Person-centered practices

Person-centered practices are based on the fundamental principle that government and service providers must listen to people about what is important to them to create or maintain a life they enjoy in the community.

When a person-centered approach is used, support and service planning is not driven by professional opinion or limited service options. Instead, planning looks at services and supports in the context of what it takes for a person to have the life they want. The person along with his/her support team identifies effective support and services that will help the person live, learn, work, and participate in  preferred communities on his/her own terms. 

These practices encourage professionals to see people as unique and whole individuals with potential and gifts to share. Using these practices, professionals and informal support people learn what is important to each person and what contributes to each person's quality of life. “Person-centered” services are an alternative to “system-centered” or “professionally-driven” approaches.

Terms like “person-centered planning” and “person-driven planning” are distinct, but they all fall under the person-centered practices umbrella. Each shares the idea that the person, not the system or its limitations, are put first during every step of the planning and support process.

Person-centered practices focus on each person's abilities and strengths, including natural supports, so that he or she can maintain or work toward:

• What is important to him or her 
• What is important for him or her.

When we use a person-centered approach, the person often is able to achieve much more than those around him/her assumed was possible.

Plans that are person-centered help children and adults develop and use resources to support their goals and preferences. It can require creativity and work to find and develop the necessary supports. It may take time and several steps to achieve each person's goals. By contrast, a service-centered approach results in a plan that is driven by what services are available.

Historically, the term “person-centered planning” was used to describe specific planning approaches for people with developmental disabilities. Person-centered planning was designed to combat support systems that too often view people through labels and deficits. Person-centered services continue to evolve as counterpoints to a model that sometimes was more about the professionals or the system and less about the people. 

Increasingly, broader society has recognized that recovery, resiliency and community success are critical to a person’s overall health and wellness. Terms and approaches such as “patient-centered” or “person-centered recovery practices” also have emerged.

As a result, today the term “person-centered planning” is used in many fields, such as:

• Aging services
• Education
• Employment
• Health care
• Mental health
• Nursing care.

The details of person-centered planning are different in each of these contexts. But, all of these approaches help professionals and communities develop whole life, person-driven practices. The common goal is to support people so they can fully engage in their community. Broadly, "person-centered planning" describes common values and methods that apply when:

• Getting to know the person and understanding their goals and needs
• Planning for services and treatments 
• Identifying supports driven by the person and/or his or her family.

The person-centered approach is fundamental to Minnesota's Olmstead Plan, but not limited to it. 

Many state and federal policies require person-centered delivery services and supports. Minnesota’s transition to person-centered practices is overseen by: 

• Minnesota's Olmstead Plan
• The Jensen Settlement Agreement
• Centers for Medicare and Medicaid Services Home and Community-Based Services Settings Final Rule
• The Minnesota Positive Supports Rule (Minnesota Rules, 9544.0030)
• Minnesota Home and Community-Based Services licensing standards (Minn. Stat. Chapter 245D).

There are requirements and components related to person-centered practices from other authorities, as well, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) and the United States Department of Labor's Workforce Innovation and Opportunity Act.

When we use person-centered practices, the people we serve experience a better quality of life. They:

• Grow in relationships
• Contribute to their community
• Make choices and have positive control over their lives
• Are treated with dignity and respect
• Have a valued social role
• Share ordinary places and activities
• Participate in local community life.

The people who deliver services benefit as well. They:

• Witness the people they support achieve goals that are meaningful to them
• Are able to work creatively and collaboratively with others to find successful solutions
• Experience fewer disruptions and crises because plans are successful more often.
• Empower the people they support
• Share the responsibility of resource allocation and decision-making.

Informed choice means that a person has all the information and therefore, is able to make an informed decision. This allows the person to have positive control over his or her life. Informed choice is a key element of person-centered practices. 

Informed choice does not mean the person, whether an adult or child, gets whatever he or she wants. Everyone experiences limitations in their lives, and person-centered practices do not change that. 

That said, limitations at one point in a person's life are not necessarily limitations forever. 

A person’s ability to make his or her own choices changes with age. In working with children, parents and guardians should be involved in choices. As children grow they develop goals and wants. Person-centered planning recognizes and respects them throughout the process.

People subject to civil commitment

When working with people who are subject to civil commitment, remember that everyone needs to balance restrictions on our freedoms with our personal desires. Having restrictions does not negate the essential humanity of a person nor his or her right to have preferences and goals. Nor does respect for an individual's preferences and goals negate the reality of restricted circumstances. The role of the support planner is to find the balance of “important for” and “important to.” Keep in mind, many restrictions are temporary, so the question may be: “What do you want to be happening now so that you can get closer to your future goals?”

When done effectively, person-centered planning may support positive behavior changes and ultimately affect a person's civil commitment status.

People who have a guardian

For a person with a guardian, informed choice means the guardian practices “supported decision-making.” This means, helping the person understand the options and supporting his or her choices. The guardian does not make a decision “for” the person, rather they work “with” the person to arrive at decisions. 

Resources

DHS has produced opportunities for service planners, guardians, school personnel and others to learn about supported decision-making. For more information, see the handouts from the May 2016 training with Jonathan Martinis (PDF) and May 2016 learning community webinar (PDF). DHS is in the process of creating a video training on the subject that should be available soon. We are developing other opportunities as well.

Policy guidance

The CBSM Person-Centered, Informed Choice and Transition Protocol page shares policy guidance related to the Person-Centered, Informed Choice and Transition protocol.

Training

DHS offers the following resources to help develop person-centered practice skills. 

Support Planning Professionals Learning Community

The Support Planning Professionals Learning Community is a resource for support planning professionals to learn about person-centered practices and how to put them to use in everyday work. For more information about upcoming sessions and other training go to the Disability Services Division training news and information page. The DSD training archive page has past presentations, recordings and handouts from previous sessions.

College of Direct Support

DHS partners with the College of Direct Support to offer online training modules for competency-based training for direct support staff. Families and people with disabilities may also use this resource. There are four sessions on person-centered planning and supports. See the DHS College of Direct Support page for more information.

University of Minnesota person-centered training

The University of Minnesota, in partnership with DHS, offers training on person-centered thinking and planning. Find out more on the University of Minnesota Person Centered Positive Supports Training in Minnesota webpage.

Future training

As more trainings are available, DHS will send out information on its lead agency and/or stakeholder eLists. To subscribe, go to the DHS manage subscriptions page and select Disability Services Division when prompted.

Resources and tools

DHS and others offer tools that may help support planners to develop their skills, such as: 

• DHS positive supports information
• Disability Benefits 101 (DB101)
• Employment First (Minnesota’s plan for competitive, integrated employment for people with disabilities)
• Housing Benefits 101 (HB101) 
• Informed Choice Toolkit
• Introduction and Guide to Supported Decision Making videos
• My Move Plan Summary, DHS-3936 (PDF): A template lead agencies use with a person who moves from one residence to another key elements of the plan are clearly communicated (For more information about the move plan summary, see the July 14, 2016, eList)
• What does person-centered mean for me? An introduction for people with disabilities, DHS-6803 (PDF)