A Guide to Person-Centered Care Plans for those with Intellectual and Developmental Disabilities

Person-centered care planning empowers individuals with intellectual and developmental disabilities to take charge of their lives. In Maryland, person-centered plans (PCPs) ensure the rights of those who receive funding through the Maryland Developmental Disabilities Association (DDA) to plan their lives the way they want them. 

The PCP is directed by the individual and created together with their team. The team includes the person’s coordinator of community services (CCS), care providers, direct support professionals (DSPs), and other important people, such as family and friends, who have been chosen by the individual. In order to continue, or request new services, the PCP must be reviewed annually and submitted to the DDA annually via the CCS.

Whether you are embarking on an initial PCP, revising a one that is in place, or preparing for an annual PCP review, there are a few considerations for optimizing the process and setting up a successful intellectual disability care plan. This blog serves as a guide for individuals with disabilities, their support staff, and family.

Five Key Considerations for Person-Centered Care Plans

1. Centered on the individual with special needs

The PCP is a holistic approach to support that places the person who is receiving DDA services at the center of decision-making. The planning process is designed to identify and address the unique needs, preferences, and goals of the individual with intellectual or developmental disabilities to promote their independence, well-being, and inclusion in the community. 

During a PCP review, the team should pay special attention to the preferences of the individual and incorporate them into the PCP. This personalized approach ensures that the plan is tailored to the individual’s likes, dislikes, and overall goals.

The PCP review environment should encourage self-advocacy, with the individual actively participating in discussions about their support plans. This empowerment builds confidence and ensures that the care plan is truly person-centered.

2. Caregiver and support network collaboration

The PCP serves as a collaborative effort to support the person receiving DDA services. This collaboration is driven by the person, coordinated by their CCS, and enhanced by important people chosen by the person such as family members, significant others, care providers, friends, and colleagues. Everyone is there in service and at the direction of the individual with special needs

By bringing together support staff, family members, and other advocates and support networks, the PCP ensures open and transparent communication among all parties. All those involved are encouraged to provide their input, thereby fostering a more effective plan. 

Each party is able to bring unique perspectives to the conversation. For example, a DSP might have valuable insight into what outings or activities the individual enjoys – say cooking versus bowling, or volunteering instead of going out to the movies.

3. Goal review and goal-setting

The PCP is a North Star for individuals, their CCS, support staff, and additional support networks. It is a time to review, revise, and reset goals to align with the person’s unique needs, preferences, and aspirations. This clarity serves as a guide for all stakeholders involved in caring for and supporting the individual.

The PCP is a wonderful opportunity to celebrate the individual’s achievements, both big and small. It also is a time to reflect on any challenges faced throughout the past year. The PCP team can work with the individual to gain and offer insights into what has worked well and what adjustments are required.

4. Feedback mechanism and guide for care providers

The PCP offers a time to assess the effectiveness of current support services. Are they meeting the individual’s needs? Would new services enhance their quality of life? Evaluating and adjusting support services as necessary ensures that the PCP is individualized, flexible, and responsive to the person’s changing circumstances.

The PCP also services as a guide for all support staff. Throughout the year, support staff should review and record progress toward goals laid out in the PCP. When new support providers join the individual’s team, they can turn to the PCP for a thorough understanding of the individual’s wishes and desires, and the services required to meet those goals.

5. Financial and physical health and wellbeing

Health considerations play a crucial role in the well-being of individuals with intellectual and developmental disabilities. During the review, assess the individual’s health status and ensure that the support plan includes necessary accommodations and healthcare provisions. 

Also, review the legal and financial aspects of the care plan. Ensure that all legal protections are in place and that financial resources are allocated appropriately to meet the individual’s needs. Doing so safeguards the individual’s rights and future well-being.

For more than 50 years, Bello Machre has offered children, adults and seniors with intellectual and developmental disabilities including Autism Spectrum Disorders, Down Syndrome, Cerebral Palsy, Rett Syndrome, epilepsy, TBI and more with the services, opportunities, and support they need to live full, independent, rich lives. We’ve been privileged to participate in hundreds of person-centered care plans annually. If you’d like to talk more about how to optimize the PCP review process, please reach out to us today.