Guidelines On Person Centred Planning In The Provision Of Services For .

Guidelines on Person Centred Planning in the Provision of Services for People with Disabilities in IrelandScope and application of this document.Person centred planning is a way of helping people or the parents/families of very youngpeople or people with high dependencies, think about what is important to them, howthey want to live and what support they want.A person centred plan can be helpful in guiding the design and delivery of highlyindividualised, dynamic support arrangements which are unique to each individual’sneeds and preferences.This document, on person centred planning in the provision of services to people withdisabilities, should prove useful to service providers in setting out the values andprinciples which underlie person centred planning and the essential elements of itsoverall approach, required context and associated methodologies.It is mainly intended to provide information and support to services supporting thedevelopment and/or realisation of person centred plans, though it is also intended toprovide information for people with disabilities and their parents, families, friends, spousesand advocates which will help them understand what is meant by person centred planning.Some introductory notes on terms used in this document.Person centredness is defined in the draft National Standards for Disability Services as‘seeking to put the person first’ (NDA and Department of Health and Children, 2004).Person centredness is generally seen as essential to the provision of good qualityservices for people with disabilities in Ireland (see, for example: Frequently AskedQuestions (FAQs), draft National Standards for Disability Services, April 2003).The draft National Standards for Disability Services define a person centred service asone which is “provided, organised and designed around what is important to the serviceuser from his or her perspective.” (the draft National Standards for Disability Services,September, 2004). They require that all planning for the provision of services topeople with disabilities should be person centred.At the heart of a person centred approach to planning lies an appreciation of the personas a unique individual, requiring that all planning is based on supporting each individuallead his or her life as and how he or she wishes. In practical terms, this means that allplanning around the design, development and delivery of all services for people withdisabilities should be both based on and actively involve the individuals availing of theseservices and each of those individuals’ unique characteristics, capabilities, needs andwishes (that is: conducted in a person centred way).11

National Disability AuthorityPerson centred plans should be viewed by service providers as a useful means of drivingperson centredness and person centred service provision, that is: as a means for bringingthis about. Nevertheless, it is important that service providers recognise and bear in mindthe fact that a person centred plan is not a plan for person centred service provision (a‘service plan’ as such) but is, rather, a personal, overall life plan for an individual.Ideally, the process of person centred planning should begin before an individual makescontact with any particular support service. Services constitute just one aspect of aperson’s life. The matter of services should, accordingly, be addressed only when aperson has developed a clear overall perspective on the life they want in general.The scope of person centred planning will, normally, extend far beyond services.Most will, however, set out a number of requirements for services or feature some moregeneral wishes which may have implications for them.2 So what is ‘person centred planning’?Definition and brief history.‘Person centred planning’ may be defined as a way of discovering: how a person wants to live their life and what is required to make that possible.The overall aim of person centred planning is “good planning leading to positive changesin people’s lives and services” (Ritchie et al, 2003).Person centred planning is not so much a new technique for planning as a new approachto - or new type of - planning that is underpinned by a very exacting set of values andbeliefs that is very different to the current norm. It is planning that takes as its primaryfocus a person - as opposed to a disability or a service or some other particular issue. Itis ‘whole person’ oriented as opposed to disability-management focused. It is aboutcitizenship, inclusion in family, community and the mainstream of life and selfdetermination and can, therefore, require some very fundamental changes in thinking andthe established balances of power, the implications of which are potentially enormousand far reaching.12

Guidelines on Person Centred Planning in the Provision of Services for People with Disabilities in IrelandIt is important to understand that person centred planning is not: assessment – whether of services or service user needs (see the UK Department ofHealth’s ‘Valuing People: a new strategy for learning disability for the 21st century’).As Ritchie et al (2003) observe, person centred planning takes as its starting point theindividual as opposed to the service and how the individual might be made to fit intothe service system. It also goes beyond services, indicating more general action byand for the individual. service planning or Individual Program Planning for service users. TraditionalIndividual Program Planning (IPP) is characterised by a synchronised andstandardised approach to addressing identified needs. Person centred planningrequires a flexible and responsive approach to meeting an individual person’s needsand changing circumstances, guided by the principles of good practice rather than astandard procedure (Sanderson, 2000).Person centred planning, service planning or individual program planning andassessment may, legitimately, exist alongside each other and have implications for eachother, however. For example: the requirement for developing a person centred plan or for updating an existingperson centred plan may be identified as part of needs assessment; a person centred plan may identify the need to develop or adjust an individualeducational or care plan to better suit an individual’s requirements, wishes andpreferences around support and/or his or her overall vision for his or her life.Originating with Wolfsenberger, person centred planning has its roots in the normalisationand independent living movements. It is grounded in a social model of disability and astrengths based approach. Person centred planning was developed because people withdisabilities often find it difficult to get the kinds of basic services, opportunities andexperiences most people take for granted – and even when they do, they frequently findthey are required to somehow fit into someone else’s idea of what that service, opportunityor experience should be like and how they should act, think or feel in relation to it (seeHowell et al, 2004 and Routledge and Gitsham, 2004; see also John O’Brien, 2004).Person centred planning seeks to: craft a vision for a person’s life as part of their local communityand/or the broader mainstream of life and describe the actions needed to move it in that direction.13

National Disability AuthorityIt accomplishes this through:1. discovering and responding effectively to the various aspirations, capacities andconcerns of individuals with disabilities;2. understanding and addressing the core issues for individuals – exploring where theperson is now, how they would like their life to change and what bringing about thatchange might entail;3. identifying and exploring choices available to the individual;4. mobilising and involving individuals’ entire social network as well as resources fromthe system of statutory services in responding to what is expressed and helping tobring about whatever changes are desired;5. making arrangements to follow up on plans on a regular basis in order to go throughthem, review progress on putting them into action and update them;6. discovering a way to record, on an on-going basis: what has been learned about what is important to an individual and what isimportant for them; what balance has been worked out between what is important to the person andwhat is important for them where there is a conflict between the the two; what others are expected to know about what is important to and for the personand/or what others are expected to do to help the person get what is important toand for them; what needs to stay the same and what needs to change - and who will do what(by when) in acting on these; what is, in fact, staying the same and what is changing following the developmentof a person centred plan - and whether this is making a real difference to theperson’s life in either case.The earliest proceduralised forms of person centred planning are associated with KarenGreen-Mc.Gowan and Mary Kovaks who ran day-long planning sessions for people withdisabilities. By 1980, Beth Mount was running training courses in ‘personal futuresplanning’ (sometimes referred to as PFP) and by the end of the eighties severalalternative formal methodologies (sometimes referred to as ‘planning styles’) had evolved.These included, for example: ‘getting to know you’, ‘individual design sessions’, and ‘24hour planning’. The history and path of evolution of these methodologies is charted inO’Brien and O’Brien (2000) and Shaddock (2000).14

Guidelines on Person Centred Planning in the Provision of Services for People with Disabilities in IrelandPerson centred plans may be developed either within services or entirely independentlyof them. In either case, it is the person or family who is to be the focus of the personcentred plan that should decide whether to develop one in the first place – and how and whether to pursue it once it is developed.A person can, of course, develop his or her own plan and take the lead in getting itimplemented. Sometimes, parents, family, spouses, friends, advocates or others will do soon their behalf (for example: where it is not possible for a plan to be guided entirely by anindividual due to extreme difficulties with insight, awareness and cognition). Plans mayalso be developed by one or more individuals acting independently on behalf of anindividual and/or his or her family – and/or by service staff specially trained for this (forexample: a legal guardian or a specially trained keyworker and expert on brain injury). InIreland, in practice, at present, person centred plans tend to be developed withinservices, though some parents and families have begun to develop plans independently.In practice, the development and implementation of plans usually requires the cooperation of quite a range of individuals, services and the broader community network, ifthey are to be really effective.The person at the centre of the planning endeavour is commonly referred to as the‘focus person’.Where this person is being supported in the process of drawing up a plan and putting itinto action, the individual supporting and guiding the planning effort is called a ‘planfacilitator’. The primary role of the plan facilitator is to ‘help someone work out what theywant and then help them work out how to attain/achieve it’ (after Ritchie et al, 2003).Facilitators may also work as agents of plan realisation, liasing with relevant support orother service providers.Whether specialist service staff, parents, family members, spouses, friends, advocates orsomeone acting independently on behalf of an individual and/or his or her family, it isextremely important that a plan facilitator is suited to the task in terms of their values,talents, capacities and skill-base. They should, normally, be formally trained andexperienced in person centred planning philosophy, methodology, tools and techniques.They should also be familiar with any significant aspects of the focus person’sbackground that are likely to impact on the person centred planning process.It is particularly important that diversity and individuality across focus persons should beacknowledged and accommodated, in compliance with equality legislation. In effect, thiswould mean that in the case of cultural and linguistic minorities, for example, a planfacilitator ought to possess or seek to acquire adequate knowledge/experience of thecultural identity and communication styles of the individual or family that is to be at the15

National Disability Authoritycentre of the planning process - and that they make specific provisions to facilitate these.(The Intercultural Press has produced a number of cultural guides which may be found tobe useful starting points in this regard, Anna Mindness’ books on Irish deaf culture,identity and communication styles and Irish Sign Language (Mindness, 1999 and 2003)being just one example. See also the Equality Authority’s website: http://www.equality.ie .)It is essential that a plan facilitator operate entirely independently of any potentiallyvested interest in the process. Where a plan is being facilitated within a service, theautonomy of the plan facilitator in his or her role as plan facilitator must be adequatelyassured. It is also imperative that a plan facilitator should adopt, encourage and projectan equal partnership approach to working with the person or family at the centre of theplanning process.Where (for whatever reason) an individual is not happy to work with a particular facilitator,another should be found.The term ‘circle or network of support’ for plan development and realisation is used torefer to everyone a person might like (or need) to involve in developing and/or working outtheir plan:- family, spouses, friends, advocates, specialist and non-specialist serviceproviders and local community groups, etc. The initial and continuing involvement of anyparticular individual, group or organisation in any part of the planning process should bein accordance with the wishes of the person at the centre of the planning endeavour and that particular individual, group or organisation.The person responsible for driving the overall process is sometimes referred to as the‘pcp champion’. Where a group of people decide to work together to drive the process,this group is sometimes referred to as a ‘guiding coalition’.Clearly, some individuals may fulfil more than one role. For example: somebody whodraws up their own person centred plan and champions the overall person centredprocess themselves, would be both focus person and pcp champion. Similarly, somebodywho supports the development of a person centred plan and also works as an agent ofits realisation would be both plan facilitator and pcp champion.Every effort should be made to ensure that everyone involved is given whatever supportthey need to play their particular part(s).This includes developing an adequate system of communication that is fully accessible toall parties likely to be involved in the person centred planning process. It may also meanengaging in some preliminary groundwork on empowerment, relationship-building andadvocacy.16

Guidelines on Person Centred Planning in the Provision of Services for People with Disabilities in IrelandThe role of the individual’s parents, siblings, family and close friends in person centredplanning is generally acknowledged as hugely significant for the planning process (see,for example: Shelton et al, 1987 and Turnbull et al, 2000). The main concern of personcentred planning is, of course, the focus person - and that person’s wishes must beupheld. Even so, planning must also take due consideration of the views of these keyindividuals in the person’s life, particularly in developing person centred plans for youngpeople or people with high dependencies. Where an individual does not want a familymember to be directly involved in his or her person centred planning process, this issuecan be explored but should not be forced. It must be acknowledged that parents andfamily members can be a valuable source of information in developing plans and a greathelp in getting plans put into action. Regardless of whether they have been directlyinvolved in the planning process, parents and family are frequently impacted by plans(sometimes directly, sometimes indirectly). The matter of consulting parents and familymembers on those parts of a plan that are likely to impact on them should be addressedas part of the planning process and the views of parents and family members on thoseissues should be sought, acknowledged and explored.Where the individual and his or her parents and family or service providers or serviceproviders and parents and family hold very different views on a particular issue, everyeffort must be made to fully understand the reasons for these differences of opinion andto explore how they might be satisfactorily addressed. Should conflicting views proveirreconcilable, the views of the focus person should be taken as paramount.3 Key principles.The six key principles underpinning person centred planning are:1. Person centred planning is planning from an individual’s perspective on his orher life: The individual around whom planning is conducted and his or her wishes aretaken as the single most important point of reference for the entire planning venture (afterMansell & Beadle-Brown, 2004).2. Person centred planning entails a creative approach to planning which asks‘what might this mean?’ and ‘what is possible?’ rather than assuming commonunderstandings and limiting itself to what is available: Person centred planning aimsto ‘unpack’ and understand what people desire and connect what is discovered withpractical ways of making things happen for them (despite apparent difficulties) - exploring17

National Disability Authoritywhat is possible for them rather than simply what is available to them (Frizzell, 2000).3. Person centred planning takes into consideration all the resources available tothe person – it does not limit itself to what is available within specialist services: Aperson centred approach to planning seeks to identify the full range of resources availableto the individual. It actively explores the individual’s own resources and what is or might bemade available in the broader community, including all non-specialised services (the draftNational Standards for Disability Services – FAQs, April, 2003; the draft NationalStandards for Disability Services, September, 2004). It is very much focused on cultivatinga shared commitment to action which has a bias towards inclusion, supporting theindividual “in moving from dependence to independence and ultimately to in

f and 10 (1)). We believe that person centred planning can help to achieve this objective. Person centred planning is a way of discovering how a person wants to live their life and what is required to make that possible. Person centred planning has its roots in the normalization and independent living movements. It is grounded in a social model of