Training Program Description: This training program is designed for professionals in the mental and chemical health community. It may also be useful to others with interested in supporting people with mental health conditions to live well. This training program supports learners in understanding the value in trends toward person and family-centered approaches in Minnesota. It provides context to this movement that is Minnesota specific and helps learners support the vision the Minnesota Olmstead Plan. The content provides both context and enhanced skills in these approaches and practices.
Directions: Please scroll down or click on the page on the menu to see additional content in the lesson.
The following lessons are included in this training program:
A Note about Language: This training program recognizes that the terms mental health professional and mental health practitioner are recognized titles have specific meaning related to scope of practice within the Minnesota mental health system. However, for the purposes of this training, the terms practitioner or professional are used interchangeably to indicate any person with professional responsibilities in the system. This includes clinical professionals such as psychiatrists. It also includes social services professionals such as case managers or peer specialists. If a specific role or scope of practice is important to content, that is made clear in content.
We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports - essentials for living, working, learning, and participating fully in the community.
– Vision Statement- President's New Freedom Commission on Mental Health; Achieving the Promise: Transforming Mental Health Care in America, 2002
“I am a licensed therapist. I fell down a rabbit hole trying to figure out the system. Then I thought, I am the “system” and if I can’t figure it out how can anyone?”
– MN Parent, 2017
The person and family-centered practices are becoming important to mental health approaches, most especially in Minnesota. They are affecting many areas of services and supports. In Minnesota, larger initiatives are pushing for our systems and professionals to adopt these approaches. This lesson helps learners understand the context of person and family-centered practices in Minnesota. It includes current definitions of these concepts. It explains why they are important in mental health services. It also provides context for considering changes beyond individual practice. (For example, at the level of the organization, system, or broader community.)
After completing this lesson you will be able to:
Minnesota has been a leader in person and family-centered approaches. This is due in part to expectations of the Minnesota Olmstead Plan. This plan requires person-centered plans for people receiving services related to disabilities. Regulations that are part of Home and Community Based Services (HCBS) also require person-centered service planning. They also require planning for family caregiver needs. People with mental illnesses in Minnesota sometimes qualify as having a disability or long-term support need. When they do, the Minnesota Olmstead Plan applies to their services. They may also be able to access HCBS through what is called the CADI (Community Access for Disability Inclusion) waiver.
Minnesota is a pilot state for Certified Community Behavioral Health Clinics (CCBHC). The state has recently expanded Systems of Care. Both the CCBHC and Systems of Care are focused on high quality, well-coordinated mental health services. Expectations of person and family-centered approaches are part their services. These and other reforms in long term support and medical treatment will continue to support person and family-centered approaches in the mental health community for years to come.
In 2002, the President's New Freedom Commission on Mental Health report found that stigma, inequities, fragmentation and gaps in mental health services were the norm. A 2017 report from a Minnesota Governor’s Task Force on Mental Health, affirmed that these problems remain.
The Governor’s report identified the way that services are funded and administered as part of the problem. In addition, this Minnesota-specific report called for more emphasis on prevention and early intervention. It also noted disparities in services in rural areas and for key populations. These populations included (among others) communities of color, immigrants, veterans, and people who are part of the LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersexual, and Asexual) communities. For many people in Minnesota, these systems are difficult to navigate. They are hard to find and offer too little that is useful. Many people still have no way to pay for these services or treatments. Stigma discourages participation. In addition, people who try to use these services do not always feel heard or understood. What is offered does not always make sense to them.
Links to the reports listed above are available in the references section below.
As person and family-centered approaches have been introduced there have been barriers and challenges to adopting them. There is still work to be done in this area. Some people in the mental health community agree that this approach is valuable. However many do not know exactly how to implement them. Others still do not believe they matter. Some concerns expressed by mental health professionals and advocates in Minnesota about these approaches include the following:
The remaining content in this lesson and other lessons in this training program are meant to add clarity and provide resources for understanding and overcoming these challenges.
Although they are being adopted across service populations, the strongest affiliation with person-centered approaches has most notably emerged from the intellectual and developmental disabilities (IDD) community. Family-centered approaches are emerging from IDD and also aging services. These communities are focused on long-term supports and services. Mental and chemical health services are focused on recovery. As a result, the translation of the value of these approaches is not always clear. However, there are many reasons that these approaches have value in mental and chemical health services.
Directions: Click on each box below to consider how person and family-centered approaches can have value in mental and chemical health services.
Mental and chemical health services need to successfully engage people and their supporters in recovery. Person and family-centered approaches help with that. Treatment and services offered without considering engagement often fail. People avoid them or don’t follow recommendations.
A 2016 report by NAMI on engagement indicated that as many as 70% of people drop out of treatment within their first few sessions. When people don’t seek services it is often attributed to stigma. People who attempt services and drop out are responding to something else. In many situations, services are delivered without regard for understanding what matters to the person. The services don’t meet people’s needs. They don’t make sense to them. Practitioners who are unaware of the person’s goals, preferences, culture, strengths, resources, and relationships will have trouble effectively working with them. These are all aspects that person and family-centered approaches.
Directions: Review the five effects that are anticipated outcomes of person-centered services from the Minnesota Olmstead Plan. Click one of the five effects to select it and then click a statement of mental health recovery to match it. Keep trying until you successfully match each effect to a statement.
Some of the core attributes of person and family-centered practices that were validated by the co-co-creation groups included:
Hope and recovery-based services were embraced. The need for shared decision-making, self-determination and dignity of risk were embraced. The idea of being included and valued as any other person in the community was embraced.
People are eager for absolute answers to what means to be person and family-centered. However, this is an ongoing and developmental process. People are apply these practices, learning new skills, and testing the boundaries of our systems. As they do, it’s becoming clearer where additional efforts need to be applied. Community and self-stigma were cited as problems that needed to be addressed. System issues such as what is offered and how things were paid for needed to be addressed. The ability of organizations and professionals to meet the needs of people in a way that were culturally responsive was named. Its clear much more effort has to go on to actively make room for communities of color and other underserved communities to lead this work of constructing solutions to issues. They know their communities and what will work. Only they can define solutions that will have meaning for them.
It is important that each individual professional have competence in these practices and approaches. At the same time, more sustained change in organizations, systems, and communities must occur. Stigma must be tackled. Funding must be realigned. Policies and practices revised. Co-creation with underserved communities and people and their families must become a central approach to defining and making these changes. The rest of the lessons in this training program go a bit deeper into each of these aspects. They provide some information and skills that you can use to move forward with these practices and approaches.
This lesson was meant to help you achieve the following learning objective:
In this lesson you learned:
This list was developed as part of a training project to help mental health professionals, practitioners, and others in the mental health community in Minnesota enhance their ability to deliver services in person and family-centered ways. The project included identifying what training and resources were already available in Minnesota and how well they might meet the needs of the mental health and behavioral health community. There was a special focus on those in Targeted Case Management roles. A standard protocol that included a review tool and at least two reviewers was used to ensure products were reviewed consistently. The following materials were reviewed and ranked as being likely to be helpful to Mental Health Targeted Case Managers or those in similar or related roles.
The Learning Community on Person-Centered Practices
TLCPCP is an organization and a global volunteer community. It focuses on supporting people who have lost or may lose positive control because of society's response to the presence of a disability or other conditions. It does so through training and development of person-centered practices. The Minnesota Department of Human Services Disability Services Division and other divisions have invested in disseminating training materials developed by TLCPCP. They have also supported development of trainers in Minnesota. The following two trainings are commonly available in the state. TLCPCP also supports other types of training. To locate trainings in Minnesota you can go to http://pct.umn.edu. Certified trainers are also listed on The Learning Community’s website. Some local trainings listed at the Minnesota site are free; others have a fee.
Person-Centered Thinking is equivalent to a full two-day training. Training is completed in groups. The terminology and strategies of this training are aligned with some state and national regulations in the area of person-centered practices. The curriculum is generic and skills are transferable to any setting including mental health settings. A wide variety of professionals could benefit from this training. This can include professionals from any scope of practice who:
The concepts and strategies in this curriculum have meaning and are useful in mental health practices. However, the examples in the core curriculum focus mostly on adults, are not all mental health related, nor always current to the context of community living. Content does not explicitly support deeper understanding of equity or diversity issues and does not use examples that represent diversity. Though there is a small portion in the new version on culture, on the whole, the curriculum does not attend to these issues. In addition, there is no specific tie in to how to use these practices to ensure family-centered practices. Trainers in this curriculum have various backgrounds. It would be important to select a training with a strong background in mental health services and supports if that is an important training need for your group.
Picture of a Life is two-day training that provides in-person learning and applying person centered thinking and planning tools to develop a person-centered description. The process is focused on helping a person envision the life they want in their community. The training include a co-trainer with support needs and others who are this person’s natural or paid supporters. Trainees get a chance to watch and participate in interviewing processes and enhance their discovery skills. Values of choice, control, direction, and shared power are modeled in the training.
The quality of the training is highly dependent on the skill and knowledge of the facilitator and the willingness of the co-training and supporters to share. Participants will likely benefit more if they attend a session where the co-trainers needs are similar to those of the populations they support. There will be no explicit connection to the mental health practices of recovery, peer support, or cultural and equity practices if the facilitator does not have these skills, knowledge, and orientations. Person-Centered Thinking (described above) is required training before attending Picture of a Life.
The Person-Centered Counseling Training Program is a blended learning model that embeds the Person-Centered Thinking skills and planning skills into online modules. The target audience for this training is counselors through the Aging and Disability Resource Centers (ADRCs) and others who are engaging in development of No Wrong Door systems. The online component is available in Minnesota via DirectCourse. For full review for this audience please see description below. For more information on the in-person day of training, contact The Learning Community for Person Centered Practices.
DirectCourse is a national online curriculum for direct support professionals and similar professionals who support people to live in their communities. It is available in Minnesota through support from the Department of Human Services. The training programs and curriculum are self-paced, competency-based, and multimedia. The following materials from DirectCourse were reviewed for the mental health community.
This online training was developed by Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities. It consists of approximately 38 hours of self-paced training for community based mental health workers. The set of available courses is listed below.
The courses in the College of Recovery and Community Inclusion can be helpful to any practitioners interested in recovery-based inclusion and self-determination models. The suite of courses in CRCI doesn’t use term “person-centered” but aligns with these approaches. They cover the scope of all mental health professionals. This material can be useful to support planners in mental health in apply the Minnesota Olmstead Plan expectations in their work. These courses consider culture and evidence-based practices. Incorporation of family into support is not included substantially.
The Minnesota Department of Human Services has purchased a limited amount of seats in Minnesota that are available for free. Contact Nancy McCulloh at mccul037@umn.edu. Rates for broader access will vary based on organization size. Information can be obtained by contacting Bill Waibel at Elsevier, b.waibel@elsevier.com.
These online materials were explicitly designed for the No Wrong Door System of Long Term Services and Supports (LTSS). It considers all populations, all ages, and all methods of payment for LTSS. Person-Centered Thinking and Planning skills are a core of the training program. There is a whole course on family caregiving and other lessons on family involvement. However, content is not strictly focused on mental health.
This content would be best for disability generalists who have a portion of their potential recipients living with serious mental illnesses. Another potential target audience is staff affiliated with Certified Community Behavioral Health Clinics or Behavioral Health Homes or similar services, where clinicians and LTSS and community professionals need to have a coordinated understanding of person-centered practices across clinical and community settings. This curriculum needs to include a one-day in-person training in PCT to be considered complete as far as PCT skills. It would need a skilled training to support groups in organizing a blended learning model for above purposes. It is not ideal as core training for MH TCM because of the more broad disability focus but is rooted in recovery principles, self-determination, and culturally responsive services.
The Minnesota Department of Human Services has purchased a full contract for this curriculum in Minnesota that makes training available for free and/or with minimal administrative costs. Go to: https://mn.gov/dhs/partners-and-providers/training-conferences/directcourse/to learn more.
The Yale Program for Recovery and Health, Person Centered Approaches has a focus on research, consultation and tools in the area of person-centered approaches in mental health and co-occurring disorders.
The following resources related to authors and researchers at this program were reviewed.
Partnering for Recovery in Mental Health is a practical guide for conducting person and family-centered recovery planning with individuals with serious mental illnesses and their families. This guide represents a new clinical approach to the planning and delivery of mental health care. It emerges from the mental health recovery movement, and has been developed in the process of the efforts to transform systems of care at the local, regional, and national levels to a recovery orientation.
This is a very solid and recommended resource that looks comprehensively at person and family-centered practices in planning specific to mental health conditions and co-occurring conditions. It provides context to recovery, self-determination, cultural needs, family support, and shared power. It is a good overall resource that would be helpful to any professional working with people with serious mental illnesses and required to complete support or treatment plans, including targeted case managers.
This book is authored by Janis Tondora, Rebecca Miller, Mike Slade and Larry Davidson and was published in 2014 by Wiley-Blackwell. It is available online as an ebook or from booksellers in hard copy, for an approximate cost of $42.00.
This resource is a downloadable booklet for organizing information a person might want in a treatment or support plan. It is meant to help people organize their thoughts and information in ways that are likely to yield person-centered goals and approaches in a treatment plan.
The strengths of this resource include: It is easily downloadable from a public site. It is concrete, process-oriented, flexible and applicable to many circumstances, and written in plain language. It gives people structure and context to taking the time to identify their goals and preferences in key areas outlined in the Person-Centered Informed Choice Protocol (DHS, 01/17). It asks people to consider including people important to them in the process. It would be a great foundation for developing a person-centered plan. Professionals and practitioners for all level of practice in mental health would benefit from being familiar with this tool. Case managers, support planners, and those in similar roles would benefit the most. There is a Spanish language version available.
Limitations of this resource include: The rights information is specific to the state of Connecticut (but could be easily customized to Minnesota). It provides little context for bigger picture aspects of history and professional responsibly. While it may work with a variety of cultures and circumstances, it does not support practitioners in how to adapt for a variety of cultures and circumstance. Family and natural supporters are considered as support but not as people who may need support. Information would need more work to translate into an operational treatment plan. Literacy would be an issue with this tool if used without assistance.
Authors are Tondora, Miller, Guy and Lanteri. Published in 2009 by Yale Program for Recovery and Community Health.
This online resource is available as a .pdf document at no cost:
The Copeland Center for Wellness and Recovery promotes mental health recovery through education, training, and research based on WRAP©. (Wellness Recovery Action Plan). It is a peer run, non-profit organization that provides training, consultation, and program activities to support the wellness, recovery, community inclusion and peer support journeys of individuals. They work with the owners of WRAP© materials at Advocates for Human Potential (AHP) to ensure the fidelity and quality implementation of WRAP© Facilitation in the health care system. There are a variety of training and consultation options offered through Copeland.
Locally people can connect and take seminars through the Kaposia which is an International WRAP© Center for Excellence.
The Developing Your Own WRAP© workshops is co-facilitated by WRAP© Facilitators in a variety of formats and agendas, including 8-12 week WRAP© groups, 2-3 day workshops, retreats. Participants in these workshops will learn how to develop their WRAP© as a personalized system to achieve their own wellness goals. These workshops are for anyone and can apply to any self-directed wellness goals. WRAP© is a safe, effective wellness process that has an evidence-base for supporting mental health recovery. It is s self-directed, peer supported process that the person engages with in ways that they prefer. WRAP© is an ongoing processes of reflecting on and engaging approaches and lifestyles that support personal wellness. Processes can be used by individuals and organizations to move to a true recovery and self-determination focus in services and supports. WRAP© has proven to be an effective approach to working with children, youth, and families and caregivers to improve relationships, feel more hopeful, create support systems, learn to self-advocate, and put a greater focus on their personal overall wellness.
WRAP© must be delivered with fidelity in order to meet the evidence based criteria. This include that participation in WRAP© be completely voluntary, that at least two peer facilators who are skilled, trained, and mentored facilitate this process, materials are appropriate, and all processes align with the values and ethics of WRAP©. (To learn more about fidelity download and read the document The Way WRAP Works!.) Professional who have their own WRAPs can benefit from the process and also understand the value and power of WRAP© in supporting recovery.
WRAP© is voluntary, focused on wellness, owned by the person, and avoids clinical or medical language. It is a powerful tool for helping people reconnect with hope, personal responsibility, and personal strategies for recovery. However, it is not something professionals can have access to without a person’s permission and it is not something professionals can require of people. If people chose to complete a WRAP© on their own, it can support their ability to more clearly define many of the aspects of the PCICTP. It is something to recommend, especially to people who have lost touch with what recovery and a life worth living means to them. However, there can be no expectation that people participate unwillingly or in order to receive services.
The cost for this entry course ranges from $100-400.00 approximately. Locally, there may be a possibility for a need-based reduction in the fee or waiving of the fee.
The content of materials developed through this contract was co-created with members of Minnesota’s communities. Co-creation include structured and open-ended conversations as well as listening sessions. It also included seven structure co-creation processes conducted in different parts of the state. These sessions include professionals and people with lived experience or their families. Community members were also invited to review and edit the content of online materials (Community Reviewers). Participants were kept informed about ongoing progress through a website.
The following sessions helped to shape refined definitions and areas of focus after the initial environmental scan was complete.
There were seven (7) Co-Creation Groups (in 6 communities) Rochester, Duluth, Mahnomen, Minneapolis, St Paul (2), and New Brighton. A total of 89 people participated in these groups. Participants included a spectrum of people with a variety life experiences and backgrounds. These processes were developed to support the maximum engagement of each participant. The following people attending a co-creation session:
The authors for the online lessons were:
There were seven community reviewers recruited to review the content of online materials that were developed. These reviewer were mental health professionals and included family members of service users. The following people served in this role:
In addition Darrin Helt of the DHS Behavioral Health Division served as editor and approver.
Web development, design, and media team: