The following steps should prove a useful guide for those planning for or helping others in getting started on creating a context that will facilitate developing and/or responding to person centred plans:
The work of establishing a framework to support person centred planning consists of:
This means developing a greater general willingness and capacity to seek out, be informed by and respond to the overall vision, life plan or simple wishes and preferences of each individual with disabilities availing of their services and their parents, families and friends (this may include, for example:
It also means fostering a culture of feedback - looking carefully and systematically at the differences between what individuals are saying they want and how things are currently done – by providing a means by which person centred plans can inform, support and act as a benchmark of the responsiveness of the service as a whole.
It means developing practical person centred thinking skills in order to be able to bring about change required in practice and culture (for example: the way teams work, staff are supervised and resources are used); developing an openness and willingness to change where necessary; and integrating service users into all aspects of the design, development, test, delivery and ongoing evaluation and continual improvement of services.
(This is the essence of a person centred approach.)
It should be noted that establishing a sustainable person centred culture within organisations normally requires engagement in some degree of organisational review and change. There will be a number of significant challenges for management and staff in moving from a traditional, service-based, ‘caring’ approach to service provision - to an approach that is based on supporting people with disabilities in getting on with their lives, developing relationships and being part of their community. Clearly, then, this process must include extensive consultation. It will, normally, also require the development and delivery of a comprehensive training programme to support the implementation of proposed developments.
The scale of this task should not be underestimated and may take some time. Target dates should be set for keypoints in framework development and progress reviewed at regular intervals.
Initially, it is likely to involve:
For further information, see, for example: Sanderson and Kilbane ‘Person centred planning: a resource guide’, 1999; the National Federation of Voluntary Bodies’ ‘Building Blocks to best practices in people centred services’ – Walls, 2002; the New South Wales ‘client-centred, solution-focused, competencies-based’ model of person-centred service planning and provision; the UK’s ‘best value review of learning services for adults - a framework for applying person centred principles’; e.g. Barbara Mc.Intosh’s ‘Person centred planning: Making it work in the UK’, 2001; The National Disability Authority’s ‘Ask Me Guidelines for effective consultation with people with disabilities’.
O’Brien and O’Brien’s ‘A little book about Person Centred Planning’, Ritchie et al’s ‘People, Plans and Practicalities: achieving change through person centred planning’ and on implementation, Cole et al (2000) and the U.K’s North West Training and Development Team (NWTDT)’s publication ‘Planning with people – developing a framework’ - or most basic training courses would be good starting points.
The appropriate levels of involvement and degrees of engagement of individual elements of the focus person’s network at various stages of plan development and realisation must be carefully worked out. This may present a challenge to existing assumptions, understandings and balances of power.
Every effort should be made to ensure that the role and responsibilities of every individual, group and organisation participating in the person centred planning process is clearly understood and agreed by them and adequately supported.
The question of who will take the lead in driving the person centred planning process at both general framework and individual plan level (and the training and support they will require to do so) is hugely important. It is likely to require considerable reflection, consultation and negotiation across all potential stakeholders. It is not a decision for service providers to make alone, amongst themselves. People with disabilities, their parents/families, friends and advocates must be actively involved.
All service providers will need to be reasonably familiar with the concepts of person centredness and person centred planning - and the likely implications of person centred planning for the services they provide. Service providers should be prepared to offer to take the lead in instigating, driving and supporting the process – but only if this is what their service user and/or his or her family wish. A person with a disability and/or his or her parents/family may wish to lead the process themselves. Where this is the case, service providers should be prepared to offer them support in this.
Whoever is driving the process will need to develop a very clear understanding of the key principles and processes of person centred planning – and at least some methodologies for developing plans and strategies for putting them into action.
The calibre and commitment of each participant in the process will constitute a key factor in determining its final, overall success.
in accordance with the recommendations of earlier sections of this document on plan facilitators.
At individual plan level this entails careful consideration of and agreement on issues of:
At a more general level, it is important to establish a routine process of monitoring, evaluating, reviewing and developing the way person centred planning is being done, so as to ensure it is having a positive effect on lives and services.
The principal challenges in implementing person centred planning are:
There is a very real need for everyone to examine the assumptions and values which underpin our views and the way we act towards and interact with each other. “We [should be] moving away from emphasising my needs toward building upon my capacities … from providing services to me in some facility toward building bridges with me to communities and neighbourhood associations … from programming me and other people with disabilities toward empowering us and our families to acquire the support we want … from focusing on my deficits to focusing on my competence … from specialised disability organisations so that we can develop and sustain relationships with people who will depend upon people like me and upon whom people like me can depend” (Kilroy, 1987). One particular advantage of person centred planning is that when it is done well, it can create or enhance a sense of purpose and empowerment for a person with a disability and generate obvious practical evidence to challenge persistent limiting and erroneous views and expectations. See Duffy, 2004 and Howell et al (2004).
Person centred planning is about helping people to live the way they want, rather than just fitting them into or making them work with what is available (after Mansell and Beadle-Brown, 2004 and the East Sussex County Council, April, 2004). It is about people’s engaging fully in the mainstream of life as and how they themselves wish. It, therefore, includes but should not be limited to availing of whatever services are available to an individual. “The more we see the job of services as helping people to lead their own lives, the more person centred planning is likely to keep its shape as a process in the person’s world; and the more person centred planning will contribute to people’s freedom and connectedness” (Ritchie et al, 2003). Clarity of all participants in the planning process on this is critical – as are the proper mindset, attitude and organisational culture of service providers.
Those who want to, can find many ways to avoid engaging the tension between current standardised reality and a desirable individualised personal future. They can compare the best (or even worst) present to worse past conditions instead of comparing it to desirable future capacities. They can dismiss the image of a desirable future as unrealistic. They can say that they would like to help but that powerful political, socio-economic or other outside forces forbid them. They can stay busy with activities that allow no time to listen and learn from focus people. (after Thaler, Kinsella, 2000 and J & CL O’Brien).
Although it can be shown that the founding ethos of many services for people with disabilities in Ireland is firmly based on many of the key principles of person-centred planning, it can also be shown that, over time, most of these services gradually moved away from an individualised approach to service provision to one grounded on more general principles of service provision based on commonalities across individuals and their disabilities - and for the common good. New forms of Individual Program Planning (IPP) evolved, requiring that staff behave in a somewhat customisable but, effectively, largely synchronised and standardised way towards all service users. Now, person centred planning requires that staff adopt a flexible and responsive approach to meeting people’s changing needs and circumstances, guided by general principles of good practice rather than standard procedures (Sanderson, 2000). Acceptance of the need for a more progressive, individualised approach to working with service users is vital – as is adopting a partnership approach to developing the practical strategies, policies, procedures and working arrangements needed to make this possible. An extensive consultation process may be required within services on person centred planning.
Person-centred planning offers a forum in which the required work of adapting to and assisting people with disabilities may be specified – and possible implementation paths proposed. (This includes assigning responsibility for leading and driving the overall process and ensuring that various strategies agreed on are implemented). Where a collaborative approach to planning is adopted, both requirements specifications and implementation proposals can be more readily and thoroughly explored and, therefore, more readily agreed and acted upon.
It is important to acknowledge that the practice of person centred planning is characteristically tempered by the fallibility of human judgement, the potential impingement of factors outside the control of the process on its success and the possibility that there will be setbacks along the way, the fact that it will be necessary to allow some time for learning and adjustment and that it is unlikely that everyone will get everything right first time.