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Client-centred care

Why client-centred care?

Client-centred care is about treating clients as they want to be treated, with knowledge about and respect for their values and personal priorities. Health care providers who take the time to get to know their clients can provide care that better addresses the needs of clients and improves their quality of care. A client-centred approach allows clients greater responsibility over treatment decisions and recovery planning.

Employment is an important part of client-centred care and recovery for people with mental health and addiction problems. Dr. Sean Kidd, a psychologist at the Centre for Addiction and Mental Health, is researching social entrepreneurship models that provide employment and address mental health disparities. The video Pathways to Wellness through Social Enterprise illustrates the role of meaningful work and supportive employment in recovery.

Definition

Client-centred care:

  • empowers clients, promoting autonomy, rights, voice and self-determination in the treatment planning and recovery process 
  • reflects the values and self-identified main concerns of each client and improves the person's engagement and participation in the treatment and recovery plan
  • considers the client's social, physical, culture, spiritual, environmental, medical and psychological needs
  • advocates safety and promotes interventions that minimize or reduce potential harms to the client
  • supports care plans that are developed in collaboration with clients, and allows clients to express their self-identified needs and choices.

Balancing risk

Client-centred practices facilitate the development of strong therapeutic relationships and enable care providers to understand how to maximize clients' strengths and minimize challenges in achieving treatment and recovery goals. Care providers negotiate between clients' decisions and ongoing risk assessments. The care plan reflects safe practices and promotes interventions that minimize or reduce potential harms to the client.

Principles of client-centred care

Client-centred care involves practice built on the following principles:

  • Clients' wishes, concerns, values, priorities, perspectives and strengths are respected.
  • Clients are considered as whole, unique human beings, not as problems or diagnoses.
  • Clients know themselves the best.
  • Care providers follow the lead of clients around providing information, making decisions and involving others.
  • Clients define the goals that determine the practices of the health care team. All team members support the client in achieving these goals.
  • Care is founded on continuity and consistency of care and caregiver.
  • The needs of clients and communities deserve a prompt response.
  • Care is universally accessible and responsive to clients' wishes, values, priorities, perspectives and concerns.
  • Clients' rights are essential to good care.

Collaboration

Client-centred care requires health care workers to collaborate with clients at four stages.

1. Identify concerns and needs

Initiate discussions or implement strategies to help you understand your clients' perspectives on their health and quality of life.

2. Make decisions

Recognize that clients are the rightful decision-makers in planning care and services.

Give clients what they need to provide informed consent about any proposed treatment.

Spend time with clients to understand the situation from their perspective.

Follow the lead of clients in terms of their desire to participate in decision-making.

3. Provide care and service

Involve clients throughout the caring and service process.

Acknowledge clients' expertise and encourage clients and communities to share their knowledge and skills.

Respect and honour clients' choices and decisions.

4. Evaluate outcomes

Engage clients in evaluating care delivery and health-related outcomes.

Related approaches

  • integrated treatment care
  • trauma-informed care.

Evidence summary

Centre for Addiction and Mental Health. (2011). Practice Model: Partners in Care. Toronto, ON: Author.

Registered Nurses' Association of Ontario. (2002). Client Centred Care. Toronto, ON: Author.

Resources

Toolkits

The Registered Nurses' Association of Ontario has produced the eHealth Toolkit that clinicians can use to improve client care and health delivery through the use of eHealth. The toolkit outlines flexible, evidenced-based strategies for nurses and other health care providers who want to integrate eHealth technology into their organizations.

Self-Management Toolkit: A Resource for Health Care Providers teaches professionals to support clients in becoming better managers of their health care. It was developed by the South West Community Care Access Centre and South West Local Health Integration Network in Ontario.

A Guide to Wellness and Comfort Activities outlines activities and resources that empower and support clients dealing with frustration, fear and / or worry. The guide was developed at the Centre for Addiction and Mental Health.

Resources for your clients and their families

Family Outreach and Response is a Toronto-based organization that offers recovery-oriented mental health support services to families.

HeretoHelp is a project of the B.C. Partners for Mental Health and Addictions Information. It provides information for clients and the general public about mental health and addiction.

The Registered Nurses' Association of Ontario provides the Health Education Fact Sheet for Clients, which offers tips for preparing for a visit with a health care provider and what to ask during the visit.

The Life Recovery Program is a trauma-informed psychoeducation course about addiction and mental health recovery. The program offers tools for clients and family members or other supports.

Recommended reading

Roth, D. & Crane-Ross, D. (2002). Impact of services, met needs and service empowerment on consumer outcomes. Mental Health Services Research, 4(1), 43–56.

Training

Client Centred Care is a free online course offered by the Registered Nurses' Association of Ontario. The course builds on the knowledge, skills and experience of health care providers and helps them to integrate evidence-based recommendations into their practice.

A story

A growing concern: Horticulture therapy offers potent opportunities for healing and growth

by Diana Ballon

Work in the garden "takes priority over interacting with my symptoms," says Toshio Ushiroguchi-Pigott. "It's a kind of medicine in a way, to be outside," caring for plants, harvesting, weeding and seeding in the greenhouse on days it's too cold outside, says Toshio, who enjoys dropping by CAMH's Sunshine Garden near his home to garden whenever he can. Run by FoodShare Toronto in partnership with CAMH, the Sunshine Garden uses horticultural principles to teach clients about food security, provide skills training and nurture self-confidence and healthy leisure activity.

"Going outside in a park is what I used to do when I was overwhelmed by symptoms," says Toshio, an outpatient with CAMH's Archway Clinic. He has found it's even healthier to actively work in a garden; his involvement in gardening has since propelled him to enroll in a landscape design certificate program at Ryerson University.

Many people like Toshio have discovered the healing powers of horticulture therapy (HT), a formal practice involving the use of plants, the garden and horticultural activities to "promote well-being for its participant," as defined by the Canadian Horticultural Therapy Association (CHTA). The benefits of horticulture therapy can take many forms, from physical and cognitive, to spiritual and emotional. Read more...

Reprinted with permission from CrossCurrents: The Journal of Addiction and Mental Health, 16(1), 2012.


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