Person Centred Planning Lets Make it Personal Person Centred Planning (PCP) was originally developed in the 1980s for people with Learning Disabilities in the USA /Canada. The main names associated with this approach are John O'Brien, Beth Mount, Connie Lyle O'Brien, Jack Pearpoint, Marsha Forest and Michael Smull. PCP has been promoted in the UK in Learning Disabilities services since the white paper 'Valuing People' in 2001. The 2014 SEN Code of Practice (0-25) expects that everyone involved in the assessment and planning process should adopt PCP practices. Children, young people and their parents should be supported to express their views and be part of decision making. What is Person Centred Planning? First and foremost it is a response to service-centred behaviour and works on the central premise that services often further disempower, devalue and exclude the people they aim to help. Traditional models of support focus on the person's deficits and negative behaviours, labelling the person and creating a disempowering mindset from the start. PCP is an alternative to these models. It comprises a range of processes sharing a general philosophical background, and aiming at similar outcomes. PCP aims to place the individual at the centre of decision-making, treating family members as partners. The process focuses 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, independence, choice and social inclusion, and is designed to enable people to direct their own services and supports, in a personalised way rather than attempting to fit within pre-existing service systems.

The tools, the Plan and taking steps towards change There are many different person centred processes that can be drawn upon. The person centred thinking tools created by Helen Sanderson Associates, are designed to help an individual plan how they would like their life to be. These tools are essentially simple, designed to elicit a huge amount of information, which can be added to over time. They are often strongly visual and adaptable to suit an individuals preference in terms of presentation. Information recorded jointly at the time of meeting creates a live record that is kept by the person and becomes their Person Centred Plan. The plan details, where possible in the individuals own words, their current life, how they would like their life to be and the kinds of changes they would like to make. The information is a powerful reference point that is shared with key people. Together, skills and activities can be identified to take steps towards their goals. Case Study: Jenny The following case study, describes how the tools were used to support Jenny, a 22-year-old young who lives with her parents. Jenny has a severe receptive and expressive communication difficulty and dyspraxia. She has a passion for watching soap operas and has very entrenched routines that dominate both her own life and her familys These routines include showering at a specific time, watching specific

television programmes sometimes twice and working through a series of activities on her iPad and then completing crosswords before she can engage in daily living activities. She attends college 2 days a week and works in a charity shop an afternoon a week, which she enjoys so long as she doesnt have to use the till. Jennys parents struggle to say no to Jenny for fear of creating an outburst and consequently Jenny has considerable control over what happens in the home. The Relationship Map was used to build rapport and to identify the key people Jenny trusts. With visual support Jenny was able to compare the different relationships she has with the different family members and describe the topics she is happy to discuss with each. It became clear that Jenny has very little contact with people outside of her family, that she misses her older sister who now attends university and that her routines prevent her from seeing two long term friends. In a discussion about her future aspirations Jenny considered her Dreams. This was a validating process as there is no right or wrong answer. Jennys dreams include being able to speak to her sister on the phone, to write neatly, to use the cooker and to stop arguing with her parents. She also hoped to be busier in the evenings, to go on outings with her old friends more often and to travel to Australia to meet the cast of Home and Away! In order to gather more detail about Jennys life the Good Day / Bad Day tool was explored with Jenny. On a good day Jenny watches all her programs and completes her routines, she isnt interrupted and there are no arguments with her parents. She goes on an outing or to a wedding or party. She is also given support at college to write neatly. Jennys bad day included talking to unfamiliar people and having to pay for shopping which is stressful, and as she is unable to calculate how much change to expect, she believes others are taking advantage of her. All information was recorded using Jennys own words and then together with her parents the Important To and Important For tool was used. This tool aims to achieve a balance between a life full of choice and a life restricted by health and safety. It was acknowledged that aside from the activities associated with her routines, the things important to Jenny included staying in touch with her sister and old friends, going on regular outings and not arguing with her parents. We explored the impact of Jennys routines in terms of the limits they place on both Jenny and her parents and acknowledged that if they persisted unchallenged she would not achieve her dreams and her good days would become fewer and fewer i.e. her routines are so time consuming that there is little space to engage in other activities. It became clear that Jennys life was too full of choice and control and that some changes were needed for her long term development and consequent health and safety. We then discussed the support that Jenny needed in order to stay safe and well and her parents began to realise that by avoiding confrontation they were fuelling Jennys routines and limiting her opportunities to learn new skills. We identified that some of the things important for Jenny included learning to tolerate interruptions to her routine, learning to help with some chores around the house, and developing her understanding of money.

Based on this discussion Jenny was supported to set the following goals:

Jenny to be given a 5 minute warning at 6.25pm and then at 6.30pm Jenny will pause the soap she is watching on television and help mum in the kitchen for 2 minutes.

Jenny to learn the value of everyday items and to identify the coins to use to pay for them.

Jenny to learn how to email her sister and her old friends. Jenny to practise handwriting so that it becomes smaller.

Progress was reviewed during a circle meeting using the Whats Working / Not Working tool. This provides a way of analysing what is happening in someones life from different perspectives and helps to identify a way forward. We learnt that Jenny was extremely angry about having to pause the remote control. However, with encouragement she reluctantly continued with this goal as she saw it in the context of her dreams i.e. if she could learn to manage her routines she will have more time and flexibility to go on outings with friends in the short-term and perhaps one day travel to Australia and meet the cast of Home and Away! This was highly motivating for her! Jennys parents learnt that Jennys explosive outbursts blow over relatively quickly and they gained confidence in being assertive and in conflict management. I learnt that change was already happening! During the review methods of supporting Jennys communication skills were effectively modelled to her parents. For example, they observed that Jenny can weigh up information and express preferences if she is afforded enough time to organise her thoughts and construct a sentence. As part of the review, we also used the What People Like and Admire tool, which builds confidence and erodes negative labels. Jennys parents celebrated her by saying Jenny is laid back, angry moods blow over quickly and Jenny is prepared to give things a go, even challenging new experiences. Jenny enjoyed receiving this praise. We continued to work on the above goals, and progress was reviewed with her parents using the Whats Working / Not Working tool at eight week intervals. Within a year Jenny had achieved the following:

Jenny can write small enough to complete a form if she thinks about the amount of space before beginning writing.

Jenny can email her sister with a prompt to put a note in her diary to do so.

Jenny is happy to press pause when watching television and come and help mum with a chore or to cook. Jenny will spend as long away from her routine as needed to complete the chore if given 5 minutes warning to first finish her routine.

Jenny is also happy to spontaneously press pause to answer the phone.

Jenny knows the value of most familiar items that she shops for. She can round up and add up the sum of the items to an approximate amount. She has a smaller purse so it is easier to find the correct change.

Circle / Review Meetings These meetings are a highly important element of person centred planning. Essentially, they are a group of trusted people who come together to help bring about change in small steps. It is an opportunity to evaluate progress, discuss conflict from different perspectives and celebrate change. It is also an invaluable safe space for the individual to practise having a voice and giving their views. For the therapist facilitating this work it is a chance to model and practice effective communication strategies in real time. Resources to support understanding and expressive language are essential to ensure that others are not leading or influencing the choices someone makes. As communication is key to effective person centred planning, speech and language therapists and others with expertise in communication are well placed to facilitate this way of working. The table below lists some Top Tips for gathering the views of an individual and for supporting them to share their views with others during meetings. Top Tips Getting started and using the tools Circles and reviews Experiment with the tools so you feel confident using them, its good to practise on yourself

Support the individual to choose/invite their key people to the meeting

Understand the individuals communication skills and the strategies which support them before you start

Support the individual to develop their own rules

Ask questions, listen, check youve understood and then record what theyve said in their own words

Offer simple choices from the outset e.g. Where people sit? Which biscuits? Which colour pen? Who speaks first? How long they want the meeting to last?

Always prepare resources to support expressive language

Have the same resources used to prepare for the meeting available in the meeting so that they can have a voice

Let the individual keep the plan you produce together, its their plan!

Provide space to discuss conflict, evaluate change and celebrate success

Action make sure the plan results in actions, which bring about change!

Model effective communication strategies e.g. allowing extended time for the individual to answer

Summary

In their simplest form the tools can be used to build rapport and gather important personal information. However, there are many other advantages, for example, the emphasis on capturing and using the individuals own words is very powerful in making advocacy work easier. The circle /review meetings allow multiple perspectives to be explored and dynamics within relationships can shift with lasting change. Communication skills and confidence develop through the process of modelling and practising skills in real time, discussing issues intrinsically motivating their own thoughts, life and aspirations! Overall, the process of using the tools, actively listening and using the information as the basis of a plan for change provides a rich and powerful process, raising expectations of the individual and those around them. Amy Duck info@amyduckspeechtherapy.co.uk Some useful References Connie Lyle OBrien & John OBrien The Origins of Person Centred Planning - A Community of Practice Perspective Helen Sanderson Associates a development training and consultancy team. Provides templates for planning tools etc. www.helensandersonassociates.co.uk Inclusive Solutions (person centred planning) www.inclusive-solutions.com