Person-centered planning and supported decision-making

The person is the plan's author

Person-centered planning is not a form. It is a stance: the person's own goals, preferences, relationships and definition of a good life drive the plan, and services are arranged to support that life rather than the other way round. In Minnesota's disability services, this is built into how support planning and assessments are meant to work, and it is a central commitment of the state's Olmstead Plan, which aims for people with disabilities to live, learn, work and enjoy life in the most integrated setting they choose. Staff who run intake, assessment and planning conversations are where that commitment either becomes real or does not.

Supported decision-making is the practice that keeps the person in the author's chair. The person chooses supporters they trust, family, friends, a support worker, an advocate, who help them understand information, weigh options and communicate a choice. The person still decides. This differs from substituted decision-making, where someone else decides on the person's behalf. Even where a court has appointed a guardian, the order covers specific decisions; it does not cover the conversation, and it does not make the person's own preferences irrelevant. Ask what the order covers. Then talk to the person.

The hardest moments are not with people who refuse to include the participant. They are with loving family members who have spoken for someone for years and do it without thinking. Redirecting well means keeping them in a role they can be proud of, supporter, while returning the questions to the person.

Redirecting to the person, step by step

Open by addressing the participant and asking how they would like the person they brought to take part.
Ask each question to the participant, by name, with eye contact, and wait. Silence is thinking time, not a cue for someone else to fill.
If the helper answers, acknowledge and return: “Thanks, that is helpful. Marcus, is that right? What would you add?”
Offer information in a form the participant can use: plain language, one option at a time, written or pictured choices, a summary to take home.
Check the decision with the participant directly: “So you want to look at warehouse jobs first. Did I get that right?”
Close by naming the supporter's role going forward, as the participant defined it, and record whose decision it was.

Who is in the room, and what is their role?

The participant

The decision maker and the plan's author. Every question goes to them first. Their words, including their goals and their objections, go in the record as theirs.

A chosen supporter

A family member, friend or advocate the participant asked to be there. Helps the person understand, remember and communicate. Does not decide. Ask the participant what they want the supporter to do, and hold to it.

A guardian or conservator

Holds legal authority over specific decisions named in the order. Confirm what the order covers rather than assuming it covers everything. The participant's preferences still matter and still belong in the plan, and many decisions in an ordinary intake fall outside the order.

Direct-support staff or a case manager

Knows the person's routines and supports, and can be a valuable source, after the participant. Should not be asked to answer for the person's preferences or goals.

You

You run the conversation. You decide who gets asked first, how long the pauses are, what format the information comes in, and whose answer is recorded as the decision.

Return the question

What you can change

You control who you ask, how long you wait, and whose answer you write down.

What to watch for

Do not let a whole intake happen with the participant silent because the helper was efficient. Do not correct the helper in a way that shames them; they have usually been doing this out of love and habit.

Your next step

Use “I want to hear from you first” at the start of your next planning conversation, and return at least one answered-for question to the participant.

Terms that shape the plan

Person-centered planning

Planning that starts from what matters to the person, in their words, and arranges services around that life. The person is the author; staff are the scribe and the resource finder.

Supported decision-making

The person makes the decision with help from supporters they choose. Help can mean explaining options, taking time, using pictures or plain language, or thinking out loud together.

Substituted decision-making

Someone else decides for the person. Appropriate only where a legal order or clear program rule assigns that authority, and only for the decisions it names.

What a guardianship order does not do

It does not remove the person from the conversation, make their preferences irrelevant or cover decisions the order does not name. Ask what it covers.

Most integrated setting

The Olmstead principle that people with disabilities should be able to live, work and take part in community life alongside people without disabilities, in the setting they choose. Planning conversations are where choice becomes real.

Dignity in redirecting

“Thanks, that is helpful. Marcus, what would you add?” Keeps the supporter respected and the participant central.

A participant's guardian tells a case manager, “I make all her decisions, so you can just deal with me.” What is the most accurate response?

Accept it. A guardian has full authority, and the participant does not need to be included.

Ask to see what the guardianship order covers, keep the participant as the primary party in the conversation, and record her preferences as hers, whatever the decision authority turns out to be.

Refuse to speak with the guardian until the participant says it is all right.

Try a situation

A young man with an intellectual disability comes to enroll in a workforce program with his mother. He wants to work in a warehouse near his home. Every time the intake worker asks him a question, his mother answers first: his schedule, his transportation, his strengths, what he can and cannot do. He looks at the table.

What does the intake worker do?

Keep going. The mother knows the details and the intake will be faster and more accurate.

Ask the mother to wait outside so the participant can answer for himself.

Turn to the participant and say, “I want to hear from you first, and your mom can add anything after. Would that work?” Then ask each question to him, give him time, and offer information in a form he can use.

Carry this forward

Person-centered planning starts from what matters to the person, in their words, and builds services around it rather than fitting the person into a service.
Supported decision-making means the person makes the decision with help they choose; substituted decision-making means someone else decides. Most people, including many with guardians, can do the first with the right support.
A guardianship order does not remove a person's voice from a conversation about their own life. Check what the order covers, and keep the person as the primary party either way.

A scenario decision about a family member who answers every question, a knowledge check and one planning conversation you will run differently.

Before your next planning or intake conversation where a helper will be present, ask the participant privately or at the start how they would like the helper to take part, and follow that instruction for the whole conversation.

Your next step

In your planning or intake conversations, who usually answers, and who should?

Notice in your next three conversations how many questions the participant answers directly

Try the opening line: “I want to hear from you first, and then anyone you brought can add to it”

Ask a participant afterward whether the plan says what they wanted

What you’ll be able to do

The person is the plan's author

Redirecting to the person, step by step

Who is in the room, and what is their role?

Return the question

What you can change

What to watch for

Your next step

Terms that shape the plan

Try a situation

Carry this forward

Your next step

Person-centered planning and supported decision-making

What you’ll be able to do

The person is the plan's author

Redirecting to the person, step by step

Who is in the room, and what is their role?

Return the question

What you can change

What to watch for

Your next step

Terms that shape the plan

Try a situation

Carry this forward

Your next step