I. Summary/Background

The Michigan Mental Health Code establishes the right for all individuals to have their Individual Plan of Service developed through a person-centered planning process regardless of age, disability or residential setting. The Individual Plan of Service may include a treatment plan, support plan or both. In the past, Medicaid or other regulatory standards have governed the process of treatment or support plan development. These standards drove the planning process through requirements on the types of assessments to be completed and the professionals to be involved. Person-centered planning departs from this approach in that the individual will direct the planning process with a focus on what he/she wants and needs. Professionally trained staff will play a role in the planning and delivery of treatment and may play a role in the planning and delivery of supports. However, the development of the treatment or support plan, including the identification of possible services and professionals, is based upon the expressed needs and desires of the individual.

The Michigan Department of Community Health (MDCH) has advocated and supported a family approach to service delivery for children and their families. This approach recognizes the importance of the family system and the fact that supports and services will impact the entire system. Therefore, in the case of minors, the child/family will be the focus of service planning and family members are integral to the planning process and its success. The wants and needs of the child/family will be considered in the planning and evaluation of supports, services and/or treatment.

Managed care strategies will play an important role in planning for and delivery of supports, services and/or treatment. Person-centered planning fits well with these strategies. Both strategies attempt to ensure that individuals are provided with the most appropriate services necessary to achieve the desired outcomes. When an individual expresses a choice or preference for a support, service and/or treatment for which an appropriate alternative of lesser cost exists, a process for dispute resolution and appeal may be indicated. This document provides guidelines for addressing dispute concerns.

The literature describes specific methods for person-centered planning, including but not limited to, individual service design, Personal Futures Planning, McGill Action Planning Systems, Essential Lifestyle Planning, Planning Alternative Tomorrows With Hope, etc. This practice guideline does not support one model over another. It does, however, define the values, principals and essential elements of the person-centered planning process and it provides illustrations to its application.

II. Values and Principles Underlying Person-Centered Planning

Person-centered planning is a highly individualized process designed to respond to the expressed needs/desires of the individual.

A. Each individual has strengths, and the ability to express preferences and to make choices.
B. The individual's choices and preferences shall always be considered if not always granted.
C. Professionally trained staff will play a role in the planning and delivery of treatment and may play a role in the planning and delivery of supports. Their involvement occurs if the individual has expressed or demonstrated a need that could be met by professional intervention.
D. Treatment and supports identified through the process shall be provided in environments that promote maximum independence, community connections and quality of life.
E. A person's cultural background shall be recognized and valued in the decision-making process.

III. Practice Guidelines

A. Essential Elements

1. The individual shall be given ongoing opportunities to express his/her needs or desired outcomes. This would include:

a. Making accommodations for communication to maximize ability for expression;

b. The identification of outcomes of value for the individual; and

c. Expectations of the service delivery system.

2. Potential support and/or treatment options to meet the expressed needs of the individual are identified and discussed with the individual.

3. The individual shall be given ongoing opportunities to express his/her preferences and to make choices. This would include:

a. Choices and options shall be clearly explained.

b. To the extent possible, the individual shall be given the opportunity for experiencing the options available prior to making a choice/decision. This is particularly critical for those persons who have limited life experiences in the community with respect to housing, work and other domains.

c. Individuals who have court-appointed legal guardians shall participate in person-centered planning to the maximum extent possible and shall have authority not otherwise specifically delegated to the guardian.

d. Parents and significant family members of minors are integral to and shall participate in the planning process unless:

i. The minor is fourteen years of age or older and has requested services without the knowledge or consent of parents, guardian or person in loco parentis within the restrictions stated in the Mental Health Code;

ii. The minor is emancipated; or

iii. The inclusion of the parent(s) or significant family members would constitute a substantial risk of physical or emotional harm to the recipient or substantial disruption of the planning process as stated in the Mental Health Code. Justification of the exclusion of parents shall be documented in the clinical record.

4. Individuals are provided with opportunities to provide feedback on how they feel about the service, support and/or treatment they are receiving and their progress toward attaining valued outcomes.

B. Illustrations of Individual Needs

Person-centered planning processes begin when the individual makes a request to the Responsible Mental Health Agency (RMHA). The first step is to find out from the individual the reason for his/her request for assistance. During this process, individual needs and valued outcomes are identified rather than requests for a specific type of service. Since person-centered planning is an individualized process, how the RMHA proceeds will depend upon what the individual requests.

This guideline includes a chart of elements/strategies that can be used by the person representing the RMHA depending upon what the individual wants and needs. Three possible situations are:

1. The individual expresses a need which would be considered urgent or emergent.

When an individual is in an urgent/emergent situation, the goal is to get the individual's crisis situation stabilized. Following stabilization, the individual and RMHA will explore further needs for assistance and if required, proceed to a more in-depth planning process as outlined below. It is in this type of situation where an individual's opportunity to make choices may be limited.

2. The individual expresses a need or makes a request for a support, service and/or treatment in a single life domain and/or of a short duration.

A life domain could be any of the following:

a. Daily activities;

b. Social relationships;

c. Finances;

d. Work;

e. School;

f. Legal and safety;

g. Health;

h. Family relationships; etc.

3. The individual expresses multiple needs which involve multiple life domains for support(s), service(s) or treatment of an extended duration.

The following chart represents the elements/strategies that can be used depending on the kinds of needs expressed by the individual.

[CHART OMITTED]

IV. Assurances and Indicators of Person-Centered Planning Implementation

It is the responsibility of the RMHA to assure that the Individual Plan of Service is developed utilizing a person-centered planning process. Below are examples of systemic and individual level indicators which would demonstrate that person-centered planning has occurred. The methods of gathering information or evidence may vary and include the review of administrative documents, clinical policy and guidelines, case record review and interviews/focus groups with individuals and their families.

A. Systemic indicators would include, but not be limited to:

1. The RMHA has a policy or practice guideline which delineates how person-centered planning will be implemented;

2. Evidence that the RMHA informs individuals of their right to person-centered planning and associated appeal mechanisms, investigates complaints in this area, and documents outcomes;

3. Evidence that the RMHA's quality improvement system actively seeks feedback from individuals receiving services, support and/or treatment regarding their satisfaction providing opportunities to express needs and preferences and the ability to make choices; and

4. The RMHA's staff development plan includes efforts to ensure that staff involved in managing, planning and delivering support and/or treatment services are trained in the philosophy and methods of person-centered planning.

B. Individual indicators could include but not be limited to:

1. Evidence the individual was provided with information of his/her right to person-centered planning;

2. Evidence that the individual chose whether or not other persons should be involved and those identified were involved in the planning process and in the implementation of the Individual Plan of Service;

3. Evidence that the individual chose the places and times to meet, convenient to the individual and to the people he/she wanted present;

4. Evidence that the individual had choice in the selection of treatment or support services and staff;

5. Evidence that the individual's preferences and choices were considered, or a description of the dispute/appeal process and the resulting outcome; and

6. Evidence that the progress made toward the valued outcomes identified by the individual was reviewed and discussed for the purpose of modifying the strategies and techniques employed to achieve these outcomes.

V. Dispute Resolution/Appeal Mechanisms

1. If in the judgement of the person representing the RMHA, an individual requests inpatient treatment, or a specific mental health support or service for which appropriate alternatives for the individual exist that are of equal or greater effectiveness and equal or lower cost, the RMHA should:

a. Identify and discuss the underlying reasons for the request/preference;
b. Identify and discuss alternatives with the individual; and
c. Negotiate toward a mutually acceptable support, service and/or treatment.

In the event that a mutually acceptable alternative cannot be reached, the person representing the RMHA should:

a. Document the individual's preference, the support, service and/or treatment the RMHA is offering, and the reason for not accepting that preference;
b. Inform the individual of their right to appeal the decision as permitted in the Grievance and Appeal Technical Requirement attachment to the MDCH/CMHSP Managed Specialty Supports and Services Contract. This would include:

i. His/her right to contact the recipient rights office for consultation, mediation or intervention in response to their request for a specific mental health support or service;
ii. His/her right to request a second opinion as referenced in the Mental Health Code, if requesting inpatient treatment; and
iii. His/her right to a Fair Hearing, if a recipient of Medicaid coverage.

2. If in the judgement of the RMHA, an individual's choice or preference for the inclusion or exclusion of a planning participant, meeting location or specific provider poses an issue of health or safety or exceeds reasonable expectations of resource consumption, the RMHA should discuss and identify the individual's underlying reason for that specific choice or preference and negotiate toward a mutually acceptable alternative that meets the outcomes intended.

3. If an individual is not satisfied with his/her Individual Plan of Service, the Michigan Mental Health Code allows the individual to make a request for review to the designated individual in charge of implementing the plan. The review shall be completed within 30 days and shall be carried out in a manner approved by the appropriate governing body. In addition, the individual has access to the appeal processes as defined in the Grievance and Appeal Technical Requirement of the MDCH/CMHSP Managed Specialty Supports and Services Contract.

4. If the individual believes that the opportunity for person-centered planning is not provided as specified in the manner above, it is the responsibility of the RMHA to inform the individual of his/her right to consult with the recipient rights office.

5. When there is a disagreement between an individual and the legal guardian or responsible parent, the RMHA staff should attempt to mediate between the two parties in order to provide an outcome which is acceptable to both parties.

VI. Definitions

Case Manager/Supports Coordinator
The staff person who works with the individual to gain access to and coordinate the services, supports and/or treatment which the individual wants or needs.

Emancipated Minor
The termination of the rights of the parents to the custody, control, services and earnings of a minor which occurs by operation of law or pursuant to a petition filed by a minor with the probate court.

Emergency Situation
A situation when the individual can reasonably be expected in the near future to physically injure himself, herself, or another person; is unable to attend to food, clothing, shelter or basic physical activities that may lead to future harm or the individual's judgement is impaired leading to the inability to understand the need for treatment resulting in physical harm to self or others.

Family Member
A parent, stepparent, spouse, sibling, child, or grandparent of a primary consumer, or an individual upon whom a primary consumer is dependent for at least 50 percent of his or her financial support.

Guardian
A person appointed by the court to exercise specific powers over an individual who is a minor, legally incapacitated or developmentally disabled.

Individual Plan of Service
A written Individualized Plan of Service directed by the individual as required by the Mental Health Code. This may be referred to as a treatment plan or a support plan.

Minor
An individual under the age of 18 years.

Person-Centered Planning
A process for planning and supporting the individual receiving services that build upon the individual's capacity to engage in activities that promote community life and honor the individual's preferences, choices, and abilities. The person-centered planning process involves families, friends, and professionals as the individual desires or requires.

Responsible Mental Health Agency (RMHA)
A Community Mental Health Services Program responsible for arranging and/or coordinating the provision of services for the individual.

Urgent Situation
A situation in which an individual is determined to be at risk of experiencing an emergency situation in the near future if he or she does not receive care, treatment or support services.

VII. Legal References:

Mental Health Code Act, 258 MI. §§ 409-1-7 (1974 & Supp. 1996).
Mental Health Code Act, 258 MI. §§ 700-g (1974 & Supp. 1996).
Mental Health Code Act, 258 MI. §§ 707-1-5 (1974 & Supp. 1996).
Mental Health Code Act, 258 MI. §§ 712-1-3 (1974 & Supp. 1996).

VIII. Related References: