PERSON-CENTERED PLANNING: BASIC CONCEPTS

LEARNING OBJECTIVESAt the end of this training, you will be able to:• Identify the policy and regulatory context of Person-Centered

Planning.• Define Person-Centered Planning.• State why Person-Centered Planning is effective.• Highlight the benefits of Person-Centered Planning.• Understand the key concepts of Person-Centered Planning.

POLICY AND REGULATORY

CONTEXT

Code of Federal Regulations [42 CFR §441.301, et seq.]• State Medicaid Agencies must ensure must that Medicaid

home and community-based services (HCBS) are delivered under a written service plan that is based upon a person-centered approach and is subject to approval by the State Medicaid Agency.

• Among other requirements, the service plan must reflect the services and supports that are important for the participant to meet the needs identified through an assessment of functional need, as well as what is important to the participant with regard to preferences for the delivery of such services and supports.

• The participant must be supported to direct the person-centered planning process to the maximum extent possible.

PERSON-CENTERED PHILOSOPHY• What is Person-Centered philosophy?

- "As no one else can know how we perceive, we are the best experts on ourselves" (Rogers, 1956).

- People are inherently good, resourceful, and are oriented toward growth.

- To grow as individuals, people require an environment that provides them genuineness (openness and self-disclosure), acceptance (being seen with unconditional positive regard), and empathy (being listened to and understood).

Carl Rogers (1902- 1987)

WHAT IS PERSON-CENTERED PLANNING?

An approach to service planning which provides program participants with the authority to exert control over his/her services, supports, and other life circumstances to the greatest extent possible.

The person-centered planning approach recognizes that participants are not merely passive recipients of care, but they are individuals who can best determine what it means to be well and what is needed to achieve wellness.

Person-centered planning recognizes that people receiving services are the primary experts in their own goals and needs.

PERSON-CENTERED VALUES: COLLABORATION (VS CONFRONTATION)

• Person-centered planning contrasts with traditional approaches to service planning, which are based on the case manager assuming an “expert” role. At times, the traditional approach prioritizes the case manager’s values and objectives over the participant’s goals and perspective.

• The case manager views his/her relationship with participants as a collaborative partnership grounded in the point of view and experiences of the participant.

• Collaboration helps in building rapport and trust with the participant. This collaborative approach offers participants an experience of being an equal partner in the decision-making process. It does not mean that case manager must agree with everything that the participant wants. Case managers discuss and evaluate benefits of granting a participant's "wants" vs. risks involved. If case managers are unable to support a participant’s "wants", they assist he participant in exploring alternatives.

PERSON-CENTERED VALUES:EVOCATION (VS. IMPOSITION)• Evocation means to draw out a participant’s

perceptions, goals, and values. The case manager starts with the assumption that the participants are resourceful in terms of making decisions for themselves.

• A key value of the person-centered approach is that the case manager draws out a participant’s thoughts and ideas, rather than imposing his/her own opinions.

• To understand participants’ perceptions, goals, and values, case managers exhibit curiosity and patience while interacting with participants. The case manager uses open-ended questions to encourage participants to talk about their experiences.

• Evocation not only helps case managers to gain more understanding of the participant, but also helps participant leads the decision-making process.

PERSON-CENTERED VALUES: AUTONOMY (VS. AUTHORITY)• Person-centered planning values and maximizes

participant autonomy. This means that case managers demonstrate respect for the participants, for their resourcefulness, and their ability to make choices. Person-centered planning requires case managers respect the participant's autonomy by providing the information needed to understand the potential risks and benefits of all reasonable service alternatives.

PERSON-CENTERED VALUES : COMPASSION [VS. DISTANCE]• In the context of person-centered planning,

compassion refers to the ability to actively promote the other’s welfare and give priority to the other’s needs. It is a commitment to seek to understand others' experiences, values, and motivations without engaging in explicit or implicit judgment.

• Case managers with a compassionate stance demonstrate an understanding that everyone strives towards a fulfilling life and at times encounters barriers which can evoke feelings of sadness, pain, and shame. Compassion is acceptance of one's path and choices, and respect for the difficult emotions that a person may experience along the way.

PERSON-CENTERED ATTITUDES

AN OPENNESS TO BEING GUIDED BY THE

PARTICIPANT

A COMMITMENT TO UNDERSTAND THE

PARTICIPANT

A CONSCIOUS RESOLVE TO BE OF

GENUINE HELP TO THE PARTICIPANT

FLEXIBILITY, CREATIVITY, AND

OPENNESS TO TRYING WHAT MIGHT BE

POSSIBLE

A WILLINGNESS TO STRUGGLE FOR

DIFFICULT GOALS

A WILLINGNESS TO ENHANCE THE HUMANITY AND DIGNITY OF THE

PARTICIPANT

TO LOOK FOR THE GOOD IN PEOPLE AND HELP TO BRING IT OUT

EFFECTIVE COMMUNICATION: THE FOUNDATION OF PERSON-CENTERED PLANNING • Express Empathy

- The state of empathy, or being empathic, refers to one’s ability to understand thoughts, feelings, emotions, and experiences of another person. In otherwords, putting oneself in another’s shoes and understanding what it means to be that person.

- Case managers show empathy toward their participants when discussing behaviors, thoughts, feelings, and life events of participants. Empathy helps case managers to build rapport and trust with participants which, in turn, helps participants to become more open and share personal history, struggles, and concerns. Active listening and reflection on part of the case managers are important for accurate empathy.

EMPATHY: WHY IS IT IMPORTANT?

• Empathy helps the participant feel valued, cared for, and accepted as a person.

• Empathy helps participants take a prizing and caring attitude toward themselves.

• An empathic climate created by case managers makes it possible for the participant to listen to his/her own experiences and share with the case manager without having the fear of being judged.

• Empathy dissolves any feelings of alienation.

EFFECTIVE COMMUNICATION: THE FOUNDATION OF PERSON-CENTERED PLANNING (Continued)• Autonomy

– Expressing respect for participants’ autonomy means acknowledging that participants who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict the case manager’s recommendation.

• Self-Efficacy– Self-efficacy in person-centered planning

refers to participants' belief in their capability to manage the events that affect their lives. Case managers' expression of empathy and autonomy toward participants enhances self-efficacy of participants.

WHAT PERSON-CENTERED PLANNING IS NOT• Remember, person-centered planning is less about

learning a technique. It is more about a compassionate way of being with participants to empower them in making decisions for themselves.

• Participants are not passive in the planning process.

• Person-centered planning should not be guided by the case manager but by the participant.

• Person-centered planning is not about a power hierarchy where case managers are placed above the participants. Person-centered planning is based on egalitarian principles.

BENEFITS OF PERSON-CENTERED APPROACH

• A better relationship with the participant• An increase in medication adherence• Improved management of healthcare

conditions• Better health outcomes• Increased participant satisfaction with

healthcare services• Improved participant self-perceptions, reduced

stress, and increased empowerment

COMMUNITY MEMBERSHIP AND INCLUSION• Community inclusion means:

– The participant is supported to achieve self-determined goals to be an active member of the community.

– The participant maintains authentic community relationships.

– The participant has the opportunity to choose from multiple experiences and community events.

– The participant is recognized for his/her strengths and has the opportunity to learn new things.

– The participant is seen as a person and is valued by others.

– The participant has a sense of belongingness.

KEY POINTS FOR CASE MANAGERS TO REMEMBER

• Promoting community inclusion among participants should be based on participant needs, specific skills, and desired life. Case managers can use these questions to understand the participant's needs:- What are the interests of the participant?- What are the strengths of the participant?- What are the goals and aspirations of the participant?- What are the priorities of the participant for the next few years?- What are the individual support needs of the participant?- What are the ideas of the participant regarding community life? - What does an ideal community life look like for the participant?- What places in the community does the participant want to access?- What supports or resources are available in the community?- What resources in the community will help the participant meet his/her needs?

A CASE EXAMPLERebecca is a 30 year-old woman who lives in Laramie. She recently joined a case management organization as a case manager. Rebecca comes from a family background where competition and hard work are highly valued. Her father often told her that feeling emotional is a sign of weakness; and empathy and compassion are better to be avoided as it shows that one is not striving enough to achieve success. As a new employee, Rebecca is confident that she would solve participants' problems with her knowledge of Medicaid.As a case manager, her first participant is Suzie, a 75 year-old widow, who lives in a small rural town in Wyoming. Suzie has mild cognitive impairment and mobility issues. Suzie is eligible for the Community Choices Waiver.In the first meeting at the participant's home, Rebecca came straight to the point and asked Suzie, "What support do you need?" Suzie replied that she is “getting by alright.” Suzie reported that she no longer drives, which makes her situation more complicated. To this, Rebecca took out a sheet of paper that had a list of all the available resources in her county. Rebecca gave that paper to Suzie and asked her to choose whatever she needed.During this whole conversation, Rebecca was focused on solving the problems that Suzie reported. Also, Rebecca spoke most of the time explaining what she thought would be best for Suzie. At one time during the conversation, when Suzie became emotional with moist eyes while talking about her difficulty in walking, Rebecca interjected saying that it is part of growing old and Suzie can use the services that would solve her problems.

Q. From a person-centered planning perspective, what things did you notice in Rebecca’s approach toward Suzie?

SUMMARYWe discussed: • Policy and regulatory context of person-centered planning• Person-centered planning• Why person-centered planning is effective• The benefits of person-centered planning• The key concepts of person-centered planning

REFLECTIONSPlease answer the following questions:

1. What are three important concepts you learned and why are they important to your role?

2. In your role, name one thing you will do differently as a result of participating in this module?