1. Support Plan for: Family & friends who helped me:............................................................................................................................................................................................................................................................................................................... This is who I am? This is what’s Import -ant to me? This is what’s import -ant for me? This is the support I need to reach my goals This support will cost This is how I will stay in control My time plan to action change Home Work Social Learning Health Date of Support Plan:

2. This is who I am Eg. Name, age, who you live with, things you enjoy doing, things you don’t enjoy doing, how people would describe you, your past, your current situation Eg. Challenging behaviour if applicable. What upsets you & how your support needs to help you manage your upset. Eg. Names of family & friends who support you Insert photo if you wish

3. This is who I am Eg. Name, age, who you live with, things you enjoy doing, things you don’t enjoy doing, how people would describe you, your past, your current situation Eg. Challenging behaviour if applicable. What upsets you & how your support needs to help you manage your upset. Eg. Names of family & friends who support you Insert photo if you wish

4. This is who I am Eg. Name, age, who you live with, things you enjoy doing, things you don’t enjoy doing, how people would describe you, your past, your current situation Eg. Challenging behaviour if applicable. What upsets you & how your support needs to help you manage your upset. Eg. Names of family & friends who support you Insert photo if you wish

5. My goals in life (How I’d like my life to be) Where & how I live

6. My goals in life (How I’d like my life to be) Health (Mental or Physical)

7. My goals in life (How I’d like my life to be) The Social Life I want

8. My goals in life (How I ’ d like my life to be) Learning

9. My goals in life (How I ’ d like my life to be) Work

10. This is what’s Important to me: Eg. To become ….. (eg. To become independent) Eg. To achieve ….. (eg. To achieve my dream of living independently) Eg. For my family/partner/children/ parents to be ……. Or not to be …… (eg. For my partner to be my partner and not my carer) Eg. To have …… (eg. To have respect) Eg. For others …… (Eg. For others to be patient with me) Eg. To keep …… (eg. To keep my dignity)

11. This is what’s important for me and why Eg. To eat a healthy diet in order to remain healthy and well Eg. To exercise in order to maintain/manage my health Eg. To have support that motivates me otherwise I won’t achieve my goals in life Eg. To be able to keep in touch with my family and friends in order to reduce my loneliness & isolation Eg. When I’m upset this is the best way to support & help me overcome my upset ……… Eg. To have support with going out and joining in activities within my community, in order to to maintain my independence, develop friendships and reduce my isolation and loneliness

12. Who or What Eg. PA (personal assistant) or Agency for 5hrs a day Eg. Membership Eg. Equipment eg laptop Allow me to do Eg. Wash/dress/shop for food/eat a healthy meal Eg. Socialise/exercise Eg. On line shopping/communica te with friends or learn new skills Benefit to me Eg. Stay healthy & well, maintain dignity & independence Eg. Socialise & make new friends, develop my confidence, reduce my loneliness & isolation, learn new skills, develop new interests, maintain my health, give me independence, shop on line This is the support I need to reach my goals Who or What will provide my support & when I need it What will this support allow me to do What will be the benefit to me

13. Describe the sort of person I would like as a PA (person specification) and think about what training they might need Eg. Male, female, age, enablers rather than carers, motivational, respectful, car driver with access to a car, similar interests Eg. What experience would someone need to have, in order to provide you with the best support? Eg. Do I want my PAs CRB (police) checked

14. Contingency Eg. If my (family) carer is unwell and unable to provide me with support then an amount of £?? will be put to one side to pay for additional PA support or agency support etc. to cover in emergencies Eg. If my (family) carer is unwell and unable to provide me with support then my (family) member will

15. My support will cost…. and it will come out of …. income Support Needed eg. PA for so many hrs per week Eg Name of agency for so many hrs per week Eg.Membership cost Eg. Activity costs Eg.Transport costs Eg Cost of aids (not funded by Occupational Therapy Eg. Cost of respite Eg. Contingency cost if natural support unwell and unable to provide support Cost of Support Eg. If PA, £11.28* ph x so many hrs pw x 52.14 weeks = £…… Eg. Cost of aid £ From which income Eg. Indicative budget, DLA, AA or ILF Cost of Support per week x 52.14 weeks or the purchase price Essex County Council Indicative Budget £ DLA Care DLA Mobility A.A. Other Totals *If employing a PA at £11.28*ph this amount allows for Employee’s gross hourly rate including Tax/NI contribution, Employer’s NI contribution, plus allowance for Holiday/Sickness cover, recruitment, Employers Liability Insurance, etc all this to be covered and advised by the ILA. **If new to employing a PA will need to include a one off cost for Employers Liability Insurance usually around £135.00 & advertising eg approx. £65.00 & CRB check

16. This is how I will stay in control This is how my support & monies will be managed Eg. I have mental capacity and am able to make my own decisions and be in control of my life. Eg. An MCA2 for finances has been done and an Independent Living Trust has been set up Eg. Name has Power of Attorney Eg. Name has Lasting Power of Attorney Eg. Name has Deputyship Eg. I will interview and select my own PAs with support from …… Eg. I will use PASS

17. My time plan to action change Action Why By whom By when Action Why By whom By when Support Plan Review Date:

18. Authorisation I give consent for this information to be shared with Essex County Council and the I.L.A.Essex Signed by: __________________________________________ Full name: __________________________________________ Relationship: ________________________________________ (if signatory is not the person named in the support plan) Date: ______________________________________________ I give full consent and permission for photographs of myself to be used in this support plan. I give consent for this information to be shared with Essex County Council and the I.L.A.Essex Signed by: __________________________________________ Full name: __________________________________________ Relationship: ________________________________________ (if signatory is not the person named in the support plan) Date: ______________________________________________