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139 Pages·2011·0.63 MB·English
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The Impact of Person Centred Planning Janet Robertson, Eric Emerson, Chris Hatton & Johan Elliott Institute for Health Research, Lancaster University Barbara McIntosh, Paul Swift, Emma Krijnen-Kemp & Christine Towers Foundation for People with Learning Disabilities Renee Romeo & Martin Knapp Centre for the Economics of Mental Health, Institute of Psychiatry Helen Sanderson Helen Sanderson Associates Martin Routledge Valuing People Support Team, Department of Health Peter Oakes Quest, University of Hull Theresa Joyce Estia Centre, South London and Maudsley NHS Trust & King’s College London Published: April 2005 © Institute for Health Research, Lancaster University In s titu te o f P s y c h ia try at The M audsley eee stiacentre Acknowledgements We would like to thanks all the people in the four sites who worked to make person centred planning a reality for so many people, and who also put up with our unending questions. Contents Summary..............................................................................................................................i Background......................................................................................................................i The Project.......................................................................................................................i Summary of Results.......................................................................................................iii Person Centred Planning Leads to Improved Life Experiences for People with Learning Disabilities..................................................................................................iii The Benefits of Person Centred Planning Vary Across Areas of Life, People and Contexts.....................................................................................................................iii The Introduction of PCP was Not Associated with Any Change in the Costs of Supports to Participants.............................................................................................vi Strengths & Limitations of the Study........................................................................vi Implications for Policy and Practice.............................................................................vii Maintain and Enhance Investment in PCP...............................................................viii Develop Systems for Monitoring the Delivery and Impact of PCP...........................ix Ensure That Services Have the Capacity and Systems for Delivering Person Centred Results.........................................................................................................................x Continue Learning about the Conditions under Which PCP Delivers the Maximum Benefits for People with Learning Disabilities...........................................................x Final Comments.............................................................................................................xi Introduction.........................................................................................................................1 Background.....................................................................................................................1 What is Person Centred Planning?..................................................................................2 The Policy Context.........................................................................................................2 Some Key Features of the Department of Health Guidance.......................................3 Context for Implementation........................................................................................5 The Future?.................................................................................................................6 Conclusion..................................................................................................................8 The Evidence Base: What is Already Known about the Impact of Person Centred Planning?.........................................................................................................................8 An Overview of the Project..........................................................................................10 Supporting the Development of Person Centred Planning...............................................13 Introduction...................................................................................................................13 Implementing Change...................................................................................................13 Leadership.................................................................................................................14 Influential Implementation Group............................................................................14 The Development Process.............................................................................................15 Building Capacity to Help People Make Plans.........................................................15 Conclusions...................................................................................................................23 The Impact of Person Centred Planning on the Life Experiences of People with Learning Disabilities........................................................................................................................24 The Approach to Evaluation.........................................................................................24 Consent.....................................................................................................................24 Information Collected...............................................................................................25 Procedure..................................................................................................................27 The Participants............................................................................................................28 Age, Gender & Ethnicity..........................................................................................28 Abilities and Additional Impairments.......................................................................29 Health Needs.............................................................................................................30 Mental Health, Emotional and Behavioural Needs...................................................31 Current Living Arrangements...................................................................................32 The Impact of Person Centred Planning.......................................................................33 Change Prior to the Implementation of PCP.............................................................33 The Impact of Implementing PCP............................................................................36 Summary...................................................................................................................43 Predicting the Outcomes of PCP...............................................................................44 The Views of the Participants...................................................................................57 The Economic Impact of Person Centred Planning..........................................................63 Methodology.................................................................................................................63 Data Collection.........................................................................................................65 Cost Estimation.........................................................................................................65 Data analysis.............................................................................................................66 Results...........................................................................................................................67 Direct Costs...............................................................................................................67 Pre-Implementation Costs.........................................................................................68 Post-implementation Costs.......................................................................................76 Cost Prediction..........................................................................................................82 Summary.......................................................................................................................85 Organisational Factors Influencing the Effectiveness of Person Centred Planning.........87 Conclusions.................................................................................................................101 Conclusions & Recommendations..................................................................................103 An Overview of the Evaluation Results......................................................................103 Person Centred Planning Leads to Improved Life Experiences for People with Learning Disabilities...............................................................................................103 The Benefits of Person Centred Planning Vary Across Areas of Life, People and Contexts..................................................................................................................104 The Introduction of PCP was Not Associated with Any Change in the Costs of Supports to Participants..........................................................................................107 Strengths & Limitations of the Study.....................................................................108 Implications for Policy and Practice...........................................................................109 Maintain and Enhance Investment in PCP..............................................................110 Develop Systems for Monitoring the Delivery and Impact of PCP........................111 Ensure That Services Have the Capacity and Systems for Delivering Person Centred Results.....................................................................................................................112 Continue Learning about the Conditions under Which PCP Delivers the Maximum Benefits for People with Learning Disabilities.......................................................112 Final Comments..........................................................................................................113 References.......................................................................................................................114 Appendix.........................................................................................................................120 Significant Differences in Personal Characteristics of Participants across Sites........120 Mean or % Values for Variables for Which Significant Change Was Reported in Table 9 for the ‘Efficacious at All’ Comparisons.................................................................121 Factor Analyses of Facilitator Views..........................................................................122 Job Descriptions..........................................................................................................124 Summary Background In 2001 the Department of Health published a new White Paper (Valuing People) that set out a strategy for the development and delivery of health and social care services for people with learning disabilities in England. A central component of this new strategy was to require Learning Disability Partnership Boards to introduce person centred planning (PCP) as a means of increasing the extent to which supports were tailored to the needs and aspirations of people with learning disabilities. The White Paper expectations were translated into ‘section seven’ guidance in LAC (2001) 23 and good practice guidance published in 2002 as Planning with People – Towards Person Centred Approaches. At the same time the Department of Health launched the Learning Disability Research Initiative. This was a policy related programme of research that sought to commission a range of research projects addressing issues relevant to the new policies laid out in Valuing People. Our project was commissioned by the Department of Health under the Learning Disability Research Initiative. Additional funding for the project was provided by the Foundation for People with Learning Disabilities. The main reasons for commissioning the project were that there was, at that time, no robust evidence either of the impact of introducing PCP or of those factors which may either facilitate or impede the introduction and effectiveness of PCP. Thus the mains aims of our project were to: • Evaluate the impact of the introduction of PCP on o the life experiences of people with learning disabilities o the nature and costs of supports provided to people with learning disabilities. • Identify personal, contextual and organisational factors which appear to either facilitate or impede the introduction and effectiveness of PCP The Project In order to pursue these aims, our project was comprised of four distinct, but related, components. First, we undertook development work with organisations in four localities in England. The selection of localities was based on two main factors. • That the organisations within the localities showed evidence of a commitment to implement PCP in order to enhance the life experiences of people with learning i disabilities. That is, we attempted to exclude localities whose primary commitment appeared to be to implement PCP in order to fulfil organisational obligations and requirements. We evaluated the commitment of organisations through local knowledge of members of the research team and discussion with key managers in candidate organisations. • That the sites, in combination, would provide a high degree of diversity with regard to the characteristics of communities and participants. Thus, for example, we sought to include localities that varied with respect to level of affluence, urban/rural location and the ethnic mix in the communities served. The essential aim of the development work was to provide additional support to local organisations to help them develop robust policies procedures and practices to implement PCP. The nature of the development work and the conclusions drawn by the external consultants who undertook the development work are presented in Chapter 2. The evaluation side of the project involved three related components that addressed distinct questions. They were: • What impact does the introduction of PCP have on the life experiences of people with learning disabilities? • What costs are associated with the introduction of PCP? • What organisational factors impede or facilitate the introduction and effectiveness of PCP? We addressed the first question by attempting to follow over a two year period each of the first 25 people in each site who participated in the PCP process. In Chapter 3 we describe the characteristics of the people who participated and present results relating to the efficacy and effectiveness of PCP in improving the life circumstances of people with learning disabilities. We addressed the second question by documenting the costs associated with developing and implementing PCP in each of the four sites and by determining the impact of the introduction of PCP on the costs of supports for the first 25 people in each site who participated in the PCP process. We present the results of these analyses in Chapter 4. We addressed the third question by undertaking interviews with managers and practitioners in each of the four sites, reviewing documentation and attending meetings. A detailed description of the approach taken and results of this organisational-level analysis are presented in Chapter 5. ii Summary of Results Person Centred Planning Leads to Improved Life Experiences for People with Learning Disabilities The results of the evaluation clearly indicated that the introduction of PCP had a positive benefit on the life experiences of people with learning disabilities. Even when we employed the more conservative ‘intent to treat’ analyses to evaluate effectiveness (rather than efficacy), PCP was associated with benefits in the areas of: • community involvement • contact with friends • contact with family • choice. These positive benefits are consistent with the comments made by the participants themselves, claims made by advocates of PCP and the results of the very small number of previous studies that have sought to formally evaluate the impact of PCP. They also support the current emphasis within health and social care policy current UK on using PCP to improve the life chances of people with learning disabilities. The Benefits of Person Centred Planning Vary Across Areas of Life, People and Contexts While the results of our evaluation indicated that PCP was both efficacious and effective, they also suggested that the impact of PCP varied markedly across the domains of ‘quality of life’ we investigated, across people and across the contexts in which people were living. Across Areas of Life While PCP was associated with benefits in some domains of ‘quality of life’, it had no apparent impact on others (e.g., more inclusive social networks, employment, physical, activity, medication) and there were three areas (risks, physical health, emotional and behavioural needs) where there was evidence of change in a ‘negative’ direction. This pattern of results (benefits in the number and variety of community-based and non- inclusive social activities, but no change in ‘stronger’ markers of social inclusion) mirrors that of research that has evaluated the impact of deinstitutionalisation. This similarity suggests that, rather than representing a radical departure from previous practices, PCP builds on the existing capacity of services and supports. In other words, PCP may be best considered an evolutionary step in the long-standing trend towards the increasing individualisation of supports and services. iii Across People Our analyses of factors that were associated with the uptake and efficacy of PCP highlighted the importance of a number of characteristics of people with learning disabilities. • People with mental health or emotional or behavioural problems were less likely to receive a plan and less likely to benefit of they did receive a plan in the areas of size of social networks, contact with friends, contact with family, choice, hours per week of scheduled activity and (depending on the measure used) number of community activities. • People with autism were less likely to receive a plan. • Women were more likely to benefit in the areas of number of community activities and choice. Men were more likely to benefit in the areas of number of hours per week of scheduled activity and contact with friends. • People with more health problems were less likely to receive a plan, but if they did were more likely to benefit in the areas of contact with friends. • People with restricted mobility were less likely to receive a plan, but if the did were more likely to benefit in the areas of contact with family, hours per week of scheduled activity and number of community activities. These results, and in particular those relating to mental health and autism, indicate some powerful inequalities in the extent to which people are likely to receive a person centred plan and, if they do, the level of benefits they can expect. Similar inequalities have previously been reported in a wide range of studies on supported accommodation and the general life experiences of people with learning disabilities in England. Across Contexts Similarly, a range of contextual factors appeared to be associated with whether people were more or less likely to receive a PCP and, if they did, the likelihood that they would benefit. • The existence of more person centred ways of working prior to the introduction of PCP was associated (perhaps unsurprisingly) with increased chances of getting PCP. It was also associated with increased chances of benefiting in the areas of hours per week of scheduled activity and choice, but with decreased chances of benefiting in the areas of size of social networks, number of community-based activities and contacts with family. These apparently contradictory results may reflect the success of pre-existing IP systems in addressing the latter three areas, thus leaving less scope for further improvements following the introduction of PCP. • Having a care manager was associated with benefits in the areas of: size of social network; number of community-based activities; choice; and contact with family. It was associated with reduced benefits in the area of contact with friends. • Similarly, living nearer to one’s family was associated with increased chances of getting PCP. It was, however, also associated with decreased chances of iv

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Janet Robertson, Eric Emerson, Chris Hatton & Johan Elliott. Institute for Health Research, we sought to include localities that varied with respect to level of affluence, urban/rural location and . Living in a less affluent area was associated with benefits in two areas: size of social networks a
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