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8/5/2021
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Operationalizing Person-Centered Care
in SUD Treatment
With 8 Dimensions
Barbara “Basia” Andraka-Christou, JD, PhD
Assistant Professor, University of Central FloridaBarbara.andraka@ucf.eduwww.bandrakachristou.com
AcknowledgementsThriving Mind, dba South Florida Behavioral Health Network (community partner)
Health Foundation of South Florida (funder)
Team Members:• Danielle Atkins, PhD• Olena Mazurenko, MD, PhD• Olivia Randall-Kosich, MHA• Rachel Totaram, MHA• Andriy Koval, PhD• Kendall Cortelyou-Ward, PhD• Kyle Belanger, BS
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Objectives
1
Describe the importance of person-centered care (PCC)
in substance use disorder (SUD) treatment
3
Identify specific approaches for operationalizing each of
the 8 dimensions
2
Summarize the 8 dimensions of PCC
4
Discuss potential barriers & facilitators to
operationalization
Broadly speaking, person-centered care is about two things:
1) individualization and
2) holistic care
Consider the opposite of PCC…
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● Our team wanted to identify HOW to do PCC
● Specifically in SUD treatment
● Across 8 dimensions
● Using perspectives of multiple types of stakeholders
● Obtained using a mixed method approach
Introduction
Qualitative Quantitative
1. Interviews with South Florida clients, clinicians, & administrators to identify different operationalization methods (n=38)
2. Create a survey to confirm importance of operationalization methods to clients (n=32)
3. Create a survey for staff to examine frequency of operationaization methods in South Florida corporations (n=61; j=6)
Our Approach
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Eight Dimensions
1Respect for preferences,
values, & culture
2Provision of information
3Integration of
care
5Physical comfort
6Integration of
family
4Emotional Support
7Transition out of care
8Access to
evidence-based treatment
Sample of operationalization
methods
There are many more
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Respect for client preferences, values, & culture
●Peer support groups○No attendance requirements○Choice in type (including non-12 step)○No overt Christian prayers
●Culture/diversity○Bilingual staff○Programming in other languages○Interpreter services○Staff diversity matches clients○Food/art from other cultures○LGBTQ programming
● Individualization of care○ Harm reduction goal option○ “Menu” of treatment options○ Recommend, don’t require○ Ask level of choice desired
● Counseling○ Group/individual not required ○ No precondition for meds○ Client choice in counselor
characteristics○ Can pick among counseling
topics○ Allow counselor changes if
desired● Can tour facility first
Provision of information●Multiple types of information
○Treatment process○Treatment purpose○How to file grievance○Treatments available, risks/benefits○Rights/responsibilities
●Methods○Verbal○Written○Visual○Public places○Group, one-on-one○Time for questions○Ask how client learns best
● Timing○ At the beginning○ Throughout
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Integration of care
●Comprehensive health assessments○Psychiatric/mental○Physical○SUDs○Family history○Dental○OBGYN○Communicable diseases
●Comprehensive treatment○Psychiatric/mental○Physical○SUDs○Family history○Dental○OBGYN○Communicable diseases
● Connecting to outside providers● Schedule appointments● Transportation help● Attend with the client● Regularly share info with
outside providers● Written/electronic medical
record provided to client● Interfacility staff communication
○ Variety of professional roles add notes to medical record
○ Variety of professional roles attend case conferences
● Staff attends court hearings/celebrates milestones
Emotional support
●Peer support specialists available●Staff includes people with lived experience●Empathy/compassion demonstrated by all staff (including front desk)●Animal therapy, pets permitted●Counseling as often as needed●Evaluated and treated for trauma●Can turn to someone on staff 24/7●Holistic health opportunities (e.g., yoga, meditation)
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Physical comfort
●All facilities:○Clean facility○Home-like facility (not like a prison/hospital)○Attractive facility○Natural lighting○Interesting artwork
●Medication available if needed●Provide necessities●Safety measures (guards, alarms)
●Residential:○Bedrooms
■Roommates optional■Couples can room together■Private lockers■Comfortable ■Staff knock■Can sleep in
○Food/beverages■Access 24/7■Can cook for self, get groceries■Nutritious and tasty■Choice in food■Respectful of different diets
○Recreation■Exercise, garden■TV, games
Family integration
●Communication (residential)○Unlimited phone calls (minutes, times of day)○Can go home for the weekend○Family can visit any time○Family events
●Family treatment/education○SUD/MHD education offered○Family coaching○Family therapy○Individual counseling for family members○Family members involvement level determined by client○Family attend treatment planning○Space for family to meet
●Parents with minors○Can room with parent (residential) ○Daycare ○Parenting classes○Staff helps navigate child welfare system requirements○Pregnant women welcome○Offer childcare supplies (e.g., diapers)
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Transition out of care
●Housing○Help with applications for housing and payment○Transitional housing available○Help with furniture○Visit housing with client
●Education/employment○Help with applications ○Can use computers on site for searches○Job fair on site○Job training opportunities on site○ESL, GED, other classes on site
●Aftercare ○Frequent check-ins post-discharge○Can continue seeing same counselor○Can come back if needed○Immediate connection to outpatient treatment
Access to evidence-based treatment
●Medications for behavioral health○For opioid use disorder ○For alcohol use disorder○For tobacco use disorder○For psychiatric disorder
●Individual counseling using EBT●Group counseling using EBT●Contingency management ●Withdrawal management●Integrated, multiple levels of care●Staff appropriately trained
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Next Steps
Step 1 Step 2 Step 3 Step 4
Confirm client preferences in
statewide sample
Examine barriers/facilitators to
implementation
Revise & validate staff survey
Implement staff survey in multistate
sample
Barriers? Facilitators?● Funding
● Culture
● Training
● State policy
● Institutional oversight, policy implementation
NOTE:
In our staff survey, we found inconsistencies in reporting of methods by administrators versus clinicians
Can you think of others?
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Resources● Davis, E. L., Kelly, P. J., Deane, F. P., Baker, A. L.,
Buckingham, M., Degan, T., & Adams, S. (2020). The relationship between patient‐centered care and outcomes in specialist drug and alcohol treatment: A systematic literature review. Subst Abus, 41(2), 216‐231. https://doi.org/10.1080/08897077.2019.1671940
● Gerteis, M. (1993). What patients really want. Health Management Quarterly, 15(3), 2‐6.
● Gerteis M, E.‐L. S., Daley J, Delbanco TL. (1993). Through the patient's eyes: understanding and promoting person‐centered care. John Wiley & Sons, Ltd.
● Marchand, K., Beaumont, S., Westfall, J., MacDonald, S., Harrison, S., Marsh, D. C., Schechter, M. T., & Oviedo‐Joekes, E. (2019, Sep 11). Conceptualizing patient‐centered care for substance use disorder treatment: findings from a systematic scoping review. Substance Abuse Treatment Prevention & Policy, 14(1), 37. https://doi.org/10.1186/s13011‐019‐0227‐0
● National Institute of Medicine. (2001). Crossing the Quality Chasm. https://doi.org/10.17226/10027
● Substance Abuse and Mental Health Services Administration. (2018). Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. https://store.samhsa.gov/product/TIP‐63‐Medications‐for‐Opioid‐Use‐Disorder‐Full‐Document/PEP20‐02‐01‐006
Learn more about our study:
Email the project: pcc@ucf.eduEmail the PI: Barbara.andraka@ucf.edu
https://ccie.ucf.edu/person-centered-care/
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