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The Impact of Person Centred Planning

The Impact of Person Centred Planning. Barbara McIntosh Co Director Foundation for People with Learning Disabilities 9th Floor Sea Containers House 20 Upper Ground London SE1 9QB. The Research Team. Janet Robertson, Eric Emerson, Johan Elliott & Chris Hatton

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The Impact of Person Centred Planning

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  1. The Impact of Person Centred Planning Barbara McIntosh Co DirectorFoundation for People with Learning Disabilities9th Floor Sea Containers House20 Upper GroundLondonSE1 9QB

  2. The Research Team • Janet Robertson, Eric Emerson, Johan Elliott & Chris Hatton • Institute for Health Research, Lancaster University • Barbara McIntosh, Paul Swift, Emma Krijnen-Kemp & Christine Towers • Foundation for People with Learning Disabilities • Renee Romeo & Martin Knapp • Centre for the Economics of Mental Health, Institute of Psychiatry • Helen Sanderson • Helen Sanderson Associates • Martin Routledge • Valuing People Support Team, Department of Health • Peter Oakes • University of Hull • Theresa Joyce • Estia Centre & • King’s College, London

  3. Why? • Policy relevance Personalisation of support • Valuing People • Improving the Life Chances of Disabled People • Independence, Well-Being & Choice Evidence based health & social care • No credible evidence-base for PCP.

  4. Project Aims • To evaluate the impact of the implementation of a specific policy at a specific point in time • What impact does the introduction of PCP have on the disadvantage, discrimination and social exclusion faced by people with learning disabilities? • What personal, contextual and organisational factors facilitate or impede the introduction and effectiveness of PCP? • What are the direct and indirect costs of introducing PCP?

  5. People & Places • Sites • Four (diverse) areas of England • Participants • First 25 people per site ‘enrolled’ into PCP • (Actually 91 people) • Diverse • Age range 16-86 • 61% men • 91% white • Wide range of abilities and needs • 73% supported accommodation.

  6. Procedure • In each site • Helped to develop systems to deliver PCP • For each participant • Information collected every three months for two years • PCP introduced at different points during the two years.

  7. The process • Agreed the participants with each authority (93 in total) • Identified a facilitator for each person • Ran training sessions concerning principles, values and process of PCP • Met 10 times in year one, 6 times in year two (in two sites)

  8. The process • Informed people about the tools of PCP; MAPS, PATHS, Essential Lifestyle Planning, Personal Planning Book • Invited self advocates, facilitators and circle of support members to training sessions • Supported people to get started, to know the detail of the person, to identify goals and achieve outcomes.

  9. The process • Identified barriers/problems and worked towards solutions during training sessions • Encouraged facilitators and self advocates to share their success stories and use a peer support approach.

  10. The Process • L.A. staff in one site ran parallel session for self advocates • Responded to requests for specialist sessions: • Autism • Communicating with people who are non-verbal • Housing options • People with high support needs • Community Capacity Building • Adult education • Employment.

  11. Organisational Process • Worked with the PCP Implementation Group to plan the training and recommend organisational changes • Fed lessons learnt and outcomes/goals to the planning group • Worked with managers to create a more person centred culture and achieve goals in people’s plans.

  12. Barriers to progress • Quotes from Participants • “it takes so much time; we’re already hard pushed in the day centre” • “How can the person make a choice of facilitators when he/she has no verbal communication.”

  13. Barriers to progress • “We’re not sure who to invite to the Circle of Support” • “It’s hard to get everyone together for the circle meeting” • “He /she isn’t well enough to participate or has little interest because of feeling unwell.”

  14. Barriers to progress • High turnover of senior staff; destabilised local authorities • Few staff had a working knowledge of PCP in 2002 • Hierarchical culture of local government • Care managers; tension with the informal nature of PCP, lack of clarity concerning their role.

  15. Barriers to progress • Front line staff acting as facilitators did not always feel empowered • Lack of or delayed appointment of PCP lead person in several sites • Unmet health needs of people prevented initial progress.

  16. Barriers to progress • Scepticism of families “we have heard this before” • Two systems of planning (old and new) running in parallel • Freeing up staff and providing cover to attend training • Time to understand and get to know people with high support needs and those who were non-verbal.

  17. Positive forces for change • Commitment and perseverance of numerous staff in each site • Good advocacy services and some voluntary sector services who had embraced the culture of person centred working • Drive and determination of families at time of change and transition.

  18. YOU CAN DO IT!!

  19. Positive forces for change • Co-facilitators between family and staff member • Use of Independent Living Fund (ILF); a hopeful sign for direct payments • Good multi disciplinary team in some sites.

  20. Positive change More contact with family More friendships More community-based activities Busier lives More choice No apparent change Physical activity Medication Work Inclusive networks Use of services ‘Negative’ change More reported health & emotional problems PCP Had a Positive Impact In Some Areas of Peoples’ Lives (But Not in Others)

  21. PCP Helped Some People More Than Others • Plans developed for 71% of participants • More likely if • Facilitator expresses greater personal commitment to PCP (12.2) • Person had key-worker at beginning of study (5.7) • Been involved in the study for longer (5.5) • Person had fewer health problems (3.7) • Person had IP at beginning of study (3.7) • Person did not have autism (2.8) • Person did not have mental health problem (2.1)

  22. PCP Helped Some People More Than Others • Increased contact with friends • Less hyperactivity (6.3) • More pro-social (4.7) • More health problems (3.7) • Fewer conduct problems (3.4) • Living further from family (3.3) • Facilitator commitment to PCP (3.1) • More facilitation of communication in meetings (3.0) • Fewer peer problems (2.7) • Not having been institutionalised (2.4) • Not having active contact with friends at baseline (2.1) • Living in supported accommodation (2.1) • Not having active contact with family (2.1) • Being more able (2.0)

  23. PCP Helped Some People More Than Others • Increase in size of social network • Focus person directs PCP meetings (6.1) • Fewer organisational barriers to PCP (4.6) • Having a smaller social network at baseline (4.2) • Not having contact with family at baseline (3.4) • Fewer community and service barriers to PCP (3.2) • Facilitating is part of paid job of facilitator (2.8) • Living in less affluent areas (2.7) • Facilitator is a member of management staff (2.6) • Being in the study for longer (2.5) • Living with an informal carer (2.5) • Not having been institutionalised (2.5) • Less severe emotional/behavioural problems (2.4) • Higher facilitator commitment to PCP (2.4) • Not having a psychiatric disorder (2.1)

  24. Observations/Lessons learnt • Achieving person centred working and culture change is a long term incremental process • The whole organisation needs to become person centred • Long term funding is required for training and implementation • PCP is a positive partner for ILF and direct payments

  25. Observations/Lessons learnt • Training and support of front line workers is key in PCP • Aim to improve confidence and competence • Stronger roles and leadership of families and self advocates is necessary • Important to train and support front line managers to have person centred teams.

  26. Observations/Lessons Learnt • Care management role needs to be re-considered • Transition planning with young people needs greater collective action across education, social services and health • Facilitators need skills in building the capacity of the community to include people.

  27. Observations/Lesson learnt • Employment requires a greater focus • Health Action Planning should be integrated and a core element of person centred planning • More investment in helping self advocates to lead in the planning process.

  28. And so ………. • PCP helps reduce disadvantage, discrimination and (to an extent) social exclusion faced by people with learning disabilities • But, be realistic about impact • PCP is an ‘evolutionary step’, not a radical departure from the past • Be aware of (and monitor) inequalities • Keep the focus on (and monitor) outcomes • Build organisational and community capability.

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