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
- A culture that promotes honesty/authenticity and is non-punitive - "lying in this program is like lying on an eye test"
- 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 must meet 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:
Self-determination and informed choice
- Emphasis is on person-centered care (the client drives the process) and ensures access to science-based information to make informed choices
- Embraces harm-reduction that spans a full-range of goals from abstinence to reduced use
- Engagement and client satisfaction are top priorities and people participate because they WANT to
Substance use disorders stem from suffering
- Seeks to understand motives for use and address root causes
- Provides trauma-informed care and trauma therapy
- Develops skills and strategies to change perspectives and build positive experiences
Relief comes from self-regulation
- Focus is on self-care as the foundation to keeping primitive brain centers “quiet”
- Cultivates neuroplasticity through education and brain training to learn how to calm self and to think greater than how one feels (engage prefrontal cortex)
- Teaches mindfulness and grounding (resourcing) techniques
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, 2018
Successful Program Completion:
- 58.8% (558/949 total discharged) were discharged with staff approval.
Of the 508 approved discharges that participated in the survey, the following was reported.
Amount of Substance Use:
- Reduced use – 87%
- Increased use – 10%
- No Change - 3%
Amount of Substance Use Related Harms/Consequences:
- Reduced consequences – 83%
- Increased areas – 10%
- Same level – 7%
Client Quality of Life (QOL):
- Increased QOL – 67%
- Same level – 29%
- Reduced QOL – 4%
Client Stage of Change:
- Maintained pre-contemplation stage – 1%
- Maintained contemplation stage – 1%
- Maintained action stage – 20%
- Maintained maintenance stage – 20%
- Movement forward along the stages – 54%
- Moved backward along the stages – 4%
- 4.79 on a scale of 1 to 5 with 5 being the highest score possible
Additional data that we began collecting in the last couple of years (246 respondents)
Please rate your understanding of how drugs and alcohol affect your brain and your body:
0 I have no understanding
10 I have some understanding
233 I have a good understanding
3 No Response
Please rate your progress regarding skill development:
0 I have not learned any new skills
22 I have learned a few skills
221 I have learned many skills
3 No Response
My service needs were met: Agree ___242___ Disagree ___1__ No Response ___3____
The staff was respectful and competent: Agree __243_ Disagree _0__ No Response ___3____
Have you seen a primary care doctor in the last year for a physical?
The following information was gathered from people who completed the program at least over 12 months ago and includes 171 participants:
Responses to the question “Please rate your quality of life”:
- Very poor – my life is miserable – 2%
- Pretty rough, but some days are okay – 4%
- So-So – my life is okay, but it could be better – 19%
- Things are going pretty well for the most part – 55%
- My life is great; everything is going my way –20%
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. – 7%
- My use is out of control and I am experiencing some problems as a result. – 2%
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.
Program Schedule: Both day and evening hours are available and the schedule can be tailored based on one's needs.