What does Person-Centered really mean? Many programs advertise themselves as person-centered, but if you look deeper the program is packaged, with one size fits all programming.
Minnesota Alternatives has defined person-centered care and builds it into all our practices:
- Engagement as a priority - human beings have an ingrained opposition to being forced
- Focus on customer satisfaction
- Locus of control is with the client- they are in charge of their recovery
- Relevant personalized treatment plans
- Program schedule is flexible in both intensity and duration
- Welcoming - rules can be conflict generating and teach people they do not need to think
- Culture that promotes honesty/authenticity - non punitive
- Relationships that provide trust, non-judgment and acceptance
- Understand power of environmental conditions - enriched environments induce positive brain development
- Offer support, education, accountability
- Peer support
- Include practical assistance and community outreach
The following program information outlines the general treatment structure, however, each client has unique needs and may not require all of the services listed below.
"The Minnesota Alternative" person - centered treatment model blends (what I consider the best) techniques and strategies from a variety of approaches that include:
- Psychiatric Rehabilitation develops critical skills Learn Key Skills and supports with a focus on functioning and understanding the environments clients are striving to function in.
- Recovery Movement which emphasizes principles of empowerment, self-determination and person centered interventions along with core values of compassion and hope.
- Concepts from neuroscience that educate clients about basic brain functioning and their capacity to undo negative or harmful patterns in their brains and create new neurological pathways that are based on positive changes.
- Mindfulness, Meditation and Imagery to help clients learn to calm themselves, observe their thoughts, become more self- aware and learn mental rehearsal to change behaviors.
- Motivational Strategies that prioritize engagement, meeting people where they are at (stage specific interventions) and skillful use of empathy and individualized goal planning.
- Cognitive Behavioral Interventions that teach clients to reframe unproductive thoughts and understand their ability to decide what meaning they want to attach to circumstances.
- Harm Reduction principles that recognize that treatment mustmeet active substance users ‘‘where they are’’ in terms of their needs and personal goals. Thus embracing the full range of harm-reducing goals including, but not limited to, abstinence. This means that small incremental positive changes are seen as steps in the right direction.
- Emotion based Interventions that include intentional meditations to help with focusing the mind, experiencing emotions, letting go, changing behavior and building positive experiences.
- Trauma treatment that includes EMDR, Somatic Experiencing, Trauma Focused CBT and Prolonged Exposure.
- Holistic Interventions that include meditation, acupressure/massage which can help with stress reduction, relaxation, and increased energy flow that can promote healing.
- Common sense practical assistance which means staff can assist with a variety of practical “real life” needs.
The following core principles help develop a culture that is authentic, useful, and client centered:
- Acceptance - Allowing clients to be open and candid about why they are attending and not judging or criticizing their situation.
- Flexibility/Tolerance - Developing a schedule that fits client needs and other life obligations. Program hours and length of treatment are established based on each person’s needs. Some people may need to attend a few hours per week for a few weeks, while others may need to come multiple times and for many months. It seems illogical to expect everyone to attend the same amount of treatment sessions as each person has unique needs.
- Honesty – If the culture truly practices acceptance and meets people where they are at, people will be honest. A client coined this phrase: Lying in the program is like lying on an eye test. It only means people will not get the help they need.
- Generalizable – Teaching skills and educating about topics that generalize easily to the day to day lives of the clients. This includes skills reinforcement discussions about the successes and the missed opportunities of skill use.
- Individualized - Tailoring program interventions so they meet people where they are at. People use substances for different reasons and it is important to understand the motives underlying substance use and then help people develop alternative ways to meet their needs.
Criteria for Completion:
Clients graduate when they have accomplished their treatment goals and when they feel ready to manage their issues without treatment. (Long term support is available.)
Completion is not linked to number of hours or days completed.
Conventional programs generally measure client’s readiness for discharge by the number of days or sessions they have attended. They often require numerous packets to be completed, and most require that clients have a goal of abstinence.
Minnesota Alternatives uses other measures as indicators for success. As discussed earlier, clients graduate when they have accomplished their treatment goals and when they feel ready to manage their issues without the program support. Completion is not linked to the number of hours or days completed.
Goal completion is easy to measure, but a client’s internal sense of readiness is less concrete. Generally, clients seem ready once they have put some other things in place that help support their recovery. This could be taking classes, a volunteer or paid job, self-help groups, joining a club, developing a new hobby, or developing more supports. Offering on-going support through the Peer Support Center helps people feel more comfortable with moving from active treatment to long-term support.
Minnesota Alternatives has been keeping outcome data since the doors opened in 2009 as summarized below:
The data below covers the period September 2009 to December 31, 2016.
Successful Program Completion:
- 60.5% were discharged with staff approval.
Of the approved discharges, the following was reported.
Amount of Substance Use:
- Reduced use – 90%
- Increased use – 6%
- No Change - 3
- Unknown - 1%
Amount of Substance Use Related Harms/Consequences:
- Reduced consequences – 82%
- Increased areas – 10%
- Same level – 27%
- Unknown - 1%
Client Quality of Life (QOL):
- Increased QOL – 68%
- Same level – 28%
- Reduced QOL – 3%
- Unknown - 1%
Client Stage of Change:
- Maintained pre-contemplation stage – 1%
- Maintained contemplation stage – 1%
- Maintained action stage – 21%
- Maintained maintenance stage – 22%
- Movement forward along the stages – 51%
- Moved backward along the stages – 4%
- 4.77 on a scale of 1 to 5 with 5 being the highest score possible
Additional data that was added to the discharge survery in the last couple of years (116 respondents):
Please rate understanding regarding how drugs and alcohol affect your brain and your body:
0 - I have no understanding
6 - I have some understanding
107 - I have a good understanding
3 - No Response
Please rate your progress regarding skill development:
0 - I have not learned any new skills
7 - I have learned a few skills
106 - I have learned many skills
3 - No Response
My service needs were met: Agree - 113 Disagree - 0 No Response - 3
The staff was respectful and competent: Agree - 113 Disagree - 0
No Response - 3
Have you seen a primary care doctor in the last year for a physical?
80 - Yes
32 - No
4 - Unknown
12-Month Post Discharge Outcomes based on survey of 126 clients that were discharged with staff approval and contacted at least 12 months after the completion of the program.
Responses to the question “Please rate your quality of life”:
- Very poor – my life is miserable – 3%
- Pretty rough, but some days are okay – 4%
- So-So – my life is okay, but it could be better – 18%
- Things are going pretty well for the most part – 53%
- My life is great; everything is going my way –22%
Responses to the question “Please describe the role of substance use in your life”:
- I am not using at all. – 44%
- I am using in what I consider reasonable amounts and am not having any consequences from use. – 47%
- I am using more than I would like, and am having some consequences from use. – 8%
- My use is out of control and I am experiencing some problems as a result. – 1%
Response to the question “Have you been in the hospitalized for addiction or mental health issues since you were discharged?”
- No – 83.5%
- Yes – 10%
- Unknown –6.5%
Response to the question “Have you had any other treatment since you were discharged?”
- No – 79%
- Yes – 15%
- Unknown – 6%
There is a lot of work to be done to define what is effective and how to measure success, but there does appear to be one consistent finding:
If a program can engage and retain them, people will show positive change.
Both day and evening hours are available and can be tailored to meet the needs of each individual.