Person-centred Planning - Limitations

Limitations

Many of the limitations discussed below reflect challenges and limitations in the implementation of Person-Centered Planning approaches in the context of formal human service systems.

Another approach to this question is to envision Person-Centered Planning as an approach that is anchored in the person's natural community and personal relationship network. In this view, the Person-Centered Plan (PCP) offers a platform for the person and their trusted allies to identify and express their vision and commitments without limiting that expression to what can or will be provided by the service system.

Some time later, the formal system can develop a plan for service delivery that may be based on and consistent with the person's plan, that recognizes and supports the contributions of the person, family and community, and that clearly acknowledges the limitations of what the system is prepared to provide.

John O'Brien sums up the problem of trying to deliver person centredness through formal service systems that have a very different culture thus:

Many human service settings are zones of compliance in which relationships are subordinated to and constrained by complex and detailed rules. In those environments, unless staff commit themselves to be people's allies and treat the rules and boundaries and structures as constraints to be creatively engaged as opposed to simply conforming, person centred work will be limited to improving the conditions of people's confinement in services.

He calls for leadership to challenge these boundaries:

Most service organisations have the social function of putting people to sleep, keeping them from seeing the social reality that faces people with disabilities...People go to sleep when the slogan that "we are doing the best that is possible for 'them'" distracts from noticing and taking responsibility for the uncountable losses imposed by service activities that keep people idle, disconnected and alienated from their own purposes in life. One way to understand leadership is to see it as waking up to people's capacities and the organisational and systemic practices that devalue and demean those capacities.]

A key obstacle to people achieving better lives has been the risk averse culture that has been prevalent in human services for a variety of reasons. Advocates of person centred thinking argue that applying person centred thinking tools to the risk decision making process, and finding strategies that are based on who the person is, can enable a more positive approach to risk that doesn't use risk as an excuse to trap people in boring and unproductive lives.

The key advocates of PCP and associated Person Centered Approaches warn of the danger of adopting the model in a bureaucratic way – adopting the 'form' of PCP, without the philosophical content. By changing it to fit existing practices rather than using it in its original form, most or all of its effects are lost. The hope of funding it in the USA was to influence the processes, such as planning through the Medicaid home and community-based waiver services for people moving from institutions to the community (Racino, 1999).

The philosophical content expects services to be responsive to the needs of people that use the service, rather than prescriptive in the types of services offered. These principles are reliant on mechanisms such as individualised funding packages and the organisational capacity to design and deliver "support" services. It is essential that organisations and agencies providing services make a commitment to strive for person-centredness in all of their activities, which can result in major changes in areas of practice such as recruitment, staff training, and business planning and management.

While secondary users may debate the use of person-centered approaches to achieve the myriad goals it attempts to achieve, i.e., increased inclusion (Schwartz, Jacobson and Holburn, (2000). "Defining Person-centeredness", others point to recent research such as "The Impact of Person Centred Planning" (Emerson et al. 2005), which suggests that Person Centred Planning can make a considerable difference to people's quality of life and explores the optimum conditions for Person Centred Approaches. 'Valuing People Now' says

"Person centred planning has been shown to work. The world's largest study into person centred planning described how it helps people get improvements in important parts of their lives and indicated that this was at no additional cost"

However it continues

"too few people have access to proper person centred planning... In too many local authorities, person centred planning is not at the centre of how things are done. The challenge of the next three years is to take all this innovative work and make sure that more – and eventually all – people have real choice and control over their lives and services"

Person-centered planning in the USA has continued to be investigated at the secondary research level and validated for more general use (e.g., Claes, et al., 2010).

Local Authorities in Britain are now being challenged by government to change their model to one that is founded on Person Centred Approaches

"This move is from the model of care, where an individual receives the care determined by a professional, to one that has person centred planning at its heart, with the individual firmly at the centre in identifying what is personally important to deliver his or her outcomes"

The government recognises that this will require a fundamental change in the way services are organised and think:

"Personalisation is about whole system change."

In New York State (USA), the Office for People with Developmental Disabilities (OPWDD)OPWDD, has mandated the use of person-centered planning in all new service development for people with intellectual disabilities. Person-centered planning is central to the new approaches to person-directed supports with are based on stronger self-determination than traditional person-centered approaches.