What it means to be person-centered and why it’s critical when assessing people with complex needs

About the author: Nancy Shanley is Managing Director of Clinical Services responsible for providing Medicaid screening, assessment, eligibility, and PASRR consulting support to help state agencies advance their LTSS and HCBS programs.

Most people feel apprehensive when encountering a new situation, but knowing what to expect can help. As Home and Community-Based Services (HCBS) assessment professionals, we gather accurate, relevant, and meaningful information about each person’s support needs and goals. Accuracy is key because this information helps states deliver the right type and intensity of services and in the right settings, that align with an individual’s unique personal constellation of goals, preferences, and needs. This is especially important when assessments influence service delivery or care plan objectives.

But what about the experience of the person we’re assessing? What do they need to feel more comfortable? And how can we, as assessment professionals, help?

A person-centered assessment approach

A person-centered assessor takes the time to let each person know what they’ll experience, how the information gathered may inform their access to services, and the choices they might eventually make about services. This approach aligns with key HCBS values of informed choice, individual empowerment, and self-determination while driving outcomes that more thoroughly reflect individual needs and priorities.

With over 30 years’ experience supporting Long-Term Services and Supports (LTSS) and HCBS programs, I firmly believe that many benefits, both to the individuals we assess and our state clients, spring from an intentional, rigorous application of a person-centered approach to assessment encounters. By applying these principles, we can:

• Improve assessment accuracy by eliciting more accurate and thorough information from assessed individuals,
• Increase the individual’s engagement and confidence in assessment outcomes and in the decisions those outcomes impact,
• And reinforce their sense of agency, choice, and internal locus of control as they navigate often complex pathways to services and supports.

First steps to achieve a person-centered assessment

A person-centered assessment approach is about giving and getting good information. It’s also about supporting and reinforcing someone’s sense of agency regarding the assessment experience itself, thereby increasing their confidence in advocating for their goals and preferences during post-assessment service planning.

When interacting with assessment participants, we refer to these four guiding principles:

• Assessors explore each individual’s communication and interaction preferences and adjust their style accordingly. Instead of assuming that a one-size-fits-all approach is effective, truly person-centered assessors adapt their style to suit the individual's needs. Some people need an assessor to slow down to process verbal information confidently. Some need us to speak up. Some find consistent eye contact intrusive, while others need it to feel engaged and attended to. Individuals can focus on giving us good information and telling their own unique story when they don’t have to struggle to understand or be understood.?
• Assessors use active listening skills. Most of us played the telephone game as children where we sat in a circle and whispered a message from kid to kid. Do you remember how the original message often turned into something completely different?but nearly always funny by the end? Assessors who want to “get it right” frequently stop to verbally reflect back what we understood the person to have said. When they confirm or correct our reflection, they gain better control over their message, and we obtain a more accurate view of their experience.
• Assessors empower individuals with information and choices. To feel more in control, people need to know what to expect before, during, and after an assessment. As assessors, we prepare and empower individuals by describing the assessment process, including how it can be adapted to their needs, how assessment information may impact access to services, where to get information about services, and about the kinds of choices they can make as services are identified to meet their needs.
• Assessors remain acutely aware of cultural influences and trauma-related sensitivities. Person-centered assessors must prioritize understanding and addressing the cultural preferences that are important to the person we’re assessing. Simultaneously, we must recognize how our own cultural background might influence how we interact with, perceive, or interpret individuals whose experiences grew out of different cultural environments than our own.

Mastering a person-centered approach to assessment takes time to learn and attune to individual communication preferences. But the outcome is an environment that helps each person to comfortably engage throughout their assessment and lets them know how each assessment item will be recorded or scored. Because the way individuals experience their assessment encounters matters, a person-centered approach is crucial to the delivery of effective LTSS and HCBS services.

View additional insights and information on how Maximus is partnering with states on delivery of LTSS and HCBS services.