E.Birt - Are we there yet PCP - 201109

Edward Birt Page 1 of 29
Report: Are We There Yet? Barriers and Facilitators
to Establishing Person Centred Planning Within
Funded Disability Service Systems
Edward Birt, November 20091
Overview:
This paper has been developed to explore the factors that hinder (barriers)
and those that assist (facilitators) in the establishment of person centred
funded disability services.
1. Introduction: A brief literature review exploring person centred planning
and the key recognised best practice approaches to enabling person
centred planning (PCP) within funded disability services,
2. PCP in Australia: an overview of where PCP sits in relation to
Australian disability legislation.
3. Barriers and Facilitators of PCP: An overview of the barriers and
facilitators of person centred planning identified in the literature.
4. Organisational Review:
a) Life Without Barriers Individual Planning Framework: Review of an
implementation plan for a PCP framework for an Australian funded
disability service provider.
b) Research: The results of a structured questionnaire as completed by
34 staff and 5 clients of the service that explores their views in relation
to identifying the key barriers and key facilitators to person centred
planning.
5. Discussion and conclusions: A range of conclusions and
recommendations are presented by way of a discussion at the end of
the paper.
1
Submitted as an assignment as part of a Postgraduate Masters of Health Sciences course
(Developmental Disability) to the University of Sydney by the author on 20
th
November 2009
as part of a final year inquiry topic.

“…person-centered planning may be best considered an evolutionary
step in the long-standing trend towards the increasing individualization
of and personalization of services. This point is important.”
- Robertson et al, 2006, p. 413
1. Introduction: What is Person Centred Planning?
15 years ago Beth Mount identified that person centred planning is a person
centred alternative to conventional “system centred” planning (Mount, 1994,
p.104). Person Centred Planning (PCP) is a planning methodology providing
a framework for enabling people with disability to design their own services
and to ensure that service delivery is structured around the persons needs
and goals (Dowling et al, 2007, Mansell & Beadle-Brown, 2004). As originally
envisioned PCP is a way of assisting people with disabilities become more
independent and take a strengths based and active role in planning their
futures, using and building on existing social supports to meet goals (Callicot,
2003).
Five essential outcomes of the PCP process were outlined by John O’Brien
over two decades ago; 1) presence and 2) participation in the community, 3)
positive relationships, 4) respect and 5) competence (O’Brien, 1987). PCP is
a way of organising the supports that a person requires to meet their lifestyle
choices and has evolved over many years to now be recognised as a best
practice approach to ensuring that funded disability supports are tailored to
the individual needs and personal aspirations of people with a disability (e.g.
Holburn et al, 2004).
Person Centred Planning is recognised as being associated with a range of
positive outcomes for people with disability who access funded disability
services including:
• Reducing isolation and promoting friendships and networks of support,
• Promoting contact with family,

• Developing and promoting skills, autonomy and independence,
• Enhancing dignity, respect and valued social roles and
• Increasing choice and self-determination.
These outcomes have been demonstrated in a range of qualitative studies (as
noted in Robertson et al 2007) and more recently empirically with randomised
control trials exploring outcomes associated with PCP (Robertson et al, 2005,
Robertson et al, 2006, Holburn et al, 2004, O’Brien & Lovett, 1992).
The following range of broad recurring themes from the person centred
planning literature in relation to facilitating person centred planning help to
define what PCP:
• Supports the self determination and independence of the person with a
disability (e.g. Holburn et al, 2004),
• Allows the control of planning processes to rest with the person with a
disability and their family enabling them to play a role in the design of
services to meet their needs (e.g. Dowling et al, 2007, O’Brien &
Lovett, 1992, Wiese & Parmenter, 2008),
• Listens to and understands the person (e.g. Thompson et al, 2008),
• Develops positive future focused plans (e.g. CDDS 2004),
• Accesses community resources and promotes community inclusion
(e.g. Mount, 1998), and
• Ensures action planning, commitment and follow through (e.g. Dowling
et al, 2007).
Person centred planning approaches are also designed to facilitate a shift in
power away from service providers and towards service users (Holburn et al,
2004) through enabling the recipients of funded disability services, to shape
these services in order to meet their needs and to assist them to work towards
their future goals and aspirations (Dowling et al, 2007).
2. How does Person Centred Planning sit within the Funded Disability
Service Landscape of Australia?
Planning based on the individual needs and personal goals (i.e. PCP) of
people with a disability is a legislated requirement of funded disability services

Table 1. Individual Planning and the Law: Some examples of references to
Individual Person Centred Planning from Australian disability legislation.
State / Territory Legislation Reference
Australian Capital
Territory
Disability
Services Act
(1991)
Schedule 2: 4. Services should be tailored to
meet the individual needs and goals of people
with disabilities
New South
Wales
Disability
Services Act
(1993)
2. Application of Principle (d) [services] to
meet the individual needs and goals of the
persons with disabilities receiving services,
Northern
Territory
Disability
Services Act
(2004)
Schedule 3: Section 3 (2) Objectives (d) the
services should be tailored to meet the
individual needs and goals of the people with
disabilities receiving those services;
Queensland Disability
Services Act
(2006)
Division 2 – Service Delivery Principles 25.
Services to be tailored to meet individual
needs and goals (1) Services should be
tailored to meet the individual needs and
goals of people with a disability.
South Australia Disability
Services Act
(1993)
Schedule 1 (Principles) 4. … persons with
disabilities— (a) have the right to choose
between those services, and to choose
between the options available within a
particular service, so as to provide assistance
and support that best meets their individual
(including cultural) needs;
Tasmania Disability
Services Act
(1992)
PART 2 - Funding of Services for Persons
with Disabilities, Schedule 3: 4. Services are
to be tailored to meet the individual needs
and goals of persons with disabilities.
Victoria Disability Act
(2006)
Division 3 — Planning 52 Guiding principles
for planning (2) Planning should—(a) be
individualised; (b) be directed by the person
with a disability; (j) facilitate tailored and
flexible responses to the individual goals and
needs of the person with a disability;
Western
Australia
Disability
Services Act
(1993)
Schedule 2; Objectives for Services and
Programmes: 4. Programmes and services
are to be tailored to meet the individual needs
and goals of the people with disabilities
receiving those programmes and services.
in Australian States and Territories (e.g. Disability Act (Victoria), 2006, Section
52). While PCP is legislated through all Disability Services Acts across

Australia today (see Table 1, above) how this planning is carried out, what it
means for the client and the service and how to achieve and evidence that
progress is being made are all fundamentally important issues disability
service providers must wrestle with in a service system ever more focused on
demonstrating outcomes for service users.
3. What are the features that have been identified in the literature that
are a) barriers to, or b) facilitators of Person Centred Planning?
a) Barriers to PCP
Despite the centrality of person centred individual planning in the principles
and values, legislation and ethos of funded disability services there are a
range of barriers reported in the adoption and take up of person centred
planning including lack of understanding of the process, insufficient process
ingredients, lack of funding, lack of commitment and lack of training
(Robertson et al, 2007).
Holburn & Vietze emphasise the fact that PCP should be a challenge to the
system as it is truly a harbinger of organisational change (1999) and for this
reason will be actively challenged, much like any organisational change
process is, by the existing power structures. Therefore PCP by it’s very
nature is a barrier to it’s own success.
“Ironically for Person Centred Planning to survive in an agency it
needs support from the very system it views as detrimental and
seeks to change.”
- Holburn & Vietze, 1999, p.118
Kinsela (2000) identified a range of key barriers in terms of the variety of
planning options and formats available and the individualised and complex
nature of person centred planning. He outlines a common error whereby
process becomes all important rather than actual outcomes for people
(Kinsella, 2000). This then is a key danger to consider when implementing

any new “framework” and should stand as a cautionary note to Life Without
Barriers and other agencies as he states, “Too often people never develop a
repertoire of planning techniques and so many organisations, in the pursuit
of standardisation, stick with one process” (p.5).
Team processes (or the lack of them) can be a barrier to PCP according to
Holburn & Vietze (1999). This is mentioned in relation to the link between
more traditionally formal clinical specializations that are important in
supporting many people with developmental disabilities and ensuring
interdisciplinary processes occur to enable teams to work together to
achieve common person centred goals. To many clinical specialists the
goals and planning methodologies of person centred planning can appear
naïve and / or unrealistic (Holburn & Vietze, 1999) and if these issues are
not explored then the very real risk comes into play of power struggles and
parallel planning processes eventuating. Also outlined in this paper is the
still very real issue (10 years later) of regulatory compliance with it’s focus
on health and safety (and paperwork). To then apply another layer of
planning, for which the parameters may not be clearly understood or
outlined, and hence difficult to regulate, over the top of these regulatory and
compliance issues means that often the clearer (if often largely
meaningless in terms of client outcomes) bureaucratic processes will
continue to take precedence.
The real and apparent inflexibility of the vast majority of funding
arrangements is also identified as a barrier to PCP in the literature (Holburn
& Vietze, 1999, CDDS, 2004). This is clearly an issue with confusion about
the way to realize dreams and goals when one seems tied to a particular
funding arrangement / service user outcome and it is easy for support
workers and clients “wouldn’t it be nice…” (person centred) ideas to be
dismissed by a few words of a (probably overworked and possibly unaware)
manager or simply through stalling silence or further even by offering a
limited, though seemingly rich variety, of choice, i.e. set parameters that

allow the service provider to tick off the outcomes as having been “provided”
to the funding body.
A study by Everson & Zhang (2000, cited in Robertson et al, 2007) identified a
number of common factors that inhibited person centred planning including:
• Behavioural problems for the focus person effectively limiting the
achievement of identified plan goals,
• Communication impairments and social skills deficits made it difficult to
determine wants and needs,
• Difficulty coordinating members of the persons support circle,
• Difficulty expanding the persons circle of support to include people
other than paid services,
• Difficulty engaging the persons peers, and
• Opposing views held by family members and service providers
(Everson & Zhang, 2000, cited in Robertson et al, 2007)
It also seems fair to say (from this authors perspective at least) that a
potential barrier to PCP is the very literature that aims to promote it. In many
ways the literature seems to be very focused on barriers and what is wrong
with the system. This is likely a necessary step in the evolution towards a
more person centred service system though it can be easy to read many of
these articles as a type of “holier than thou” one upmanship which can
become tiresome and may have the effect of turning people’s attitudes away
from these powerful approaches to working with people with disability and
actually divide teams. A positive strengths based approach focusing on the
facilitators to PCP would be far more conducive to supporting the changing
culture. Indeed it is in the way the information is presented – for each
barrier chosen is in fact a facilitator in disguise. Choose any of the Everson
& Zhang (2000) barriers listed above and you may find it surprisingly easy to
develop it’s positive alter ego.
“It is wise to direct your anger towards problems - not people; to
focus your energies on answers - not excuses.”
- William Arthur Ward

b) Facilitators of PCP
Interestingly, though logically, a recognition and regular discussion of the
barriers and uncertainties that become apparent when PCP is introduced has
been highlighted as an important strategy in a transition to a person centred
service (Holburn & Vietze, 1999). Holburn and Vietze (1999) also recommend
focusing on a small number of people with whom to implement PCP while at
the same time focusing on systemic changes to benefit all clients.
The importance of clear policy, and most importantly training and supervision
around PCP is strongly emphasised in the literature together with giving clear
expectations around processes and, particularly, outcomes (e.g. Lawlor &
York, 2007, Mansell and Beadle-Brown, 2004, Robertson, 2007(b), Wiese &
Parmenter, 2008).
The literature indicates a number of recurring themes in relation to ensuring
the effective implementation of person centred planning processes and these
may be considered “benchmarks” for good practice that may require further
exploration and research.
For example, Wiese and Parmenter (2008) note the fundamental importance
of training in person centred planning. Barbara McIntosh and Helen
Sanderson (in Institute for Health Research, 2005) emphasise the cultural
change process that is required of organizations for the successful
implementation of person centred planning.
The key role of the support facilitator (aka “Key Worker”) is emphasized and
requires in depth training and ongoing formal supports. The importance of the
role of the key worker or facilitator is critical to ensuring the plan is developed,
actions are taken and progress is monitored. This role is described as
“pivotal” (CCS Report, 2007).
The CCS report (2007) outlines the importance of spending time with and
simply getting to know the person as an important facilitator to PCP. In this

light, service user participation and involvement in the PCP process is noted
as a facilitator and Dowling and colleagues (2007) go on to emphasize the
importance of developing a “framework” to enable service users participation
to design their own services.
Wiese and Parmenter (2008) identify a series of key features or components
applying to a person centred approach to planning for people with disability
that should effectively be considered as facilitators to PCP processes:
• Involving a range of stakeholders,
• Ensuring stakeholders have a shared value base focused on
empowering the focus person,
• A team commitment,
• The presence of an action plan,
• Monitoring and evaluation of outcomes,
• Taking an ongoing approach to planning, and
• The non-compulsory nature of person centred planning.
Individualised service user control of funding is regarded by many as a means
of facilitating a more person centred approach to service delivery (e.g.
Mansell and Beadle-Brown, 2004). While this certainly rings very true to this
author (refer to discussion), there are those who are cautioning that a
wholesale and unplanned move to individualised funding may ultimately result
in less choice and service flexibility for service users in years to come (Baker,
2008) and these warnings must be closely explored.
4. Research: Focus on an Existing National Funded Disability Service
Provider
4.1 Individual Planning at Life Without Barriers
a) Overview of Life Without Barriers
Life Without Barriers (LWB) is a funded disability service provider providing a
range of support services to adults, children and young people with disabilities
and their families and carers across Australia. The agency prides itself on the

provision of “…innovative community based support for people with a
disability…”2
b) Organisational Individual Planning Framework
Recently organisational attention has been paid to the research, development
and roll out / implementation of the organizations “Person Centred Individual
Planning Framework”. This framework has the stated aims of providing
“…those supporting people with disability at Life Without Barriers with a robust
and comprehensive framework ensuring that people’s support needs are
being provided for at the same time as ensuring planning is person centred
and focused on the personal goals and aspirations of clients of the service.”3
The Individual Planning Framework essentially consists of the organizations
values, policy, processes and resources (Figure 1) all of which are designed
to support person centred planning at the agency. The processes and
resources that underpin the framework include those component parts
identified in the literature (e.g. Callicott, 2003) as necessary for PCP to be
conducted including an emphasis on time management, personal profiles,
listening to and understanding the person, arranging logistics of meetings,
developing future vision and a clear plan and evaluating ongoing
implementation of the plan etc.
Figure 1. Life Without Barriers Individual Planning Framework
2
Life Without Barriers, 2009 Annual Report, Introduction, p.3
3
IPF Framwork Overview, LIfe Without Barriers, 2009.

e) Person Centred Individual Planning Implementation Strategy
A range of training materials have been developed to assist in the
implementation (“roll out”) of the Individual Planning Framework to the
organization. A “peer based train the trainer” strategy has been adopted to
facilitate the take up of the approaches outlined in the framework at the
operational level and a trainers
pack has been developed (Figure
2). Expressions of Interest for peer
based trainers have resulted in 34
people being trained in the delivery
of the package and regional
training is now underway for
operational teams across the
country. Baseline measures using
internal audits have been
completed in relation to a number
of benchmark indicators to
determine the current quality of
Individual Plans and these will be
reviewed on an annual basis. Figure 2. LWB Individual Planning
Training Package
4.2 Research Methodology
In exploring potential barriers and facilitators in relation to the successful
uptake of Person Centred Planning at LWB the work of Robertson and
colleagues (2007(a) & 2007(b)) was reviewed and the range of issues that
both helped and hindered person centred planning were identified. These
“factors” identified in the Robertson studies related “…to the characteristics of
participants, contextual factors and the process of PCP” (Robertson et al,
2007(b) p.239) and formed the basis of a 67 item questionnaire.

a) Procedure – Questionnaire
Particpants were asked to complete a questionnaire (Attachment 1) consisting
of 67 items which were ranked according to a 5 point Likert scale in relation to
the perception the respondent had of the item’s impact on Person Centred
Planning in regards to whether they thought the item was:
1. Always a barrier
2. Can be a barrier
3. Has no impact,
4. Somewhat helpful
5. Very helpful,
to facilitating the processes of person centred planning.
Client respondents completed a modified 42-item version of the same
questionnaire written in a plain English format with the removal of repeated
items and a change of language in an effort to make the questions more
relevant and client focused (identifying Item numbers were not altered so
answers could be compared between clients and staff).
b) Subjects
i) Staff Respondents
34 respondents completed the questionnaire. All were members of staff. All
were being trained to roll out Individual Planning training to other staff in the
organization after they had expressed an interest in training other staff in the
new framework for Individual Planning at LWB4
. In other words all
respondents had demonstrated a prior interest in PCP as they had put
forward “expressions of interest” to become Person Centred Individual
Planning trainers in their region as part of a peer based, train the trainer, roll
out strategy. The mean period of engagement with LWB for the questionnaire
4
The following essential criteria were required to be fulfilled by IP trainers (i.e. survey
respondents): Quoted from the EOI that trainers responded to:
“IP trainers must be staff members of Life Without Barriers Disability Services who:
• Are passionate about working with clients to achieve quality outcomes,
• Possess a good working knowledge of disability legislation and policy,
• Are valued and credible team members who are respected by their colleagues.
• Are excellent communicators,
• Are people who enjoy sharing ideas with others and mentoring their colleagues,
• Have demonstrated experience in training and / or supervising groups / teams.”

respondents was 16 months with the period of time spent working at the
agency ranging from 2 months up to the longest serving respondent who had
worked at LWB for 6.5 years. Respondents filled a range of positions and
included titles such as Team Leader, Disability Support Coordinator,
Operations Manager and Learning and Development Officer. Respondents
came from around the country from a range of urban and regional locations
(for an overview see Table 2 below).
Table 2. Questionnaire Staff Respondent (N=34) Origin.
State / Territory Capital City Regional
Australian Capital Territory 0 0
New South Wales 2 10
Northern Territory 1 1
Queensland 3 8
South Australia 2 1
Tasmania 0 1
Victoria 1 1
Western Australia 3 0
TOTALS 12 22
ii) Client Respondents
A focus group for clients accessing Life Without Barriers community based
day services in Newcastle NSW was facilitated by the author to gain feedback
from service users about their perceptions of the barriers and facilitators to
person centred planning. A small group of 5 service users reviewed a revised
list of 42 of the items in the questionnaire with support from the author.
4 of the 5 respondents displayed a high level of awareness of the purpose of
person centred planning through their responses to the author’s question
“What do you think person centred planning is all about?” at the beginning of
the session with statements including:
• “This is your goals”

• “Self-improvement”
• “Long-term goals” and
• “Goals and how to make them possible.”
d) Results: Summary of questionnaire responses
A statistical review of the responses was conducted to identify the mean
scores for each of the items. This allowed the responses to be ranked
according to the mean scores and then the items that were scored at 2.0 or
below listed as “Key Barriers” and 4.0 or above as “Key Facilitators” to person
centred planning. These results are illustrated in the following four tables
outlining key barriers (tables 3 & 4) and key facilitators (tables 5 & 6). Tables
3 and 5 indicate results from staff respondents (N=34) and tables 4 and 6 are
from client respondents (N=5). Ranking of the mean responses in this way
gives an indication of the items that staff and clients perceived to be key
barriers and key facilitators of person centred planning.
Table 3. Summary of items Identified by staff (N=34) as Being Key Barriers to PCP
in Survey Questionnaire in Descending Order (i.e. the strongest barrier is listed first)
with Mean Score on Likert Scale
Factors Identified by Staff as a Being a Key Barrier to PCP Mean Score
12.
41.
56.
48.
33.
43.
49.
62.
40.
The IP facilitator is hostile to PCP*
Staffing issues, e.g. staff shortages*
Inaction, nothing happens*
Lack of knowledge and understanding of PCP*
High support worker turnover
Participant reluctance to engage in process*
Family attitudes or disinterest*
Lack of staff skills and knowledge*
Time management issues*
1.1
1.6
1.6
1.6
1.7
1.9
1.9
1.9
2.0
* These factors were also identified by clients as key barriers.

Table 4. Summary of Items Identified by clients (N=5) as Being Key Barriers to PCP
in Survey Questionnaire in Descending Order (i.e. the strongest barrier is listed first)
with Mean Score on Likert Scale
Factors Identified by Clients as a Being a Key Barrier to PCP Mean Score
12.
58.
50.
41.
66.
62.
56.
40.
39.
44.
52.
51.
49.
48.
43.
Support worker is hostile to Individual Planning*
Transport issues
Health issues
Not enough staff*
Risk issues
Lack of staff skills and knowledge*
Inaction, nothing happens*
Not enough time (time management issues)*
Not enough choice (rigid routines)
Lack of money
Negative management attitudes
Negative support worker attitudes
Poor family attitudes or disinterest*
Not knowing about or understanding PCP*
Not wanting to engage in planning*
1.0
1.0
1.0
1.3
1.5
1.5
1.5
1.5
1.5
1.7
2.0
2.0
2.0
2.0
2.0
* These factors were also identified by staff as key barriers.
Table 5. Summary of Items Identified by staff (N=34) as Being “Key Facilitators”
(Helpful) to PCP in Survey Questionnaire in Descending Order (i.e. strongest
facilitator is listed first) with Mean Score on Likert Scale
Factor Identified by Staff as Being Key Facilitators to PCP Mean Score
31.
20.
36.
1.
37.
35.
32.
38.
30.
2.
Clear procedures are available for individual planning*
The client makes his/her own decisions*
There are high levels of service user involvement*
IP facilitators have a high personal commitment to PCP*
Clear procedures for assessment
There is regular support worker training*
Clear procedures for activity planning*
Clear procedures for teaching
Support workers provide active support to clients*
The client has a key worker*
4.9
4.8
4.8
4.8
4.7
4.7
4.7
4.7
4.6
4.4

21.
23.
6.
29.
45.
The client has a large network of unpaid supports*
The client has a large social network*
The IP facilitator has lots of contact with the client*
Clear procedures for support to clients
Developing circle of support and involving others*
4.4
4.4
4.4
4.3
4.0
* These factors were also identified by clients as key facilitators.
Table 6. Summary of Items Identified by clients (N=5) as Being “Key Facilitators”
(Helpful) to PCP in Survey Questionnaire in Descending Order (i.e. strongest
facilitator is listed first) with Mean Score on Likert Scale
Factor Identified by Clients as Being Key Facilitators to PCP Mean Score
27.
36.
1.
20.
32.
2.
21.
60.
48.
30.
45.
46.
31.
23.
6.
35.
Having lots of staff
Being involved in the planning as a client*
Staff and Key Workers have a high commitment to PCP*
Being able to make your own decisions*
Clear procedures for activity planning*
Having a key worker*
Having a big network of support*
Communication between services
Knowing the planning process
Receiving active support from staff*
Developing circle of support and involving others*
Participant communication and understanding
Having clear steps for individual planning*
Having a big social network*
Lots of contact with the key worker*
Regular support worker training*
5.0
4.8
4.8
4.8
4.8
4.6
4.6
4.5
4.5
4.4
4.3
4.3
4.3
4.3
4.0
4.0
* These factors were also identified by staff as key facilitators.
As can be seen from the tables there is a good degree of agreement between
both clients and staff (items marked with an asterisk (*) in the tables are
identified by both groups) that a range of factors can have a significant impact
on person centred planning and this is discussed further in the next section.

5. Discussion and Conclusions
As per the findings of Robertson and her colleagues the questionnaire
conducted as part of this inquiry topic and based on her work identified that
there are factors “relating to the characteristics of participants, contextual
factors and the process of PCP” (Robertson et al, 2007(b) p.239) that act as
either barriers or facilitators to realizing person centred planning.
It would seem the approach taken to the development and implementation of
the “Individual Planning Framework” by Life Without Barriers as outlined
briefly in this paper appears sound in it’s approach in terms of current
Australian standards to PCP for funded disability services and in taking a
planned approach based on research and recognised best practice as it aims
to ensure the following areas are addressed as per the literature’s
recommendations:
• A recognition and discussion of the barriers and uncertainties
associated with the introduction of PCP.
• A focus on systemic changes to benefit all clients.
• Training (training and more training).
• Development of clear policy to support PCP processes.
• Introduction of the “key worker” role across the agency.
• Enhanced service user participation and involvement through the
development of user friendly forms, templates and checklists and the
emphasis in the training package on “Client Friendly” approaches to
planning.
• Incorporating the views and inputs of a range of stakeholders
• An emphasis on processes that empower the client,
• Team commitment,
• The presence of an action plan, with built in timeframes for monitoring
and evaluation of outcomes.
Also procedurally there are a number of key procedural facilitators as
identified by staff and clients in the questionnaire as being key facilitators that
the framework ensures are addressed including:
• Clear procedures are available for individual planning

• There are high levels of service user involvement
• Clear procedures for assessment
• Clear procedures for activity planning
• Clear procedures for teaching
• The client has a key worker
• Clear procedures for support to clients
It is worth noting this paper has identified the following barriers that may
cause problems as they have not been fully accounted for:
• Trying to roll out PCP to all clients across all service types may simply
be too much to ask and a more focused group may have been
beneficial to success.
• It may be interpreted in some quarters that PCP is compulsory for all
clients following the same process, tools and templates within the
trainers pack.
The implementation effectively utilises what amounts to an A-B-A research
design to monitor the impacts of implementing the new framework across the
organization. It is also worth noting that where training does not go ahead (as
the author anticipates it may not in some regions due to, for example, natural
staff attrition - one of the 34 trainers has already resigned) it may be possible
to consider these areas as random “controls” in the review of follow up data
collection at the 12 month mark to determine effectiveness of the framework
and the implementation strategy in terms of outcomes for clients.
It is worth noting that in this and other research (e.g. Everson & Zhang, 2000)
barriers and facilitators are often identified as being located within the focus
person or their direct supports (e.g. in this study both “Participant reluctance
to engage in process” and “Family attitudes or disinterest” were key barriers
while “The client makes his/her own decisions” was a key facilitator). When
one considers that PCP is implemented by providers within the disability
sector to meet people with disabilities support requirements it almost seems
disingenuous to then proceed to identify those support needs or a person’s
characteristics as a barrier to PCP. Without individual support needs due to

disability and impairment the funded services would not exist therefore to
suggest that the person is a barrier to PCP seems very odd though these
findings are fairly consistent (e.g. Robertson et al, 2007(a)). While the
application of PCP is not limited to the disability sector it’s use is legislated
within this sector. This may underscore a deeper lack of understanding about
what PCP is as the process was initially envisaged and designed exactly for
people with severe disabilities (e.g. Mount & Zwernick, 1988) and in many
ways the more severe the impairment of functioning the more applicable and
appropriate PCP actually is.
The identification of the influence of attitudinal barriers to person centred
services is clear in the results of the questionnaire with 33% of the key client
and staff barriers being in relation to attitudinal items on the part of staff,
family or service users themselves. Responses identifying attitudinal issues
leads one to question whether there is a fundamental systemic issue at play
that needs to be addressed – where is this “attitude” coming from? It appears
that with regards to funded services in Australia today that the service user is
not automatically treated with the respect they deserve as an automatic
response from service providers and that this can be “the luck of the draw” for
clients and families accessing funded services. In any other business model if
the service recipient (customer) were so disregarded then the model would
surely collapse. If so much of the formula for success rests on the attitude of
staff and managers and people need absolute procedural clarity before they
can effectively implement person centred planning then it would seem there is
a significant problem. It is worth exploring whether there is the need for a
more fundamental shift towards a more customer service oriented approach
to the delivery of funded services. Presently it is fair to say that funded
disability services in Australia treat their government provider/s of funds as the
customer (as indeed they effectively are) yet this leaves much to chance in
terms of quality services for the true end user, the client receiving operational
support. If a client accessing services in 2009 comes into an agency where
person centred services have become the core way of doing business,
building services one person at a time, then they have got lucky however too
often this is not the case. As Kinsela so aptly put it “Those who pay do not

feel the pain of poor decisions and, thus, make the same mistakes
repeatedly” (2000, p.10) in his reference to this fundamental flaw of having
the provider of funds so clearly perceived by services providers as the actual
customer.
The feedback about the importance of networks of support for clients as
indicated by both clients and staff in their responses to the questionnaire
administered in this study are consistent with other research findings (e.g.
Robertson et al, 2007(a)) and this must continue to be a focus of PCP.
While PCP has become a part of the mainstream disability lingo it is still the
case that planning is often driven by services and systems more than by
people for whom the services have been created. The development of this
paper will provide a range of useful strategies to continue to strongly drive
service delivery at Life Without Barriers, a large non government provider, in a
person centred direction. It is clear that there is truth in Robertson’s
observation, “Services need to be aware of the potential problems that PCP
may come across so that strategies can be developed to overcome them.”
(Robertson et al, 2007 (a), p. 305)
* * * * * * * * * *

References
Baker, K. (2008). Individualised funding: What it requires to work. National
Disability Services.
Callicott, K.J. (2003). Culturally sensitive collaboration within person-
centered planning. Focus on Autism and Other Developmental
Disabilities, 18, pp. 60 – 68.
CCS Disability Action (2007). Inquiry into the Quality and Care of Services
Provision for Disabled People: Submission with Recommendations.
New Zealand.
Centre for Developmental Disability Studies (2004). Client participation in the
Individual Planning Process. Prepared for the NSW Department of
Ageing, Disability and Home Care by the Centre for Developmental
Disability Studies, August 2004.
Dowling, S., Manthorpe, J. & Cowley, S. (2007). Working on person-centred
planning: From amber to green light? Journal of Intellectual Disabilities,
Vol.11(1), pp.65-82.
Holburn, S. & Vietze, P. (1999). Acknowledging barriers in adopting person
centred planning. Mental Retardation, Vol. 37, No. 2 April 1999, pp,
117-124.
Holburn, S., Jacobson, J.W., Schwartz, A.A., Flory, M.J, Vietze, P.M. (2004).
The Willowbrook Futures Project: A Longitudinal Analysis of Person-
Centred Planning. American Journal on Mental Retardation, Vol. 109
(1) pp. 63-76
Kinsela, P. (2000). What are the barriers in relation to person centred
planning? Report: The Joseph Rowntree Foundation.
Lawlor, D. & York, M. (2007). Assessing goal attainment for quality

improvement. Journal of Intellectual Disabilities, 11, (3), pp.241 – 255.
Mansell, J. & Beadle – Brown, J. (2004). Person centred planning or person
centred action? Policy and practice in intellectual disability services.
Journal of Applied Research in Intellectual Disabilities, 17, pp. 1-9.
Mount, B. (1998). More than a meeting: Benefits and limitations of personal
futures planning. In J.O’Brien & C.Lyle O’Brien (Ed’s), A Little Book
About Person Centred Planning (pp.55-68). Toronto: Inclusion Press.
Mount, B., & Zwernick, K. (1988). It’s never too early, it’s never too late: A
booklet about personal futures planning (Pub. No. 421- 88-109). St.
Paul, MN: Metropolitan Council.
O’Brien, J. (1987). A guide to life-style planning: Using the Activities
Catalogue to Integrate Services and Natural Supports Systems. In G.T.
Bellamy & B. Wilcox (Eds.), A comprehensive guide to the Activities
Catalogue: An alternative curriculum for youth and adults with severe
disabilities (pp. 175-189). Baltimore: Brookes.
O` Brien J. & Lovett H. (1992). Finding a way to everyday lives: the
contribution of person centred planning. Harrisburg, PA: Pennsylvania
Office of Mental Retardation. (from the Research and Training Center
on Community Living, Center on Human Policy, Syracuse University).
Robertson J., Emerson E., Hatton C., Elliott J., McIntosh B., Swift P., Krinjen-
Kemp E., Towers C., Romeo R., Knapp M., Sanderson H., Routledge
M., Oakes P. & Joyce T. (2005). The Impact of Person Centred
Planning. Institute for Health Research, Lancaster University,
Lancaster.
Robertson, J., Emerson, E., Hatton, C., Elliott, J., McIntosh, B., Swift, P.,
Krinjen-Kemp, E., Towers, C., Romeo, R. Knapp, M., Sanderson, H.,
Routledge, M., Oakes, P. & Joyce, T. (2006). Longitudinal analysis of

the impact and cost of person-centred planning for people with
intellectual disabilities in England. American Journal on Mental
Retardation, Vol. 111, No. 6, Nov. 2006, pp. 400-416.
Krinjen-Kemp, E., Towers, C., Romeo, R. Knapp, M., Sanderson, H.,
Routledge, M., Oakes, P. & Joyce, T. (2007(a)). Reported barriers to
the implementation of person-centred planning for people with
intellectual disabilities in the UK. Journal of Applied Research in
Intellectual Disabilities 2007, 20, pp. 297–307
Robertson, J., Emerson, E., Hatton, C., Elliott, J. McIntosh, B., Swift, P.,
Krinjen-Kemp, E., Towers, C., Romeo, R., Knapp, M., Sanderson, H.,
Routledge, M., Oakes, P. & T. Joyce, T. (2007(b)). Person-centred
planning: factors associated with successful outcomes for people with
intellectual disabilities. Journal of Intellectual Disability Research, 51
(3), pp. 232 – 243.
Thompson J., Kilbane J. & Sanderson H. (2008) Person Centred Practice for
Professionals. Open University Press.
Wiese, M. & Parmenter, T. (2008). Contemporary approaches to case
management: Supporting people with a developmental disability. In E.
Moore (Ed.), Case management for community practice: A textbook for
students and practitioners (Chapter 9). Oxford, UK: Oxford University
Press.

ATTACHMENT 1. Questionnaire
Factors Impacting on Person Centred Individual Planning
Questionnaire
Date: __________________
Name: __________________
Role:
1. Direct Support Professional
2. Coordination &/or Management
3. Family Member
4. Client
5. Other (describe): ____________
Engagement / Relationship to Life Without Barriers:
1. Employee
2. Contractor
3. Volunteer
4. Family Member
5. Client
6. Other (describe): _____________
Service Type in which you work / you access (N.B. complete one
questionnaire for each service type):
1. Supported Accommodation
2. Community Living / Drop In Support
3. Attendant Care
4. Respite
5. Alternative Family Care Services
6. Community Access and Participation Services
7. Employment Support Services
8. Clinical Services
9. Case Management
10.Other (describe): ___________

Length of involvement with Life Without Barriers:
______ Years, _______ Months
1. Key Features of Individual Person Centred Planning
1. Please describe what you consider to be the key / important features of
individual person centred planning:
2. Does Life Without Barriers do Individual Person Centred Planning?
a) Do you feel the Life Without Barriers service within which you work or have
involvement presently conduct individual person centred planning for service
participants as you have described it here?
1 2 3 4 5
Never Rarely Sometimes Usually Always
b) Comments:

3. Factors that Help and Hinder Person Centred Individual Planning
For each of the items indicated below rate each one with a score of 1 to 5 (as
per the scale below) for how important you feel it is in terms of being a barrier
to or beig helpful to the development of individual person centred plans for
clients in the service in which you work:
Scoring Scale:
1 2 3 4 5
Always a
Barrier
Can be a
Barrier
No Impact on
IPCP
Somewhat
Helpful
Very Helpful
Item Score (circle one)
1. IP facilitators have a high personal commitment to
IPCP
2. The client has a key worker
3. The client has been with Life Without Barriers for a
long time (12 months+)
4. The client has few health problems
5. The client already has a current IP
6. The IP facilitator has lots of contact with the client
7. The IP facilitator provides direct support to the
client
8. Direct support to is provided by contracted support
workers
9. Direct support is provided by employed support
workers
10.The client has autism
11.The client has challenging behaviour
12.The IP facilitator is hostile to PCP
13.The client has active mental health issues
14.The client has emotional issues
15.The client currently lives in a large congregate
care facility
16.The client formerly lived in a large congregate care
facility
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5

17.The client has no known psychiatric disorders
18.The client lives near to family
19.The client has lots of contact with family
20.The client makes his/her own decisions
21.The client has a large network of unpaid supports
22.The client has a guardian appointed for decision-
making
23.The client has a large social network
24.The client has impaired mobility
25.The client is non verbal
26.The client uses alternative communication to
speech
27.Support worker to client ratios are 1:2 or less
28.Support worker to client ratios of 1:3 or more
29.Clear procedures for support worker support of
clients
30.Support workers provide active support to clients
31.Clear procedures are available for individual
planning
32.Clear procedures for activity planning
33.High support worker turnover
34.The client is new to the service
35.There is regular support worker training
36.There are high levels of service user involvement
37.Clear procedures for assessment
38.Clear procedures for teaching
39.Rigid routines or activities
40.Time management issues
41.Staffing issues, e.g. staff shortages
42.Arranging planning meetings
43.Participant reluctance to engage in process
44.Money
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5

45.Developing circle of support and involving others
46.Participant communication and understanding
47.Ability to access activities and services
48.Lack of knowledge and understanding of PCP
49.Family attitudes or disinterest
50.Participant health issues
51.Support worker attitudes
52.Management attitudes
53.Getting others to share workload
54.Systemic issues, please name them:
________________________________________
55. Participant behaviour
56.Inaction, nothing happens
57.Support worker turnover
58.Transport issues
59.Resource issues, please name them:
________________________________________
60.Communication between services
61.Participant mobility and access issues
62.Lack of staff skills and knowledge
63.Goal issues, e.g. unrealistic, difficult to meet
64.Linking different planning systems
65. Lack of social work, care manager, or social
services input
66. Risk issues
67. Other issues, please name them:
________________________________________
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
Further Comments (feel free to attach a separate piece of paper):

Thankyou for taking the time to complete this questionnaire
Your responses are confidential
Table from Robertson et al (2007), p.236 & Robertson et al (2007), p.305
Krinjen-Kemp, E., Towers, C., Romeo, R., Knapp, M., Sanderson, H.,
Routledge, M., Oakes, P. & Joyce, T. (2007). Person-centred
planning: factors associated with successful outcomes for people with
intellectual disabilities. Journal of Intellectual Disability Research, 51
(3), pp. 232 – 243.

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