision to ensure professional development and practice quality. This qualitative study examined 35 service coordinators’ perspectives on supervision in two distinct supportive housing program types (permanent and transitional). Thematic analysis of in-depth interviews yielded three contrast themes: support versus scrutiny, planned versus impromptu time, and housing first versus treatment first. Supervisory content and format resulted in differential perceptions of supervision, thereby influencing opportunities for learning. These findings suggest that unpacking discrete elements of supervision enactment in usual care settings can inform implementation of recovery-oriented practice.     

“I see your punitive measure and I raise you a person-centered bar”: Supervisory Strategies to Promote Adoption of Person-Centered Care

Community Mental Health Journal - Person-centered care remains a high priority within community mental health services. Clinical supervision is an embedded resource for professional development and...     

Do Providers Know What They Do Not Know? A Correlational Study of Knowledge Acquisition and Person-Centered Care

Person-centered care (PCC) is a central feature of health care reform, yet the tools needed to deliver this practice have not been implemented consistently. Person-centered care planning (PCCP) is a treatment planning approach operationalizing the values of recovery. To better understand PCCP implementation, this study examined the relationship between recovery knowledge and self-reported PCCP behaviors among 224 community mental health center staff. Results indicated that increased knowledge decreased the likelihood of endorsing non-recovery implementation barriers and self-reporting a high level of PCCP implementation. Findings suggest that individuals have difficulty assessing their performance, and point to the importance of objective fidelity measures.