Person-centred planning (PCP) is a set of approaches designed to assist an individual to plan their life and supports.[1] 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 many other sections of society who find themselves disempowered by traditional methods of service delivery, including children, people with physical disabilities, people with mental health issues and older people.[2] PCP is accepted as evidence based practice in many countries throughout the world.[3]
Person-centred planning was adopted as government social policy in the United Kingdom through the 'Valuing People' white paper in 2001, and as part of 'Valuing People Now', a 3-year plan, in 2009.[4][5][6] It is promoted as a key method for delivering the personalisation objectives of the UK government's 'Putting People First' programme for social care.[7] The coalition government continued this commitment through 'Capable Communities and Active Citizens' (2010), and in 2011 over 30 health and social care organisations set up a sector-wide agreement 'Think Local, Act Personal' (2011) to transform adult social care.[8]
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 are important to someone now and in the future, and acting on this in alliance with their family and their friends.[9]
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' refers 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-centered planning has similarities to other processes and ideas, but was first named and described more definitely by a group of people in the US, including the Center on Human Policy's Rehabilitation Research and Training Center (RRTC) on Community Integration e.g., Julie Ann Racino, Zana Lutfiyya, Steve Taylor, John O'Brien, Beth Mount, Connie Lyle O'Brien, technical assistance "partners" of the RRTC (e.g., Michael Smull, Wade Hitzing, Karen Green-McGowen, Nick Arambarri) and person-centred planning in Canada by Jack Pearpoint, Judith Snow and Marsha Forest. 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.
Disabled people in the UK and USA developed the social model of disability, arguing for a shift in the balance of power between people and the services on which they rely. Person centred planning is based in the social model of disability because it places the emphasis on transforming the options available to the person, rather than on 'fixing' or changing the person. Specifically person-centred planning was based diversely on principles of community integration/inclusion/ normalisation/social role valorization.[10] Prior to its inception, these principles were crystallised by John O'Brien and Connie Lyle O'Brien in the 'Framework for Accomplishment' which listed five key areas important in shaping people's quality of life, and asserting that services should be judged by the extent to which they enable people to:
Share ordinary places
Make choices
Develop abilities
Be treated with respect and have a valued social role
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.
The person-centered concept grew out of the critique of the "facility-based services" approach in the US (and worldwide) that was central to the development of "support approaches" in the US[12][13] The nationwide technical assistance funded by the National Institute on Disability Research and Rehabilitation (NIDRR), which included the person-centered approaches, is reported in the "Journal of Vocational Rehabilitation".[14]
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. One of the benefits of person-centered planning is that it can address the perennial "service problems" of ethnicity, gender, culture and age by starting with planning by or with the "whole person".
Person-centred planning is not 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-centered planning through the Rehabilitation Research and Training Center on Community Integration in the US was, in part, an agency and systems change process as opposed to only an "individual planning" process moving to an "individual budgeting process".[15]
Person-centred planning involves the individual receiving the service, with family members, neighbors, employers, community members, and friends, and professionals (such as physician/ doctors, psychiatrists, nurses, support workers, care managers, therapists, and social workers) developing a plan on community participation and quality of life with the individual. In contrast, traditional models of planning have focussed on the person's deficits and negative behaviours, labelling the person and creating a disempowering mindset from the start.
Person-centred planning offers an alternative to traditional 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, interdependence, choice and social inclusion, and can be designed to enable people to direct their own services and supports, in a personalised way.
Methods
Person-centered planning 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 means such as community participation, employment and recreation.
Beth Mount characterised the key similarities or 'family resemblances' of the different person centred methods and approaches into four themes:
seeing people first, rather than diagnostic labels
using ordinary language and images, rather than professional jargon
actively searching for a person's gifts and capacities in the context of community life
strengthening the voice of the person, and those who know the person best in accounting for their history, evaluating their present conditions in terms of valued experiences and defining desirable changes in their life[16]
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 of support (Canada), MAPS (Canada), personal futures planning (O'Brien & Mount, US), Essential Lifestyle Planning (Maryland, US), person centred reviews, Getting to Know You (Wisconsin, US), and most recently the use of Person centred thinking tools[17] to build from one page profiles[18] 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. If part of a regular planning process in the US, regular plan updates are usually required by regulatory agencies (e.g., state offices in the US through local agencies).
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 on 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. In the US, person-centered planning can help to create new lifestyles, new homes and jobs, diverse kinds of support (informal and formal) and new social relationships.
Limitations
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 acknowledges the limitations of what the system is prepared to provide.
John O'Brien sums up the problem of trying to deliver person centredness through formal service systems that have a very different culture thus:
Many human service settings are zones of compliance in which relationships are subordinated to and constrained by complex and detailed rules. In those environments, unless staff commit themselves to be people's allies and treat the rules and boundaries and structures as constraints to be creatively engaged as opposed to simply conforming, person centred work will be limited to improving the conditions of people's confinement in services.[19]
He calls for leadership to challenge these boundaries:
Most service organisations have the social function of putting people to sleep, keeping them from seeing the social reality that faces people with disabilities... People go to sleep when the slogan that "we are doing the best that is possible for 'them'" distracts from noticing and taking responsibility for the uncountable losses imposed by service activities that keep people idle, disconnected and alienated from their own purposes in life. One way to understand leadership is to see it as waking up to people's capacities and the organisational and systemic practices that devalue and demean those capacities.[20]
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 doesn't use risk as an excuse to trap people in boring and unproductive lives.[21]
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 hope of funding it in the USA was to influence the processes, such as planning through the Medicaid home and community-based waiver services for people moving from institutions to the community.[22]
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 "support" 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 secondary users may debate the use of person-centered approaches to achieve the myriad goals it attempts to achieve, i.e., increased inclusion (Schwartz, Jacobson and Holburn, 2000) and "defining person-centeredness", others point to recent research such as "The Impact of Person Centred Planning", 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.[23] 'Valuing People Now'[24] 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.
Person-centered planning in the USA has continued to be investigated at the secondary research level and validated for more general use (e.g., Claes et al. 2010).
Local authorities in Britain are now being challenged by government to change their model to one that is founded on person centred approaches:[25] "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 for People with Developmental Disabilities (OPWDD), has mandated the use of person-centered planning in all new service development for people with intellectual disabilities.[26] Person-centered planning is central to the new approaches to person-directed supports with are based on stronger self-determination than traditional person-centered approaches.
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 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.[27]
Community psychology is concerned with the community as the unit of study. This contrasts with most psychology which focuses on the individual. Community psychology also studies the community as a context for the individuals within it, and the relationships of the individual to communities and society. Community psychologists seek to understand the functioning of the community, including the quality of life of persons within groups, organizations and institutions, communities, and society. They aim to enhance the quality of life through collaborative research and action.
Independent living (IL), as seen by its advocates, is a philosophy, a way of looking at society and disability, and a worldwide movement of disabled people working for equal opportunities, self-determination, and self-respect. In the context of eldercare, independent living is seen as a step in the continuum of care, with assisted living being the next step.
Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance use disorders, mental health, HIV/AIDS, chronic illness, diverse disabilities or other serious challenges to stable housing.
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.
Inclusion in education refers to all students being able to access and gain equal opportunities to education and learning. It arose in the context of special education with an individualized education program or 504 plan, and is built on the notion that it is more effective for students with special needs to have the said mixed experience for them to be more successful in social interactions leading to further success in life. The philosophy behind the implementation of the inclusion model does not prioritize, but still provides for the utilization of special classrooms and special schools for the education of students with disabilities. Inclusive education models are brought into force by educational administrators with the intention of moving away from seclusion models of special education to the fullest extent practical, the idea being that it is to the social benefit of general education students and special education students alike, with the more able students serving as peer models and those less able serving as motivation for general education students to learn empathy.
"The normalization principle means making available to all people with disabilities patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life or society." Normalization is a rigorous theory of human services that can be applied to disability services. Normalization theory arose in the early 1970s, towards the end of the institutionalisation period in the US; it is one of the strongest and long lasting integration theories for people with severe disabilities.
Supported living or supportive living refers to a range of services and community living arrangements (CLAs) designed with individuals with disabilities and their families to support disabled citizens to attain or retain their independence or interdependence in their local communities. Supported living is recorded in the history of the NASDDDS, celebrating its 50th Anniversary. Community Supported Living Arrangements (CSLA) was a landmark federal multi-state demonstration to illustrate the federal role in community living in the US. Supported living is considered a core service or program of community living programs funded through federal-state-local partnerships.
A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.
A group home, congregate living facility, care home, adult family home, etc., is a structured and supervised residence model that provides assisted living and medical care for those with complex health needs. Traditionally, the model has been used for children or young people who cannot live with their families or afford their own homes, people with chronic disabilities who may be adults or seniors, or people with dementia and related aged illnesses. Typically, there are no more than six residents, and there is at least one trained caregiver there 24 hours a day. In some early "model programs", a house manager, night manager, weekend activity coordinator, and four part-time skill teachers were reported. Originally, the term group home referred to homes of 8 to 16 individuals, which was a state-mandated size during deinstitutionalization. Residential nursing facilities, also included in this article, may be as large as 100 individuals in 2015, which is no longer the case in fields such as intellectual and developmental disabilities. Depending on the severity of the condition requiring one to need to live in a group home, some clients are able to attend day programs and most clients are able to live normal lifestyles.
Psychiatric rehabilitation, also known as psych social rehabilitation, and sometimes simplified to psych rehab by providers, is the process of restoration of community functioning and well-being of an individual diagnosed in mental health or emotional disorder and who may be considered to have a psychiatric disability.
The recovery model, recovery approach or psychological recovery is an approach to mental disorder or substance dependence that emphasizes and supports a person's potential for recovery. Recovery is generally seen in this model as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. Recovery sees symptoms as a continuum of the norm rather than an aberration and rejects sane-insane dichotomy.
Supported employment refers to service provisions wherein people with disabilities, including intellectual disabilities, mental health, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment. Supported employment is considered to be one form of employment in which wages are expected, together with benefits from an employer in a competitive workplace, though some versions refer to disability agency paid employment. Companies such as Skilcraft in the United States are an example of "supported employment" which is defined in law for state and federal reimbursements.
John O'Brien is a leading thinker who has written widely in the field of disability. He is a pioneer and lifelong advocate of Person Centred Planning. To this end, he was co-developer of two models for person centred planning, namely the McGill Action Planning System (MAPS) and Planning Alternative Tomorrows with Hope (PATH). His values based approach emphasises learning with each person about the direction their lives could take, challenging and overcoming practices, structures and values that lead to segregation and underestimation rather than inclusion, and an approach to change in people's lives based on 'imagining better'. His thinking is based on Social Role Valorisation and the Social model of disability. He is an Associate Editor of Mental Retardation, and on the Advisory Boards of the Georgia Advocacy Office and Georgia PASS. With Herbert Lovett, O'Brien co-wrote “Finding A Way Toward Everyday Lives,” a paper cited by others in the disabilities field as a significant reference point in the early development of person-centered planning.
Community integration, while diversely defined, is a term encompassing the full participation of all people in community life. It has specifically referred to the integration of people with disabilities into US society from the local to the national level, and for decades was a defining agenda in countries such as Great Britain. Throughout recent decades, community integration programs have been increasingly effective in improving healthcare access for people with disabilities. They have been valued for providing a "voice for the voiceless"
Family support is the support of families with a member with a disability, which may include a child, an adult, or even the parent in the family. In the United States, family support includes "unpaid" or "informal" support by neighbors, families, and friends, "paid services" through specialist agencies providing an array of services termed "family support services", school or parent services for special needs such as respite care, specialized child care or peer companions, or cash subsidies, tax deductions or other financial subsidies. Family support has been extended to different population groups in the US and worldwide. Family support services are currently a "community services and funding" stream in New York and the US which has had variable "application" based on disability groups, administrating agencies, and even, regulatory and legislative intent.
Simon Duffy is a British welfare rights researcher, philosopher, activist and co-founder of Citizen Network and the Centre for Welfare Reform.
Planning Alternative Tomorrows with Hope (PATH) is a strengths-based person-centred planning process developed by John O'Brien, Marsha Forrest and Jack Pierpoint. The PATH process is designed to help a focus person establish their own vision for their life and imagine what supports and connections will help them achieve this vision.
The Citizen Network Research, formerly the Centre for Welfare Reform is a Sheffield-based think tank which works globally on advancing citizenship for all. It was launched in 2009, changed its name in 2022, and has published a range of materials offering progressive innovations in welfare reform. It is not linked to any particular political party but is aligned with progressive politics in the UK and also works internationally. The Director and founder is Dr Simon Duffy.
Life project of the person with disability was introduced for the first time in the Italian regulatory system by Law no. 328 of 8 November 2000 and it represents the heart of Law no. 112 of 22 June 2016, which has among its fundamental principles the activation of paths to promote the well-being, full social inclusion and autonomy of people with disabilities. A systemic approach to the Life Project also represents the guarantee element of rights and quality of life aimed at giving full effect to the principle of social inclusion expressed in Article 19 of the Convention on the Rights of Persons with Disabilities. The latter provides that every person with disabilities is guaranteed the right to full integration in the community by ensuring equal freedom of choice as well as full involvement in society life.
Herbert Lovett (1949–1998) was an American psychologist known for his contributions to the field of intellectual and developmental disabilities. He was an advocate for inclusive support and equal access to education, work, housing, and human rights for children and adults with disabilities.
↑ Sanderson, H.; Lewis, J. (2012). A practical guide to delivering personalisation: Person-centred practice in health and social care. London: Jessica Kingsley Publishers.
↑ O'Brien J. (1989) What's worth working for? Leadership for Better Quality Human Services. Syracuse NY. The Center on Human Policy, Syracuse University for the Research and Training Center on Community Living of University of Minnesota.
↑ Racino, J. (1999). Policy, program evaluation and research in disability: Community support for all. Binghamton, NY: The Haworth Press.
↑ Mount, B (1992) Person Centred Planning; A Sourcebook of Values, Ideas and Methods to Encourage Person-Centered Development. New York, Graphic Futures
Cambridge, P. and Carnaby, S. 2005. Person Centred Planning and Care Management with People with Learning Disabilities. Jessica Kingsley Publishing, London.
Claes, Claudia; Van Hove, Geert; Vandevelde, Stijn; van Loon, Jos; Schalock, Robert L. (2010). "Person-Centered Planning: Analysis of Research and Effectiveness". Intellectual and Developmental Disabilities. 48 (6): 432–453. doi:10.1352/1934-9556-48.6.432. ISSN1934-9491. PMID21166549.
Department of Health (UK) (2001), Valuing People, London, UK: Author
Department of Health (UK) (2007), Valuing People Now, London, UK: Author
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, Max; Allen, Julie; Woodhead, Neil; Reid, Stephen; Irwin, Lori; Sanderson, Helen (11 July 2008), A Positive Approach To Risk Requires Person Centred Thinking(PDF), London, UK: Personalisation Network, Care Services Improvement Partnership, UK Department of Health, retrieved 28 April 2017
Racino, J. (1999). "Statewide approaches to community integration: moving toward technical assistance strategies that make a difference". Journal of Vocational Rehabilitation. 13 (1): 31–44.
Robertson, J.; Emerson, E.; Hatton, C.; Elliott, J.; McIntosh, B.; Swift, P.; etal. (2005), The impact of person centred planning(PDF), Lancaster, UK: Institute for Health Research, Lancaster University, retrieved 15 June 2017
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.
This page is based on this Wikipedia article Text is available under the CC BY-SA 4.0 license; additional terms may apply. Images, videos and audio are available under their respective licenses.
