Untitled - Mental Health Foundation

139 Pages·2011·0.63 MB·English

by  Eric Emerson

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
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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.
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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.

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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
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