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Improving Services by Recognizing Systematic Diversity within Client Populations

Cluster-based Planning is an emerging best practice that defines and describes the shared lived experiences of sub-groups of people who make up larger populations of citizens with behavioral healthcare needs. Cluster-based Planning is intended to improve our ability to match consumers with the right services, at the right time.



What Is a Cluster?

A Cluster Is A Subgroup of A Larger Population in Need That Shares Common Problems, Strengths, Treatment Histories (or lack of treatment history), Social and Environmental Contexts, and/or Life Situations.

Each cluster has a one-page prose description that incorporates historical and more holistic information provided by community experts including consumers, treatment providers, family members, and other knowledgeable citizens. Cluster Descriptions also take into account public policy and the scientific knowledge available that guided past treatment as well as the social and environmental contexts that have affected members of each cluster.

Cluster-Based Planning is a systematic process that facilitates clinical practice, treatment planning, program development and outcomes-based management of services. As shown in Figure 1 below, the Cluster-Based Planning system assumes that large groups of consumers, such as adults with severe and persistent mental health issues, should not be served as if they were members of a single homogeneous group. Instead, these larger groups are comprised of distinct, natural subgroups, or Clusters of people. Members of each Cluster share key components of their bio-psychosocial histories and life stories.


Matching Services by Cluster


Clinical experience and continuing research confirm that the members of different clusters typically receive or need different types and intensities of services and that the associated costs should differ by cluster.  Knowledge of cluster history therefore facilitates matching consumers with evidence-based and/or emerging best practices.  In addition, rather than using the same "yardstick" to measure success for each group, treatment goals/outcomes should be different for each cluster.  Even when individuals in different clusters are pursuing the same long-term recovery goals, their more immediate challenges and pathways to success are likely to be different.


Measuring Outcomes & Improving Care

By describing different Clusters, identifying and measuring targeted outcomes, and tracking more targeted services and the use of resources, your agency can begin to answer the question of “What Works, For Whom, And At What Cost?” This information can form the basis for:

  • Developing or Using Best Practice and Evidence-Based Services
  • Identifying and Measuring Progress on Meaningful Recovery Outcomes,
  • Continuous Quality Improvement
  • Better Understanding and Management of Service Utilization and Costs
  • Staff Recruitment, Retention, Training, and Development
  • Sub-Population Driven Predictive Analytics
  • Integrating Behavioral Health with Primary Care