Person Centred Planning
Encyclopedia
Person-centred planning is a set of approaches designed to assist someone to plan their life and supports. It is used most often as a life planning model to enable individuals with disabilities or otherwise requiring support to increase their personal self-determination and improve their own independence. Person-centred planning was adopted as government policy
Social policy
Social policy primarily refers to guidelines, principles, legislation and activities that affect the living conditions conducive to human welfare. Thus, social policy is that part of public policy that has to do with social issues...

 in the United Kingdom through the 'Valuing People' White Paper
White paper
A white paper is an authoritative report or guide that helps solve a problem. White papers are used to educate readers and help people make decisions, and are often requested and used in politics, policy, business, and technical fields. In commercial use, the term has also come to refer to...

 in 2001, and as part of 'Valuing People Now', the 'refresh' of this white paper in 2009. It is promoted as a key method for delivering the personalisation objectives of the UK government's 'Putting People First' programme for social care.
PCP is accepted as evidence based practice in many countries throughout the world. It is most often used for life planning with people with learning and developmental disabilities
Developmental disability
Developmental disability is a term used in the United States and Canada to describe lifelong disabilities attributable to mental or physical impairments, manifested prior to age 18. It is not synonymous with "developmental delay" which is often a consequence of a temporary illness or trauma during...

, though recently it has been advocated as a method of planning personalised support with many other sections of society who find themselves disempowered by traditional methods of service delivery, including children, people with physical disabilities, people with mental health issues and older people. http://www.csci.gov.uk/default.aspx?page=2098&key=

Background


"Person Centred Planning discovers and acts on what is important to a person. It is a process for continual listening and learning, focussing on what are important to someone now and in the future, and acting on this in alliance with their family and their friends"


Person-centred planning was created in response to some specific problems with the way in which society responds to people with disabilities. Those who first described the processes were responding to the effects that 'services' can have on people's lives. In this context 'services' is a general term used to refer to the organisations which are set up to help people in relation to their disability (or at least in relation to how other people have responded to that disability). It would include health and social care services funded by government or local authorities, but also privately funded or voluntary sector projects of many kinds.

Person-centered planning has similarities to other processes and ideas, but was first named and described more definitely by a group of people in the US, including the Center on Human Policy's Rehabilitation Research and Training Center (RRTC) on Community Integration e.g., Julie Ann Racino (US technical assistance manager for the states, 1985–1993), John O'Brien (human services thinker)
John O'Brien (human services thinker)
John O'Brien is a leading thinker who has written widely in the field of disability. He is a pioneer and lifelong advocate of Person Centred Planning...

 and creator of a similar process on life planning, subcontractor of the RRTC), Beth Mount, Connie Lyle O'Brien, technical assistance "partners" of the RRTC (e.g., Michael Smull, Wade Hitzing, Karen Green-McGowen)and then person-centred planning in Canada by Jack Pearpoint, Judith Snow and Marsha Forest. Whilst it was developed because of the social and service response to disability, it was quickly recognised to be as useful for many other individuals and groups of people.

The title 'person-centred' is used because those who developed it and used it initially shared a belief that services tend to work in a 'service-centred' way. This 'service-centred' behaviour appears in many forms, but an example is that a person who is isolated would be offered different groups to attend (each run by a service specifically for people sharing a specific label), rather than being helped to make friends in ordinary society. The person-centered concept grew out of the critique of the "facility-based services" approach in the US (and worldwide)which was central to the development of "support approaches" in the US (e.g., Racino, et al., 1993, Taylor, et al., 1987).
The nationwide technical assistance which included the person-centered approaches is reported in the Journal of Vocational Rehabilitation (Racino, 1999).

A central idea behind person-centred planning, is that services which are set up to respond to problems of social exclusion, disempowerment, and devaluation, can unintentionally make the situation of individual people worse (i.e. further disempower, devalue and exclude people). Person-centred planning is designed specifically to 'empower' people, to directly support their social inclusion, and to directly challenge their devaluation. One of the benefits of person-centered planning is that it can address the perennial "service problems" of ethnicity, gender, culture and age by starting with planning by or with the "whole person".

Person-centred planning isn't one clearly defined process, but a range of processes sharing a general philosophical background, and aiming at similar outcomes. As it has become more well known further processes and procedures have also been given the title 'person-centred planning'. Some of these have little in common with person-centred planning as originally envisaged. Person-centered planning through the Rehabilitation Research and Training Center on Community Integration in the US was, in part, an agency and systems change process as opposed to only an "individual planning" process moving to an "individual budgeting process" (e.g., Racino, 1999).

Person-centred planning involves the individual receiving the service, with family members, neighbors, employers, community members, and friends, and professionals (such as physician/ doctors, psychiatrists, nurses, support workers, care managers, therapists, and social workers) developing a plan on community participation and quality of life with the individual. In contrast, traditional models of planning have focussed on the person's deficits and negative behaviours, labelling the person and creating a disempowering mindset from the start.

Person-centred planning offers an alternative to traditional models, striving to place the individual at the centre of decision-making, treating family members as partners. The process focusses on discovering the person's gifts, skills and capacities, and on listening for what is really important to the person (O'Brien & Mount). It is based on the values of human rights, inter-dependence, choice and social inclusion, and can be designed to enable people to direct their own services and supports, in a personalised way.

Methods

Person-centered planning utilises a number of techniques, with the central premise that any methods used must be reflective of the individual's personal communication mechanisms and assist them to outline their needs, wishes and goals. There is no differentiation between the process used and the output and outcomes of the PCP; instead it pursues social inclusion (e.g., community participation, employment and recreation) through inclusive means.

Person centred thinking skills, total communication
Total Communication
Total Communication is an approach to deaf education that aims to make use of a number of modes of communication such as signed, oral, auditory, written and visual aids, depending on the particular needs and abilities of the child.-History:...

 techniques, graphic facilitation
Graphic facilitation
Graphic Facilitation is the use of large scale imagery to lead groups and individuals towards a goal. The method is used in various processes such as meetings, seminars, workshops and conferences...

 of meetings and problem solving
Problem solving
Problem solving is a mental process and is part of the larger problem process that includes problem finding and problem shaping. Consideredthe most complex of all intellectual functions, problem solving has been defined as higher-order cognitive process that requires the modulation and control of...

 skills are some methods commonly used in the development of a person centred plan, as are PATH (Planning Alternative Tomorrows With Hope), circles of support (Canada), MAPS (Canada), personal futures planning (O'Brien & Mount, US), Essential Lifestyle Planning (Maryland, US), person centred reviews, Getting to Know You (Wisconsin, USA), and most recently the use of person centred thinking tools to build from one page profiles into person centred descriptions/collections of person centred Information and on into full scale plans.

The resultant plan may be in any format that is accessible to the individual, such as a document, a drawing or an oral plan recorded onto a tape or compact disc. Multimedia techniques are becoming more popular for this type of planning as development costs decrease and the technology used becomes more readily available. Plans are updated as and when the individual wishes to make changes, or when a goal or aspiration is achieved. If part of a regular planning process in the US, regular plan updates are usually required by regulatory agencies (e.g., state offices in the USA through local agencies).

Person-centred planning can have many effects that go beyond the making of plans. It can create a space during which someone who is not usually listened to has central stage. It can insist that discussion is centred around what the person is telling us is important to them, with their words and behaviours, as well as what others feel is important for the person. It can engage participants personally by allowing them to hear of deeply felt hopes and fears. It can assist people in a circle of support to re-frame their views of the person it is focused on. It can help a group to solve difficult problems. In the US, one researcher hopes it can help to create new lifestyles, new homes and jobs, diverse kinds of support (informal and formal)and new social relationships (Racino, 1999).

Limitations

Many of the limitations discussed below reflect challenges and limitations in the implementation of Person-Centered Planning approaches in the context of formal human service systems.

Another approach to this question is to envision Person-Centered Planning as an approach that is anchored in the person's natural community and personal relationship network. In this view, the Person-Centered Plan (PCP) offers a platform for the person and their trusted allies to identify and express their vision and commitments without limiting that expression to what can or will be provided by the service system.

Some time later, the formal system can develop a plan for service delivery that may be based on and consistent with the person's plan, that recognizes and supports the contributions of the person, family and community, and that clearly acknolwledges the limitations of what the system is prepared to provide.

John O'Brien sums up the problem of trying to deliver person centredness through formal service systems that have a very different culture thus:
Many human service settings are zones of compliance in which relationships are subordinated to and constrained by complex and detailed rules. In those environments, unless staff commit themselves to be people's allies and treat the rules and boundaries and structures as constraints to be creatively engaged as opposed to simply conforming, person centred work will be limited to improving the conditions of people's confinement in services.
He calls for leadership to challenge these boundaries:
Most service organisations have the social function of putting people to sleep, keeping them from seeing the social reality that faces people with disabilities...People go to sleep when the slogan that "we are doing the best that is possible for 'them'" distracts from noticing and taking responsibility for the uncountable losses imposed by service activities that keep people idle, disconnected and alienated from their own purposes in life. One way to understand leadership is to see it as waking up to people's capacities and the organisational and systemic practices that devalue and demean those capacities.]


A key obstacle to people achieving better lives has been the risk averse culture that has been prevalent in human services for a variety of reasons. Advocates of person centred thinking argue that applying person centred thinking tools to the risk decision making process, and finding strategies that are based on who the person is, can enable a more positive approach to risk that doesn't use risk as an excuse to trap people in boring and unproductive lives.

The key advocates of PCP and associated Person Centered Approaches warn of the danger of adopting the model in a bureaucratic way – adopting the 'form' of PCP, without the philosophical content. By changing it to fit existing practices rather than using it in its original form, most or all of its effects are lost. The hope of funding it in the USA was to influence the processes, such as planning through the Medicaid home and community-based waiver services for people moving from institutions to the community (Racino, 1999).

The philosophical content expects services to be responsive to the needs of people that use the service, rather than prescriptive in the types of services offered. These principles are reliant on mechanisms such as individualised funding packages and the organisational capacity to design and deliver "support" services. It is essential that organisations and agencies providing services make a commitment to strive for person-centredness in all of their activities, which can result in major changes in areas of practice such as recruitment, staff training, and business planning and management.

While secondary users may debate the use of person-centered approaches to achieve the myriad goals it attempts to achieve, i.e., increased inclusion (Schwartz, Jacobson and Holburn, (2000). "Defining Person-centeredness", others point to recent research such as "The Impact of Person Centred Planning" (Emerson et al. 2005), which suggests that Person Centred Planning can make a considerable difference to people's quality of life and explores the optimum conditions for Person Centred Approaches. 'Valuing People Now' says


"Person centred planning has been shown to work. The world's largest study into person centred planning described how it helps people get improvements in important parts of their lives and indicated that this was at no additional cost"

However it continues


"too few people have access to proper person centred planning... In too many local authorities, person centred planning is not at the centre of how things are done. The challenge of the next three years is to take all this innovative work and make sure that more – and eventually all – people have real choice and control over their lives and services"

Person-centered planning in the USA has continued to be investigated at the secondary research level and validated for more general use (e.g., Claes, et al., 2010).

Local Authorities in Britain are now being challenged by government to change their model to one that is founded on Person Centred Approaches
"This move is from the model of care, where an individual receives the care determined by a professional, to one that has person centred planning at its heart, with the individual firmly at the centre in identifying what is personally important to deliver his or her outcomes"
The government recognises that this will require a fundamental change in the way services are organised and think:
"Personalisation is about whole system change."


In New York State (USA), the Office of Intellectual and Developmental Disabilities, has mandated the use of person-centered planning in all new service development for people with intellectual disabilities. Person-centered planning is central to the new approaches to consumer-directed supports with are based on stronger self-determination than traditional person-centered approaches.

Outcomes

Person centred thinking and planning is founded on the premise that genuine listening contains an implied promise to take action. Unless what is learned about how the person wishes to live, and where they wish to go in their lives is recorded and acted upon, any planning will have been a waste of time, and more importantly a betrayal of the person and the trust they have placed in those who have planned with them.

In the UK initiatives such as individual budgets and self directed supports using models like In Control mean that Person Centred Planning can now be used to directly influence a person's Support Planning, giving them direct control over who delivers their support, and how it is delivered.

PCP tools can be very powerful methods of focused listening, creative thinking and alliance building that have been shown both by experience and by research to make a significant impact in the lives of people who use human support services, when used imaginatively by people with a commitment to person-centeredness. Used well, with enthusiasm and commitment, these tools can be an excellent way of planning with people who might otherwise find it difficult to plan their lives, or who find that other people and services are planning their lives for them.

See also

  • Developmental Disability
    Developmental disability
    Developmental disability is a term used in the United States and Canada to describe lifelong disabilities attributable to mental or physical impairments, manifested prior to age 18. It is not synonymous with "developmental delay" which is often a consequence of a temporary illness or trauma during...

  • Direct Support Professional
    Direct Support Professional
    Direct support professionals are people who work directly with people with developmental disabilities with the aim of assisting the individual to become integrated into his /her community or the least restrictive environment....

  • Disability rights movement
    Disability rights movement
    The disability rights movement is the movement to secure equal opportunities and equal rights for people with disabilities. The specific goals and demands of the movement are: accessibility and safety in transportation, architecture, and the physical environment, equal opportunities in independent...

  • Family Movement
    Family Movement
    The Family Movement, also known in the past as the Parent Movement, is an arm of the disability rights movement, a larger social movement. The Family Movement advocates for the economic and social rights of family members with a disability. Key elements include: social inclusion; active...

  • Independent living
    Independent living
    Independent living, as seen by its advocates, is a philosophy, a way of looking at disability and society, and a worldwide movement of people with disabilities working for self-determination, self-respect and equal opportunities...

  • Matching Person & Technology Model
    Matching Person & Technology Model
    The Matching Person & Technology Model organizes influences on the successful use of a variety of technologies: Assistive Technology, Educational Technology, and those used in the workplace, school, home; for healthcare, for mobility and performing daily activities...

  • Self Advocacy
  • Social model of disability
    Social model of disability
    The social model of disability is a reaction to the dominant medical model of disability which in itself is a Cartesian functional analysis of the body as machine to be fixed in order to conform with normative values...

  • Social role valorization
    Social role valorization
    In psychology and social work practice, Social Role Valorization is the name given to an analysis of human relationships and human services, formulated in 1983 by Wolf Wolfensberger, PhD, as the successor to his earlier formulation of the principle of Normalization...


Further reading

  • Cambridge, P. and Carnaby, S. 2005. Person Centred Planning and Care Management with People with Learning Disabilities. Jessica Kingsley Publishing, London.
  • Claes,C., Van Hove, G., Vandevelde, S., Van Loon, J., & Schalock, R. (2010, December). Person-centered planning: Analysis of research effectiveness. Intellectual and Developmental Disabilities, 48(6), 432–453.
  • Department of Health 2001 Valuing People DOH London
  • Department of Health 2007 Valuing People Now DOH London
  • Emerson, E. et al. 2005 The Impact of Person Centred Planning Institute of Health Research, Lancaster University, Lancaster
  • Falvey, MA., Forest, M., Pearpoint, J. and Rosenberg, RL. 1997. All My Life’s a Circle. Using the tools: Circles, MAPS & PATHS. Inclusion Press, Toronto.
  • Helen Sanderson Associates "What is Person Centred Planning?" Available from: http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-planning.aspx
  • Neill, M. Allen, J. Woodhead, N. Reid, S. Irwin, L. Sanderson, H. 2008 "A Positive Approach to Risk Requires Person Centred Thinking" London, CSIP Personalisation Network, Department of Health. Available from: http://networks.csip.org.uk/Personalisation/Topics/tags/?tag=Risk [Accessed 8 December 2008]
  • Neill, M. Sanderson, H. Bailey, G. 2008 One Page Profile to Person Centred Plan or Support Plan Stockport, Helen Sanderson Associates. Available from: http://helensandersonassociates.co.uk/PDFs/One%20Page%20Profile%20to%20Person%20Centred%20Plan%20or%20support%20plan%20-%20Nov_08%20FINAL.pdf [Accessed 8 December 2008]
  • O'Brien, J. and Blessing, C. 2011. Conversations on Citizenship and Person Centred Work. Inclusion Press, Toronto.
  • O'Brien, J. and Lyle O'Brien, C. 1988. A Little Book About Person Centred Planning. Inclusion Press, Toronto.
  • O'Brien, J. and Lyle O'Brien, C. 2006. Implementing Person Centred Planning: Voices of Experience. Inclusion Press, Toronto.
  • Perske, R. 1988. Circles Of Friends. Abingdon Press, Nashville.
  • Platt, D. 2007 Seizing The Day On Person Centred Thinking and Planning With Older People Speech to Practicalities and Possibilities Conference, CSCI London.
  • Racino, J. (1999). Statewide approaches to community integration: moving toward technical assistance strategies that make a difference. Journal of Vocational Rehabilitation, 13(1), 31–44.
  • Racino, J., Walker, P., O'Connor, S., & Taylor, S. (1993). Housing, support and community (pp. 50–51). Baltimore, MD: Paul H. Brookes. [S. Taylor, J. Racino, & B. Shoultz (Eds.), Community Participation Series, Volume 2].
  • Sanderson, H., Kennedy, K., Ritchie, P. and Goodwin G. 1997. People, Plans and Possibilities: Exploring person centred planning. SHS, Edinburgh
  • Sanderson, H. and Smull, M. 2005. Essential Lifestyle Planning for Everyone. Helen Sanderson Associates, London.
  • Schwartz, AA., Jacobson, JW., Holburn, SC. 2000. Defining Person Centeredness: Results of Two Consensus Methods. Education and Training in Mental Retardation and Developmental Disabilities. 35.
  • Taylor, S., Racino, J., Knoll, J., & Lutfiyya, Z. (1987). The nonrestrictive environment: On community integration of persons with the most severe disabilities. Syracuse, NY: Human Policy Press.

External links

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