Person-centered Community Research Articles

Knit is a Four-Letter Word

This paper explores the language of knit as a key influence on its status as an artform and craft. The basic nature of the language used in knitting is so commonplace, so entrenched in our language at large, that it leads to distinct associations with everydayness that knit can struggle to overcome, often leading knit to be considered “only” a simple craft. We find that the skills needed for knitting are disassociated with the value of knitting as skill and cultural presence. From dismissive language aimed at the knitter to cultural significance throughout history from metaphor to online neologisms this paper explores the relationship knitting has had with both creating and being shaped by language. Historical linguistics associates a range of “higher” crafts with imported Romance language words, whereas the “lower” craft status of knit is echoed by its use in in the English language (and elsewhere) where simple, domestic words are used. The historical and cultural reckoning of knit, and the language that perpetuated these attitudes today, has influenced perception consciously and subconsciously. With new terminology heralding knit as an evolving, person-centred community that is driving the subject forward. Knit, in its own terms, has many a yarn to tell.

Community mental health interventions for people with major depressive disorder: A scoping review.

People with major depressive disorder continue to be marred by chronically pernicious yet preventable outcomes in the biopsychosocial aspects. With the reallocation of healthcare resources towards the fight against the coronavirus 2019 pandemic, much emphasis has been placed on existing community mental health interventions to ameliorate the disruption of mental health services. Moreover, the recent propulsion of community mental health services by the World Health Organization Mental Health Action Plan 2013-2030 ignited the need to bolster existing community interventions by providing comprehensive, responsive and integrated mental healthcare. The enhanced emphasis on mental healthcare in the community and the heightened demands of people with major depressive disorder underscores the need to explore the current state of community mental health interventions. This scoping review examined 51 primary studies published from year 2010 to 2020 using Arskey & O'Malley's five-stage framework and provided an overview of the impact of existing community mental health interventions for people with major depressive disorder. Findings using thematic analysis have recommended the adoption of person-centred community mental healthcare via the biopsychosocial approach for people with major depressive disorder. Enablers of community mental health interventions were driven by culturally appropriate care and augmented by technology-driven modalities. Challenges and gaps of community mental health interventions include the perpetuation of stigma and misconception, complex demands of persons with major depressive disorder and lack of holistic and long-term outcomes. Given the impact of major depressive disorder on the various biopsychosocial aspects, it is envisioned that our insights into the enablers and barriers of community mental health interventions will guide prospective interdisciplinary and nurse-led interventions in holistically improving the care of persons with major depressive disorder in the community settings.

Achieving congruence in 'being and doing' community nursing.

Conceptual and theoretical frameworks for person-centred community nursing practices have not yet been fully developed. There is a need to explore this further in order to guide future district nursing, which forms part of the community nursing discipline in the UK. The contemporary district nursing role is undergoing change, although there appears to be little consensus about the district nurse's (DN) vision across the UK, and little indication of the theoretical position underpinning this change. Meeting strategic requirements (National Health Service (NHS), 2019; Scottish Government (SG), 2017a&b), DNs have advancing clinical expertise and are recognised for their technical skills. However, one may contend that this emphasis on 'doing' in practice contributes to practice decisions made exclusively on task performance by strategic decision-makers, and DNs continually viewing themselves as invisible (National Assembly for Wales,, 2019; Queens Nursing Institute (QNI), 2006; Dickson 2018; 2020). District nursing education may contribute to this lack of clarity as curricula are based on borrowed theory from other disciplines that continue to focus on 'how to do', with little emphasis on 'how to be' a DN, and the continued decrease in DN numbers across the UK may be a consequence. In this paper, I explore current evidence that underpins district nursing practice, education and research in the UK, and advocate the use of the Person-centred Practice Framework (PCPF) (McCormack and McCance, 2017) as a means of unifying and guiding 'being a person-centred DN.' This will enable practitioners who can draw on multiple forms of evidence to inform their advancing practice. This article offers philosophical and pedagogical principles to underpin person-centred education going forward. I argue this will promote congruence between 'doing' and 'being' a DN, giving a voice to DNs, and direction to their specialism.

Dissemination of person-centered community care for mild dementia using local cooperatives in Korea during the COVID-19 pandemic.

BackgroundTo promote aging in place and improve the quality of life for persons with mild dementia during COVID‐19 pandemic, there is a need to support them in their community in‐person approach. Therefore, person‐centered community care for individual service and support in the community is an urgent priority. This study aimed to develop a person‐centered community service for mild dementia patient to collaborate with local cooperatives and test its feasibility.MethodsThis study was done from March to December, 2020. The person centered community service manual was developed based on previous guidelines and studies. The manual guided person‐centered assessment, tailored intervention, and outcome evaluation based on six domains; person‐hood, daily life, cognitive health, physical activity, safety, and community support. The local cooperatives for community care participated to provide comprehensive needs assessment and individualized service to the community residents with mild dementia. The staff visited the patient’s home and provide individual service. The feasibility study was tested with the staff and patients.ResultsThis study found that the service was effective for initial rapport, comprehensive assessment, individualized planning, person‐centered service provision, referral to community service, and outcome evaluation. However, service provider’s increased workloads and the time for home visiting and completing the service were identified as barriers during pandemic period. In addition, service providers still experienced lack of knowledge and skills in enhancing safety such as precaution and social distancing.ConclusionThe person‐centered community service can be useful to enhance the safe and sustainable community services during COVID‐19 pandemics. Collaboration with local cooperatives can be the best practices through the well‐designed manual.

Creating healthful cultures through Critical Creativity

During Covid lockdown in 2021, I was invited to offer a masterclass to masters students at Queen Margaret University, Edinburgh: ‘In the leadership module we have a masterclass, groupwork, study time and a plenary that ties together. We even have a book club!!! The aim is to be generic, not nursing/health focused. The learners make space to consider application in their own areas/specialisms. ‘We were wondering if you would like to/could do a masterclass within the strand of healthfulness. We really value your storytelling and know you are really passionate about healthfulness from an ecological perspective. We would love it if you could draw on your experiences of politics, environment... The more creative the better. ‘We would want learners to consider their role in creating healthful cultures and ways that they might go about it.’ How could I resist, given my decades-long passion for transformational practice development and inquiry within a critical creativity landscape in health and social care? In my retirement, I have continued to work successfully in this way in a variety of contexts, including political activism. I responded: ‘I would love to show how healthful cultures can be created, with stories from my person-centred community engagement work in creating a neighbourhood plan [for 21st century local housing development] and campaigning for positive personal and community political responses to the climate and ecological emergency. Stories that show up something of how conditions can be created to enable the ecology of human flourishing to be embodied in action. Also, how I am seeing the stirrings of transformative change in local politics that have previously been very traditional in the way they work with people.’ This article is based on that webinar, because students not only enjoyed it, but we heard that some were also able to transfer the learning to their different professional contexts. Therefore, for this paper, I repurposed and elaborated the material for a wider audience. Health and social care services are increasingly offered in new ways in the community and I imagine more health and social care professionals will be setting up innovative ways of working. I hope, therefore, that sharing my experience of creating cultures where everyone flourishes by doing things differently, as well as critically and creatively with the whole self, will be helpful. I will share four stories of how I do that in a variety of contexts and show you, through images and metaphors, how I have gone about that, first in health and social care but primarily for now in political and campaigning contexts. Through the stories, I will show you what it takes as a person to create healthful cultures. Woven through the article is an introduction to critical creativity and its three mandalas. They are there for you to look at with soft eyes/letting the words wash over you – without digging into meaning at this point. My hope is that you begin to get a sense of where the mandalas fit into the stories and, if you so choose, into your own stories and practice. The parts of the mandalas are italicised in the text as they are mentioned.

ICT-based person-centered community care platform (IPC3P) to enhance shared decision-making for integrated health and social care services

BackgroundCommunity care is a care model with the aim of shifting care services from being hospital based toward community-based care. Advances in platforms based on information and communications technology (ICT) with a person-centered approach provide the potential to improve the delivery of health and social care services toward community-based settings. ObjectivesThe aims of this study were to describe the ICT-Based Person-Centered Community Care Platform (IPC3P) and to determine its impact on health- and social-care-related shared decision-making and quality of life among community residents. MethodsAn online platform was developed with the aim of enhancing community care. The platform had four components: (1) comprehensive health and social needs assessment system, (2) personalized community care planning, (3) needs-based health and social care services delivery, and (4) health community engagement. Community residents were invited to use and evaluate the impact of the IPC3P on their quality of life and shared decision-making regarding health and social care services. They provided feedback about the platform by completing two surveys: at baseline (before using the platform) and 6 months after using the platform. ResultsData of 164 community residents were analyzed in this study. Between baseline and after using the platform, the quality of life reported by the participants increased significantly in all domains, with clear improvements also noted for shared decision-making about health and social care services. The IPC3P received positive feedback from the participants for its usability, familiarity, and ease of use. Some participants also reported their desire for the addition of more functions that support health communities. ConclusionThe IPC3P has the potential to enhance the involvement of community residents in their own care. The findings of this study can be used to support the wider implementation of the IPC3P to promote person-centered community care.

Stories of belonging: from the national to the personal. Based on the workshop drawing ourselves, drawing our country: from Greek specificities to a globalizing Dialogue (PCE 2018 Conference, Vienna, 8-12 July 2018)

ABSTRACT In the 21st century, the push and pull between localism and globalization define competing discourses. Social and political identities serve as external supports to a ‘symbolic universe’, a sense of belonging. Yet, today, social representations of an imagined homogeneous national entity are being challenged by mass immigration, refugee crisis and competing models of a global village. Within Person-Centered community discussions on diversity and identity, centering on both the client and the therapist is not uncommon. In our workshops and seminars about the representations of national identities of therapists and more precisely of Greek therapists, we have noted that there is an intense need for therapists to be aware of their own national identities in relation to discourses, stories as emotional narratives and hope for new national identities. As Greek and Person-Centered therapists, in becoming aware of and examining our own personal national narratives, we hope to begin to be active agents through the discussion of a global ethical community, a global politeia.

Using therapeutic contracts in person-centered counseling and psychotherapy: the perspectives of experienced Greek person-centered therapists

ABSTRACTThe therapeutic contract is an important aspect of the counseling process. However, it has received limited research interest, especially in the person-centered community. The objective of this qualitative study was to examine the perceptions and use of therapeutic contracts of seven experienced, person-centered therapists in Greece. A grounded theory design was chosen to guide the analysis of the data that were collected through semi-structured interviews. The emergent theoretical model was conceptualized as a system organized around the core category of ‘Forming a Safe – Attuned Framework’, which included the key-categories ‘Coordination game’, ‘Boundary setting’, and ‘Equal relationship’. Data analysis also revealed the contextual input of the ‘Therapist’s characteristics’ and the contextual output of the ‘Client consequences’. The emergent theory suggests that experienced person-centered therapists utilize therapeutic contracts in the first session with a new client in order to create a safe environment in which they can work cooperatively and develop their relationship. This process is guided by specific characteristics of the therapists (e.g. their sense of professional identity), and leads to various positive consequences for clients (e.g. facilitating their personal freedom). The study has important implications for practicing professionals, as well as for the training of new person-centered therapists.

Development of ICT-Based Comprehensive Health and Social-Needs Assessment System to Enhance Person-Centered Community Care.

We developed a comprehensive health and social-need assessment system to evaluate the diverse needs of elders with chronic illnesses in the community and to enhance the connection of their needs to health and social services. A comprehensive needs-assessment tool and profiles were integrated into the ICT system. We found that care managers could assess elders' needs comprehensively and connect those needs to suitable health and social services systematically.

The preliminary measurement properties of the person-centred community care inventory (PERCCI)

PurposeResearchers investigating person-centredness in older people’s long-term community care are hindered by the lack of appropriate measures. Studies have tended to rely on proxy indicators or generic instruments, risking invalid results. This new research aimed to develop and psychometrically test a person-centredness scale for use in older people’s community services.MethodsQuestionnaire items were sourced from groups of older people and mapped to a conceptual framework of person-centredness. A postal questionnaire in 2015–2016 tested these items with older people supported by mental health and social care services in five areas of England. Dimensionality was assessed through exploratory factor analysis and a confirmatory bifactor model, with classical item analysis removing weak items. Test–retest analysis was undertaken through a repeated postal questionnaire 3 weeks after the first.ResultsThree factors were identified, representing (i) interpersonal and (ii) organisational aspects of person-centred care; and (iii) negatively phrased items. Removing weaker items resulted in an 18-item scale. The bifactor analysis concluded the summary scale was ‘essentially unidimensional’. The Person-centred community care inventory (PERCCI) had excellent reliability, with Intra-Class Correlation Coefficient of 0.886 [95% CI 0.818–0.929]. A priori hypotheses about associations with satisfaction metrics and support variables were broadly confirmed.ConclusionsThe PERCCI has promising measurement properties and can be recommended for use in research with older adults using community mental health and social care services. Future developments must identify how sensitive the instrument is in detecting changing service quality.

New models of care in practice: person-centred community care, hospital admission reduction, integration

New models of care in practice: person-centred community care, hospital admission reduction, integration

The impact of a person-centred community pharmacy mental health medication support service on consumer outcomes

Background: Mental illness is a worldwide health priority. As medication is commonly used to treat mental illness, community pharmacy staff is well placed to assist consumers.Aim: To evaluate the effectiveness of a multifaceted, community pharmacy medication support service for mental health consumers.Method: Pharmacists and pharmacy support staff in three Australian states were trained to deliver a flexible, goal-oriented medication support service for adults with mental illness over 3–6 months. Consumer-related outcome measures included perceptions of illness and health-related quality of life, medication beliefs, treatment satisfaction and medication adherence.Results: Fifty-five of 100 trained pharmacies completed the intervention with 295 of the 418 recruited consumers (70.6% completion rate); 51.2% of consumers received two or more follow-ups. Significant improvements were reported by consumers for overall perceptions of illness (p < 0.001), the mental health domain of quality of life (p < 0.001), concerns about medication (p = 0.001) and global satisfaction with medication (p < 0.001). Consumers also reported an increase in medication adherence (p = 0.005).Conclusions: A community pharmacy mental health medication support service that is goal-oriented, flexible and individualised, improved consumer outcomes across various measures. While further research into the cost-effectiveness and sustainability of such a service is warranted, this intervention could easily be adapted to other contexts.

Impact of a person-centred community rehabilitation service on outcomes for individuals with a neurological condition

Purpose: To evaluate the impact of a person-centred, community rehabilitation service on outcomes for people with a neurological condition, in the first year of service.Method: A prospective, observational, pre-post study was conducted with 206 people who had a neurological condition and attended the rehabilitation service to restore function (e.g., Stroke); maximize recovery in an ongoing situation (e.g., Spina Bifida); or maximize function and independence while preparing for inevitable decline (e.g., Parkinson’s Disease). Outcomes were measured via self-report questionnaires, prior to, and following three months of rehabilitation. The primary outcome was achievement of self-identified goals, measured by the Patient-Specific Functional scale. Secondary outcomes included the Lawton Instrumental Activities of Daily Living (IADL) scale, EQ-5D-5L European Quality of Life scale, and ICECAP-O – Index of Capability for Older Adults and health and medical resource use.Results: Participants demonstrated significant goal achievement and a significant reduction in health and medical resource use. There were small positive changes in the Lawton IADL, EQ-5D-5L, and ICECAP-O however these changes were not significant.Conclusions: In the first year of operation, the community rehabilitation service made a significant impact on outcomes for individuals with a neurological condition. Further research is required to identify appropriate measures of activities of daily living and quality of life that reflect person-centred rehabilitation outcomes for restoring function, maximizing function, or preparing for functional decline.Implications for RehabilitationSelf-identified goals are an important guide for achievement of meaningful outcomes for individuals with a neurological condition.Person-centred outcome measures are required to evaluate the benefits of a person-centred community rehabilitation service for individuals with a neurological condition.

Introduction to the Special Issue on Pre-Therapy

Garry Prouty (1936–2009), creator of Pre-Therapy, left the person-centered community a body of unique and radical knowledge that continues to inspire both professionals and lay people in their ques...

Expert Patient Programme Catalonia: a person-centered community perspective

Introduction: We are facing a paradigm shift, evolving from a paternalistic model to a deliberative model in which the person —as a patient, relative or carer— takes a protagonist, active, dynamic and directional role, encouraging responsibility, empowerment and shared decisions. In addition, we must consider the tendency to promote a focus on the individual and their environment, which is committed to a partnership between the health and social world and comprehensive care from a population and integrated vision. This change of role implies a link between the community and health systems. In this sense, it has been implemented the Expert Patient Program CataloniaTM (EPPC), an initiative committed to taking responsibility for people with chronic health problems and to promoting self-care. The EPPC is a multidisciplinary initiative based on patient-healthcare professional collaboration and team work. In EPPC, Expert Patient (EP) leads the process and transmits knowledge about their disease to other patients who suffer from the same health problem. The healthcare professional becomes an observer, and only intervenes if it is necessary. The Expert Patient is a 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117086– http://www.ijic.org/ person suffering from a chronic disease who is able to take responsibility for their disease and selfcare, identifying symptoms, and acquiring the skills to manage the physical, emotional and social aspects of the disease. This program, launched in 2006, is a community activity that belongs to the Prevention and Chronicity Attention Programme. It is one of the 32 projects identified as strategic in the Catalonia Health Plan 2011-2015 of the Department of Health of the Catalan Government. Objective: Implementation of a community activity focused on people with chronic diseases in order to promote changes in habits and lifestyles to improve their quality of life. Methods: The EPPC consists of nine 90 minute sessions over 2.5 months, specifically designed for each chronic disease. Sessions are divided in two blocks, a theoretical and a practical one. The number of patients is limited to 10 to 12 per group, and the aim is to guarantee effective and freeflowing communication between the participants. The evaluation of the EPPC is qualitative and quantitative. It is divided in two stages: the first stage is carried out during group sessions and at the end of the session. The quantitative evaluation is performed at the 6th and 12th month after the group sessions have ended. The improved knowledge, the change in lifestyles, the degree of self-care and the satisfaction of participants were estimated. During the second stage, there has been assessed the use of health care services related to doctor and community nurse of the emergency departments and emergency hospital admissions, making a comparative study from of one year before the intervention until one year after the end of it. Results: Period 20062014 (1st semester) Number of patients participating: 4000, from which 276 have been Expert Patients who have led a group. Coverage: 212 Primary Health Teams in Catalonia and 3 Hospital Units within Catalonia and with the involvement of various Healthcare providers of the Catalan Health System. Health providers : 21. Diseases: Chronic Heart Failure, COPD, Diabetes Mellitus type 2, Fibromyalgia, Oral Anticoagulant Therapy, Breaking the tobacco habit, Anxiety and Chagas disease in its chronic stage. Number of groups: 390. Number of healthcare professionals participating: Total number as observers 800: 538 nurses, 215 family doctors and 47 social workers, Conclusions: After completing the program, a continual improvement in time, respect knowledge, habits and lifestyles, self-care and quality of life have been observed. In heart failure provoked by decompensation and COPD, compared to a year before the start of the intervention, a more than 40% reduction and 30% reduction, respectively, in the average of visits per patient (primary, emergency and hospital admissions) is observed. In oral anticoagulant treatment, there is, on one side, a five percentage points improvement in disease control and, on the other side, a reduction in average of visits to the doctor and nurse, and a reduction of about 10% of the average complications. Lessons learned: Peer learning in community performances shows that the active participation of the members of a community are key to promote and create a paradigm shift in health care by building a model of integrated and holistic person-centered care. Limitations: The different speed of Programme implementation in terms of territory, healthcare provider and the community to which each group belongs. Suggestions for future research: Measuring the effectiveness of the Programme through a trialand-cost effectiveness. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 2 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117086– http://www.ijic.org/

Person-Centered Approach, Positive Psychology, and Relational Helping

It is more than 20 years since the death of one of the most influential American clinical psychologists of the 20th century, Carl Rogers, who founded the client-centered school more than 50 years ago. Client-centered psychology remains a distinctive and alternative approach because of its assertion that the organismic valuing process is the engine of therapeutic change and the attendant implications for nondirective practice. Many of its ideas are also firmly integrated into other newer forms of therapy that acknowledge the person-centered approach as the foundation stone on which they were built. But less well understood is that many of the core ideas associated with person-centered psychology—such as its focus on therapeutic relationships, intrinsic motivation, and human potential—are topics that are alive and well in contemporary mainstream psychology. The aim is to promote bridge building among the person-centered community to these other areas of psychology.

Workforce development and challenging behaviour: training staff to treat, to manage or to cope?

Staff working directly with adults' challenging behaviours in learning disability services need to be very good at what they do. They also need to want to do the job. A theory-practice gap exists, however, between what is known about effective, evidence-based approaches and whether and how these are used in person-centred community services. Many frontline staff working with people with the most serious challenging behaviours do not have the skills to implement programmes to change behaviour. This discussion article reviews workforce development in the context of clinical and service guidelines and asks whether the legitimate purview of frontline staff is treating challenging behaviour, managing it or simply coping with it on a daily basis, whilst maintaining the best quality of life possible for service users.

Five Messages LTC Leaders Must Manage

Five Messages LTC Leaders Must Manage

Knowledge or Acknowledgement? Psychotherapy as ‘the art of not-knowing’—Prospects on further developments of a radical paradigm / Erkennen oder Anerkennen? Psychotherapie als „Kunst des Nicht-Wissens”—Ausblicke auf weitere Entwicklungen eines radikalen Paradigmas / ¿Conocimiento o Reconocimiento? La Psicoterapia como ‘El Arte de No Saber’—Perspectivas de Futuros Desarrollos de un Paradigma Radical

A way of celebrating the one hundredth anniversary that Carl Rogers himself probably would have liked is to proceed with the understanding of what his revolution means today and what challenges are ahead for tomorrow: within and outside of the ‘person-centered community’. What tasks are ahead if we try to carry Rogers' intentions forward? Such developments need to be carefully rooted in and checked towards the anthropological foundations of person-centeredness. The paper intends to give a short overview of some major developments in the Person-Centered Approach understood from an ‘encounter-philosophical’ point of view, and its ethical and epistemological foundations, with the focus on psychotherapy. Based on this, some consequences for a newer understanding of psychotherapy in general as an ethical enterprise and further developments of the Person-Centered Approach are indicated.