A person-centred thinking is a set of values, skills and tools used in person centred planning and in the personalisation of services used by people who need support provided by social or health care. Person centred thinking can be used to build a person centred plan over time. The person centred thinking tools were developed by the Learning Community for Person Centred Practices. Person centred thinking tools are used in person centred reviews, for example (what people like and admire about me, what is important to me now, what is important to me in the future, how best to support me, what is working and not working for me, what is working and not working for my family, what is working and not working for others). It’s related to Person centred planning because that 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. 2
Using a range of approaches to planning, and person centred thinking, will benefit anyone assisting in support planning for people who are making decisions about how they want to live and use their personal budget. These approaches should also be available to people who want to develop their own support plan, including self-funders. Person centred planning is a practical way for people to have choice and control in their lives. 3
It is a way of helping people who want to make some changes in their life. It is an empowering approach to helping people plan their future and organise the supports and services they need. It is a way to help people, think what they want and need out of life and plan how to do it. The person is the “key” to the planning process. The planning process helps to get others who care about the individual to help in the planning and doing. It provides effective way to listen and respond to people.
Person centred planning is based on an explicit set of beliefs and values concerning people with disabilities, services and communities. At the heart of all the planning approaches is the belief that every single individual has their own life to lead, a life that is right for them. Everyone involved needs to have good skills in person centred thinking, in the value based skills that underlie the planning. We all think about, and plan our lives in different ways. Some people have very clear ideas about what they want and how to achieve it, others take opportunities as they arise. Some people dream and then see how they can match their dreams to reality.
The beliefs and values on which person centred is based put the individual in the context of their family and their community first. The difference is in how the client is the centre in decision making. Person centred planning involves the client at every stage. It seeks to help the client set their own goals and make decisions about how they will try to achieve them. It aims to give the client back control in their lives and encourages them to develop problem solving skills and to consider their own best interests. Other approaches are often based on “professionals specialist knowledge and views”, decisions are made by the professionals in meetings that the client may not even be part of.
Person-centred thinking tools in common use include one-page profiles, ‘working/not working’, ‘important to/important for’, ‘good day/bad day’, communication charts, ‘doughnut’ of staff roles and responsibilities, relationship circles, learning logs and person-centred reviews. These tools provide an agenda which a person and the people who know that person best can think together, focussing on what is important to that person, how they wish to live, and then introduce changes that will move towards those aspirations.
Practitioners of person centred thinking suggest that it’s possible to build up from one or two pieces of person centred thinking, piece by piece based on the area of the person’s life that they feel is most important to consider next, this process of building gradually creates a collection of person centred information, equivalent to a ‘full’ person centred plan, and more importantly a range of co-produced actions. Where a person has a specific budget allocated to pay for their social care, this portfolio of person centred thinking tools (a ‘person centred description’) can also be extremely useful as a basis to write a support plan, which explains how they will use this budget to meet what is important to and for them.
The person is at the centre of the planning process. Person centred planning is rooted in the principles of shared power and self-determination. Power is an issue because many people are limited in their power in comparison to others. Others control their lives. They direct how people spend their time, what they eat, how they behave, even what they say. In this context, planning can become just a further indignity. Person centred planning can be used to redress this balance as far as possible. People using person centred planning make a conscious commitment to sharing power. Built into the process of person centred planning are a number of specific features designed to shift the locus of power and control towards the person. The outcome is to help the person to get a better life on her own terms. Family and friends are partners in planning. Person centred planning puts people in the context of their family and their community.
It is therefore not just the person themselves that we seek to share power with, but family, friends and other people from the community who the person has invited to become involved. Often it is family members who know the person best. They care about the person in a way that is different from everyone else and they will probably be involved in supporting the individual for the rest of their lives. They often bring huge commitment, energy and knowledge to the table. Person centred planning starts from the assumption that families want to make a positive contribution and have the best interests of the person at heart, even if they understand those best interests differently from other people. In person centred planning, families are not caricatured as one dimensional – either ‘over-protective’ or ‘not interested‘; instead they are invited to tell their side of the persons story with the richness of detail which can provide the clues for change.
It is a crucial priority for services to sustain values and strengthen peoples family connections. Sharing power with families means seeking their active involvement and building a partnership. This has to be based on families and professionals getting to know and trust each other. The plan results in on going listening, learning, and further action. Person centred planning should not be a one off event. It assumes that people have futures; that their aspirations will change and grow with their experiences, and therefore the pattern of supports and services that are agreed now will not work forever. Person centred planning is based on learning through shared action, about finding creative solutions rather than fitting people into boxes and about problem solving and working together over time to create change in the persons life, in the community and in organisations.
Sorting important to/for. The first and fundamental person-cantered thinking skill is to be able to learn what is important to someone, what is important for them and the balance between the two. This is a principle that underpins the achievement of person-centred change. What is important to a person is what they say through their own words and behaviours about what really matters to them. What is important for people are the things that help people become or stay healthy and safe, whether it is important to them or not. The balance between the two is the compromise that all of us experience in life. We all need to find a balance so that our lives are not just about what we choose, but also what we know needs to happen for us to be safe and healthy. To find the balance we need to know:
What is important to a person?
What is important for a person?
What else do we need to learn?
The Doughnut sort. It is the tool like “doughnut”. The first ring in the inner core, which consists of the core responsibilities of staff or people providing support. The next ring is areas where staff need to exercise their own judgement and be creative. These are areas where people must make decisions, problem solve and creatively think about possibilities and potential. The final ring is areas beyond the scope of the staff member’s role and responsibilities. All roles have limits and boundaries, some of which are formally in place, and some of these are informal, for example family preferences or respect for cultural differences. Before using doughnut tool you need to know what is important to and for someone, before you begin to use the doughnut tool to clarify the roles of supporters in specific situations.
What is the working/not working. As soon as there is enough information about someone recorded in a one-page profile, need to use the person-centred thinking tool “working/not working” to build an action plan to make sure that changes actually happen, rather than there just begin a plethora of person-centred information. It is simple way to analyse what is happening in someone’s life, whether what is important to them is present in their life, and whether they are being supported in the way that makes sense to them. Problem surface where there are areas of disagreement in people’s lives. By looking at what is working and not working from different perspectives, it is clear where there is agreement and where there is difference.
It is powerful to look at areas of disagreement in the context of what people see as being the same. It enables people to see things “all the way round”, to stand in different peoples shoes and to hear it from their perspective. It prevents us from inadvertently changing aspects of a person’s life that are working for them. “Working and not working” from different perspectives contains two of the core principles of negotiation. When you get each persons perspective on paper, they feel listened to. When you tease situations apart in enough detail, you can find areas of agreement. This enables you to start on “common ground”.
One page profiles provide a description of a person, focusing on what others like and admire about them, what is important to them and what we need to know or do to provide good support. One page profile develops into descriptions as we learn more about the person, and record this information. One page profiles are developed by thinking what we know about what’s important to the person, and the support they need. One Page Plans should include: What we like and admire about the person, what is important to them, and what support the need.
White Paper Valuing people, it has four principles: rights, choice, independence and inclusion. There are legislations in the place to support the White Paper, including – Discrimination Act 1999, Human Rights Act 1998, the Mental Health Act 2012, the Health and Social Care Act 2012 (Regulated activities), the Essential Standards.
Community Care Act and Equality Act.
Commissioning is about using public money to buy in services. In the past services were commissioned with the needs of groups of people in mind and individuals had to accept what was offered for their perceived needs, for example; day care at a local centre. Person centred planning means that commissioning is now shaping services to meet people’s needs rather than fitting people into the services on offer eg the individual might prefer a trip to the pub rather than spend time in a day centre. For person centred planning the individual decides what they want and this might not be from the services that are on offer. This makes it difficult for Care Managers to commission services as they may not be wanted or needed. For example many homes have been built around the belief that who a person lives with should be determined by their disability.
We have homes for people with Downs Syndrome, homes for people with Autism, homes for people with multiple disabilities. Many of these small residential homes have been founded also on the belief that people with similar levels of need should live together. With person centred planning people with disabilities should be supported to choose who they live with (if anyone), how they live, where they live and who supports them. In order for individuals to have the same freedoms and choices as the rest of society the services that are commissioned must provide for individual needs and not be service led.
In the past local authorities commissioned services in block packages. For example they might buy in the services of a home help agency whose workers would provide morning and evening visits to individuals to prepare a meal, clean etc. That left very little choice for individuals who just wanted some help with developing their own life skills and have someone work alongside them, something that the agency couldn’t provide. The person centred approach takes into account individual needs so commissioning must be much more flexible. Strategic commissioning is designed to take a more ‘holistic’ approach to commissioning, by assessing what users really need from services, addressing gaps in provision and looking at new ways of purchasing services from external providers.
A person centred team is a team with a structured sense of purpose. The team knows what is important to and for its members and this is recorded in a team plan.
A person-centred team uses person-centred thinking within the team context, to clarify the purpose of the team, what is important to the team and what support team members need. Teams can work through seven questions to explore becoming a person centred team. Each question uses a range of person centred thinking tools to answer it. Information about purpose, what is important to the team, action and reflection is recorded and updated in a person-centred team plan. Use this to explain your own settings person centred team.
Person centred thinking skills, when used widely can create a person centred culture that makes self-directed support more likely. When this is present in organisations we see person centred teams, positive and productive meetings, a different approach to choice and risk, staff supervised in a person centred way and a strong focus on community connections. Innovative organisations are using individual service funds to ensure people can direct their own support.
The role of manager is to have policies, procedures and planning documents for person centred strategies, to ensure that staff has training, monitor and review. The facilitator will have an understanding of their role through training and having a procedure to follow.
The facilitator will have an understanding of their role through training and having a procedure to follow. These facilitators are usually subject experts, however draw on the knowledge of the participants and then fill in any gaps. Training facilitators focus on the foundations of adult education: establish existing knowledge, build on it and keep it relevant.
Introduce the idea of one-page profiles and person-centred planning. Provide information on person-centred planning and support planning. Introduce person-centred thinking tool into their practice. Introduce person-centred reviews. Support people or families to lead their own plans. Contribute to person-centred reviews and person-centred planning meetings. Contribute to actions resulting from the action plan. Support managers to ensure that the plan is implemented. Support people to take an active role in their own plans.
Introduce person-centred thinking and practices within the team. Use person-centred tools to build the team. Integrate tools so they are used by team, systematically and habitually, not just as “one offs”.
Develop a person-centred team plan.
Introduce person-centred thinking tools through groups that the professional is involved in. Integrate person-centred thinking skills, tools and approaches habitually in all professional practice, from recruitment through to exit interviews. Contribute to discussions on how to broaden and deepen person-centred approaches. Change paperwork to incorporate person-centred thinking, such as learning logs.
Person-centred thinking skills include being able to problem solve, promote dignity, privacy and inclusion in a collaborative manner – in other words, being able to do things with a person rather than to them. It means being able to use person centred planning tools such as the one page profile or the ‘doughnut’ to build a plan of support that considers the person’s life, likes and dislikes etc.
Challenges include, if individuals are unconscious or not mentally capable of making decisions.
If the person is unconscious then we need to wait till that person is conscious and if they are not mentally capable of making decisions then needs to involve family members and professionals. You have to decide which person is the person who is at the centre of the ‘thinking’, because each person in the interaction will have different needs and requirements, which may not be the same.
Courtney from Study Moose
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