Tool: 4+1 questions

Page posted: 3/6/24

The 4+1 questions tool, DHS-8479C-ENG (adapted from The Learning Community for Person-Centered Practices) helps the provider learn from their efforts and develop next steps. The provider should always begin the use of the 4+1 tool by identifying a question the team wants to answer. For example, the provider might ask: “Is the person feeling better about themselves?”

Once the provider identifies a question the team wants to answer, the provider should ask the following four questions:

1. What has the team tried?

2. What has the team learned?

3. What is the team pleased about?

4. What is the team concerned about?

Then, the last question (the “+1”) is the action step at the end: What should the team do based on the information shared in questions 1-4?

Example

Mandy’s team wants to know if Mandy is feeling better about herself, so they use the 4+1 questions tool to answer the question and identify action steps.

Is Mandy feeling better about herself?

1. What have we tried?	2. What have we learned?	3. What are we pleased about?	4. What are we concerned about?
Light therapy	· Doesn’t like the brightness or heat of the box. · Throws the box, causing damage.	· Will tolerate the box for about 10 minutes in the late afternoon.	· Still not sleeping well. · Highly irritable about sitting with the box.
Swimming twice a week	· Likes the water and is happy once she arrives. · Hard to get motivated to leave the house.	· Gets physical exercise. · Sleeps best on pool days.	· Lack of motivation to leave the house.
Weekly animal therapy	· Likes going to therapy. · Visits with two women who also attend.	· Meets friends during this time. · Engages with the animals.	· Does not have opportunities to see these friends outside of therapy.
Antidepressant: Remeron (mirtazapine) 45mg	· Fully willing to take medication from February through November.	· Takes medications consistently. · Sleeps better. · Seems more social.	· Increased appetite. · Slight weight gain.
Increased time with quilt club members	· Enjoys going to monthly meetings. · Feels accepted and valued by other members.	· Has finished two quilt projects with help from quilt friends. · Makes phone calls often.	· Needs a way to ensure rides to monthly club meetings. · Missed two meetings due to lack of ride.

+1: What should we do based on the information just shared?

· Discontinue the light box because we have tried for nine months with no apparent positive effect.

· Increase pool time to every other day and provide other incentives to motivate Mandy.

· Help Mandy find time to hang out with one of the women she often talks to at animal therapy.

· Maintain Mandy’s daily dose per the practitioner’s orders and monitor every six months or as recommended by the practitioner.

· Remind Mandy to call her friends the day before quilt club to get a ride.

Next step

Mandy’s team wants to understand why she resists an activity she enjoys. To address this question from all perspectives, they use the working/not working tool, as described on Psychotropic Medication Manual – Tool: What’s working/not working.

Additional resources

DHS – Person-centered practices
DHS – Frequently asked questions about formal person-centered planning
Psychotropic Medication Manual
Psychotropic Medication Manual – Person-centered tools to support medication management