Adult placements and person-centred approaches
Standard 1.1 states that the adult placement should support the person to live independently, to express their views, and to make choices and decisions, with assistance as needed.
- schemes highlighted that adult placement is founded on the relationship between the service user and adult placement carer, and that carers' attitudes and values are the key to person-centred practice.
- schemes said that adult placement carers are given clear expectations of their role at recruitment, and sign up to a way of working that focuses on the individual.
- 'valuing people'(4), with its promotion of person-centred placements, has brought these issues more to the forefront of people's minds. One carer in the practice survey said, 'It makes you think, not make assumptions'.
- formal person-centred planning did not have a high profile in any of the four schemes visited in the practice survey, and yet the service users visited described the experience of living in an adult placement in a way consistent with being person-centred.
- although the adult placement carers were working in a person-centred way, good practice was not being achieved through schemes' use of formal person-centred planning systems (nor always through rigorously applied adult placement processes).
- adult placement workers, adult placement carers, or service users rarely used the term 'person-centred'.
- staff in some of the schemes visited believed they had been developing person-centred working for some time, and that they were trailblazing rather than following person-centred planning trends.
- one scheme had produced draft proposals to achieve a more person-centred approach.
- several adult placement workers had trained as person-centred planning facilitators, and several adult placement carers and service users in another scheme were involved in a local authority person-centred planning pilot, but both these projects were peripheral to scheme operations.
Given that adult placement is valued for its focus on individual need, it is perhaps surprising that the literature search did not produce any specific studies of person-centred planning or approaches in adult placement services.
There is much literature available on person-centred planning, promoting the benefits to service users and explaining how it should be done.
As indicated in the introduction to this guide, person-centred planning, as defined in ' Valuing people'(4), 'is a process for continual listening and learning, focusing on what is important to someone now and in the future, and acting upon this in alliance with their family and friends.'
The challenge of person-centred planning for adult placement practice
The national minimum standards for adult placement schemes are explicit in focusing on the individual. They state that regulators should look for evidence of positive outcomes for individuals, including active participation, consistent with principles of rights, independence, choice and inclusion. This should include evidence of meeting the service users' assessed and changing needs, and requires local authorities to be person-centred rather than service-centred.
The model of adult placement places some curbs on the idea of pursuing an individual's 'dream' or supporting the person to do what they want, putting it at odds with the principles of person-centred planning. It can be extremely difficult to get the balance right for everyone, as in reality anyone living in a family must respect family members and family rules. This may involve limitations on an 'ideal' lifestyle.
Yet, the practice survey did find evidence that person-centred planning was happening. It was not referred to explicitly, but was an informal version that had proved to be effective.
There is a wealth of material available to improve and develop knowledge and skills in this area, and the opportunity to make a real difference. If it does not happen, some service users will miss out and not receive the support that they need to fulfil their dreams.
'Person-centred planning is likely to lead to families working as partners with professional staff and the person to plan and provide support...It includes families in developing a shared understanding of what matters most to the person and in planning and providing support'. (25)
The challenge of person-centred planning for local authorities
The implications for local authorities are fundamental. The implications are for commissioners, planners, and providers of services alike. It is not adequate for one part of the organisation to make changes: person-centred planning must be supported throughout. This is service provision that requires investment. Failure to resource person-centred planning adequately will result in lots of plans, but few people having different lives.
According to Sanderson et al(25), person-centred planning requires:
- a change in the relationship between paid staff and the people they are paid to serve
- a change in the content of the work; more time will be spent on helping people make connections in the community
- a change in the relationship with the employing organisation: staff will work with more autonomy and more flexibility, and they will be recruited, supported and directed in different ways.
One Brent carer and participant in the local authority's person-centred planning pilot said person-centred planning is 'a great guide-you have to listen, write it down, talk to [the person]'.
In the case of adult placement, local authorities need to recognise that lack of ongoing care-manager involvement can result in practice that impedes person-centred approaches. Local authorities will need to balance limited resources against the practice implications of ending active care-management involvement in adult placements.
Approaches to person-centred planning
There is no single 'best' way of doing person-centred planning; a number of different 'brands' or styles of person-centred planning are marketed. Schemes may wish to think about:
Essential lifestyle planning (ELP): essential lifestyle planning is a tool that lets you know how someone wants to live and shows you how they would like it to happen through an extremely detailed action plan
ELP lets you discover what is important to service users, what support they need (from their perspective) to remain healthy and safe. A good plan reflects the perceptions of the service user and those who love and care for that person. Essential lifestyle plans look at:
- what people like and admire about service users
- what is important to service users
- how to provide support
- identification of successful methods
- how to solve problems.
ELP is a good way of starting to get to know someone, and work out what is needed on a day-to-day basis. It does not focus on 'dreams' unlike some of the other methods.
Personal futures planning: this is similar to essential lifestyle planning, and includes access to community resources. It is a way of describing life now and looking at what the person wants in the future. It provides more of an overview than the detail of some of the other approaches.
MAPS: this is similar to PATH, below, in that it focuses on desirable futures or dreams, and how service users might try to achieve these. It covers people's history and identifies their gifts.
PATH: PATH stands for Planning Alternate Tomorrows with Hope. This is a fast-moving tool that can be quite graphic and powerful. It pays most attention to the process of change, and helps a group of people who are committed to the service user to understand the plan and how it will progress. This is not so much about gathering information, but planning action. It focuses on the 'dream' and works its way back from there, mapping actions required along the way.
Individual service design: this aims to gain a greater understanding of service users by seeing the past through their eyes. From this it is possible to identify how services need to be designed.
Circles of support: a circle of support is a group of people who meet to help someone along the path to their hopes and dreams: a support network. The focus person asks the support group to help them to leap over barriers that they might come across. The support group also helps the person by opening new doors to opportunities and experiences.
Several organisations have developed expertise in this area and you may want to check the following websites:
You may also wish to consider some of the person-centred-planning training programmes on offer. For examples you can go to: