Covid recovery: learning from person-centred approaches
This report draws on four case studies of person-centred approaches to public service delivery, along with wider evidence, and summarises learning from person-centred approaches
3. What are the strengths of and barriers to adopting Person-centred approaches?
Strengths of Person-centred approaches
This section of the report discusses the benefits of person-centred approaches with illustrative examples drawn from the evaluations and case studies mentioned above. It starts by considering the benefits for the individual but also looks at some of the wider benefits for families, communities, society, front-line staff, and public services.
For the Individual - people highly value the relational aspect of their interaction with services.
The process evaluation of the Dundee and Glasgow Pathfinder [19] found that building trust was crucial in reaching out to people with little previous contact with services. Qualities such as 'humaneness' and 'friendliness' were significant in helping individuals to overcome feelings of anxiety or shame around using services. Parents described feeling that they had felt like they had been 'treated like a normal person', that they 'had been really listened to' and experienced 'empathy' and 'understanding'. Even when agreed outcomes, such as increasing benefit uptake had not yet been achieved, some individuals advised that their involvement with the service:[19]
"made me feel better about the future. My position has not changed much but they helped it not get worse. They made me feel like people are out there that they will help me, like reaching out for help is normal."
The quality of the relationship and the personal qualities of the workforce are crucial in gaining trust in settings such as at HMYOI Polmont, where young people may, otherwise, find it difficult to ask for support around risk of self-harm or suicide. Additionally, a study of the Housing First [33] initiative to address homelessness, found that where an individual's previous experience with services has been stigmatising, qualities such as "stickability" facilitated the forming of a trusting relationship.
The holistic nature of person-centredness seeks to understand not only the underlying factors which influence the presenting issue, but also the impact of multiple and complex needs and risks on one another. As the Pathfinder process evaluation indicates, working holistically enables the individual to prioritise the matters which they view as most urgent. [19] The Drug Deaths Taskforce highlights the importance of recognising that substance use may be a coping mechanism for trauma or stressors such as poverty.[16] Addressing these issues first may facilitate other goals such as employability or a reduction in harmful substance use.
The strength-based aspect of person-centred approaches may enable a more equal partnership between individual and professional. As the House of Care evaluation demonstrated, drawing on the assets of the individual facilitates self-management and empowerment, enabling them to have more control over their care and treatment. [34]
For Families - A family-centred approach recognises the significance of personal relationships in the lives of individuals. Impactful policies, such as The Promise [1], recognise and validate the importance of the family in the life of a child. Where a more individualised approach is taken (with a narrower focus on the needs of the child), intervention by services may be experienced as adversarial with the needs of family members set against each other.
A whole family approach seeks to avoid this. Similarly, the Drugs Death Taskforce [16] acknowledges that for a person with substance use issues, family and other close contacts are who they wish to receive support from, and they are more likely to be available in a crisis than service providers. Whole family approaches strengthen these relationships by understanding the needs and assets of all those involved and how these influence the family as a unit.
For Communities - The evaluation of innovation and creativity in the Third Sector in response to Covid-19 found significant benefits to communities where their assets are drawn on to support their members. [31] Not only do community based and community run services have significant advantages around flexibility and accessibility, they also produce positive outcomes for those working within such initiatives and the communities they serve; a sense of mutual aid encourages a sense of belonging and community solidarity. [31]
Further, the evaluation of youth work during the covid pandemic relates the experiences of young people who took part in volunteering within their communities. Not only did people in the local area benefit from such activities, but the young people's participation had a positive impact on how they were viewed by community members.
Similarly, the Drug Deaths Taskforce recognises the positive contribution which people with lived experience of substance use can make around communicating a message of hope and recovery to communities. [16]
For Society - Person-centred approaches can also have wider societal level benefits. Policies such as "Unlocking Potential, Transforming Lives" [35] seek to identify and develop the skills and abilities of people in prison. Addressing offending through a strength-based approach enables people to make a positive contribution, thereby benefiting wider society. The Drug Death Taskforce [16] acknowledges the sympathy in society for people with substance use problems; in shifting substance use from justice to health, this holistic approach may further influence public opinion within wider society, encouraging empathy and understanding and a reduction in fear.
For Front-line staff - The strongly relational aspect of person-centred approaches and the ethical foundation on which this is built may appeal to the workforce in services and roles where there is an emphasis on personal qualities and values. Working holistically enables the workforce to better understand the person's circumstances, facilitating mutual trust. Where person-centred approaches are used, this may lead to greater job satisfaction and staff retention.
For Public Services - Ultimately, person-centred approaches may reduce demand for public services. The evaluation of Housing First [33] asserts that working holistically within a relational service may prove cost effective. Meeting a wide range of needs beyond providing accommodation could have a positive impact on reducing offending and problematic substance use and better health outcomes.
By drawing on and supporting the strengths of individuals, families and communities, this empowering and resilience-building approach may similarly increase the use of informal networks in meeting needs. This may prevent people requiring intervention from public services and it could support their exit from such involvement.
Barriers to Person-centred approaches
The case studies and wider literature served to identify a number of barriers to adopting a person-centred approach. These barriers are summarised in the table below.
| Administrative Barriers |
|
|---|---|
| Resource Constraints |
Person-centred approaches can be resource intensive in terms of both design and delivery. Limited budgets may reduce the ability of services to be holistic and bespoke and can result in the use of strict eligibility criteria to target services to those most in need. |
| Competing Priorities [10] |
Competing priorities at a national and local level (e.g., multiple overlapping strategies and delivery plans) can restrict resources and act as a barrier to person-centred approaches. Crisis responses to events like the cost of living crisis or the Ukrainian resettlement scheme can detract (time and funding) from longer term strategic work to deliver person-centred approaches [10]. |
| Siloed Working |
Siloed working can prevent holistic and person-centred policy development. Failure to understand and appreciate the roles and remits of other statutory and third sector services may result in opportunities being missed for joint working resulting in duplication and people being unable to access the services they need. |
| Restrictive/ Short-term Funding |
A highly competitive funding environment may hinder inter-agency cooperation. Restrictive short-term funding may push services towards more task focused or service centred approaches. |
| Reporting Requirements [10] |
Reporting requirements can impede person-centred approaches when they become burdensome, especially when there are competing priorities and funding arrangements. This can be challenging for staff, especially when this is seen as disproportionate or duplicate information is required. |
| Defining and Measuring Success |
It may be difficult to demonstrate a strong causal link between person-centred approaches and agreed outcomes leading to a perceived lack of accountability. |
| Data and Intelligence Sharing [10] |
The absence of a common platform for secure data sharing across organisations may hinder the legitimate exchange of intelligence and/or information and mitigates against more targeted and person-centred services. |
| Legal Barriers |
Policy aims may be restricted by legislation, e.g., the impact of the Misuse of Drugs Act 1971 and the Equalities Act 2010 on situating substance use within a Health rather than a Justice context. |
| Cultural Barriers |
|
|---|---|
| Risk Adversity |
A culture of blame within organisations, professions and wider society may result in risk averse practices. For example, risk aversion to sharing data can prevent holistic working inherent in person-centred approaches. |
| Paternalistic Attitudes |
Paternalist attitudes whereby services providers automatically assume that they know best what individuals need and what is in their interest. |
| Ineffective Leadership |
A lack of leadership / commitment to person-centred approaches from senior managers may enable other barriers listed here to take hold. |
| Incompatible Organisational Values |
Where the workforce holds discriminatory views around certain groups of people, this may be manifested in punitive attitudes and a lack of ethical practice. |
| Lack of Appropriately Trained Staff |
The interpersonal skills within the workforce may not exist to effectively build relationships and trust. There may also be a lack of trauma informed practice / understanding within some organisations. |
| Mistrust of Government Organisations |
May result in persons avoiding contact with services or being cautious around information they choose to disclose. |
| Built Environment Barriers |
|
|---|---|
| Limitations of the Built Environment |
Where the physical setting is at odds with the ethical principles of person-centred approaches this could restrict the type of support which may be given or impact on how support is received. Examples include settings which are not therapeutic or locations where privacy is compromised. |
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