Person Centred Planning

Person Centered Planning(PCP) is a process designed to assist someone to make plans for their future. 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 in the United Kingdom through the 'Valuing People' White Paper in 2001, and is accepted as good practice in many countries throughout the world. It is most often used for life planning with people with learning and developmental disabilities, though recently it has been advocated as a method of planning personalised support with other sections of society who find themselves disempowered by traditional methods of service delivery, including 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 is important to someone now and in the future, and acting on this in alliance with their family and their friends" [ Thompson J. Kilbane J. Sanderson H. (2008) Person Centred Practice for Professionals. Open University Press]

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-centred planning has similarities to other processes and ideas, but was first named and described more definitely by a group of people in the USA and Canada including John O'Brien, Beth Mount, Connie Lyle O'Brien, Jack Pearpoint, Marsha Forest and Michael Smull. 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.

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.

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-centred planning recognises that traditional models of planning for service provision have operated "around" the individual receiving the service, with professionals (such as doctors, psychiatrists, nurses, support workers, care managers, OTs and social workers) making decisions regarding the types of support received. Traditional models have also focussed on the person's deficits and negative behaviours, labelling the person and creating a disempowering mindset from the start.

PCP offers an alternative to such 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. It is based on the values of human rights, independence, choice and social inclusion, and is designed to enable people to direct their own services and supports, rather than attempting to fit within pre-existing service systems.

Methods

PCP 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 through inclusive means.

Person Centred Thinking Skills, Total Communication techniques, Graphic Facilitation of Meetings and Problem Solving skills are some methods commonly used in the development of a person centred plan, as are PATH (Planning Alternative Tomorrows With Hope) Circles, MAPS, Personal Futures Planning, Essential Lifestyle Planning, Person Centred Reviews and most recently the use of [http://www.csrpcp.net/default.aspx?page=16600 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.

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.

Limitations

Readers may note that 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.

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 does use risk as an excuse to trap people in boring and unproductive lives. [ [http://networks.csip.org.uk/Personalisation/AdviceonPersonalisation/Risk/?parent=3151&child=3681 A person centred approach to risk - Risk - Advice on Personalisation - Personalisation - Homepage - CSIP Networks ] ]

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 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 bespoke 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 some argue that there is no empirical evidence that PCP works in achieving 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. [http://www.lancs.ac.uk/fass/ihr/publications/ericemerson/the_impact_of_person_centred_planning_final_report.pdf] The difference between pieces of research can sometimes be caused by whether they are assessing the effects of genuine person-centred planning, or the effects of changes made in organisations. 'Valuing People Now' [Valuing People Now, Department of Health, December 2007 ] 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"

Local Authorities in Britain are now being challenged by government to change their model to one that is founded on Person Centred Approaches [ [http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/LocalAuthorityCirculars/DH_081934 LAC (DH)(2008)1: Transforming social care : Department of Health - Publications ] ]

"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 Mental Retardation and Developmental Disabilities (OMRMDD), has mandated the use of person-centered planning in all new service development for people with mental disabilities. This means that programs have been developed using the person-centered philosophy. New York has hired some of the top person-centered advocates in the United States, such as Beth Mount, as consultants.

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 [http://www.in-control.org.uk/ 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. [Sanderson H. Duffy S. (2008) Support Planning in J. Thompson, J. Kilbane, H. Sanderson (eds) Person Centred Practice for Professionals, Open University Press pp 256 - 279]

PCP tools can be very powerful methods of focussed 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-centredness. 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.

ee also

*Developmental Disability
*Direct Support Professional
*Independent living
*Disability rights movement
*Social model of disability
*Social role valorization
*Citizenship Model

References

Further reading

*Cambridge, P. and Carnaby, S. 2005. "Person Centred Planning and Care Management with People with Learning Disabilities". Jessica Kingsley Publishing, London.
*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.
*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/AdviceonPersonalisation/Risk/?parent=3151&child=3681 [Accessed 21st July 2008]
*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.
*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.

External links

* [http://thechp.syr.edu/rsapub.htm Writings of John and Connie Lyle O'Brien]
* [http://www.learningcommunity.us/ The Learning Community for Person Centered Practices (Person Centered Thinking and Essential Lifestyle Planning and more...)]
* [http://www.inclusion.com/artcommonsensetools.html Common Sense Tools on the Inclusion Network]
* [http://RenownHealth.info Home Care Services in Nevada] Reviews an ongoing discussion and struggle with Nevada Medicaid officials and leading health care providers to secure self-directed care for Nevada's disabled and elderly people.
* [http://www.helensandersonassociates.co.uk/PDFs/TheImpactofPersonCentredPlanning-FinalReport.pdf The Impact of Person Centered Planning (pdf)]
* [http://www.circlesnetwork.org.uk/what_is_person_centred_planning.htm The Circles Network - What is Person Centred Planning?]
* [http://www.isja.org.uk/links_pcplanning.html Key articles on person centred planning on the www.isja.org.uk directory]
* [http://valuingpeople.gov.uk/dynamic/valuingpeople8.jsp Key Papers on 'Valuing People (2001)']
* [http://www.bild.org.uk/factsheets/person_centred_planning.htm British Institute of Learning Disabilities Factsheet on Person Centred Planning]
* [http://www.skillnetgroup.co.uk/publications/person_centred/index.php Skillnet Group] - Guide on how to do a person centred plan
* [http://www.csci.gov.uk/default.aspx?page=2098&key= Seizing The Day (2007)] - Speech by Dame Denise Platt on Person Centred Thinking and Planning with Older People
* [http://www.csrpcp.net/ Person Centred Planning Pages]
* [http://www.lancs.ac.uk/fass/ihr/publications/ericemerson/the_impact_of_person_centred_planning_final_report.pdf The Impact of Person Centred Planning (2005)] - Institute of Health Research report measuring the Impact of Person Centred Planning
* [http://www.communityworks.info/articles/cb_path.htm Community-Building and Commitment-Building with Path] , from Implementing Person-Centered Planning: Voices of Experience