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Person-centred planning: an example from England

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1 Person-centred planning: an example from England
Julie Beadle-Brown and Paul St Quintin Tizard Centre Somerset Social Services University of Kent Taunton Canterbury Somerset England England

2 Outline Introduction to PCP in England
Some examples of how PCP is used Implementation Link to funding arrangements Link to other person-centred approaches Somerset example

3 Introduction to PCP in England
What is PCP “Person centred planning is a process for continual listening and learning, focussing on what is important to someone now and in the future, and acting upon this in alliance with their family and friends. This listening is used to understand a person’s capacities and choices. Person centred planning is the basis for problem solving and negotiation to mobilise the necessary resources to pursue a person’s aspirations. These resources may be obtained from someone’s own network, service providers or from non-specialist and non-service sources”. (PCP guidance, p12)

4 PCP….. Places the person at the centre (based on rights independence and choice) Involves family members and friends as full partners in the planning It reflects the person’s capacities, what is important to the person (now and in the future) and specifies the support they require to make a valued contribution to their community It builds a shared commitment to action that will uphold the person’s rights It leads to continual listening, learning and action and helps the person to get what they want out of life. (adapted from PCP Guidance for implementation (pages 13-14)

5 PCP is…. A family of approaches and techniques
Essential lifestyle planning PATH Maps Personal Futures Planning O’Brien and Lovett (2000) Essential lifestyle planning: developed initially to help people to move from institutions to community services, focuses on gathering information about the person’s core values and preferences from the person themselves and from family, friends and staff. This information becomes the basis of a contract with service provider. Aims to provide person with a secure and effective base of service assistance. PATH: focuses on the identifying the dream or desirable future, and what is needed to at least move closer to that – it is a plan of action as such. Maps: linked to creation and development of circles of support for the focus person and often for the family and sometimes for the staff. Involves helps to develop a plan of action now – taking into account person’s history, dreams, gifts and strengths, needs etc. Personal futures planning: Seeking capacities among family, friends and community, discovering a vision of a desireable future, building stronger and more effective support by joining people in a process of learning through making small positive changes; specifying and working for changes in the service system which would allow the system to offer more relevant assistance.

6 History and Policy Individualised planning systems have been around for 30 years (USA first) Individual Programme plans (Houts and Scott, 1975; Blunden, 1980) Individual service plans (Brost et al., 1982; Emerson et al., 1987) Case/care management (Challis and Davies, 1986) In 2001, the white paper “Valuing People” put forward PCP as one of the central tools for achieving the vision of rights, independence, inclusion and choice for all people with intellectual disability. Central to the building of person-centred approaches to help people life fulfilling lives.

7 Is it different from previous systems?
Yes, in intensity/emphasis placed on: Service user voice – considers aspirations and capacities expressed by service users or their advocates rather than needs and deficiencies. Involvement of families and wider social network in addition to resources in statutory system. The support required to achieve goals rather than limiting goals to what services can provide - the “readiness model” is replaced by the “support model” (Sanderson, 2000)

8 How is it different? “It is not simply a collection of new techniques for planning to replace Individual Programme Planning. It is based on a completely different way of seeing and working with people with disabilities, which is fundamentally about sharing power and community inclusion” (Sanderson, 2000, p.2)

9 Link to person-centred finances
Direct Payments – payments made directly to the person to purchase their own support/services. Sometimes payments made via a trust. Independent Living Fund – money to pay for personal and domestic care to enable severely disabled people to live at home. Indirect payments – individual payments made to an agency or service provider.

10 Does it make a difference on an individual basis
Anecdotal evidence that it does make a difference in individual cases. Susan Alan (from PCP Implementation Guidance)

11 Does it happen and does it make a difference on the wider scale?
Evidence from previous forms of individual planning is that implementation is poor (See Mansell and Beadle-Brown, 2004, for review) Little research evidence that PCP is implemented or makes a real difference on a large scale Emerson et al. (in press) Somerset Emerson et al (in press) – findings taken from conference presentation in Belfast at beginning of February and related here by permission from Eric. 100 people in 4 areas with input on developing PCP for each person. Monitored over 2 years with battery of quality of life measures and lifestyle taken every 3 months. Also looked at the organisational and service level issues and at issues of costing. Found that there was impacts on some areas of life and for some people and in some contexts. Pre-PCP data showed no changes over time. Some impact on social networks, choice and day activity but not on work, physical activity, medication levels or service utilisation. Negative impact: increase in rates of health problems (i.e. made people more aware but no increased intake in service utilisation). Increase in emotional and behavioural problems and in risk. It wasn’t possible to maintain PCPs for everyone. Only 2 thirds of people actually had a maintained PCP therefore helping in some areas but not others – helped in areas where other forms of planning and other interventions had an effect. Didn’t help in things which were more difficult to change – e.g. getting people jobs etc. PCP was less effective for men, for those who were less able and those with more helath problems and more emotional and behavioural problems – therefore may actually widen inequality. Worked better in smaller, more flexible and well-managed organisations (voluntary and advocacy) When oganisations are looking to drive or respond to wider change (e.g. day service modernisation, transition from school) When staff are sure about their role in PCP and are supported to work in person-centred ways When there is leadership from people who can change things When community-based options already exist or can be created for individuals – worked best with individualised supports/budgets. PCP is an evolutionary step not a radical departure from the past. Emerson advised that people trying to implement PCP need to listen to people who have done it already – experiences, successes and failings but also need to learn from past experiences in own services and localities. Be realistic in terms of expectations we set up, especially for families and services – must not become a failed promise. Be aware of and monitor inequalities Build organisational and community capacity/readiness – PCA not just PCP.

12 Barriers to implementation
Kinsella (2000) Lack of evidence base Complex process History Misconception that only one type of planning possible In UK, process led by service staff Not really been taken on board by self-advocacy/family groups/ national parent organisations.

13 Barriers to implementation?
Mansell and Beadle-Brown (2004) Resource constraints (rationing of resources – danger of shifting responsibility for some goals from services to circle of support), No legal mandate that says plans must be acted upon, even where there is then often delay and limitations applied (e.g. in education) Expenditure constraints Skill shortages in staff Services themselves not really person-centred. Also some people with learning disabilities don’t necessarily want them – too much hassle and not enough support.

14 Person-centred planning and person-centred action
Informs about longer-term direction, the bigger picture Informs about individual strengths, possible directions and aspirations, grounded in reality Person-centred action Active support Total communication Positive behaviour support

15 Person-centred approaches
Active Support is…. Providing enough help to enable people to participate successfully in meaningful activities and relationships So that people gain more control over their lives, gain more independence and become more included as a valued member of their community Irrespective of degree of intellectual disability or presence of extra problems Positive Behaviour Support is… A way of working with people who present challenging behaviour, which doesn’t focus narrowly on the challenging behaviour and trying to reduce it Focuses on preventative and educational approaches. Involves careful assessment of the function of the challenging behaviour, changing the situation so that triggering events are removed, teaching new skills that replace challenging behaviour, minimizing natural rewards for challenging behaviour and an emphasis on improving overall lifestyle quality. Total communication is… A way of supporting people with communication difficulties. Involves the complementary use of signs, symbols, pictures, photographs and objects, as well as speech to improve understanding, expression and literacy or other forms of verbal communication such as vocalisations or humming. Involves ensuring that everyone providing support uses the same methods and that all means of communication are valued and responded to.

16 An example from Somerset – Person Centred Approaches
These ensure that services are responsive to individual needs. Examples are:  Communication Development Plans: all staff teams need to report on how they are encouraging choice and control for individuals  Housing Associations offering tenancy agreements  Somerset Leisure Access Project recruits local volunteers to support people into activities of their choice – 100 matches

17 An example from Somerset – Planning with Individuals
Somerset will be piloting an approach involving a person with a learning disability and their family carer working together with care staff to develop a person centred plan  My Health Book is an example of individual planning to meet the health needs of a person with a learning disability  Transitions Personal Advisors are using PCP for all young people making the transition from Children to Adult Services.

18 An example from Somerset – Training & Information
Awareness of the need for individual planning will be integral to induction training for all new Social Services staff. It will include “Value Base” training delivered by people with LD  PCPs with young people coming into services: presentations are being made to students in schools and parents of people with a learning disability covering the individual planning options such as Direct Payments

19 Conclusion – key issues
Making PCP fit with assessment and care management Developing mainstream services for people to access Support for users and affordability of Direct Payments Cultural change

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