Butkus, S., Rotholz, D., Lacy, K., Abery, B., & Elkin, S.,

2002,

Reviewed by Janet Robertson,
Institute for Health Research,
Lancaster University

Methodology

PCP was introduced in 1998 on a statewide basis in the South Carolina Department of Disabilities and Special Needs. This chapter contains 3 sections that describe: systems changes; the process and content for training PCP facilitators; and assessment of participants' initial satisfaction with PCP. The study described here is contained within the section on initial satisfaction with PCP.

An attempt was made to survey all people who had been involved in a PCP meeting over a 30 day period in Spring 1999. This was done by a telephone survey in which participants in planning meetings were asked how they felt about the planning process and the independent facilitator who led the meetings. The purpose of the survey was to learn about the views of people who were actually involved in the planning process. All surveys were conducted within 14 days of the initial planning meetings. The survey took about 10 minutes by phone. Ninety six per cent of those contacted agreed to participate.

This survey collected quantitative and qualitative information from family members, friends and support staff who participated in the meetings. The survey (the PCP-SS) consisted of 36 likert type closed-ended questions and two open-ended questions ('what did you like most', and 'what did you like least' about the planning process). All respondents were asked 31 of the questions, with 3 only being asked of family or friends and 2 only being asked of family. Respondents indicated the extent to which each statement accurately described their experience in a PCP process. For quantitative analysis, the 36 items were grouped on a conceptual basis into 11 subscales by 3 people intimately familiar with PCP.

Critical appraisal

The results section could be presented in a more informative way. The quantitative results are presented for staff and family/friends combined. It would have been more informative to have satisfaction scores presented separately for the two groups. With respect to the conceptual grouping of the 36 items, it may have been more appropriate to use statistical methods for grouping items.

The satisfaction survey is limited to a specific part of the PCP process: the actual development of the plan and the meeting itself. As the authors note, PCP is an ongoing process and other issues that need to be considered include consumer satisfaction with PCP, evaluation of plan quality, and evaluation of the degree to which personal outcomes are achieved through PCP implementation. This latter question is of vital importance. Whilst participants may be satisfied with PCP two weeks following the initial meeting, if the goals of plans are not met, for example due to lack of resources, then satisfaction is going to decrease. There is also no comparative information on satisfaction with previous styles of planning.

Key findings

• A total of 242 interviews were conducted: 68 with family or friends; and 174 with staff. Both staff and family/friends reported moderate to high levels of satisfaction in all categories. Staff reported significantly greater levels of satisfaction overall than family friends with the PCP in which they had taken part. Satisfaction ratings were significantly higher in some areas for both staff and family/friends. Tukey tests showed that lower levels of satisfaction were reported by family/friends for: premeeting preparation; participation of the focus person; and the extent to which the PCP meeting was informative about the focus person's needs and wants. Staff reported lower levels of satisfaction for: premeeting preparation; participation of the focus person; and uniqueness of the process.
• For the qualitative analysis, open ended responses to 'what did you like most about the planning process in which you recently took part' and 'what did you like least about the planning process in which you recently took part' were analysed via an inductive procedure referred to as 'constant comparative analysis' (CCA). This involved close examination of qualitative data to identify common themes and linkages between them. Responses were grouped by content with two raters independently assigning each answer to a response category and resolving discrepancies through discussion.
• Responses to what was liked most were put into 21 categories. Respondents most frequently commented on the facilitator skill in leading the meeting (n=61) and on the meeting's focus on the individual rather than programs or services provided (n=50). Third most common was that PCP allowed the focus person to express themselves during the meeting (n=36). Next was that focus person was involved rather than just observing (n=31). Only 3 out of the 242 respondents responded that they did not like the PCP process.
• Responses to what was liked least were grouped into 17 content categories. The most common response was that they liked everything (n=76). The two most common criticisms were the logistics of the meeting such as time, or location not being ideal, or meetings taking too long (n=43) and that the focus person did not participate as much as possible (n=17). All other responses were made by 13 people or less.

Social work practice/policy implications

This study indicates good satisfaction with initial PCP meetings. It is not clear why the satisfaction of family/friends is less than that of staff and attempts should be made to ensure that planning is equally satisfactory for all stakeholders. Overall, the lowest level of satisfaction was with 'adequacy of resources'. PCP cannot be effective in the absence of sufficient resources to meet the goals of plans. As the authors note: 'Having a terrific plan means little unless there is the will and capacity to implement it with a high level of integrity'. Having good planning meetings which produce good plans is only a starting point in the PCP process