Ten Reflections on Person-Centered Care

If you work in a hospital, a group home, a school, or social services, you’re likely already using person-centered approaches.

But what is it? What does it look like? We asked CPI Certified Instructors (professionals who are certified to teach our programs in their workplaces) from a variety of backgrounds for a definition, and the meaning it has for them.

"We all want to be treated compassionately and empathically when we experience agitation or frustration."

Rania Ghobrial, ASD Resource Team
Nonviolent Crisis Intervention^® Certified Instructor
Peel District School Board

We all have something in common. We all want to be treated compassionately and empathically when we experience agitation or frustration. When we’re feeling heated or in high-alert mode, we’d rather not experience embarrassment, further frustration, or be berated or have our concerns shelved by others. The guarantee is that responding in an adversarial fashion to someone who isn’t themselves is only going to elicit an unwelcome response.

With this in mind, person-centeredness is especially meaningful in my work with students with an Autism Spectrum Disorder. It’s extremely important because it focuses on the relationship—and in the heat of the moment, when things have derailed, we want to treat an upset student in a genuinely caring and proactive fashion, like how a wise and judicious parent would.

Whether they’re calm or in cognitive arousal, there are times when we must re-examine our responses (particularly the words we use) to our clients, students, and families. Tapping and working with outside resources (families, caregivers, community agencies), building trust and confidence, and developing a culture of collegiality is imperative. All this is ultimately the genesis to enhancing relationships with our clients.

“A one-size-fits-all approach to treatment is inherently limited and cannot apply in every instance.”

D.C. Foster, Behavioral Health Intervention Specialist
Master Level Nonviolent Crisis Intervention^® Certified Instructor
Arizona State Hospital

With all the well-thought-out and different programs, therapies, interventions, and wellness approaches, if you take away the fads, the glitz, the shine, and the newness of it all, and it’s still successful, you will find at its core a commitment to patient-centeredness. No matter the label of the technique, if it succeeds, it’s because of its patient-centered foundation. In contrast, a one-size-fits-all approach to treatment is inherently limited and cannot apply in every instance. This is because people change, and time—as well as the natural evolution of things—influences and changes along with us.

The inclusive concept of patient-centeredness brings with it a unique look into an individual’s life experiences, as it examines the small pieces and parts of a person that may often be missed or taken for granted. Past and present wants, feelings, needs, experiences, and relationships are just a few of the character constructs it’s necessary to build a care plan around. Their value in this approach can be priceless when constructing and developing that person’s strength-based wellness plan.

Each of us can shine brightly and burn intensely, our hearts lighting our way as we move forward in life. I would offer that the strength of any individual allows for their creative expression to be appropriately nurtured and channeled. Taking a patient-centered approach makes these things not only possible, but probable.

“The concept promotes critical thinking around patient-centered care, which in turn guides appropriate approaches and involvement of resources.”

LeAnn McCormick, Onboarding Coordinator, Educational Services
Dementia Capable Care and Senior Level
Nonviolent Crisis Intervention^® Certified Instructor
Riverside Medical Center

As a healthcare professional, I frame approaches so that the patient is at the heart of the plan that’s developed by all disciplines. It goes beyond just knowing the patient or the patient’s family’s preferences. Person-centeredness goes beyond fashioning an efficient task list, and expands critical awareness to encompass values, family preferences, life experiences, culture, and social circumstances. The concept promotes critical thinking around patient-centered care, which in turn guides appropriate approaches and involvement of resources. There is freedom in this understanding, helping reach full patient potential.

During daily “huddles” in my organization, individual preferences and care approaches are shared with all disciplines. Examples may include information such as identifying visitors that create anxiety in the patient with interventions on how to change the approaches.

Our documentation system allows a space for notes to be posted electronically for all disciplines as an FYI. It’s also part of the care plan that’s accessed by all disciplines.

In long-term care, adopting the “Can Do,” “Will Do,” “May Do” terminology across disciplines to communicate in a common language and tactics is also helpful to reach full potential.

“We work with our clients to develop a plan that allows them to get their exact same need met in a more adaptive or acceptable manner.”

Tracy Vail, MS, CCC/SLP, Autism Consultant, Speech/Language Pathologist
Senior Level Nonviolent Crisis Intervention^® Certified Instructor

8 Ways to Help a Child on the Autism Spectrum
Context Blindness and Autism

My definition of person-centered care is that it involves taking the values and preferences of the person we are serving in every aspect of treatment. In my work with children and adults with autism, it means teaching them to communicate and engage with others within activities that they find valuable and enjoyable.

With regards to their behavior, it means that once the function of their maladaptive behavior is determined in the Postvention stage, if they are cognitively able, we work with them to develop a plan that allows them to get their exact same need met in a more adaptive or acceptable manner. If the person is a child, we work closely with their parents to make sure we’re all teaching the child to get their needs met in a more functional manner. We also make sure that whenever a behavior change needs to be made, that change is socially significant and is one that will allow the child to be successful in their environment.

“Identifying where the client is in terms of thinking provides a better roadmap for providing the most appropriate intervention.”

Christopher Fernandes, MA, LMHC, CSAC, Clinical Behavioral Psychotherapist
Nonviolent Crisis Intervention^® Certified Instructor
New Bedford Public Schools

The meaning behind person-centered care really is understanding that you cannot make a person change; change comes from the person. The power, motivation, and the will to act comes from the person. As therapists, we can set up the conditions that increase the likelihood of change through encouragement, nonjudgment, reflective listening, and unconditional positive regard.

Attempting to get someone to change a behavior when they are not aware of the behavior leads to resistance. It’s important to understand that there is no such thing as a resistant client, but only a therapist who attempts an intervention that the client is not ready to attempt. Client-centered care approaches meet them at the stage of change they are at.

If you want to be a better client-centered therapist, the best tip I can give you is to identify where the client is in terms of their problem.

• Are they oblivious to their problem?
• Are they thinking about their problem?
• Have they tried to act on change already?
• Have they acted and failed on their intervention?

Identifying where the client is in terms of thinking provides a better roadmap for providing the most appropriate intervention.

Here are some quick reminders about practicing person-centered care approaches:

• Listen, understand, reflect.
• Try not to make a judgment.
• Reframe the resistance.
• Create ambivalence by restating the two conflicting conditions the client discusses.
• Give the client choice and power.

“I begin each evaluation with a personal interview where I learn the individual’s life story.”

Maria Miller, Occupational Therapist
Dementia Capable Care Certified Instructor and DCCT
Wilkes Barre VA Medical Center

A person-centered care model is based on the unique needs, values, and beliefs of each individual patient rather than the time schedule and/or productivity standards of the therapist.

Working in an outpatient mental health program in addition to a dementia unit, I begin each evaluation with a personal interview where I learn the individual’s life story. On the dementia unit, I often become the keeper of their stories as they begin to forget the details, and we use these stories to make ongoing connections even as the dementia progresses.

My treatment strategies are developed for each individual patient and I work collaboratively with them to select goals that are meaningful to them so I may assist them in achieving maximum therapeutic outcomes.

“In almost all patient interactions, I use a motivational interviewing technique.”

D.K. Johnson, Linkage to Care Coordinator
Dementia Capable Care Certified Instructor
University of Cincinnati Medical Center

Being person-centered means focusing on the needs, strengths, and potential barriers of the person I’m working with.

I practice it with the patients I assist in the emergency department (ED) and when I volunteer with hospice clients. I work with patients between the ages of 18 and 64 who are HIV positive. I assist patients who are dealing with mental health and drug and alcohol use and connect them with proper resources.

In almost all interactions, I use a motivational interviewing technique. However, it is so important to focus on the patient first. Motivational interviewing can be useless if I don’t understand where they are at during their crisis or problem. Building rapport with the invidiual helps me help them obtain the most beneficial resources.

When working with hospice clients, I listen to their needs and to identified activities they can do. I also get a sense of why they may feel depressed and how to help them and their family work through moments like this. It’s very important to be client-centered so I can help them get the tools they need to move forward.

“Focusing on the person and what is truly important to them, what they know or remember, and what makes them feel in control and safe.”

Tammy Whitehead, MA, OTR/L, Regional Rehab Director
Dementia Capable Care Certified Instructor
Life Care Centers of America

I’ve had the opportunity to not only teach the person-centered approach, but also to see the wonderful outcomes and tremendous success that occurs when this approach is used. When teaching, I focus on personhood and what that means especially in terms of who the individual is or was depending on what stage of dementia they’re in. I stress the importance of knowing your resident so you can use the patient-centered care approach.

I’d like to share a story. I was teaching a course and my participants were sharing about a resident who’d been a challenge for several weeks when it came to bathing. She would resist any attempt at showering, so the staff initially thought that she wasn’t worried about cleanliness, and they didn’t want to force her.

In class, we discussed personhood, generational changes, and patient-centered approaches. I asked the staff if they had spoken to the lady’s family and if they knew their residents’ bathing preferences: Whether their residents liked to take a bath in a bathtub (very typical for the generation), take a sponge bath (also typical), or take a shower. I suggested that they set their client up in front of the sink with basin, soap, and water and that they assist only as needed. I asked them to stand back and observe and let their client direct the activity herself.

When I returned the following week, the staff were elated with their success, as their client was now giving herself a sponge bath daily with minimal assistance.

This to me is what the client-centered care approach is all about: Focusing on the individual and what is truly important to them, what they know or remember, and what makes them feel in control and safe.

“Identifying strengths prevents a deficit-based approach and helps enlist the client’s involvement in their own recovery.”

T.D. Loftus, MS, LMHC, Quality Management and Compliance Officer
Senior Level Nonviolent Crisis Intervention^® Certified Instructor

What is the meaning of person-centeredness? It’s an approach that involves looking at all major facets of the individual in front of you. Coming from a high-fidelity, evidenced-based approach of Wraparound, one looks for the strengths and needs of their client. In the past, the major focus was on psychosocial needs. That doesn’t help when someone is hungry, doesn’t have a stable living situation, has troubling medical conditions, or when any other factors that may affect their quality of life are at play.

The focus on integrated, client-centered care is beyond theory now. Certified Community Behavioral Health Clinics (CCBHCs) are a major initiative at the federal level driven by the Excellence in Mental Health Act. This model is designed to provide for a comprehensive range of services for vulnerable individuals with complex psychosocial, mental health, and substance use conditions. Eight states will receive a grant and within those states, participating behavioral health agencies will need to become CCBHC entities. My agency is fortunate to be one.

How can it be effectuated? In Wraparound, one valuable tool is the Strengths, Needs, and Cultural Discovery assessment. This process is prepared with the client. Identifying strengths prevents a deficit-based approach and helps enlist the client’s involvement in their own recovery. Rather than culture being defined by race, ethnicity, socioeconomic status, where one lives and so on, it focuses on the individual or the family.

What is important to the person might not be the same as broad brush strokes ascribed to an identified population.

Another factor that’s important to take into consideration is the learning style of the client. There are many models. One of the simple ones is using an Auditory, Visual, and Kinesthetic paradigm. Does the client learn by hearing, do they need to see something to learn, or do they learn by doing? While people can tap into more than one learning style, many of us tend to prefer one or the other.

“It starts with basic training, and the PERSON is the focus, not the task.”

Pamela Atwood, MA, CDP, CADDCT, CLL Director, Dementia Services
Dementia Capable Care Certified Instructor
Hebrew HealthCare

Person-centeredness to me is an evolution of care. It starts with basic training of people who really want to provide care to others—teaching critical thinking skills, how to adapt care, and how to transform practices.

It then evolves beyond task-orientation to the WHY of care. The why is to provide compassion, improve quality of life, relieve suffering, and/or enhance meaning and joy to a person in need.

Because the WHY differs from individual to individual, PCC is not a singularly defined action. No single strategy will work. How to deliver PCC will change depending on who the person is, and what the goal is.

The PERSON is the focus, not the task, not the practice. Tasks and procedures are just steps to facilitate person-centered care.

Person-centered care adapts to the preferences and needs of the individual receiving the care. A client who is afraid of a caregiver and resists being helped will need the caregiver to know what makes him or her relax. For true person-centered care, the caregiver needs to implement those strategies BEFORE the client resists. We may all feel better with music, but which specific kind of music or piece makes the client relax? Which excites? Which stresses?

For me, it starts before the individual is a client. Our staff is skilled at helping people feel at home and engendering trust in their caring; however, to cut their learning curve, I evaluate the client in their living environment BEFORE they come to us. I interview the individual; I speak with the primary family. And then I share my knowledge with the team, so they have something to discuss beyond medical diagnoses and medication reconciliation.

We try to have favorite comfort foods on hand the first day of admission. We ask them to tell us about their work if they were proud of that, or the art studio they used to sponsor, or the recipe they use for matzo balls.

It’s about honoring the personhood of those in our care; recognizing their unique vulnerabilities and cherishing the opportunity to be a part of their journey.

We do this so that they do not fear the ills of aging: loneliness, suffering, and despair.

“Our strategic plan is not only to identify, but to anticipate needs and offer solutions.”

Karen Barnash, RN, Training Coordinator
Dementia Capable Care Certified Instructor
Friendship Senior Option

In my care community, we offer the friendship spirit in everything we do.

Since we are a continuing care retirement community, we serve senior residents who are at any level of need along life’s journey. We are fortunate to have a leadership team that recognizes the impact and the essentialness of viewing each resident as the individual that they are.

We look for those unique qualities in personhood that help us gain insight into a life, so that we can relate at a more intimate level.

Therefore, our strategic plan is not only to identify, but to anticipate needs and offer solutions, providing a more comfortable and nourishing environment.