Purpose
Mental health providers are faced with the challenges of completing quality documentation on time, building a therapeutic alliance, and managing a client’s treatment compliance. Stanhope, Ingoglia, Schmelter, and Marcus (2013) examined the impact of person-centered planning and collaborative documentation on service engagement and medication adherence within community mental health centers (CMHC). As part of person-centered planning, collaborative documentation is being explore as a tool that works to benefit the agencies and clients by ensuring treatment services appropriately reflect the client’s values and preferences and that documentation is completed in a timely manner.
Background
Stanhope, Ingoglia, Schmelter, and Marcus (2013) emphasized there are challenges clinicians experience with lack of engagement in mental health services among people with a mental illness. Contributing factors to disengagement from services include mistrust in the mental health system, poor alliances with providers, a perception that providers are not listening to them, and inadequate opportunities to make decisions and collaborate in treatment. Mental health agencies are starting to place an emphasis on transparency and utilizing a collaborative approach to documentation so that it represents a true reflection of the treatment session.
Historically, clinicians have viewed documentation as “the enemy” because it competes with time spent with clients and many rely on “no-show” appointments to complete paperwork. Collaborative documentation can be used as a clinical tool in completing assessments, treatment plans, and progress notes together with clients during the session. This method offers clients with the opportunity to share their input and perception on services that were provided. Additionally, it allows clients and clinicians to explore important issues, clarify any misunderstandings, and focus on progress.
According to the researchers, person-centered planning is defined as “a highly individual comprehensive approach to assessment and services.” This treatment approach allows providers to collaborate with clients to develop customized treatment plans that identify life goals and potential barriers. Person-centered care is a structured way of organizing treatment that focus on making continuous use of strengths-based assessment strategies, recognizing appropriate supports, and empowering clients to be active participants. During this study, researchers looked to determine whether person-centered care planning combined with collaborative documentation improved service engagement and medication adherence among clients at ten geographically diverse community mental health centers (CMHCs).
Methodology
This study was a randomized controlled trial of person-centered care planning with collaborative documentation among clients receiving services at ten CMHCs. Five CMHCs were randomly assigned to the experimental condition, which provided training in person-centered planning and collaborative documentation to agency clinicians. The five CMHCs in the control condition provided treatment as usual. The study period was 11 months (May 2009 to March 2010).
For clients to be eligible for this study, participants were required to be aged 18 or older, have had one or more psychiatric hospitalizations or two or more psychiatric emergency room visits in the past year, have a DSM-IV axis I diagnosis, and meet at least two functional criteria of severe mental illness. Altogether, 177 clients at the CMHCs in the experimental condition and 190 clients at the CMHCs in the control condition participated.
The first aim of this study was to compare changes in the overall rate of clinician-reported medication adherence between clients in the experimental CMHCs and clients in the CMHCs in the control group. The provider who was best able to determine a client’s medication adherence rated adherence (yes or no) on a monthly basis for 11 months. For the second aim, client-level analyses were conducted separately for CMHCs in the experimental and control groups to examine whether the odds of medication adherence changed over time. Finally, logistic regression models, including a random effect for site, were run to calculate the effect of the intervention on the odds of an appointment no-show. The models used data received from each CMHC on the total number of appointment no-shows and the total number of appointments.
Conclusion
Results indicate the intervention had a positive impact on medication adherence over time. Medication adherence at CMHCs in the experimental condition increased by 2% per month over the 11-month period (B=.022, p≤.01). The control condition showed no significant change in rate of medication adherence (B=.004, p=.25), and by the end of the study, the rate of medication adherence for the control condition was lower than for the experimental condition.
In the client-level analyses, the odds of medication adherence over 11 months increased by 25% among clients in the experimental condition but by only 1% among clients in the control condition. An intervention effect generally was seen across client-level characteristics. Medication adherence over the 11-month study among clients with schizophrenia and bipolar disorders was significantly more improved at CMHCs in the experimental group.
Overall, the study found that person-centered planning and collaborative documentation were associated with greater engagement in services (a decrease in no-shows) and higher rates of medication adherence. Therefore, the study findings supported the theory that if clients have greater control over their treatment and services are genuinely oriented toward their individual goals, clients will be more engaged with services and more compliant with medication.
References
Stanhope, V., Ingoglia, C., Schmelter, B., & Marcus, S. (2013). Impact of Person-Centered Planning and Collaborative Documentation on Treatment Adherence
Psychiatric Services, 64 (1), 76–79.
Jonathan Torres, M.S.
WKPIC Doctoral Intern