Covid recovery: learning from person-centred approaches

1. How can we better define Person-centred approaches?

The term 'person-centred approaches' was first coined by Carl Rogers in the 1960s. It initially referred to a therapeutic, highly individualised, and non-directive style of counselling.^[11] However, over time the term has evolved and moved away from its original, more narrowly defined meaning.

From the case studies, policy documentation and broader literature, it is possible to distil a number of 'core' attributes that characterise current use of the term person-centred approaches within Scotland. These are set out in the table below.

The term 'person-centred' is often used as an umbrella term to describe a range of approaches that share similar attributes to those outlined in the table above. Other related terms that are often used interchangeably with the term can be seen below in Figure 1 and include:

The UN^[12], WHO^[13] and OECD^[14] for example use 'People centred'. Person-centred approaches are also closely related to policy concepts such as "nothing done to me without me," "no wrong door" and "no-one left behind." The key attributes of person-centred approaches are closely aligned with the four pillars of Christie Commission report and the objectives of public service reform.^[15]

Contrasting Person-centred Services with 'Task' or 'Service' Centred Approaches

It is useful to contrast person-centred approaches with other more traditional styles of service provision. In task centred approaches, involvement from a service focusses on a single or limited range of issues and the interaction ends once this is addressed through providing information, or the resolution of straightforward problems. The focus is on the task, rather than the person; the solution is more important than the relationship.

Similarly, person-centred approaches can be contrasted with service centred or service centric involvement.^[16] Service centred practice is identified as a way of working which prioritises the needs of the service provider. Service centred approaches may fail to fully understand the needs of the person and often set the professional in a position of power, casting people into roles such as "service user", "client" or "patient" ^{[16] [17] [18] [19] [7]}.

Is Person-centred always the right approach to take?

Taking an intensive / holistic person-centred approach may not always be the 'optimum' approach, especially when service responses are required quickly, when resources are highly constrained or when a simple and standardised intervention is required. While the case studies highlighted in this paper relate to highly complex situations which benefitted from holistic person-centred approaches, in some instances less person-centred approaches may be more appropriate. This may be particularly true in circumstances relating to:

• Standardised Interventions – for example, where interventions relate to a single issue, are low risk, or are focused on straightforward procedure.
• Crisis interventions – when urgency requires professionals to make decisions not in partnership with the person, or where the person cannot manage using their own strengths.

However, even in these instances where a less person-centred approach is taken we should expect to see some elements of the 'core' attributes of a person-centred approach such as dignity, respect and the avoidance of stigma.

Furthermore, services, no matter how transactional, should always be designed around people's needs, rather than being driven by what the system / organisation thinks it should offer as this can often lead to the wrong solution, costly repeat visits, poor experiences for staff, service users and those around them.