Person-Centered Planning
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Making the Long-Term Services and Supports System Work for People with Dementia and Their Caregivers 
Source: TAEStates serve a substantial number of people with dementia and their family caregivers in their Aging Networks and LTSS systems. Serving this population effectively involves accommodating the needs of a population that, in addition to memory loss, experiences a variety of physical, cognitive, and behavioral symptoms resulting from dementia, along with other medical conditions. In model dementia-capable systems, programs are tailored to the unique needs of people with Alzheimer’s disease or other dementias, and their caregivers.
(PDF) Caption: Making the Long-Term Services and Supports System Work for People with Dementia and Their Caregivers
(PDF) Caption: Dementia Capability Toolkit
Associated Date: November 2011 Compendium of Evidence-Based Alzheimer’s Disease Interventions Volumes 1 and 2
Source: TAE
Attached is evidence-based compendium and report on Alzheimer's Disease interventions It has several components and represents a major effort to summarize the literature in the field.
(PDF)
(PDF)
Associated Date: September 2010
Assistive Technology for People with Dementia and Their Caregivers at Home: What Might Help
Source: TAE
The ADSSP National Resource Center prepared this report to provide an overview of assistive technology (AT) products that are designed for persons with dementia and their caregivers. The target audience is the general public, caregivers, home and community service providers, and public programs that provide long-term care services and supports.
(PDF)
Associated Date: September 16, 2010
Developing and Implementing Self-Direction Programs and Policies: A Handbook
Source: National Resource Center for Participant Directed Services
This Handbook was developed by the staff at the Cash and Counseling Program Office to provide state staff, policymakers, service providers, program participants, and other stakeholders with a single comprehensive source of information about self-direction programs and policies.
(External Link) Caption: National Program Office for Cash & Counseling
(PDF)
Associated Date: May 04, 2010
VT Options Counseling Take Home-Action Plan
Source: Vermont
Vermont's ADRC partner agencies use this form to create Action Plans with individuals during options counseling to organize
next steps towards their goals. It has places for key resources, contact information, next steps, due dates, and roles for the various people helping.
(Word)
(PDF)
Associated Date: February 2013
NRCPDS Program/Operations Toolkit
Source: NRCPDS
ACL funded the NRCPDS to create this Toolkit that provides the Aging and Disability Network with effective tools and resources to fully understand, implement, and manage participant-directed programs and systems. Additionally, there is a toolkit focused on Financial Management Services (FMS).
(External Link) Caption: Financial Management Services (FMS) Toolkit • File type: web
(External Link) Caption: Program/Operations Toolkit • File type: web
Associated Date: January 2013
Communicating for Person Centered Relationship Oriented Counseling
Source: North Dakota
These slides are from North Dakota's training for Options Counselors on Person Centered communication including interviews. The training includes types of communication with examples.
(Powerpoint)
(PDF)
Associated Date: October 2012
Person Centered Approaches
Source: North Dakota
These are slides from North Dakota's training for Options Counselors on person-centered approaches.
(Powerpoint)
(PDF)
Associated Date: October 2012
ADRC Services Continuum Handout
Source: Portland State University
This handout for Oregon's Options Counseling 101 training explains and illustrates the differences in services along the "continuum" from Information and Referral to Case Management.
(Word)
(PDF)
Associated Date: February 2012
MD Support Plan
Source: Maryland
This detailed Consumer Support Plan template was developed by Maryland for use in options counseling. It is available as a document, as web enabled automated versions, and even through mobile devices. The automated versions are currently mock-ups for the pilot phase. The template is person centered and includes a list of some resources.
(External Link) • File type: web
(External Link) Caption: mobile version
(PDF)
Associated Date: January 2012
Long Term Care Options Counseling Action Plan TIP SHEET
Source: New York
New York developed this tip sheet to support the Options Counselor in developing a useful plan that is person-centered and self –chosen. Sample guiding questions are provided and can be used as needed. Feel free to develop your own.
(Word)
(PDF)
Associated Date: October 2011
Wisconsin Motivational Interview Webcasts
Source: Wisconsin
Motivational Interviewing is a person-centered directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence. 4 webcasts have been recorded and published to provide newly hired staff an opportunity to learn about this evidence based communication strategy. Debra Murray PhD, (MINT trainer) was recruited as the presenter for the trainings.
(External Link) Caption: WI DHS Training
Associated Date: January 2012
Maine Person-Centered Planning Training Evaluation survey
Source: Maine
Maine developed this survey to evaluate their Person Centered Planning for Older Adults training.
(PDF)
Associated Date: September 2011
New Mexico Person-Centered Planning Tool
Source: New Mexico
New Mexico developed this Person-Centered Planning Tool that enables consumers to assess life situations, eligibility for benefits, home and healthcare supports, medication management, housing, finances, legal affairs, caregiver resources and other aspects of daily living. The tool was developed to help consumers as they make decisions that enable them to live independently and manage the supports and services they need.
(PDF)
Associated Date: October 2009
New Hampshire Home and Community Living Guide
Source: New Hampshire
This document can help individuals start an inventory of things they value most, and give them a chance to reflect on their strengths and abilities. By putting these ideas on paper, and reviewing them with family, friends and caregivers, individuals can help their loved ones carry out their plans, if they are not able to do so themselves.
(PDF)
Associated Date: July 2011
New Hampshire Long-Term Care Support Counseling Reflective Practice Training
Source: New Hampshire
This orientation session places long term support counseling in a theoretical context of person centered relationship oriented care as a framework for effective communication across the network of care.
(Word)
(PDF)
Associated Date: June 2011
New Hampshire Long-Term Care Support Counseling Person Centered Communication Training
Source: New Hampshire
This orientation session places long term support counseling in a theoretical context of person centered relationship oriented care as a framework for effective communication across the network of care.
(Word) Caption: Module II
(PDF) Caption: Module II
Updated July 27, 2011
Person-Centered Planning: Structures for Options Counseling
Source: Patty Cotton
2011 National Grantee Meeting Session: Using Person-Centered Planning Techniques in Long-Term Support Options Counseling
(Powerpoint)
(PDF)
Associated Date: February 14, 2011
Virginia's PCP Terminology Chart
Source: Virginia
This terminology chart represents work Virginia has done through a CMS Systems Transformation Grant to make terminology in statutes, regulations and policies across the health and human services system more person-centered. They have incorporated this terminology especially into their Money Follows the Person (MFP) program and into draft options counseling standards. The chart is also an example of the Aging & Disability Partnerships Terminology Survey.
(Word)
(PDF)
Associated Date: January 31, 2011
Person-Centered Transitional Care, North Carolina
Source: North Carolina
This presentation describes North Carolina’s Community Connections program and its goal of developing a model of collaborative community-based services. These results of a mid-point evaluation of Community Connections demonstrate the progress that had been made to facilitate access to services and supports for consumers during transitions, especially from hospital to home.
(Powerpoint)
Added August 5, 2010
Forsyth “Hospital to Home Program for Older Adults”
Source: North Carolina
In this presentation staff of the Forsyth Medical Center and the Forsyth Medical Center Foundation in North Carolina present an overview of their activities implementing a Person-Centered Hospital Discharge Planning program in North Carolina. The “Hospital to Home Program for Older Adults is being conducted by Forsyth Hospital which is participating in North Carolina’s PCHDM initiative. The Forsyth Hospital transition program is based on the Coleman Model. North Carolina’s CRCs are building on existing relationships established by the Community Care Network to expand the program’s engagement with critical pathway providers.
(Powerpoint)
Added August 5, 2010
Increasing Person-Centered Thinking - Improving the Quality of Person-Centered Planning
Source: Amado and McBride, Institute on Community Integration UAP, University of Minnesota
This manual is intended to be used as a resource in training programs on Person-Centered Planning. The Minnesota State Department of Human Services contracted with the University of Minnesota’s Institute on Community Integration to provide training about Person-Centered Planning for two years to these provider agencies, the local Arc’s, and staff of other agencies involved in the Performance-Based Contracting project.
(PDF)
Added May 24, 2010
Idaho Real Choices
Source: Idaho State University – Institute of Rural Health
This presentation was conducted by Russell Spearman at the 2010 National Conference in a session entitled "CMS/AoA Development of a Person-Centered Hospital Discharge Model Grant - Lessons Learned".
(Powerpoint)
(PDF)
Updated March 2, 2010
Oregon's Example: Implement a Person-Centered Hospital Discharge Model
Source: Oregon
This handout entitled Oregon's Example: Implement a Person-Centered Hospital Discharge Model was provided as part of the 2010 National Meeting during the session Quality Improvement Methods to Guide Real Systems Change.
(Word)
(PDF)
Updated March 2, 2010
Integrating Person-Centered Planning into I&R/A and Options Counseling
Source: Technical Assistance Exchange
This is the Power Point presentation by Christina Neill Bowen given at the 2010 National Meeting during the session entitled Integrating Person-Centered Planning into I&R/A and Options Counseling.
(Powerpoint)
(PDF)
Updated March 2, 2010
ADRCs as a Vehicle for Culture Change
Source: New Hampshire ADRC, University of New Hampshire
This is the Power Point presentation by Susan Fox and Wendi Aultman given at the 2010 National Meeting during the session entitled ADRCs as a Vehicle for Culture Change.
(Powerpoint)
(PDF)
Updated March 3, 2010
Navigating Choice and Change: Implementing Person-Centered Planning
Source: University of New Hampshire, Susan Fox & Patricia Cotton
This is the Power Point presentation by Susan Fox and Patty Cotton given at the 2010 National Meeting during the session entitled Integrating Person-Centered Planning into I&R/A and Options Counseling.
(Powerpoint)
(PDF)
Updated March 2, 2010
Empowering the Consumer: Agency Transition to Person-Centered Planning and Participant Direction for Elders
Source: Massachusetts ADRC & CLP
This is the Power Point presentation by Jeffrey Keilson and Christine Alessandro given at the 2010 National Meeting during the session entitled Transition to Participant Direction: Making Agency Culture.
(Powerpoint)
(PDF)
Updated March 2, 2010
Person Centered Thinking Resource Guide
Source: Learning Community for Person Centered Practices and was authored by Michael Smull and Helen Sanderson
North Carolina's Person Centered Thinking Resource Guide describes the essential skills and tools needed to implement person-centered plans and keep them alive.
(PDF)
(PDF)
Updated January 7, 2010
Michigan CLP Participant Direction Tool
Source: Michigan
This tool connects demonstrates how participants can identify their desires and preferences as they move through the person-centered planning process. It is to educate both participants and professionals.
(PDF)
Updated December 15, 2009
Ohio CLP Participant Training and Reference Guide
Source: Ohio
Ohio developed the handbook "My Care, My Way Program" to help consumers make informed decisions about directing their own care. The handbook provides assistance with all the steps related to taking responsibility for planning and directing one's own care at home.
(PDF)
Added November 2, 2009
Kentucky NHD Reassessment Form
Source: Kentucky
This form is used by Kentucky to determine if a change in the consumers NHD care plan is necessary. It reassesses medication usage and Activities of Daily Living.
(Word)
(PDF)
Added January 10, 2009
Kentucky NHD Plan of Care Part 2
Source: Kentucky
This is Kentucky's NHD Plan of Care Part 2. It covers NHD services.
(Word)
(PDF)
Added January 10, 2009
Kentucky NHD Plan of Care Part 1
Source: Kentucky
This is Part 1 of Kentucky's NHD Plan of Care document. The plan of care is based on identifying problem areas and goals to overcome these problems.
(Word)
(PDF)
Added January 10, 2009
Coffey Article - "Let Elders Live Indpendently and with Dignity: ADRCs and the Role Title IIIb Attorneys"
Source: Journal of Poverty Law and Policy
This article was written by Gene Coffey and published in the Journal of Poverty Law and Policy.
(PDF)
Updated October 13, 2008
Life Planning and Personal Futures Planning - Monthly Call Summary - January 5, 2006
Source: The Lewin Group, ADRC-TAE
These call notes are from a Monthly Grantee Call on Person Centered Planning and Thinking.
(Word)
(PDF)
Associated Date: January 05, 2006
Home Care Quality: Emerging State Strategies to Deliver Person-Centered Services
Source: AARP Public Policy Institute
This AARP Public Policy Institute Issue Paper examines the efforts of South Carolina, Washington and Wisconsin to improve home care quality by using a more person-centered approach. The initiatives described in this report point to the significant ongoing efforts that states are using to ensure quality care and support in the home. The challenge for state officials continues to be the creation of quality assurance systems that place consumer needs and goals for quality of life first.
(External Link)
Updated June 11, 2010
Resources from the ADRC-TAE January 2006 Call on Life Planning and Personal Futures Planning through a Person-Centered Planning Process
Source: The Lewin Group, ADRC-TAE
This page about the ADRC-TAE January 2006 Call on a Person Centered Planning Process includes links to all call resources. The call was intended to focus on life planning and personal futures planning through a person-centered planning process. This topic is important to ADRCs because in helping individuals find the best current support service fit or to plan for potential future support service needs, often through options counseling, ADRC staff can take advantage of person centered techniques that elicit and document an individual's preferences.
(Internal Link)
Associated Date: January 01, 2006
Life Planning and Personal Futures Planning through a Person-Centered Planning Process - Call Audio - January 5, 2006
Source: The Lewin Group, ADRC-TAE
This is the call audio for the January 2006 ADRC-TAE Standing Grantee Call on Person Centered Planning and Thinking.
(Internal Link)
Associated Date: January 05, 2006
Flyer for Staff Training on Person Centered Thinking by Michael Smull
Source: Michael Smull, Support Development Associates
This sample flyer gives a description of the two-day staff training offered by Michael Smull on person-centered thinking. ADRC-TAE does not endorse any particular vendors or their services.
(Word)
(PDF)
Updated February 10, 2009
Person Centered Thinking Skills
Source: Michael Smull, Support Development Associates
This presentation introduces person-centered thinking and includes tools that emphasize this kind of thinking. The presentation was given during the ADRC-TAE January 2006 call on life planning and personal futures planning through a person-centered planning process.
(Internal Link)
(PDF)
Updated February 10, 2009
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