Person- and Family-Centered Practices: State Policy Resource Guide
This guide highlights resources, strategies, and promising practices for state policymakers interested in implementing person- and family-centered practices within their systems to better support caregivers.
Challenges and Opportunities
Historically, systems, organizations, and professionals have often made decisions for people who receive long-term services and supports without their input. In recent decades, the support systems for older adults and people with disabilities have changed significantly and have generally started to embrace person-centered values. However, many systems still struggle to put person-centered principles into practice so that people have the power to define and pursue their own idea of a good life.
The National Center on Advancing Person-Centered Practices and Systems (NCAPPS) is funded by the Administration for Community Living and the Centers for Medicare and Medicaid Services. NCAPPS supports states to transform their service and support systems to make person-centered thinking, planning, and practice a reality for older adults and people with disabilities receiving long-term services and supports.
Definitions
- Person-centered thinking focuses language, values, and actions toward respecting the views of the person and their loved ones. It emphasizes quality of life, well-being, and informed choice.
- Person-centered planning is directed by the person with helpers they choose. It is a way to learn about the choices and interests that make up a good life and identify the supports (paid and unpaid) needed to achieve it.
- Person-centered practices are present when people have the full benefit of community living and when supports are designed to assist people as they work toward their desired life goals.
State Example
Massachusetts Department of Developmental Services (DDS) — available on the DDSLearning website
- Person-centered practices include both “person-centered thinking” and “person-centered planning.” To be person-centered means treating individuals with dignity and respect; building on their strengths and talents; helping people connect to their community and develop relationships; listening and acting on what the individual communicates; and taking time to know and understand individuals and the things that make them unique. Person-centered thinking involves a deep respect for individuals and their equality. Person-centered planning involves a process and approach for determining, planning for, and working toward what an individual with a disability or an older adult wants for their future.
Caregiver Engagement
As states seek to make their systems more person-centered, it is critical that they engage caregivers to understand where improvements can be made. Strong engagement efforts are culturally and linguistically competent and accessible and prioritize groups that are underserved or underrepresented. States can:
- Facilitate regular, ongoing meetings and workgroups with caregivers to learn from them and develop authentic relationships
- Dedicate funding to compensate caregivers for their time participating and providing feedback
- Engage family caregivers early and meaningfully within systems change efforts
- Ensure materials and meeting formats are accessible, such as scheduling American Sign Language interpreters and making documents Section 508 compliant
- Review engagement strategies for alignment with National Culturally and Linguistically Appropriate (CLAS) Standards
Resources
- The “Toolkit for Stakeholder Asset Mapping” guides states through the process of mapping out community members and partners and how they are already engaged. Developing an asset map provides the opportunity to identify existing groups, communication practices, trusted relationships, and products to springboard from as opposed to starting the engagement process from scratch.
- The “Engaging People Who Receive Services: A Best Practice Guide” details five strategies and proven practices to directly involve people who receive services in system planning and improvement.
- In “Providers Must Honor and Welcome Culture,” part of the NCAPPS Culture and Person-Centered Practices video shorts series, Maria Martinez describes caring for her aging mother and how important culture is to them.
State Example
The Utah Division of Services for People with Disabilities (DSPD) created its Be Informed and Be Involved webpage as a one-stop shop for self-advocates and family members of people with disabilities to remain up to date on changes happening at DSPD and how to get involved. DSPD also turned its asset map into a searchable online tool to support people in finding organizations and opportunities for connection.
Services and Supports
To ensure that people are getting the services and supports they need and want, states can:
- Assess where there are systemic obstacles and barriers to person-centeredness
- Review and adjust person-centered plan templates so that what is “important to” the person and “important for” them is reflected
- Develop an infrastructure for exchanging information about the person-centered plan among the person, their families, case managers, service providers, and direct support professionals
- Guarantee flexibility within person-centered planning processes and move away from a “one-size-fits-all” approach.
Resources
- The “Person-Centered Practices Self-Assessment” is designed to help human service agencies measure their progress in developing a more person-centered system. It contains questions about observable practices across eight system domains: Leadership; Person-Centered Culture; Eligibility & Service Access; Person-Centered Service Planning & Monitoring; Finance; Workforce Capacity & Capabilities; Collaboration & Partnership; and Quality & Innovation.
- The “Person-Centered Planning: Choosing the Approach that Works for the Person” brief reinforces the importance of aligning person-centered planning approaches with the wishes and needs of the person for whom the plan is being developed, rather than adopting a one-size-fits-all approach.
- “Promising Practices for Person-Centered Plans” describes indicators of truly person-centered plans for quality monitoring purposes.
State Example
Every North Dakota Health and Human Services division has completed the “Person-Centered Practices Self-Assessment” process to establish baselines, create action plans, and measure progress toward building a more person-centered system.
Workforce
Having a well-trained workforce composed of people who actively practice and exemplify person-centered principles in their day-to-day work and interactions is key to supporting people to live their idea of a good life. States can:
- Establish initial and ongoing trainings to bolster staff knowledge and expertise in person-centered thinking, planning, and practice
- Generate competency standards and outline person-centered skills expected of staff
- Offer frequent opportunities for staff to “test” their skills through interactive workshops or practicing scenarios
- Designate a point person or team that can support staff in troubleshooting or finding solutions to complex situations
Resources
- “Five Competency Domains for Person-Centered Planning” describes five skill areas, or domains, that facilitators should possess to support a fully person-centered planning process: They are: Strengths-Based, Culturally Informed, Whole Person-Focused; Cultivating Connections Inside the System and Out; Rights, Choice, and Control; Partnership, Teamwork, Communication, and Facilitation; and Documentation, Implementation, and Monitoring.
- Created for team members within the State Health Insurance Assistance Program, Senior Medicare Patrol, and the Medicare Improvement for Patients and Providers Act programs, the Office of Healthcare Information and Counseling Person-Centered Thinking Toolkit provides an overview of person-centered thinking, actionable ideas for how team members can implement person-centered practices in their day-to-day work and outlines a variety of person-centered tools and resources for use.
State Example
The Person-Centered Practices team at the Texas Health and Human Services Commission (HHSC) created a 16-minute video that is shown to all new HHSC hires as part of their orientation. In the video, people with lived experiences, their families, and HHSC staff share their personal and professional experiences with person-centered practices and the value of balancing what’s important to and for people.
Data, Research, and Quality Improvement
Conducting research, collecting data on person-centered outcomes, and analyzing the data can help states identify areas for improvement and pockets of innovation. States can:
- Establish quality monitoring processes for reviewing person-centered plans
- Provide transparent and publicly accessible data on person-centered outcomes
- Outline quality standards or indicators for person-centered plan documentation and the planning process itself
- Create a performance measurement system for person-centered planning
Resources
- The National Core Indicators-Intellectual and Development Disabilities (NCI-IDD) and National Core Indicators for Aging and Disability (NCI-AD) can be used to assess in greater depth the experience of people who receive supports as it relates to person-centered practices and supports. In the “Person-Centered Practices in the National Core Indicators Data” brief, questions from the NCI-IDD and NCI-AD surveys are organized into the four main principles of person-centered practices that emerged from a national environmental scan of articles, policy statements, regulations, and websites of national aging, disability, and mental health organizations, created by NCAPPS.
- “Using NCI-IDD and NCI-AD Data to Assess Progress with Person-Centered Requirements in the CMS Settings Rule” provides a hypothetical example of how one U.S. state used National Core Indicator data to monitor person-centered planning and practices in alignment with federal requirements for person-centered planning.
- The “Person-Centered Thinking, Planning, and Practice: A National Environmental Scan of Indicators” outlines indicators that may be used to assess person-centered principles in aging and disability systems, including mental health systems.
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