Transcript PCRP Coaching Characteristics

What’s in your *PCP toolbox?
Articles:
 Article - The Top Ten Concerns About Person-Centered Care Planning in Mental
Health Systems
 Child, Adolescent, and Family Issues: Team-Based Planning and the Wraparound
Process
 Introduction to the Documentation of Person-Centered Service Plans
 PCRP Outcomes Research Article
Documents & Resources:
 SCRSN Learning Collaborative Person-Centered Recovery Planning Schedule &
Objectives
 Blank Recovery Plan Template
 Charting to the Plan - Skill Building Language
 Person-Centered Care Questionnaire - Family Member
 Person-Centered Care Questionnaire - Person in Recovery
 Person-Centered Care Questionnaire - Practitioner
 Person Centered Recovery Plan PowerPoint
 Sample Recovery Plan Worksheet
 Sample Assessment – “Roma Inpatient”/Sample Treatment Plan – “Roma Inpatient”
 Strengths Based Assessment Sample – Items/Sections may be integrated as helpful
 PCP Toolkit for Persons in Recovery/PCP Toolkit for Persons in Recovery - Spanish
Version
*Currently posted at: http://www.spokanecounty.org/mentalhealth/content.aspx?c=2996
What ELSE would it be helpful
to include?

Roma, Narrative Summary – Inpatient; Full Mr. Blake
sample – adult outpatient (used in December training);
Child/Family plan

Narrative Summary outlines?

Coach/Supervisor Self Assessment in PCP

USPRA Webinar link when live?

Plan Summary feedback forms (for internal PCP
coaching. Consistent with, but would not replace RSN
Compliance Tool)

PCP Process Indicators?
How’s it going?

Updates from sites and supervisors:

Tell me about what your supervision looks like (in general)
and if you have been able t0 incorporate PCP coaching?


Based on these experiences: What are YOUR
priorities/questions for this (and future) supervisors’ call?


What, if anything, have you been able to try/implement since
December? With staff? With persons in recovery?
May need to prioritize in agenda
Are you (or your Team) “stuck” on anything I can be
helpful with?
Previously Identified
Questions/Topics of Interest

Barriers to Engagement in the treatment
planning process; Relationship between Stage
of Change, MI and PCP

Clarification of the use of SMART in each
objective (note – this applies to objectives, NOT
interventions);

Additional info on person centered narrative
summary (how to write one and why it is
important);

How to pull in progress notes coaching


? Mr Blake Note? ; restructuring of case based calls should allow
time for review of note
Dealing with “Top Ten Concerns”
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What might get in your way??
Top 10 Implementation Concerns
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
If given choice, people will make BAD ones
Payers won’t let us do this; regs prohibit this
The forms don’t have the right fields
Consumers aren’t interested/motivated
It devalues clinical expertise; violates
boundaries
Its what the clubhouse does…
Lack of time/caseloads too high
“Our clients are too sick”
It doesn’t fit with focus on EBPs
Don’t we already do PCRP?
What was on YOUR minds then…
How about now?
Common Beliefs/Concerns that Hinder PCRP
Implementation
Total
%
Rank
Concern
10. PCRP is no different/don’t we already do it?
18
75%
1
5. PCP doesn’t fit with the focus on rigorous EBP
11
46%
2
8. There is not enough time to do PCRP
11
46%
2
1. We won't get paid; regs prohibit this
7. It is not part of standard clinical
care/therapy/treatment
8
33%
3
8
33%
3
3. Our planning forms don't have the right fields.
9. Clients are too sick/impaired to partner with us on
PCRP
6
25%
6
25%
4. Consumers aren't motivated
5
21%
6. PCRP devalues clinical expertise
2. If given increased choice, consumers may make BAD
ones
4
17%
2
8%
How to manage engagement
barriers in PCP?
 It
depends on how you understand WHY the
person is reluctant to participate
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Just not “there” yet – here’s where you use your best
evidence-based MI strategies
Or maybe they are mandated into care…
Practical limitations, e.g., child care
Fear of disappointment, skeptical it is the “real deal,”
e.g., why get hopes up?
Uncertainty re role: need for driver’s ed
Fear of change/failure
REAL limitations limit role – how ELSE can you maximize
involvement – PCP has been carried out for decades
in DD/MR arena
Importance of
An Integrated Summary
• Data collected in assessment is by itself not sufficient for
treatment planning
• Data must be woven together in a cohesive
understanding of the whole person Formulation

Moves from the “what” (facts only) to the
“why” (i.e., how you make sense of the
data.)

Informed by both the person’s
understanding as well as by your
professional opinion

Is the “bridge” between the data and
the plan; should have a direct impact on
the plan’s content
 Assessment
data may have multiple references to a
person not using medication effectively. The summary
notes: “long history of medication non-compliance in the
community has led to repeated hospitalizations”
 This
is NOT a formulation but rather, a re-stating of the
data/facts
 The
task in formulation/integrated understanding is to try
to understand WHY the person is not using meds
effectively as a tool in his/her recovery
 This may take the plan in very different directions...

Person is concerned re: side-effects: exploration of meds with different sideeffect profiles; consultation with nutritionist to get support to off-set weight-gain;
family-based interventions to help couples deal with sexual side-effects

Person does not believe they have an illness/believe meds are poison: trustbuilding; motivational approaches; psycho-education; peer specialist
engagement interventions; empathic understanding

Person has religious objections to taking medications; has cultural preference
to use alternative healing strategies: collaboration with faith-based or cultural
healers; integration of alternative strategies along-side traditional tx/meds

Person experiences stigma re: use of psych meds; family/others have advised
them not to take it: family-based interventions; NAMI involvement; peer
support; exposure to positive recovery role models

Person becomes disorganized/cant track complex med schedule: cognitive
remediation; occupational therapy consult to develop compensatory strategies
to promote organization
ONE Possible Structure:
Formulation – Guiding “Ps”

Pertinent history: e.g., personal; psychiatric; & legal

Predisposing factors: e.g., trauma history, head injury, cooccurring medical issues, family hx

Precipitating factors: e.g., What led to current admission or
forensic involvement?

Perpetuating factors: e.g., What factors contribute to repeated
adverse outcomes, e.g., cycle of readmissions?

Previous treatments and responses: e.g., A synthesis (not a
chronological listing) of adverse and positive responses to range
of previous treatments

Protective factors/preferences: e.g., strengths/assets that will
improve person’s chance of achieving stability and recovery
Objectives should be SMART
 An
objective is a meaningful step (in the eyes of
both the person & staff) toward the longer term
goal; a concrete change in functioning or behavior
 Simple
or Straightforward
 Measurable
 Attainable
 Realistic (relevant/results-oriented)
 Time-framed
Objectives
 Simple
litmus test for measurability: Read
the objective out loud:
At
the end of 1 month, etc., will you
definitively be able to say yes / no that
the objective was accomplished.
If
not, the objective as written was likely
too “soft” on the front end
Objectives - Wording
interact
participate
socialize
cooperate
coherent
rescue
appropriate
actively
willingly
calm
relevant
agitated
normal
increase
decrease
improve
These terms commonly mean different things to different
people. If you use them, be careful to further define them in
behavioral terms, e.g., improve sleep disturbance…?? as
evidenced by sleeping a minimum of 5 hours per night for 7
consecutive days.
The Person-Centered Plan as an
Integrating Framework for Quality in a
Changing Healthcare Climate
Incorporates
EBPS, including IMR
Encourages PeerBased Services
Maximizes SelfDetermination & Choice
Derived from a
Comprehensive
Assessment of Needs &
Strengths
Promotes Cultural
Responsiveness
Focuses on Natural
Supporters/Community
Settings
Informed by Stages of
Change & MI Methods
Respects Both Professional &
Personal Wellness Strategies
Emphasis on the
Attainment of
Meaningful
OUTCOMES
Consistent w/ Standards of
Fiscal & Regulatory Bodies,
e.g., CMS, JCAHO, CARF
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Stage of Change & PCP

Your impression of the person’s stage of
change should inform the development of the
plan

For example:

A more modest, learning-oriented objective
assuming pre-contemplative stage of change:


Gary will identify two negative consequences of
substance use as evidenced by correctly stating
these to SA counselor in weekly SA rehab group for
3 consecutive weeks.
A more ambitious, behaviorally-oriented
objective assuming action stage of change:

Gary will demonstrate active use of coping
strategies to remain substance-free on 100% of
community passes over the next 90 days
Consider Stage of Change Implications
Ohio
Village
Prochaska &
DiClemente
Stage of
Treatment
Treatment
Approaches
 engagement/
Dependent
unaware
High risk/
Unidentified or
Unengaged
Precontemplation
Engagement
Dependent
aware
Poorly
coping/not selfdirected
Contemplation
/preparation
Persuasion
Independent
aware
Coping/Self
responsible
Action
Active
Treatment
relationship building
 practical help
 crisis intervention
 Motivational
interviewing
 psycho-education;
build awareness
 goal setting
Solution-focused
therapies
 counseling/ CBT
 skills training/rehab
 self-help groups
Relapse
Prevention
 relapse-prevention
 expand skills training
WRAP plans
 mindfulness
Interdependent
aware
Graduated or
Discharged
Maintenance
Progress Notes:
Charting TO the Plan
• Routine documentation should be directly
linked to goals/objectives/ & interventions
noted on the PCP
• This is fundamentally different from our
“traditional” style of writing progress
notes
• Some EHR formats prompt you to explicitly
identify which goal/objective/intervention
from the plan are being addressed in the
current contact/encounter
Progress Note Basics
• Notes should provide a measure of how effective the
intervention has been by clearly (but concisely) detailing:
• a clear description of the staff's intervention (action)
• the participant's response to that intervention (action),
• progress made (or not made) toward the IAP goal
and/or objective
• Next steps/plan moving forward
• What kinds of questions/issues are coming up around
notes?
Charting to the Person-Centered Plan
Service Note Basics
• The provider must document each face-to-face
encounter with the participant in Service Notes. These
notes should provide a measure of how effective the
intervention has been by clearly (but concisely)
detailing:
• a clear description of the staff's intervention
(action)
• the participant's response to that intervention
(action),
• progress made (or not made) toward the IAP goal
and/or objective
• Next steps/plan moving forward
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