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 changes in people’s lives and services” (Ritchie et al, 2003).
Person centred planning is not so much a new technique for planning as a new approach to - or new type of - planning that is underpinned by a very exacting set of values and beliefs that is very different to the current norm. It is planning that takes as its primary focus a person - as opposed to a disability or a service or some other particular issue. It is ‘whole person’ oriented as opposed to disability-management focused. It is about citizenship, inclusion in family, community and the mainstream of life and self-determination and can, therefore, require some very fundamental changes in thinking and the established balances of power, the implications of which are potentially enormous and far reaching.
It is important to understand that person centred planning is not:
- assessment – whether of services or service user needs (see the UK Department of Health’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 the individual as opposed to the service and how the individual might be made to fit into the service system. It also goes beyond services, indicating more general action by and for the individual.
- service planning or Individual Program Planning for service users. Traditional Individual Program Planning (IPP) is characterised by a synchronised and standardised approach to addressing identified needs. Person centred planning requires a flexible and responsive approach to meeting an individual person’s needs and changing circumstances, guided by the principles of good practice rather than a standard procedure (Sanderson, 2000).
Person centred planning, service planning or individual program planning and assessment may, legitimately, exist alongside each other and have implications for each other, however. For example:
- The requirement for developing a person centred plan or for updating an existing person centred plan may be identified as part of needs assessment;
- A person centred plan may identify the need to develop or adjust an individual educational or care plan to better suit an individual’s requirements, wishes and preferences 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 normalisation and independent living movements. It is grounded in a social model of disability and a strengths based approach. Person centred planning was developed because people with disabilities often find it difficult to get the kinds of basic services, opportunities and experiences most people take for granted – and even when they do, they frequently find they are required to somehow fit into someone else’s idea of what that service, opportunity or experience should be like and how they should act, think or feel in relation to it (see Howell 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 community and/or the broader mainstream of life and
- Describe the actions needed to move it in that direction.
It accomplishes this through:
- Discovering and responding effectively to the various aspirations, capacities and concerns of individuals with disabilities;
- Understanding and addressing the core issues for individuals – exploring where the person is now, how they would like their life to change and what bringing about that change might entail;
- Identifying and exploring choices available to the individual;
- Mobilising and involving individuals’ entire social network as well as resources from the system of statutory services in responding to what is expressed and helping to bring about whatever changes are desired;
- Making arrangements to follow up on plans on a regular basis in order to go through them, review progress on putting them into action and update them;
- Discovering a way to record, on an on-going basis:
- What has been learned about what is important to an individual and what is important for them;
- What balance has been worked out between what is important to the person and what is important for themWhere there is a conflict between the the two;
- What others are expected to know about what is important to and for the person and/or what others are expected to do to help the person get what is important to and 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 development of a person centred plan - and whether this is making a real difference to the person’s life in either case.
The earliest proceduralised forms of person centred planning are associated with Karen Green-Mc.Gowan and Mary Kovaks who ran day-long planning sessions for people with disabilities. By 1980, Beth Mount was running training courses in ‘personal futures planning’ (sometimes referred to as PFP) and by the end of the eighties several alternative formal methodologies (sometimes referred to as ‘planning styles’) had evolved. These included, for example: ‘getting to know you’, ‘individual design sessions’, and ‘24-hour planning’. The history and path of evolution of these methodologies is charted in O’Brien and O’Brien (2000) and Shaddock (2000).
Person centred plans may be developed either within services or entirely independently of them. In either case, it is the person or family who is to be the focus of the person centred 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 it implemented. Sometimes, parents, family, spouses, friends, advocates or others will do so on their behalf (for example: where it is not possible for a plan to be guided entirely by an individual due to extreme difficulties with insight, awareness and cognition). Plans may also be developed by one or more individuals acting independently on behalf of an individual and/or his or her family – and/or by service staff specially trained for this (for example: a legal guardian or a specially trained keyworker and expert on brain injury). In Ireland, in practice, at present, person centred plans tend to be developed within services, though some parents and families have begun to develop plans independently.
In practice, the development and implementation of plans usually requires the co-operation of quite a range of individuals, services and the broader community network, if they 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 it into action, the individual supporting and guiding the planning effort is called a ‘plan facilitator’. The primary role of the plan facilitator is to ‘help someone work out what they want 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 or other service providers.
Whether specialist service staff, parents, family members, spouses, friends, advocates or someone acting independently on behalf of an individual and/or his or her family, it is extremely 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 and experienced in person centred planning philosophy, methodology, tools and techniques. They should also be familiar with any significant aspects of the focus person’s background that are likely to impact on the person centred planning process.
It is particularly important that diversity and individuality across focus persons should be acknowledged and accommodated, in compliance with Equality legislation. In effect, this would mean that in the case of cultural and linguistic minorities, for example, a plan facilitator ought to possess or seek to acquire adequate knowledge/experience of the cultural identity and communication styles of the individual or family that is to be at the centre 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 to be 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 potentially vested interest in the process. Where a plan is being facilitated within a service, the autonomy of the plan facilitator in his or her role as plan facilitator must be adequately assured. It is also imperative that a plan facilitator should adopt, encourage and project an equal partnership approach to working with the person or family at the centre of the planning 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 to refer to everyone a person might like (or need) to involve in developing and/or working out their plan:- family, spouses, friends, advocates, specialist and non-specialist service providers and local community groups, etc.. The initial and continuing involvement of any particular individual, group or organisation in any part of the planning process should be in 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 who draws up their own person centred plan and champions the overall person centred process themselves, would be both focus person and pcp champion. Similarly, somebody who supports the development of a person centred plan and also works as an agent of its realisation would be both plan facilitator and pcp champion.
Every effort should be made to ensure that everyone involved is given whatever support they need to play their particular part(s).
This includes developing an adequate system of communication that is fully accessible to all parties likely to be involved in the person centred planning process. It may also mean engaging in some preliminary groundwork on empowerment, relationship-building and advocacy.
The role of the individual’s parents, siblings, family and close friends in person centred planning 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 person centred planning is, of course, the focus person - and that person’s wishes must be upheld. Even so, planning must also take due consideration of the views of these key individuals in the person’s life, particularly in developing person centred plans for young people or people with high dependencies. Where an individual does not want a family member to be directly involved in his or her person centred planning process, this issue can be explored but should not be forced. It must be acknowledged that parents and family members can be a valuable source of information in developing plans and a great help in getting plans put into action. Regardless of whether they have been directly involved in the planning process, parents and family are frequently impacted by plans (sometimes directly, sometimes indirectly). The matter of consulting parents and family members on those parts of a plan that are likely to impact on them should be addressed as part of the planning process and the views of parents and family members on those issues should be sought, acknowledged and explored.
Where the individual and his or her parents and family or service providers or service providers and parents and family hold very different views on a particular issue, every effort must be made to fully understand the reasons for these differences of opinion and to explore how they might be satisfactorily addressed. Should conflicting views prove irreconcilable, the views of the focus person should be taken as paramount.