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Developing the Person-Centered Plan

Person-Centered planning involves active participation from the person, as well as family members and those closest to the person who know him/her best. By asking questions and gathering input from the group, an effective plan can be developed which incorporates how the person's needs can be met and goals for the future obtained. The result is an individualized plan that supports personal life choices.

One feature of Person-Centered planning that can be extremely helpful in developing an effective plan is the Circle of Support. This is a group of people chosen by the person and/or family to help develop and monitor the Person-Centered plan. They are typically family, friends, co-workers, neighbors, church members and the person's Service Coordinator (SC), Early Interventionist (EI) or Qualified Intellectual Disability Professional (QMRP). They agree to meet on a regular basis and help the person identify and achieve personal aspirations and goals. Members of the Circle participate because they care about the person and want to work together to overcome obstacles and open doors to new opportunities. If someone has no family or close personal supports, the Circle may be comprised primarily of staff members who know him/her well. Using a Circle of Support is optional.

DDSN offers two types of Person-Centered planning. One is conducted by the Service Coordinator, Early Interventionist or Qualified Intellectual Disability Professional and is required for anyone receiving services through DDSN. This plan identifies existing services and supports which will benefit the individual. It is intended to be practical, positive, and realistic and based on achieving positive outcomes for the person. In addition to the support plan developed by the SC, EI or QMRP, the individual or family member can choose to have a life plan. Through Life Planning, people can:

  • Explore and prioritize those things that are most important to them
  • Develop a sense/picture of how they want their lives to be
  • Explore preferences and possibilities of where and with whom they wish to live
  • Explore preferences and possibilities for how they wish to spend their time and energy
  • Explore current/available resources and possible untapped resources

The person or family member can also ask the Service Coordinator, Qualified Intellectual Disability Specialist or Early Interventionist to provide a list of Life Planners. Once a Life Planner has been selected, the person/family member contacts the SC, QMRP, or EI to authorize and arrange the service. The Life Planner will then make contact directly with the person or family member to finalize the meeting plans. The SC, QMRP or EI is not required to attend the Life Plan meeting but is to make every effort to participate if invited.

At the Life Plan meeting, the Life Planner guides the person and the Circle of Support through the process of planning for the person's immediate and long-term future. Information on identified needs, as well as knowledge of and information from the person are used to identify his or her preferences, talents, interests, and hopes for a meaningful life both now and in the future. The team helps the person identify specific goals and develop a plan of supports, activities, services and resources needed to realize specified goals. The plan includes supports that may or may not cost money.

It may be necessary for the Life Plan meeting participants to schedule additional meetings and stay in contact with one another so that the progress on the goals can be discussed and adjusted as needed.

If the SC, EI or QMRP develops the Person-Centered plan for support services, they are responsible for monitoring the services listed on the plan. As changes occur in the individual's life situation, the SC, EI or QMRP updates or changes the plan as needed. If a Life Plan was conducted for the person, the SC, EI or QMRP will receive a copy of the plan and incorporate any goals which their involvement will be needed. The person for whom the Life Plan was written or other person selected from the meeting participants will be responsible for monitoring the Life Plan. However, all involved- the person, his or her family, and Circle members-share the responsibility for implementing the plan.