Quick Guide to Person-Centered Planning

Person-centered planning (PCP) aims to develop a comprehensive plan that specifically addresses the distinct preferences, choices, and requirements of the individual. Unlike the traditional individual support plan (ISP), which follows a standardized approach, PCP employs a person-centered approach.

The planning process extends beyond mere customization of supports and identification of necessities. It revolves around identifying what holds genuine significance for the individual and ensuring that these aspects are prominently featured in the plan. It is crucial to be deliberate and purposeful throughout each phase of the person-centered planning process.

Principles of person-centered services

There are five fundamental person-centered principles that are essential to the planning process:

• Choice: Everyone has the right to make decisions, ranging from daily choices to major life decisions. This includes decisions about daily routines, types of support and treatments received, vocational pursuits, and residential preferences.
• Competence: Every person possesses unique abilities and skills that enable them to engage in meaningful activities and contribute to their communities.
• Community presence: An individual’s community encompasses their living environment, workplace, and recreational spaces. It is crucial for each person to be actively connected to their community.
• Community participation: Each person benefits from being part of personal relationships and social networks, which foster a sense of belonging and acceptance within the community.
• Respect: Every individual holds a valued role within their community and deserves to be treated with dignity and respect in all interactions.

These person-centered principles serve as foundational guidelines for creating plans that genuinely reflect the preferences, capabilities, and social connections of each individual.

Key considerations for person-centered planning

Before initiating person-centered planning services for your clients, there are some processes your organization needs to have in place. Let’s review how to build an environment in which person-centered planning can work.

Community activities

Community plays a pivotal role in person-centered planning, especially as individuals with intellectual and developmental disabilities (IDD) often face isolation from their communities. Throughout the planning process, it’s crucial to assess how the individual currently interacts with their community and their desired level of engagement. Promoting community inclusion for those receiving support is central to this process.

Similar to other facets of person-centered planning, it’s essential to delve into each person’s unique circumstances. The concept of inclusion and the strategies to achieve it vary widely. Some individuals may require assistance in establishing new connections and avenues for social interaction, while others may need support in nurturing existing relationships.

Your PCP should facilitate the individual’s active participation in community life in ways that are personally significant. Ideally, it should enable access to community services and opportunities equivalent to those available to individuals without disabilities. This approach aims to empower individuals to engage fully in their communities and lead fulfilling lives.

Cultural competence

Traditional treatment planning often overlooks an individual’s cultural beliefs and values, yet these elements are crucial for creating a person-centered plan. Cultural values significantly influence how individuals and their families perceive disability, community dynamics, and support services.

It’s essential to honor, respect, and celebrate each person’s unique cultural perspective. Awareness of one’s own cultural biases and perspectives is important; avoid imposing personal values onto the individual you support. Consider pursuing additional training in cultural competence, particularly regarding specific cultural practices, values, or other needs relevant to the person you are assisting in their person-centered planning journey. This approach ensures that the plan respects and integrates the cultural identity of the individual, fostering a more inclusive and effective support framework.

Creating a care team and building rapport

Person-centered planning relies on collaborative teamwork. A cohesive team is essential to ensure that planning meetings are productive and that all available supports are effectively utilized. The team should work well together while maintaining a clear focus on the individual.

Central to the team is the person receiving services, who holds the most significant role. Other team members typically include a mix of the individual’s family, friends, and paid professionals. It is crucial to invite individuals who:

• Have a positive and established relationship with the person.
• Are trusted by the person to assist in life decisions.
• Are dedicated to supporting the person’s needs.

Most teams also include professionals or legally responsible parties, such as case managers or guardians. However, whenever feasible, the individual receiving services should have the autonomy to decide who participates in their meetings. This approach ensures that the person-centered plan reflects their preferences and priorities, fostering a supportive environment tailored to their unique circumstances.

Person-centered planning process

Once you’re ready to implement a person-centered planning process for your clients, follow these steps.

Creating a plan structure

The structure of a person-centered plan can vary across states and service settings, so it’s crucial to understand the specific requirements applicable to your situation. However, most person-centered planning includes several key components.

Personal profile

The personal profile provides a detailed description of the individual, highlighting:

• Unique traits and characteristics
• Qualities appreciated by others
• Strengths, talents, and skills
• Factors that contribute to good and bad days
• Likes, dislikes, and preferences
• Significant relationships

This section aims to give readers a comprehensive understanding of the individual, emphasizing what matters most to them and positive aspects of their life.

Vision statement

Also known as “Hopes and Dreams” or “Future Statement,” this section articulates the individual’s aspirations in their own words. It encompasses:

• Desired living and working environments
• Leisure activities and hobbies
• Social and familial relationships
• Educational or vocational ambitions
• Long-term and short-term life goals

Action plan

The action plan outlines specific objectives and goals, categorized into those important for the person and those important to the person. Each goal specifies:

• Resources required to successfully achieve the goal, such as personal strengths and community connections.
• Environmental factors that support goal attainment, like proximity to transportation.

The plan also identifies potential challenges and strategies for overcoming them, empowering the individual to acquire new skills and enhance their independence. It includes details on:

• Implementation
• Responsible parties
• Timelines for completion

Services and supports

This section details the specific services and supports the individual requires, including:

• Daily support services
• Transportation arrangements
• Supervisory needs
• Behavioral support strategies
• Therapeutic interventions
• Adaptive equipment requirements

Additionally, it addresses identified risk factors and contingency plans to mitigate them effectively.

Signatures

All participants involved in developing the plan should sign to indicate their engagement and commitment to supporting the individual. For formal service agreements, separate approval signatures signify endorsement from legally responsible parties for plan implementation.

Plans that govern formal services typically have a separate section for approval signatures. These signatures indicate that the parties who are legally responsible for making decisions and implementing the plan have approved of it.

Ensuring accountability to the plan

Have you ever attended a person-centered planning meeting where little has changed for the person since the last plan was created? Too often, PCPs are drafted with good intentions but then forgotten.

This lack of progress can be deeply disheartening for the individual you support. It sends a message that their aspirations are not valued, potentially leading them to lose hope for positive change in their lives.

When crafting a PCP, it’s essential to ensure it is actionable and that all involved parties are held accountable for their responsibilities. Here are key strategies to achieve accountability within the plan itself:

Personal accountability

Identify key team members who are crucial for supporting the individual and implementing their plan. This may include those responsible for:

• Providing daily services
• Aiding in specific steps towards goals
• Monitoring the progress of the plan
• Updating the PCP as necessary

Clearly define each team member’s role in the individual’s support network. For relationships that are unlikely to change, consider specifying individuals by name. This should encompass both paid professionals and unpaid supporters. Describe how the team will monitor adherence to the plan and promptly make adjustments as needed.

SMART goals

Avoid setting vague or open-ended objectives. While initial goal setting may start broadly, this approach lacks accountability. Instead, adopt the SMART criteria for goal setting:

• Specific: Clearly define the objective.
• Measurable: Establish criteria to track progress.
• Achievable: Ensure goals are realistic and feasible.
• Relevant: Align goals with the individual’s aspirations and needs.
• Time-bound: Set a clear timeline for achieving each goal.

Incorporating these fundamental components alongside personal accountability can significantly enhance the individual’s outcomes and ensure the PCP remains a dynamic tool for meaningful progress. This approach fosters a supportive environment where the person’s goals are actively pursued and achieved, reinforcing their confidence and hope for a fulfilling future.

Follow-up with clients

A truly person-centered approach adapts as the person’s needs change. As a result, the PCP must be a living document that changes over time. Although it may change, the plan itself serves as a critical tool for accountability, consistency, and communication.

After the plan is written, be sure the team knows what follow-up is expected. Document:

• Timelines for all goals and objectives
• Who is responsible for which action steps
• How to request plan updates or revisions
• When the team will meet again
• How the team will keep in touch between meetings

You must also monitor the person’s services and progress so you can make unscheduled changes as needed. Changes often occur because:

• The person’s interests, goals, or needs change
• The person gains new skills or resources
• The person encounters new barriers
• The plan is not effective

Sometimes, significant changes in a person’s life can mean making major changes to the plan. Other times, the plan may need only minor adjustments in between scheduled planning meetings.