A person centred plan may include a description of the individual, past and present. It should normally, however, include a description of a vision of a more positive future for the individual (short, medium and/or long term) together with a goal-based action plan for the attainment of this more positive future.
Typical components of a good person centred plan are (after, for example, Smull, 1996, Howell et al, 2004, Helen Sanderson Associates, 2005 and Irish practitioners) a description of:
Howell et al (2004) also point out that each person centred plan should be:
A person centred plan should be drawn up in such a way that it can genuinely:
Person centred plans may take many forms. They may be paper-based (e.g. a workbook, scrapbook or storyboard), may take the form of a video or other form of artwork or may be worked out through roleplay, etc. – as the focus person wishes. For ideas on flexible usage of more structured options, see, for example: Jonikas and Cook, 2004.
It is important to appreciate that plans may need to be reviewed and adjusted from time to time, so as to reflect changes in people and circumstances over time (see, for example: Fleming, 2001).
The actual process of drawing up a person centred plan consists of a number of key activities, namely:
1. Familiarisation: with everyone and everything that is important to the individual at the centre of the planning action and that needs to be addressed as part of their person centred planning process.
A formal planning meeting may be arranged - in which case, the individual or family at the centre of the planning process decide(s) whom to invite to the meeting. Inviting people who may have an important role in or something to say about important aspects of a person’s or family’s life can be useful as they may have useful insights or suggestions to offer on particular issues. The agenda for the meeting may be set by the focus person or his or her family or by the plan facilitator. Alternatively, it may be allowed to evolve naturally from the group.
It is important to note that some people may not want a formal meeting, however.
Where an individual does want a formal planning meeting, formal person centred planning methodologies referred to earlier (MAPs (Making Action Plans), PATH (Planning Alternative Tomorrows with Hope), ELP (Essential Lifestyle Planning), etc.) can be helpful in providing orientation, structure, direction and movement to the meeting and ensuring that a good range of potentially significant issues for the individual and ways of addressing them are explored. When using formal methodologies and procedures, care must be taken to ensure the appropriateness and/or adaptation of the method or procedure to the individual and the setting. A general guide to the appropriateness of a number of sample methodologies to varying situations and circumstances is provided in the Appendix to this document.
Some generally useful strategies for effective familiarisation to help ensure the development of a good person centred plan, include (after Doyle and Straws, 1976):
2. Decision-making and action-planning: on where priorities lie, which options to pursue, who is going to take action on the important issues - what actions and when.
A useful strategy for decision making and action-planning to help ensure the development of a good person centred plan, is (after Doyle and Straws, 1976) to work, in a general way, from the beginning, towards reaching some definite conclusions by the end of the planning action.
This may mean having to take quite some time to get a clear understanding of particular items an individual may identify in his or her plan. For example: expressing the wish to ‘get married some day’ may actually mean wanting to get married; it might also mean wanting to be treated more like an adult or wanting to lead a more independent life or wanting to live in a regular house as opposed to a larger residence.
It may also mean having to take quite some time (and a creative approach) to find a way forward on areas which pose significant challenges and/or key areas of concern for those participating in the planning process - so as to be able to come to an agreement on all matters on which opinions differ.
One example of an area which could pose significant challenges is resources. (‘We think it good practice to make clear what resources are on the table as people begin to plan’ (O’Brien and O’Brien, 2000). It is worth noting that Irish practitioners find it helpful to review, clarify and confirm resources available at all stages of the planning process. It has also been the experience amongst Irish service providers that it is good practice to maintain a bank of knowledge of general and community resources to help inform the planning process.)
Key areas of concern for those participating in the planning process may warrant some exploration. Service providers’ concerns may, for example, be found to be basically insurance-related – in which case, taking out independent insurance may serve to allay the fears of a service provider. Parents’ concerns may stem from a protective attitude or from not realising the extent of the capability displayed by their child outside of their home environment - in which case, showing a parent a video of their child displaying a degree of capability unknown to the parent may suffice to allay any fears they may have.
It can happen that somebody can see a planning meeting as an opportunity to discuss issues not related to the planning work at hand. Particularly where the individual at the centre of the planning effort does not want to discuss these matters, it is important that they are not allowed to distract from the main issues or cause distress to the focus individual or others in attendance. The fact that these matters have been raised and are important to the individual who has raised them should be acknowledged and noted – and another time set to discuss them (after Quality through individual planning – St. Michael’s House, 2001).
3. Developing a strategy around progressive realisation and review: agreeing a date and time to look at progress and problems, how difficulties might be addressed and what else may be tried - and whether the person at the centre of the planning process has changed his or her mind on anything since the last discussion of their plan.
It is extremely important that arrangements are made at the time of developing the plan, for following-up on it to find out whether, how quickly, how easily and how well it is becoming a reality and whether it is bringing about real change for the better in the life of the individual - or whether it needs to be revised. Decisions should be made on dates, times and ways of tracking progress before drawing planning activities to a close.
4. Recording the plan and ongoing learning about both the person at the centre of the planning process and the process itself: It is important that some form of record be made of all the important issues that emerge at each stage of the planning process. This should be done in a way that makes sense first-and-foremost to the individual at the centre of the planning endeavour – but also to all those who will be impacted by it (including service providers who wish to use particular parts of the plan to help design more person-centred services and/or deliver them in a more person centred way).
Three key considerations in drawing up a person centred plan are: ethics, resources and potential pitfalls.
Throughout the plan development process, due consideration should be given to the following ethical issues.
Resources/supports for person centred plan realisation fall into two main categories: social and service. Social resources include family members, allies or friends committed to their understanding of the focus person’s well-being and networks of other contacts (community, occupational, etc.). Service resources include available public funding, person centred planning facilitators, consultants, a broad range of specialist and general services and service elements and delivery systems (some more accessible than others).
Information from person centred planning practitioners in the UK suggests that ‘initially, the costs of person centred planning can be higher than conventional planning’ (Mc.Intosh, 2001). Information from Irish practitioners, however, suggests that good person centred plans do not always require extra resources – though they do require the good management and effective use of existing resources. Cole et al (2000) suggest re-organising resources to achieve more flexible support, focusing resources on individuals, creating more ordinary community opportunities and natural supports for people and ensuring that organisations work together, collaboratively and creatively.
For planning which results in a requirement for additional resources, Cole et al (2000) suggest a number of strategies for increasing the amount of support available for implementing plans. These have been echoed by Irish practitioners. They include, for example: the recognition of less obvious social resources and the creative allocation of service resources across individuals’ social networks e.g. training and supporting service providers to recognise, build up and mobilise people’s community networks and identify and foster individuals’ natural supports.
Three serious potential pitfalls to avoid in person centred planning are:
Having completed the essential groundwork of developing a good plan and clearly defining strategies and responsibilities for putting the plan into action, the final key to making a person centred plan a reality is:
It should be understood that simply asking people or services to act or change in particular ways – by particular dates, will not be enough. Usually some negotiation of action or changes is needed - and this may take some time, sustained effort and creative thinking. PCP champions or guiding coalitions will need to be prepared to argue the case for action or change in very practical terms e.g. ‘SWOT’ (the strengths, weakness, opportunities and threats of things as are - or if left as are - versus what is proposed) and a costs/benefits analysis of actions or changes required.
Regular review meetings on plan progression can provide the encouragement required to sustain effort, the opportunity to figure out what is and is not working well (and why) and a forum in which to discuss some alternatives to plan implementation strategies which have not been found to be working as effectively as hoped.