!Person centred planning or person-centred action policy and practice in intellectual disability services

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!Person centred planning or person-centred action policy and practice in intellectual disability services

  1. 1. Journal of Applied Research in Intellectual Disabilities 2004, 17, 1±9Person-Centred Planning or Person-CentredAction? Policy and Practice in IntellectualDisability ServicesJim Mansell and Julie Beadle-BrownTizard Centre, University of Kent at Canterbury, Beverley Farm, Canterbury, Kent CT2 7LZ, UKAccepted for publication 25 September 2003Background This critical review considers the nature and previous attempts at individual planning are analysed.importance of person-centred planning in the context of The assumption that person-centred services will be pro-current British policy and service development in intellec- duced by a new kind of individual planning is questioned.tual disability. The difference between person-centred Conclusions Consideration is given to what would beplanning and other kinds of individual planning is dis- necessary to make services more person-centred, includ-cussed. ing changes in power relations, funding arrangements andMaterials and method The scale of the task of implementing staff training and supervision.person-centred planning as a national policy initiative isconsidered. The limited evidence base for person-centred Keywords: individual plan, intellectual disability, person-planning is reviewed and the reasons for the failure of centred plan, policy In distinction to these methods, however, person-centredIntroduction planning emphasizes three other characteristics found wanting in them. Firstly, it aims to consider aspirationsWhat is person-centred planning? and capacities expressed by the service user or those speak-Person-centred planning is an approach to organizing ing on their behalf, rather than needs and de®ciencies. Thisassistance to people with intellectual disabilities. Devel- emphasis on the authority of the service users voice re¯ectsoped over nearly 30 years in the USA, it has recently dissatisfaction with the perceived failure of professionalsassumed particular importance in the UK because it forms to attend to what matters most to service users, the extenta central component of the 2001 White Paper Valuing to which services are seen to constrain or impose goalspeople. (Crocker 1990; OBrien & Lovett 1992) and the observation Person-centred planning is represented by a family of that services sometimes create arti®cial hurdles betweenapproaches and techniques, which share certain character- goals in an inappropriate `readiness model (Wilcox &istics (OBrien & OBrien 2000). It is individualized, in that Bellamy 1987) or `developmental continuum (Taylor 1988).it is intended to re¯ect the unique circumstances of the Secondly, person-centred planning attempts to includeindividual person with intellectual disabilities in both and mobilize the individuals family and wider socialassessing and organizing what should be done. It shares network, as well as to use resources from the system ofthis focus with other approaches to individualized plan- statutory services. This partly re¯ects the special interestning adopted in intellectual disability services, such as that family and friends have:individual programme plans (Houts & Scott 1975; Blunden1980; Accreditation Council on Services for Mentally Often it is family members who know the person best.Retarded and Other Developmentally Disabled Persons They care about the person in a way that is different1983; Jenkins et al. 1988) or individual service plans (Brost from everyone else and they will probably be involvedet al. 1982; Emerson et al. 1987), as well as with case in supporting the individual for the rest of their lives.management methods adopted across many client groups They often bring huge commitment, energy and(Challis & Davies 1986). knowledge to the table. (Sanderson 2000, p. 4)# 2004 BILD Publications
  2. 2. 2 Journal of Applied Research in Intellectual Disabilities The implication is that families in particular have a stake implementation one of the priorities for the Learningin the arrangements made to support an individual with Disability Development Fund and the Implementationintellectual disabilities in a way that service employees do Support Team. (Department of Health 2001b, p. 50)not. Mobilizing the service users social network is also Guidance issued subsequently (Department of Healthintended to broaden and deepen the range of resources 2001a) is intended to create a large-scale programme ofavailable to help them; indeed for some authors, there is training and implementation. The White Paper sets out anthe suggestion that services are part of the problem more ambitious programme of targets for the introduction ofthan they are part of the solution (OBrien & Lovett 1992, person-centred planning (numbers, unless otherwise indi-p. 13). The social network is seen as a richer source of cated, from Valuing People (Department of Health 2001b)):imagination, creativity and resources than the service 1 By April 2002:system, not least in the area of forming and maintaining 1.1 Learning Disability Partnership Boards to agree asocial relationships, where intellectual disability services local frameworkare seen as weak (Emerson & Hatton 1994). 2 By 2003 `speci®c priorities for: The third distinctive characteristic of person-centred 2.1 People still living in long-stay hospitals (about 1500planning is that it emphasizes providing the support people)required to achieve goals, rather than limiting goals to 2.2 Young people moving from childrens to adult ser-what services typically can manage. vices (number not known) 3 By 2004 `signi®cant progress for: Person centred planning assumes that people with 3.1 People using large day centres (about 50 000 people) disabilities are ready to do whatever they want as long 3.2 People living in the family home with carers aged as they are adequately supported. The `readiness over 70 (about 29 000 people (Mencap 2002)) model is replaced with the `support model which 3.3 People living on NHS residential campuses (about acknowledges that everyone needs support and some 1500 people) people need more support than others. (Sanderson 2000, p. 6) The scale of the task Taken together, these three characteristics are presented This is an extremely ambitious target for public policy, notas making a fundamental break with previous methods of only because of the number involved but because of theindividual planning: nature of peoples disabilities. The population of people with intellectual disabilities include many individuals It is not simply a collection of new techniques for with very severe problems, which are likely to hinder or planning to replace Individual Programme Planning. impede the development and maintenance of relationships It is based on a completely different way of seeing and with other people, making the maintenance of effective working with people with disabilities, which is fun- person-centred planning dif®cult. For example, a recent damentally about sharing power and community study of adults in residential care (Mansell et al. 2002) inclusion. (Sanderson 2000, p. 2) found that 43% had major communication dif®culties, 63% had impaired social interaction and 35% had severe chal- lenging behaviour. Each of these, alone and in combinationWhy is person-centred planning important? with others, presents substantial dif®culties. For example,Person-centred planning has been increasingly fashion- there is evidence that staff often misjudge the receptiveable in intellectual disability services, but it has assumed language ability of people with intellectual disabilitiesparticular importance since its adoption as a primary (McConkey et al. 1999; Purcell et al. 1999; Bradshawvehicle for change by the 2001 White Paper Valuing people. 2001), a common error being to rely too heavily on verbal The White Paper identi®es person-centred planning as communication. Thus, in presenting and discussingcentral to delivering the Governments four key principles options in the context of a person-centred planning meet-(rights, independence, choice and inclusion) and a high ing, staff (and perhaps others too) risk failing to explainpriority for management attention and resources. possible courses of action adequately. Similarly, the extent to which people with intellectual disabilities can under- Given the importance of person-centred planning as a stand choices and decisions is often limited and requires tool for achieving change, we will make supporting its careful assessment (Murphy & Clare 1995; Arscott et al. # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 1±9
  3. 3. Journal of Applied Research in Intellectual Disabilities 31999). The nature of the dif®culties experienced by the are less important than they might once have been inindividual service user may also interfere with person- recruiting and sustaining a `circle of support, then othercentred planning. For example, aggression or self-injur- sources of motivation are important. Bulmer (1987) pointedious behaviour often results in negative emotional con- out that the most convincing general explanation of thesequences for staff (Hastings 1995; Emerson & Hatton nature of caring relationships is reciprocity. What sustains2000), which may make it more dif®cult to empathize with and nurtures helping relationships among people who arethe individual or to identify feasible means to achieve their not kin is a sense of exchange and balance in the relation-goals. ship. Here, people with very substantial disabilities face a None of these characteristics is, in itself, insuperable, particular problem in that they may have great dif®cultyand individual case illustrations (e.g. OBrien & Mount maintaining the sense of balance required in the relation-1989) show that irrespective of the level of intellectual ship. Qureshi et al. (1989) noted the importance of paymentdisability or the nature of additional problems, people to community care helpers as a way of enabling recipientswith intellectual disabilities can have close personal rela- of care to feel that this balance is maintained. The dif®cultytionships; but the studies cited indicate the scale of the of recruiting citizen advocates for people with intellectualdif®culty to be overcome. disabilities perhaps re¯ects this as well as purely practical It is therefore not surprising that many people with problems.intellectual disabilities are extremely socially isolated.Studies of people in residential settings, for example, often Assessing the policy initiativeshow low levels of contact from other staff and otherresidents, particularly for people with severe and pro- There is now no serious alternative to the principle thatfound intellectual disabilities (Emerson & Hatton 1994; services should be tailored to individual needs, circum-Mansell 1994; Felce & Perry 1995). Studies of the social stances and wants. It is hard to remember a time whennetworks of people with intellectual disabilities show that services for people with learning disabilities were notthey are often extremely restricted and dominated by expected to be individualized. But in the 1960s, in Britainfamily and staff. Cambridge et al. (2001) found that, on and North America, custodial care, depersonalization,average, people living in the community 12 years after block treatment and rigidity of routine were the norm.deinstitutionalization had very limited social networks People did not have their own clothes; their possessionscompared to the wider population. They found that only were taken away, or lost, or destroyed, or stolen by19% of members of these networks were unrelated to staff. There was no expectation of change and thereforeintellectual disability services. Robertson et al. (2001) found no need to plan anything (Blatt & Kaplan 1966; Morriseven smaller networks. Forrester-Jones et al. (2004) found 1969).that people with mild or moderate intellectual disabilities Individualization of service organization has beenattending a supported employment programme had net- accompanied by the development of assessment and plan-works averaging less than 50 people and nearly two-thirds ning tools, from early work on goal planning (Houts &of network members were staff, family or other service Scott 1975) through to care management (Challis & Daviesusers. Building the `circle of support required around an 1986). However, it has also been accompanied by theindividual to undertake person-centred planning is there- investment of much greater resources in service provisionfore likely to be dif®cult for many people in the White and by new, smaller-scale services in the communityPaper target groups. (Mansell & Ericsson 1996). Greater individualization in A third reservation about the scale of the task implied in practice may therefore be the result of a number of differ-the White Paper is the general dif®culty in modern society ent aspects of the great changes in service provision, actingof developing and sustaining relationships of the kind alone or of both in combination. It may owe at least asrequired. The language of person-centred planning is much, for example, to changes in the kinds of servicesthe language of reciprocity, mutual interdependence provided and the associated changed attitudes of staff as itand community. However, community, in the sense of does to particular methods of planning.the closely knit, mutually supportive neighbourhood or Assessment of the weight given to person-centred plan-village exempli®ed in sociological studies (e.g. Bulmer ning in the 2001 White Paper Valuing people therefore1986; Young & Willmott 1986), is scarcer in reality than requires evaluation of the contribution made by planningit is in rhetoric. In practice, it is family, and overwhel- systems as distinct from other changes in service organiza-mingly women, who undertake the role of helping people tion (i.e. answering the question `are individual planswith substantial needs (Dalley 1988). If tradition and duty effective?). If person-centred planning is not likely to# 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 1±9
  4. 4. 4 Journal of Applied Research in Intellectual Disabilitiesdeliver the bene®ts required in terms of individualizing in care management assessment, with evidence of stan-services and driving their redevelopment, then its adop- dard assessments that do not address the particular needstion as a central plank of the policy seems problematic. In of people with intellectual disabilities (Challis 1999).particular, the diversion of large amounts of time, effort There is also evidence from several larger-scale evalua-and money into switching from existing planning systems tions that individual plans are not well-connected to theto person-centred planning may not be justi®ed if this real lives of people using services. Shaddock & Bramstonturns out to be `more of the same. 1991) found serious de®ciencies in the planning process in 50 plans drawn from group homes for people with devel- opmental disabilities. Clients, relatives and advocatesAre individual plans effective? were often not present when goals were set. Long-termAs Kinsella (2000) pointed out, there is almost no evidence goals were often omitted. Typically, goals and objectivesof the effectiveness of person-centred planning compared were not written in speci®c measurable terms, criteriato other approaches. What evidence there is largely com- were not stated and the conditions under which the beha-prises individual case studies referred to in the course of viour should occur were omitted. Cummins et al. (1994)commentaries on the process and its desirability (e.g. found that 19% of plans for 199 people had no review dateOBrien & Mount 1989; Certo et al. 1997; Everson & Reid and 30% of meetings were not attended by any family,1997; Department of Health 2001a). A systematic review by friends or advocates of the individual service user. In aRudkin & Rowe (1999) found no statistically signi®cant later study, Cummins et al. (1996) analysed 163 plans fromoutcome differences with good statistical power for people 11 community-living support services. The average levelreceiving person-centred planning. of presentation was poor. Only 14% offered any criterion Despite the lack of an evidence base, there are studies of for evaluating performance objectives, the average numberother forms of individualized planning, which share some of skill-building objectives was 3.25 per plan, and only 39%characteristics with person-centred planning. These of plans were current. Conroy et al. (unpublished MScinclude studies of individual programme plans in intel- Dissertation, University of Kent) compared 18 people wholectual disability services, studies of care management had functional individual programme plans with 18 whoarrangements and studies of the individualized planning did not and found no difference between the groups inprocess in special educational needs. satisfaction, observed levels of engagement or records of The ®rst observation from these studies is that, in prac- participation in activity. Stancliffe et al. (1999) evaluatedtice, individual planning only reaches a minority of service plan objectives for 126 adults with mental retardationusers. An inspection of day services by the British Social living in institutional or community settings and foundServices Inspectorate (1989) found that only 25% of service no signi®cant change in outcomes associated with havingusers had an individual programme plan on ®le. Felce et al. an objective. Miner & Bates (1997) found that participation(1998) reported that during the implementation of the All- in person-centred planning increased the extent to whichWales Strategy for intellectual disability services, the high- parents or guardians contributed to individual educationalest level of individual plan coverage achieved was only planning or transition planning meetings. These families33% of service users. Problems in resourcing the level of perceived that meetings were more favourable and almostindividual planning required are also evident in special all rated person-centred planning as valuable and effec-education, where despite a legal mandate, half of educa- tive, although there was no difference in their satisfactiontion authorities fail to achieve the 18-week target for with the meeting.production of a plan (Audit Commission 1998), and in Thus, case studies suggest that person-centred planningcare management, where failure to hold effective reviews can be valuable and may change the perception of parti-have been identi®ed as a common problem area (Challis cipants. There are no good-quality, systematic evaluations1999). of person-centred planning, but as person-centred plan- Where individual plans are created, they are often a ning shares many characteristics with previous attempts atpaper exercise. The Social Services Inspectorate (1989) individual planning, evidence from these is relevant. Thisfound evidence that plans were in case notes but not evidence suggests that when implemented on a large scale,necessarily used. Radcliffe & Hegarty (2001) found that there are problems with coverage, quality and outcomes.in two and three out of eight cases they studied in 1998 and In order to achieve greater individualization of service1999, individual plan goals were not translated into the organization and delivery, it may therefore be helpful todaily programme of support to service users. Cambridge analyse why earlier attempts at individual planning(1999) suggests that administrative interests predominate appear to have failed. # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 1±9
  5. 5. Journal of Applied Research in Intellectual Disabilities 5 be functional; it may serve the purpose of the organizationsWhy do individual plans fail? involved.Resource constraints Implementation gapA recurrent theme in reviews of care management is thatan important factor shaping the operation of such indivi- A second feature evident in evaluation of individual plansdualized planning systems is the need for service organi- is what might be called the implementation gap ± the failurezations to control expenditure (Challis 1999). In the to carry through plans into practice. Although the evi-absence of effective ®nancial information systems enabling dence is limited because so few studies have addresseddevolved budgets, the freedom for care managers to outcomes ± real changes in the lives of the people withdesign individually tailored arrangements is likely to be intellectual disabilities studied ± there are suf®cientconstrained. This appears to be achieved through the grounds in the literature cited to be concerned that per-introduction of waiting lists, the use of standardized pro- son-centred planning (or any other kind of individual Ácedures for assessment (prix ®xe rather than a la carte), the planning) is largely a paper exercise.bureaucratization of management processes and the reser- The explanation for this implicit in the White Papervation of funding decisions to higher-level managers Valuing people is that there is insuf®cient understandingremoved from direct contact with service users. (and so the appropriate reform is more training in how to An important factor in the British context may be that, do person-centred planning). The alternative formulationunlike the USA, individualized service plans are not given above is that lack of resources prevents implementa-legally mandated. The scope for redress if aspirations tion and undermines the motivation to take planningare ignored or subverted is therefore very limited. Even seriously. In addition, there is a further aspect of indivi-in British special education, where there is a legally dual planning, which may help explain its limitations inenforceable right to a plan, delay and a restricted range practice; that is, the relationship between objective settingof options appear to have been used to ration resources. and the skills and daily practice of staff providing support.Administrative culture may therefore be as important as There is extensive evidence that front-line staff workinglegal entitlement in promoting meaningful individual with people with intellectual disabilities, especially peopleplanning. with severe and profound intellectual disabilities, typically If cost control does intrude in this way, the implication is provide little in the way of facilitative assistance to supportthat simply changing the style of planning, from whatever engagement in meaningful activity at home and in thewent before to person-centred planning, is unlikely to community (Emerson & Hatton 1994; Perry & Felce 2003).make any difference. It would be expected that, if person- In consequence, levels of engagement are low, with relatedcentred planning became at all widespread, mechanisms evidence that people do not continue to develop and growwould be developed to constrain it within ®nancial in competence in adult life (Cambridge et al. 2001) andlimits. One particular risk that person-centred planning have restricted social networks and relationships. Only apresents in this respect is that it explicitly embraces the small proportion of these staff are trained (Ward 1999), andidea that informal care is important and possibly even recent Government initiatives acknowledge this andpreferable to formal service provision. Thus, it opens include attempts to substantially increase trainingup the possibility for service agencies to now de®ne (Department of Health 2001c, 2002). Therefore, if indivi-activities, which they would previously have funded, as dual plan goals are developed that involve providingthe responsibility of the `circle of support. There is skilled support to the individual (for example, in accessingsome evidence from the care management literature of unfamiliar places and situations, or in coping with muchemotional support and counselling not being provided higher levels of stress and demand), it is likely that staffeven though identi®ed as areas of need in their own right will not be able to provide suf®ciently skilled help for(Challis 1999), which might re¯ect rationing judgements people with more complex needs.that some kinds of services are not to be provided by the Thus, where goals have resource implications ± movingformal sector. from a residential home to supported living, for example ± This suggests the possibility therefore that the failure of expenditure constraints may prevent their achievement.individual planning is not primarily because of lack of Where they are concerned with changing individualunderstanding or of the particular kind of planning experience without major new resources ± such as helpingapproach used, but a by-product of the need for public a person with severely challenging behaviour to shopagencies to control their budgets. In this sense, failure may more independently ± skill shortages among staff may# 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 1±9
  6. 6. 6 Journal of Applied Research in Intellectual Disabilitiesdo so. Both situations are likely to lead to individual 3 More use could be made of direct payments and user-planning becoming a paper exercise with little impact controlled trusts/independent living trusts for peopleon real life. In a sense, staff working through these pro- with severe intellectual disabilities, as well as those withcesses in services are once again in the grip of a `readiness more mild disabilities. This would potentially empowermodel, not for the client but for the service ± `we are service users in achieving their individual plan, providingwaiting until the person gets a new home/job/we get more security and consistency of service (in that oncetraining/policy changes/we are reorganised. In this situa- agreed, it is harder for a direct payment to be taken awaytion, individualized planning becomes a kind of displace- or reduced in amount without evidence of mismanage-ment activity, using staff energy, time and resources but ment of the direct payment). However, for this to happen,not making any difference to peoples lives. local authorities need to be more open to the possibility of Is a new kind of planning going to change this? Is trust-managed direct payments.pushing investment into training lots of people to make 4 National policy could set the expectation that personalindividual planning person-centred the best use of goals and plans would be resourced and achieved, insteadresources? of maintaining an equivocal stance that asserts on the one hand that person-centredness is a high priority but avoids, on the other, holding local social services departments toWhat would it take to make services more account for its delivery.person-centred? 5 Performance management by government could focusThe implication of this analysis is that making British not on numbers of plans produced, but on the quality ofservices more person-centred will not result from attempts the plans and the extent to which they are implemented.to achieve the widespread introduction of a new model of The focus of policy implementation and monitoring couldindividual planning. Rather, it directs attention to the way shift from person-centred planning to person-centredservices are funded and to the skills staff have. action. This would be likely to require a shift from a The ®rst area in which change is needed to address the rationalist policy implementation framework, in whichbalance of power that diminishes the potency of individual implementation is treated as a largely mechanical process,aspirations in public planning processes is to strengthen to focus on what Wenger & Snyder (2000), cited in OBrienthe hand of the individual service user against social & OBrien (2000), called communities of practice ± `groupsservices departments in determining the goals and imple- of people informally bound together by shared expertisementation of any individual plan. There are several ways, and a passion for a joint enterprise. The development ofwhich are not mutually exclusive, in which this might be such communities, with evidence of real effects in the livesachieved: of the people they serve, would be a higher priority than1 Person-centred planning could be given legal weight, as extent or coverage of plans.is the case in some other countries. This might be based on This directs attention to the quality of work of stafflegal entitlement to fair, humane and effective treatment providing support and advice to people with intellectualbased on a constitution or on human rights legislation. This disabilities and their families. Whatever national policywould allow individual service users to challenge failure says, it is these staff who make it a reality or not. Here tooto provide services to help them achieve what they want there are several steps that could be taken to make servicesand to test the decisions of public agencies in terms of their more person-centred:reasonableness. As British special education experience 1 Training in the goals of service provision could empha-shows, legal entitlements are not everything; but in those size action that makes a tangible difference in the dailycountries where they exist, there is evidence of them being lives of people with intellectual disabilities as a priority,used to secure improved services. and distinguish this from action which is consistent with2 Funding decisions could be decoupled from individual appropriate values but does not actually lead to change.planning by replacing local budgets managed to a ®xed This is likely to require a balance to be struck betweenlevel, with social security entitlements based on assessed relatively ordinary and more special activities. Ordinary,status. This would give service users with disabilities of a even mundane activities, which occur frequently and doset degree an absolute entitlement to a particular level of not necessarily require great resources to change (but fromfunding; it would re-focus individual planning arrange- which many people with intellectual disabilities arements in social services departments on the content of the excluded through lack of appropriate staff support) mayplan and on helping people achieve better lives, instead of be important opportunities for personal growth, develop-on rationing. ment and empowerment. The kind of dramatic, dif®cult, # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 1±9
  7. 7. Journal of Applied Research in Intellectual Disabilities 7expensive activities that are often identi®ed as important Beverley Farm, Canterbury, Kent CT2 7LZ, UK (E-mail(because of the belief that they will transform expecta- j.mansell@kent.ac.uk)tions about individual people with intellectual disabilities)do not necessarily have much impact beyond the eventitself. References2 Staff training could focus more on ways of facilitating Accreditation Council on Services for Mentally Retarded andreal change for people with intellectual disabilities, instead Other Developmentally Disabled Persons (1983) Standards forof on individual planning systems. For staff with care Services for Developmentally Disabled Individuals. Joint Commis-management responsibilities, these would include broker- sion on Accreditation of Hospitals, Chicago.age skills. For those providing or managing direct support Arscott K., Dagnan D. & Kroese B. S. (1999) Assessing the ability of people with a learning disability to give informed consent toto individual, these would be likely to include approaches treatment. Psychological Medicine 29 (6), 1367±1375.such as active support (Felce et al. 2000) and positive Audit Commission. (1998) Getting in on the Act: a Review of Progressbehaviour support (Kincaid & Fox 2000). These on Special Educational Needs. Audit Commission, London.approaches help staff develop skills to facilitate greater Black P. (2000) Why arent person centred approaches and plan-participation in activities and relationships by people with ning happening for as many people and as well as we wouldcomplex needs. like? http://www.doh.gov.uk/vpst/pcp.htm3 The supervision and monitoring of the quality of sup- Blatt B. & Kaplan F. (1966) Christmas in Purgatory: a Photographicport provided by staff to the people they serve could focus Essay on Mental Retardation. Human Policy Press, Syracuse,on real changes in the everyday lives of people rather than New York.on plans and planning. Blunden R. (1980) Individual Plans for Mentally Handicapped People: These changes would be entirely consistent with the a Procedural Guide. Mental Handicap in Wales Applied Research Unit, Cardiff.aspiration of proponents of person-centred planning, that Bradshaw J. (2001) Complexity of staff communication andit should be a process of `continual listening, and learning; reported level of understanding skills in adults with intellec-it should be focused on what is important to someone now, tual disability. Journal of Intellectual Disability Research 45 (3),and for the future; and acting upon this in alliance with 233±243.their family and friends in which `having meetings, invol- Brost M., Johnson T. Z., Wagner L. & Deprey R. K. (1982) Getting toving the person and making the plan are not the outcomes. Know You: One Approach to Service Assessment and Planning forThe outcome is to help the person to get a better life on her Individuals with Disabilities. Wisconsin Coalition for Advocacy,own terms (Sanderson 2000). They also re¯ect the concern Madison.of some (Black 2000) that making person-centred planning Bulmer M. (1986) Neighbours: the Work of Philip Abrams. Cambridgea prescription in national policy is unlikely to produce the University Press, Cambridge.changes wanted in the lives of individual people with Bulmer M. (1987) The Social Basis of Community Care. Allen & Unwin, London.intellectual disabilities. As OBrien & OBrien (2000) Cambridge P. (1999) The state of care management in services forpointed out: people with mental retardation in the UK. In: Psychiatric and Behavioural Disorders in Developmental Disabilities and Mental agencies that want to bene®t from person-centred Retardation (ed. N. Bouras), pp. 391±411. Cambridge University planning often act as if person-centred planning were Press, New York. a sort of tool box of techniques which staff could be Cambridge P., Carpenter J., Beecham J., Hallam A., Knapp M., trained to use in workshops by studying protocols, Forrester-Jones R. & Tate A. (2001) Twelve Years on: the Outcomes hearing about ideas, and perhaps trying out a tech- and Costs of Community Care for People with Learning Disabilities nique or even two for homework. Such context-free and Mental Health Problems. Tizard Centre, University of Kent at training no doubt teaches something, but we think it Canterbury, Canterbury. deprives learners of the kinds of social supports for Certo N. J., Lee M., Mautz D., Markey L., Toney L., Toney K. & Smalley K. A. (1997) Facilitating natural supports: assisting Lisa inventive action that were available to the people who to connect with her dreams. Developmental Disabilities Bulletin 25 developed the ®rst approaches to person-centred (1), 27±42. planning. Challis D. (1999) Assessment and Care Management: Develop- ments since the Community Care Reforms. In: With Respect toCorrespondence Old Age ± Research Vol. Cm 4192-II/3 (ed. Royal Commission on Long Term Care). The Stationery Of®ce, London.All correspondence should be directed to Prof. Jim Challis D. & Davies B. (1986) Case Management in Community Care.Mansell, Tizard Centre, University of Kent at Canterbury, Gower, Aldershot.# 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 1±9
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