Critically Review Approaches to Person Centred Practice

9 September 2016

This grid is used as the basis on which to search for opportunities the person can take to integrate with, and contribute to the community, leading to a” valued social role” (Sanderson and Lewis 2012) It gathers information into different categories, (such as the person’s relationships, favourite places, gifts and capacities). This simple structure is beneficial in keeping information and support to a minimum, simply identifying a “window for change. ” (Sanderson and Lewis 2012) as patterns and oppurtunities become obvious from the layout.

This in turn simplifies the process of identifying the support needed as the person’s gifts and capacities are clearly marked, which reduces the risk of under or over-supporting the person, both of which would hinder progress. For example, someone (Person A) who has moved to a new community identifies that they would like to be part of a local sports team or club but is unsure of how to do so . The layout of the information is helpful in highlighting someone’s own strengths to themselves, and should in theory give them motivation to take advantage of the opportunities identified.

Critically Review Approaches to Person Centred Practice Essay Example

For example, person A’s gift and capacities section shows that they are friendly and easy-going (gifts) and very good at swimming (capacities). Having this information so plainly recorded may encourage the person to take the daunting step to join a team by boosting their self- esteem, and would for example perhaps identify the local swimming team as a good opportunity based on their strengths. Having identified the person’s gift as swimming in the grid for example, means that the person will receive “just enough support” (for example getting to and from the swim team practices) but they are free to independently partake.

If this information where not so clear, there is a chance of over-supporting the individual, (perhaps getting into the pool with them) which would infringe on their independence. The “PFP” therefore concentrates on what the person can give to the community, and identifies where these gifts can be utilised, which gives positive results for the person, who gets to indulge in their hobby, and make solid community connections.

They are less likely to fail from the approach of concentrating on the strengths and gifts, rather than highlighting what might be beyond their reach. Planning around the person, not the community, means their needs are fitted to mutually beneficial, meaningful for the person role in the community, by locating where they already “fit” rather than trying to force them to in other ways. This is a strong approach to the central idea of “seeking the potential that is in every single individual. ” (Ladyman, 2004) of person centred practice.

The simplicity of presented information this leads to quick and easy understanding of the person (which is paramount to person centred approach) it can mean it is an unsuitable approach for a person with high support needs ,who would require much more detailed planning in the approach to their support. Person centered practice is identified as being “intended to reflect the unique circumstances of the individual person with intellectual disabilities both in assessing and in organising what should be done” (Mansell, J. and Beadle-Brown, J. 2004) however the PFP approach does not go beyond this identifying opportunities process to record action plans. Missing is a structure for review or learning, meaning it can assess need and instigate change, but not record outcomes, or what action is needed for the intended result. This may result in underuse of the opportunities identified, and also means that “PFP” unsuitable for use with an individual who does not have the capacity to take advantage of the recognised opportunities independently (or with little support) as it leaves the onus on the person, not those supporting them.

While this encourages active participation of the person being planned for (a goal of person centred practice) the emphasis on the initial goal, and the lack of anywhere to record the outcome may result in the goal not being achieved as no-one is accountable for it. The “PFP” approach is more useful for those with higher ability in the disability sector, for example an older person or perhaps someone coming out of a hospital stay related to mental health, who would be getting minimal support, and could be accountable for themselves and could achieve and maintain goals almost independently.

Other approaches to person centred practice are more direct in planning action in order to bring about change and take advantage of opportunities or ambitions identified. The “PATH” approach starts with the identifying process rather like “PFP” but goes further, breaking down each step the person will need to achieve the identified objective. It is facilitated in one meeting to which the person and anyone they wish to invite (family or friends) attend along with support workers/carers and any other relevant professionals (social workers etc) whom the person consents to attending.

It is centred on identifying one positive and achievable goal, rather than listing all oppurtunities, as the PFP approach does. The process of how this will be achieved is discussed and broken down into steps (See appendices) with one person asking the questions, and one recording it on the graphic. Like “PFP”, it has different sections for compartments of information, however some are more graphically prominent. Particular emphasis is put on “The dream” and “One year on” which shows the importance of the goal itself, plus leaves the person and those supporting them accountable for the outcome in a decided timescale. See appendices). The “now” section also records what will happen immediately. For example, someone’s dream (person b) may be to do a cycle trek for charity. To achieve this dream a lot of small first things must be done, for example researching treks, equipment, training programs etc. The “Path” approach to person centred practice facilitates and records what first step will be taken, and just as importantly who will do these in the “now” section. As Sanderson stated “everyone needs support and some people need more support than others. ” (Sanderson, H. 000) This use of the person’s wider support network recognises the need for more support and provides accountability for those involved, which means it is more likely to be put into action. This approach also means that the person’s connections, family members, friends, professionals etc. are utilised and recorded. This “inclusion and mobilisation the individual’s family and wider social network” (Mansell, J. and Beadle-Brown, J. 2004)is an important aspect of person centred practice and will result in longer lasting outcomes from the planning as the person’s existing support networks are built upon and put to effective use.

This involvement also ensures that the goals decided are not singularly “shaped by staff who are facilitating the process, resulting in a narrow vision emerging in their plan” (Todd, 2002) Consultation with family and friends will bring wider views and more ideas, giving more possibilities and oppurtunities. As those at the meeting and those actioned in “enrol” are present at the consent of the person, this approach lends itself well to the choice element of person centred practice, as the person is able to choose who helps them and in what way.

To avoid the old setback of “too many cooks spoiling the pot” the “PATH” provides space time constraints to be put in “First steps”, “6 MonthsOn” and “One Year From Now. ” These indentify individual roles in supporting the dream, and also the time scale for which each role must be complete, giving a more cohesive effort as all the cogs of plan keep the overall goal turning. This theoretically will ensure that the dream will be achieved as punctually as possible because of transparency, planning and accountability.

In addition to who is important, “PATH” approaches the goal from an understanding of what motivates the person, what is important to the person. The “Dream” section informs us of the person’s aspiration(s) and may lead to discussion of why this is their dream. This in turn will better inform us of who the person is, what is important to them, what they love and at times may better inform those at the meeting (family, care workers, friends and other professionals included) of what their nightmare is, as it may become apparent that in moving towards the “Dream” they hope to move away from other situations in their life.

For example, person B may want to do a charity cycle trek in order to indulge their love of cycling. Discussion of this dream by a skilled questioner may tease out more information however, such as perhaps the person wishes to participate in order to make more friends, or feels he should contribute to charity more, or may simply want to combine his cycling hobby with a wish to travel. This “important to” information is reinforced by the “Stronger” section.

Again, skilled questioning in this section will lend itself well to person centred practice, as it gives further detail what is important to the person, what makes them happy and in turn what makes them unhappy, however this is done in a very meandering, opaque manner, which may result in unclear information and a missed learning opportunity. The discursive element of the “PATH” approach is positive in that it includes active participation from the person being planned for, however it may be difficult to facilitate with a non-verbal subject, or a person who has difficulty communicating and articulating their views and wishes.

In this case it is possible that the approach could be facilitated with adovocates speaking on their behalf (this could be family, paid workers of friends. )However well those deciding know the person however, it can never be guaranteed that the discussion will veer from the person’s dream into what may be their nightmare, as they may be unable to communicate any dissatisfaction with the outcomes. Therefore the “PATH” approach is again more suitable for those with communication skills, and a high ability to speak their views for themselves, as this will guarantee an accurate gathering of information and a relevant, desirable goal. PATH”, unlike “PFP” however, gives no opportunity to consider and record the person’s gifts and capacities. As person centred practice is focused on the person and their strengths, the “PATH” is missing a core element in its approach. A similar approach to “PATH” is the “MAP” approach (See appendic), with the person’s gifts able to slot into the “contributions” section, at the very centre of the approach. This will ensure that the person’s strengths will be built upon to help them contribute to the community, the merits of which, in person centred planning, I have clarified.

Again, the” MAP” has a place for the dream, for actions and for who will be responsible for each, and importantly when. The “thrive” section of the MAP is, like the “Stronger” section of the PATH, very important in establishing what motivates the person, which may as discussed previously bring new learning about the person and their dream albeit again in a roundabout manner. Like “PATH”, the “MA”P is facilitated by one person questioning and one person recording, while others invited join in.

A skilled questioner will be able to draw upon answers, and follow them up with leading questions, to find out why this is the persons dream, which is very important. Importantly MAP caters for more information to be recorded as a result of these questions, in the “Story” and “Nightmare” section meaning more consideration is given to what the person definatley does not want (i. e the nightmare section. )The “Story” section will inform the rest of the “MAP” better, as it draws on past experiences which could highlight dreams and nightmares. For example it could inform us that the person went to a caravan every summer and particularly enjoyed the beach nearby, which is why their dream is to go on a beach holiday. ) Knowing where the person being planned for came from, will help guide where he may, or may not, want to go in the future. For a non-verbal or minimally communitative person, “MAP” is an adept approach, as representatives from the many facets of the person’s life can be invited, with family friends and carers/support workers all contributing.

The “Nightmare” and “Story” can compliment each other in this instance, with people from their background and past / childhood informing of the “story”, whilst friends or anyone more current in the person’s everyday life can keep a check on any tangents from the discussion which may venture into the “nightmare. ” With everyone involved and everyone contributing, these sections can strike a balance with the “Dream” that is not catered for with the “PATH. ” As with the “PFP”, and “PATH”,”MAPS” is again an approach that suits when minimal support is required for the individual.

For those who need “more than others” (Sanderson 2004) The “Essential Lifestyles” (ELP) planning approach has much more scope in what information, goals and dreams can be included, and can include large, small or both goals. When approaching person centred practice, it is important to get “just enough support” for the person. A large factor in this balance is how many hours and how much support is needed, as its goal is to encourage independence and ownership of one’s life.

Removing restrictions is paramount to person centred practice, and too much support, or too little, can each be restrictive: too much support will hinder independence, too little, progress. “ELP” addresses this balance well. It begins with detailed assessment, the findings of which are put into support planning, with action points. This is then reviewed in a person centred way as often as needed, usually bi-annually quarterly if needed. The assessment is generally facilitated by a number of people through meetings including those with the person in a setting suitable to their needs (which lends itself well to person centred practice as the erson is given a chance to have their say on proceedings no matter what their ability. ) Others involved in the assessment process are relevant health professionals such as GPs, psychiatrists, behavioural therapists, and management and those who will be supporting the person. This assessment part of the “ELP” approach is therefore much more informed than the other approaches, and much more person centred as it is focused on the person; not the person’s conditions. The information gathered is done so by “Person Centred Tools. ” The range of tools include: •learning logs •important to / important for, perfect day and week, • hopes and dreams, • communication charts, • decision making profiles and agreements, • community maps, •prescence to contribution, and review tools such as: •whats working/not working •four plus one questions •person centred review This wide range means that all information needed is gathered in a person centred way, and certainly reaches the goal of “assessing and in organising what should be done” (Mansell, J. and Beadle-Brown, J. 2004) previously referred to, as these tools do “two things…the basis for action…providing further information about what is important to people. The one page plan is used to list the persons likes/dislikes, what is important to them and crucially what people “like and admire” about them. It is usually seen first in more detailed “ELP” or can be used as a stand alone plan for those who need less information. It lends itself well to person centred practice as it the individual is valued for who they are, not what they need, a real sense of the individual, with their preferences and gifts is given in the first instance, setting the tone of this approach with these things at the forefront and core of this planning process.

At times this “important to” may be something that may be deemed a risk, for example smoking, which the person may enjoy or rely upon to relax, but in the long run is harmful to health. Having the “important to” first, makes it clear that the goal of this approach is to enable the person to take calculated, informed risks that they have the right to take, that unlike the old medical models of planning, the person’s rights are catered for first and foremost.

Again this is essential to person centred practice, so the “ELP” approach is extremely fitting in allowing those who need support to be enabled to exercise their right to choose. The one page plan is also helpful in making community connections, as it can be taken, with the person’s consent to new clubs, activities, or often visitied places in the community. This is very helpful in aiding non-verbal people to establish meaningful longlasting connections as they are understood better and the people they connect with can learn how to communicate with them in their own way.

This is very important to person centred practice, which aims to involve the people it is planning for in “an inclusive community. ” The management of the risk that may be important to the person is dealt with later in the “person centred support plan”, sometimes known as “How best to support me. ” This is where the balance between what is important to a person, and what is important for their wellbeing is addressed. It has much more detail than the other approaches, which only have room for specific information.

It informs those supporting the person of details on how exactly to support the person, making it a good approach for those who need quite a bit of support. Unlike the “MAPS” or “PATH”, it can detail specifically how much support is needed (IE hand on hand support, prompting etc) which there is no room for with the other approaches. This part of the “ELP” approach is fed into by all who are connected to the person (a full list of which can be found in the inclusion web tool), and makes full use of the person centred tools.

It is a live document, and through the use of learning logs, it is constantly updated, to keep up with progress, changes and new opportunities being taken advantage of. This all lends itself well to the “just enough support” element of person centred practice, whereas the other approaches may fail as they do not have room for such detail, which may lead to the person being under or over supported, and the goal not being achieved, or community connections not being made due to over-support which stifles the person.

Many of the tools compliment each other and as new learning is made, other parts of the person’s life become better informed. For example a learning log may detail that a person enjoyed a new restaurant. This information would then be added to the person’s community map, which shows what community amenities are preferred by the person. Like the “PFP” therefore, opportunities within the community can be identified, but it is perhaps more person centred in this approach, as the choice of location is more informed more specific to the person’s preferences and wishes.

This issue of choice is very core to person centred practice and again the “ELP” approach shows to be very well tailored for supporting those with higher needs towards independence, and long-staying viable community connections and contributions. The person centred information filters through to all aspects of their life with this approach, making every aspect, instead of just one, person centred, enabling choice at every turn. This is particularly helpful in making an informed choice on behalf of someone who may not make it themselves, as it gives them as much a voice as possible in the decision making process.

The individual’s choice is given consideration not only with recordings of previous experience but is also by informing those supporting how a person makes a choice, through the use of decision making profiles, or agreements depending on the person’s ability. With the one page plan informing those supporting the person of their personality and strengths, the profile is a good way to inform us of how to present information to the person, when is best to do so and how they will present their decision.

For someone with a higher ability, the decision making agreement helps the person to understand and agree on who makes certain decisions. For example, the agreement may state that the person’s GP agrees when the person needs medication and what medication they need, but the person being planned for can decide what form the medication may take (ie liquid, tablet etc. ) In both instances, the person is given ownership of their choices, with their capacities catered for whatever they might be, which is central to the value placed on ownership, choice and independence in person centred practice.

As well as informing choice, preferences and community connections of the broader element of the person’s life, the “ELP” approach to person centred practice also allows for specific goals, similar to those in “PATH” and “MAPS”. Again person centred tools are used. “The Hopes and Dreams” tool for example, can be used to set large goals. As previously stated, all relevant information is gathered by person centred tools which then feed into the tool currently being used.

The “Hopes and Dreams” is facilitated in a similar way to the “PATH” and “MAPS” approach, however as it is part of the overall plan, and is informed by the many tools it is more likely to be accurate. This can include the “Social History” section of the “ELP” approach, which can have very important information on who the person really is, and also “good day/bad day” and “perfect week” tools can be used. Therefore like the “MAPS”, the goal is well chosen as it is clear from the information gathered what is desirable to the person, and what is not.

A big difference between the “Hopes and Dreams” and the “PATH” /”MAPS” approach is that the dream can be unrealistic or very hard to achieve. Instead of working with “what can we achieve” mentality, the “Hopes and Dreams” goes with the pretext of “shoot for the moon and you’ll land in the stars” resulting in less restrictions than “PATH” / “MAPS”, negating the “narrow vision” (Todd, 2002) that they may have. Again, this approach is much more person centred the “ELP” “aims to consider aspirations and capacities expressed by the service user, rather than needs and deficiencies” (Mansell, J. nd Beadle-Brown, J. 2004) which in turn may throw up more opportunities than “PATH” and “MAPS” realistic approach. This approach using the person centred tools to gather information means that any support is exactly what the person wishes, the use of communication charts can inform us of how a person communicates likes and dislikes, alsoleading to more opportunities. The review tools mean that progress is made, “whats working/ not working” and the “4+1” can inform us of anything that needs changed to suit the person better, with the 4+1 allowing for actions to be recorded.

As discussed previously this means that everyone, including the person, is accountable, giving a higher chance of success. To sum up, “ELP” approach is much less restrictive, better informed and has who the person is, not just what they can do, at the centre of its approach. In my opinion the “ELP” approach combines the most positive parts of the other approaches, (gifts and capacities, the community connections, and the people and things most important to someone;s life) but develops the planning further, with more detail and with the highest chance of success due to the actors discussed above. Reviewing all of these approaches, it is obvious that they all strive towards person centred practice, and each in turn is well suited to different scenarios. For the most part however, I find the “ESSENTIALS” approach much more person centred due to how informed, how detailed, and how flexible it is, and how much it focuses on the person themselves, which is the very crux of person centred practice.

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