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Exploring the role of

person-centered

planning in system

transformation

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Community for All

Our Promise, Our Challenge

Carol Blessing, LMSW – Cornell University, Citizen-Centered Leadership

Stacey Ramirez, The Arc Georgia

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Our Promise:

The Arc Mission Statement

The Arc promotes and protects the

human rights of people with

intellectual and developmental

disabilities and actively supports

their full inclusion and participation

in the community throughout their

lifetimes.

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HCBS Rules

Person Centered Planning

• The rules require:

– person-centered planning process is directed by the individual with

long-term support needs

– may include a representative whom the individual has freely chosen

and others chosen by the individual to contribute to the process.

• minimum requirements

– process results in a person-centered plan with

individually identified goals and preferences.

– assist the individual in achieving personally defined

outcomes

• in the most integrated community setting,

• ensure delivery of services in a manner that reflects personal

preferences and choices,

• and contribute to the assurance of health and welfare.

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Person Centered or Paper

Centered • Distinction between system-centered practices

and person-centered practices and the respective impact on community integration

• System-Centered Vs. Person-Centered with Beth Mount

• A good paid life is simply not good enough. This is because a good paid life is a life whose edges are hemmed by the threads of consumerism rather than a life woven in the fabric of community life through citizenship.

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Facilitation means not knowing

the outcome Part of person-centered planning is being ok with not knowing. Its critical to facilitating – versus directing - a conversation

• Paper-centered planning is knowing staff based and know what we can do we know the outcome we know we can do it

• Carol’s Person centered supports

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Questions are the template to a

good plan

• Many processes and tools used in person-centered planning.

• The process is not as critical as the questions asked, empathic

listening, and a deep commitment to pursuing competence.

Examples:

– Person without high school diploma wants to be a surgeon.

– Person with low vision wants to drive a tractor trailer

– Young boy with “significant behavior issues” wants to ride in

a space ship

Learn to ask clarifying questions. What about “this” is important?

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Share how you insure a person centered work

culture within your organization.

Person Centered

Work Culture • Person centered approaches and thinking are

reflected in the culture of the work place.

– Do your employees know their

gifts/capacities?

– Are job responsibilities linked to staffs

abilities?

– Are yearly employee reviews focused on

accomplishments are deficient?

– Does your staff recognize your abilities?

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What is your work culture?

• The extent to which person-centered

interaction will occur between supporters

and those who are supported depends

upon the interaction between two

important dimensions:

• Relationship

• Hope/Optimism

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Understanding the Impact of Culture on

Inclusion

ACCEPTANCE

REJECTION

HOPLESSNESS PESSIMISM

HOPEFULNESS OPTIMISM

Protection – people are accepted & loved but the cultural belief is that they are incapable of learning & living inclusive, interdependent lives

Punishment – likely to be against social inclusion in favor of segregation

Control – belief that with efforts & resources people could lead better lives & benefit from opportunities

Empowerment – values collaboration & relationship building between the person & their supporters in a shared partnership to Increase well-being & quality of life

The Relational Basis of Empowerment by Karl Nunkoosing and Mark Hayden-Laurelut

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Person centered cultures

translate…

…Into person centered approaches to

supports and services

• Person centered planning to practice

• Strength-based assessment

Making the Change:

• Adopt new rules and procedures for staff

and individual planning

Better plans, better services, better lives

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O’Brien 5 Valued Outcomes

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5 Valued experiences

• Belonging in a diverse variety of relationships & memberships

• Being respected as a whole person & whose gifts engage them in valued social roles

• Sharing in ordinary places and activities with other citizens, neighbors, classmates & co-workers

• Contributing by discovering, developing & giving their gifts & investing their capacities & energy in pursuits that make a positive difference to other people

• Choosing what they want in everyday situations in ways that reflect their highest purposes

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O’Brien Community Tasks

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5 Community Tasks

• Promoting interdependence by valuing & investing in social ties & associations that promote trust & mutual support & collaboration

• Living inclusive stories by opening valued social roles to people who have been excluded by prejudice, stereotyped expectations & poorly designed opportunities

• Practicing hospitality by making ordinary places acceptable & welcoming & finding effective ways to adapt to & accommodate differences that might otherwise keep people out

• Seeing & supporting capacities by adopting the practice of using what the community has to get more of what it really needs – community first

• Resolving conflicts in fair & creative ways

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O’Brien Service

accomplishments

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5 service accomplishments

How Do We…

• Assist people to make & sustain connections, memberships & friendships

• Enhance people’s reputation

• Increase people’s active involvement in the life of our communities

• Assist people to develop & invest their gifts & capacities

• Increase choice & control in people’s lives

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Comments, thoughts, questions?

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How does your agency stay true to

the mission?

• How closely aligned is your own mission

statement to the Arc of the US mission?

Small group discussion

Essential Questions

• How are you being true to the mission?

• How are you being challenged by it?

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Person-Centered Service Planning May Require a

Shift in the Way We Provide Services Role of Person

Traditional Model Client

Transitional Model Consumer

Transformational Model Contributor

Authority & Control Informed choice & Service options Staffing/Support Network Risk Orientation Quality Indicators

Professional defines & sets goals & treatment options informed by treatment options Staffing is agency-based, caseload assignment Risk is avoided Quality assurance is driven by audits from regulatory agencies

Professional sets goals &

treatment options with

consumer input & addresses

cultural & language

sensitivity

informed by available service

options within existing

programs with some

flexibility,

Staffing is agency-based &

sometimes enhanced by

natural support (unpaid)

Risk is minimized

Quality assurance is driven

by audits and by customer

satisfaction indicators

Person defines & sets goals & directs

treatment options with professional

input in deference to cultural &

language

Informed by experience & education;

services are tailored to support the

goal; new services options are

designed or obtained;

Staffing is community-based on

networks of support, paid and unpaid

Risk is anticipated and plans are in

place

Quality assurance is driven

personally defined outcomes & in

compliance with regulatory

requirements

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Role of Person

Traditional Model Client

Transitional Model Consumer

Transformational Model Contributor

Assessment & Individualized Planning Based On:

strengths, capacities, interests, preferences Needs (clinical and support)

Disability or deficiency-based & readiness assessments Based on disability & attending to what’s wrong

Asks what the consumer

wants to work on.

Assesses across a

continuum of services

with eye toward the

community

Based on addressing the

disability to help the

person improve

functioning

Capacity assessment to explore

& discover talents, assets,

interests & vision of a desirable

future

Based on addressing barriers in

the environment & building

customizing support with the

person to maximize community

participation & presence

Person-Centered Service Planning

May Require a Shift… cont’d

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Role of Person

Traditional Model Client

Transitional Model Consumer

Transformational Model Contributor

Community Access Employment Education Living Arrangements Associational Life

Day programs, sheltered employment, contained classrooms Institutional or large congregate care Specialized service-based recreation programs, group community outings

Supported employment

Blended learning

environments-inclusive

education programs

Smaller group home

options

Transitional living

programs

Community inclusion

programs & targeted

activities based on

mutual interest of

several consumers

Customized employment

Supported education

Individualized living

arrangements

Presence & participation as a

regular member in typical

community experiences

Person-Centered Service Planning

May Require a Shift… cont’d

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O’Brien on Changing the way we

change systems

• From working IN the system to working ON the system

• Developing new mental models, relationships and structures. Our personal capacity for leadership must grow

• Systematically build co-creative relationships with community to open new pathways to active participation

• Individualize support to valued social roles in the community

• Reinvest existing service resources – specifically moving away from services that perpetuate disability toward new options that are specifically designed to support inclusion

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HCBS IMPLEMENTATION

Small group discussion:

• Which of the service designs does your organization culture most resemble? Traditional, Transitional, Transformational?

• How does/can the implementation of the HCBS rule advance your organization?

• How can person-centered practice support the sustainability of your organization?

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OUR Thanks Please Join Our Afternoon Workshop: Keeping the Promise. Practical Application of Person-Centered Planning: from assessment to community

PLENARY RESOURCES:

• Citizen-Centered Leadership – See how 15 weeks can change the world! Next session begins Aug 22! www.cclds.org

• Conversations on Citizenship & Person-Centered Work. (2011. O’Brien and Blessing).

• Pathfinders. People with Developmental Disabilities and Their Allies Building Communities that Work Better for Everybody. (2015. O’Brien and Mount).

• The Relational Basis of Empowerment (2013. Nunkoosing and Hayden-Laurelut).

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Questions? Carol Blessing

Senior Extension Faculty

K. Lisa Yang and Hock E. Tan

Institute on Employment and Disability

cjb39@cornell.edu

518.265.3759 (cell)

Stacey Ramirez

State Director, The Arc Georgia

Office of The Arc of the United States

sramirez@thearc.org