Person-centred planning: an example from England

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)

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

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.

14. Person-centred planning Person-centred action Active support Total communication Positive behaviour support 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

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