Person-centred planning (PCP) is a set of approaches designed to assist an individual to plan their life and supports. 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. PCP is accepted as evidence based practice in many countries throughout the world.
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. It is promoted as a key method for delivering the personalisation objectives of the UK government's Putting People First programme for social care. 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.
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.
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. 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 Grow in relationshipsO'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.
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 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".
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".Racino, J. (1999). Policy, program evaluation and research in disability: Community support for all. Binghamton, NY: The Haworth Press.
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 lifeMount, B (1992) Person Centred Planning; A Sourcebook of Values, Ideas and Methods to Encourage Person-Centered Development. New York, Graphic Futures
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 to build from one page profiles 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: