I deliver or oversee person-centered services

A nurse helping an elderly man

On this page you will find person-centered resources for Home and Community-Based Service providers (residential and non-residential), Managed Care Organizations (case managers and insurers), service planners/care coordinators, direct service staff and service providers, agency management and State and local officials and staff.

Please note that this resource library is intended to support the development of person-centered thinking, planning and practice skills and concepts. The resources provided are not intended as legal guidance or direction, and may not be directly applicable to New York State, but rather are included for informational purposes and examples of best practices.

Resources are organized into the following categories (please click on the document title and/or the URL to access the resource):

Five Skill Areas Facilitators Should Have to Best Support Person-Centered Planning
Document Type: Guide
Source: National Center on Advancing Person-Centered Practices and Systems (NCAPPS)
Description: This plain language guide documents the five skills (or competencies) facilitators of person-centered plans should have. It provides detailed explanations of each of the skills so that all participants of person-centered planning know what to expect from the facilitator.
URL: https://www.hsri.org/files/uploads/publications/NCAPPS_StaffCompetencyDomains_PlainLanguage_Final.pdf


That Discomfort You're Feeling Is Grief
Document Type: Article
Source: Harvard Business Review
Description: The author recounts an interview with David Kessler, an expert on grief. Kessler shares his thinking on grief, how to manage it, and finding meaning in grief.
URL: https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief


Brené Brown Video on Empathy
Document Type: Video
Source: Royal Society of Arts (RSA)
Description: Brene Brown narrates this animated short video that looks at the difference between empathy and sympathy and focuses on the four qualities of empathy. The empathy skills discussed in the video can provide support for people experiencing trauma.
URL: https://www.youtube.com/watch?v=1Evwgu369Jw


Person Centered Planning & Inclusion
Document Type: Podcast
Source: LOMAH Disability Podcast
Description: On this episode of the LOMAH podcast, guest Erin Sheldon discusses person centered planning and inclusive supports. Please click on the link titled ‘Episode Website' near the bottom of the page or on the left side of the page to listen to the podcast. You can also listen to the podcast on Apple Podcasts. Listeners do not have to subscribe to listen to the podcast.
URL: https://podcasts.apple.com/us/podcast/person-centered-planning-inclusion/id1238352496?i=1000419960374


The Clinical Consult Podcast - Informed Consent: The Basics
Document Type: Podcast
Source: National Register of Health Service Psychologists
Description: Dr. Jeffrey Barnett, PsyD, ABPP, a licensed psychologist and Associate Dean and Professor of Psychology at Loyola University Maryland, discusses the basics of informed consent. Discussion includes the value of the informed consent process, the fact that it is a process, and provides examples of situations where informed consent is to be given. He also reviews the differences between ‘consent' and ‘assent'.
URL: https://www.nationalregister.org/education-training/podcasts/?mm=informed-consent-basics#mm-featured__1


Understanding Person-Centered Care
Document Type: Podcast
Source: Pursuing Quality Long-Term Care: National Consumer Voice for Quality Long-Term Care
Description: On this podcast Sonya Barsness discusses the philosophy that honors needs, preferences and goals of aging people by emphasizing choice, self-determination, relationships and purposeful living. Please click on the link titled ‘Episode Website' near the bottom of the page or on the left side of the page to listen to the podcast. You can also listen to the podcast on Apple Podcasts. Listeners do not have to subscribe to listen to the podcast.
URL: https://podcasts.apple.com/us/podcast/understanding-person-centered-care/id1522955998?i=1000499469082


Dr. Laura Brackin Returns to Discuss Person Centered Care Planning
Document Type: Podcast
Source: Home Care America Podcast
Description: In this episode of the Home Care America podcast, Dr. Laura Brackin discusses the importance of person-centered care planning with rich details from her decades of experience. You can click on the arrow beneath the box on the left side of the webpage to listen to this podcast. You can also listen to the podcast on Apple Podcasts. Listeners do not have to subscribe to listen to the podcast.
URL: https://podcasts.apple.com/us/podcast/dr-laura-brackin-returns-to-discuss-person-centered/id1605863897?i=1000552544478


An Introduction to Trauma-Informed Care
Document Type: Article
Source: Dr. Karyn Harvey
Description: An article that introduces trauma informed care and the positive impact that Direct Support Professionals (DSPs) can have on the quality of life of a person with a history of trauma.
URL: https://publications.ici.umn.edu/frontline-initiative/13-1/an-introduction-to-trauma-informed-care


Frontline Initiative
Document Type: Newsletter
Source: Institute on Community Integration
Description: This newsletter series covers the issues important to direct support professionals and supervisors who support people with disabilities living in a variety of community settings. Click on a topic of interest under the heading of products. The topic can then be downloaded for free to read by clicking in the yellow box where it says ‘Free'.
URL: https://ici.umn.edu/series/7


What does Person-Centered Planning mean?
Document Type: Article
Source: Institute on Community Integration: Frontline Initiative - Article by Betsy Gadbois
Description: An article by Betsy Gadbois that explores the essence of person-centered planning.
URL: https://publications.ici.umn.edu/frontline-initiative/14-1/what-does-person-centered-planning-mean


Choice, Direction, and Control: How do I support these in my duties as a DSP?
Document Type: Article
Source: Institute on Community Integration: Frontline Initiative - Article written by Desiree Loucks Baer
Description: An article exploring choice, direction and control from the perspective of the role of a direct support professional.
URL: https://publications.ici.umn.edu/frontline-initiative/14-2/choice-direction-and-control-how-do-i-support-these-in-my-duties-as-a-dsp


The Changing Roles & Expectations of Direct Support Professionals
Document Type: Article
Source: NADSP Update, Author Joseph M. Macbeth
Description: An article that explores the changing expectations and roles of direct support professionals.
URL: https://ici.umn.edu/products/frontline-initiative/151/DSP-Changing-Expectations/#DSP-Changing-Expectations


Person-Centered Cultural Humility: 10 Personal Commitments
Document Type: PDF Document
Source: Danyetta Najoli
Description: The 10 Commitments of Person-Centered Cultural Humility is a set of agreements that direct support professionals and front-line managers can use as they work to support people with disabilities.
URL: https://www.danyetta.com/_files/ugd/618f1e_bfaca23b3ded4d9fa9dbda0c634a09bd.pdf


Public Health Live! Person-Centered Healthcare in Planning and Practice
Document Type: Recorded Webcast
Source: University at Albany School of Public Health
Description: This one-hour webcast presents a conceptual understanding of person-centered planning and practice. The speakers, Tanya Richmond of Support Development Associates and Kate Barkley of Fort Hudson Care Management, share insights on the evolution of person-centered thinking, discuss person-centered planning and practice in the context of the HCBS Final Rule, and show how the core concepts of person-centered planning are being put into practice in a care management setting.
URL: https://www.albany.edu/cphce/phl_0320.shtml


Fact Sheet on Person-Centered Planning (in English, Spanish, Chinese)
Document Type: Fact Sheet (PDF)
Source: Public Consulting Group, Inc.
Description: A brief fact sheet including background information on the person-centered planning provisions included in the HCBS Final Rule.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/fact_sheet.htm


Person-Centered Planning, Practice and Thinking Poster (#14063) (in English, Spanish, Chinese)
Document Type: Poster (PDF)
Source: New York State Department of Health
Description: A one-page resource that provides easy to understand definitions of person-centered planning, thinking and practice.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/poster.htm


HCBS Rule Fact Sheet (in English, Spanish, Chinese)
Document Type: Fact Sheet (PDF)
Source: New York State Department of Health
Description: A fact sheet that gives an overview of the HCBS Final Rule and its relevance in New York State.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/hcbs_rule.htm


National Center on Advancing Person-Centered Practices and Systems (NCAPPS)
Document Type: Website
Source: Administration for Community Living (ACL) and the Center for Policy and Education (CPE)
Description: The NCAPPS website hosts many current informational resources to help States implement person-centered thinking, planning, and practice in a way that is in line with federal policy. The goal of NCAPPS is to promote systems change that makes person-centered principles not just a hope but a reality in the lives of people who use services and supports across the lifespan.
URL: https://ncapps.acl.gov/


When People Matter More than Systems
Document Type: Presentation (PDF)
Source: Michael J. Kendrick, PhD
Description: The keynote speaker presentation from "The Promise for Opportunity" Conference held in Albany, NY, on March 27-28, 2000.
URL: https://creativeoptionsregina.ca/wp-content/uploads/2015/08/When-People-Matter-More-Than-Systems.pdf


Shared Decision-Making
Document Type: Article (Web)
Source: William Godolphin, Healthcare Quarterly 12(sp), August 2009, Longwoods.com
Description : An article that discusses shared decision making.
URL: https://www.longwoods.com/content/20947/healthcare-quarterly/shared-decision-making


Adult Day Services in Home and Community-based Settings
Document Type: Recorded Webinar
Source: New York State Office for the Aging
Description: A webinar presentation describing the historical institutionalization of individuals with disabilities and disabling conditions, leading up to the Home and Community-Based Services (HCBS) Final Rule and the culture change required to implement the Rule. The presentation also addresses Adult Day Services and the Day Habilitation Model in the context of person-centered planning and implementation across the Aging network in New York State.
URL: https://meetny.webex.com/recordingservice/sites/meetny/recording/0ea7e95bf6e71039bdea0050568ced19/playback


Supported Decision Making Program
Document Type: Website
Source: Administration for Community Living (ACL)
Description: Website that provides information about supported decision-making and the history of ACL's support for the National Resource Center for Supported Decision Making.
URL: https://acl.gov/programs/consumer-control/supported-decision-making-program


Supported Decision-Making New York
Document Type: Website
Source: Supported Decision-Making New York
Description: Website for Supported Decision-Making New York (SDMNY), which was formed in 2016. This website contains information and resources about both SDM in general and specifically for New York State.  
URL: https://sdmny.org/


Supported Decision Making Podcast
Document Type: Podcast
Source: Advocacy for Inclusion (AFI)
Description: Series of 10 podcast episodes from Advocacy for Inclusion (AFI), an Australian-based advocacy group. The intent of this series of podcasts is to inform listeners of the skills they can develop to support others in their decision-making. The host speaks broadly about building these skills but there is also a focus on supporting people with disabilities. To access each podcast episode, use the ‘Play' button on an episode in the ‘All Episodes' list; it is not necessary to log in or subscribe to Spotify to listen.
URL: https://open.spotify.com/show/27gtq0WjWW7T8OuQZwH21d

Listen, Learn, Act: Selected Writings by Michael W. Smull on Essential Lifestyle Planning, Self-Determination, and Organizational Change
Document Type: Article (Web)
Source Support Development Associates, Michael W. Smull
Description: This resource provides a compilation of articles by a single author on topics related to person-centered planning for Individuals with Disabilities.
URL: https://allenshea.com/wp-content/uploads/2019/04/listenlearnact.pdf


Person-Centered Planning: PATH, MAPS, and Circles of Support
Document Type: Article (Web)
Source: Inclusion Press
Description: This resource outlines the person-centered planning tools PATH, MAPS and CIRCLES which were developed to assist individuals, families, and their support networks to plan positive futures.
URL: https://inclusion.com/path-maps-and-person-centered-planning/


Person-Centered Planning: Overview and Workshop
Document Type: Website and Video
Source: Administration for Community Living
Description: An overview of person-centered planning, including a video of an ACL-hosted person-centered planning workshop from August 2017 which provides an example of a long-term services and supports system embracing person-centered thinking, planning, and practices.
URL: https://acl.gov/programs/consumer-control/person-centered-planning


Person-Centered Planning: Analysis of Research and Effectiveness
Document Type: Research Article (PDF)
Source: American Association on Intellectual and Developmental Disabilities, Claudia Claes, Geert Van Hove, Stijn Vandevelde, Jos van Loon, and Robert L. Schalock, Intellectual and Developmental Disabilities , Vol. 48, No. 6: 432-453
Description: A research article on the effectiveness of person-centered planning.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/docs/analysis.pdf


Becoming a Person-Centered System – A Brief Overview
Document Type: Article (PDF)
Source: Michael W. Smull, Mary Lou Bourne, & Helen Sanderson, April 2009.
Description: Click on the 'Attachments' link at the bottom of the webpage to find the full text of the article that describes creating a person-centered system based on the concept that use of a set of values-based skills at all levels of the system will drive change throughout the system.
URL: http://allenshea.com/wp-content/uploads/2017/02/BecomingaPersonCenteredSystem-ABriefOverview.pdf


Self-Directed Services
Document Type: Website
Source: Centers for Medicare and Medicaid Services
Description: This page provides an overview of self-directed Medicaid services, including service options, self-direction guidelines, support guidelines, and financial management services (FMS).
URL: https://www.medicaid.gov/medicaid/ltss/self-directed/index.html


Moving Past the Limits in Person-Centered Planning
Document Type: Article (PDF)
Source: John O'Brien, Inclusion Press, December 2017
Description: An article written by Learning Institute Faculty member John O'Brien on moving past limits in person-centered planning, identifying constraints on inclusive roles and relationships, and ideas for strengthening person-centered planning.
URL: https://inclusion.com/site/wp-content/uploads/2017/12/Past-the-Limits-of-Person-Centered-Planning.pdf


The Contribution of Person-centered Planning to Care Management
Document Type: Article (PDF)
Source: John O'Brien, Inclusion Press, February 16, 1999
Description: An article written by Learning Institute Faculty member John O'Brien on the contribution of person-centered planning to care management, including potential benefits, costs and uncertainties, and distinct contributions and processes.
URL: https://inclusion.com/site/wp-content/uploads/2017/12/Person-Centered-Planning-and-Case-Management.pdf


Situational Tool for Exploring Possibilities
Document Type: Assessment Tool (PDF)
Source: Rutgers University, The Boggs Center on Developmental Disabilities
Description: The Situational Tool for Exploring Possibilities (STEP) is part of a person centered, individual-focused planning process to support job seekers in an effective job search. The purpose of a situational assessment is to discover a job seeker's skills, preferences and support needs when that person requires additional work experiences to help determine his/her career goal.
URL: https://rwjms.rutgers.edu/boggscenter/publications/documents/STEP-F.pdf


Balancing Choice and Risk
Document Type: Presentation (PDF)
Source: Centers for Medicare and Medicaid Services
Description: A presentation that discusses the dignity of risk and the importance of choice and self-determination and provides insights from an individual and systems perspective on balancing choice and risk.
URL: https://www.medicaid.gov/sites/default/files/2019-12/balancing-risk-choice_0.pdf


Supports for Community Participation
Document Type: Presentation (PDF)
Source: Centers for Medicare and Medicaid Services
Description: A presentation that discusses supports for community participation, including emerging practices, sample definitions, policies and procedures, and an overview of system structures to support community participation.
URL: https://www.medicaid.gov/sites/default/files/2019-12/supports-for-community-participation-final.pdf


Risk Assessment and Mitigation Strategies
Document Type: Presentation (PDF)
Source: Centers for Medicare and Medicaid Services
Description: A presentation on risk assessment and mitigation strategies, including information on federal regulations and key elements of a comprehensive risk assessment and mitigation process.
URL: https://www.medicaid.gov/sites/default/files/2019-12/risk-assessment-mitigation.pdf


Person-Centered Planning: A Guide to Help Direct Support Professionals Understand their Role in the Person-Centered Planning Process
Document Type: Guide (PDF)
Source: Community Mental Health for Central Michigan
Description: A guide to help Direct Support Professionals understand their role in the person-centered planning process, including a PCP training checklist, history of person-centered planning, guiding principles, and forms.
URL: https://www.cmhcm.org/userfiles/filemanager/1124/


Minnesota Guide to Assistive Technology: Getting Started
Document Type: Website
Source: State of Minnesota
Description: Information to help with the consideration, selection, and use of assistive technology to help people with disabilities, and those who serve and care for them, better understand and access assistive technology.
URL: https://mn.gov/admin/at/getting-started/

Three Person-Centered Care Strategies to Change the Trajectory for Residents in Senior Living
Document Type: Webinar
Source: Pioneer Network Videos
Description: This webinar presents three person-centered care strategies to provide support for residents experiencing urinary incontinence. The webinar looks at how to increase residents’ access to their outdoor spaces, their indoor spaces, and utilize effective products, procedures, and practices to provide support for those residents experiencing urinary incontinence.
URL: https://www.youtube.com/watch?v=hz_Wqaz9Mf0


Person-Centered Decision-Making: Options Less Restrictive Than Guardianship (Part 1)
Document Type: Podcast
Source: National Center on Elder Abuse (NCEA)
Description: In this podcast (Part 1 of 2), two attorneys with expertise in guardianship and alternatives to guardianship discuss options available to people with a focus on healthcare and personal decision-making. They provide explanations of guardianship terminology and insight into the restrictive levels of various options such as Advanced Directives, Physician Orders for Life-Sustaining Treatment (POLST), Limited and Full Guardianship, and Supported Decision-Making.
URL: https://www.youtube.com/watch?v=uCa6IS0fbm4


Person-Centered Decision-Making: Options Less Restrictive Than Guardianship (Part 2)
Document Type: Podcast
Source: National Center on Elder Abuse (NCEA)
Description: In this podcast (Part 2 of 2), two attorneys with expertise in guardianship and alternatives to guardianship discuss options available to people with a focus on financial and property decision-making. They provide explanations of guardianship terminology and insight into the restrictive levels of various options such as informal support, Authorized Signers, Joint Accounts, Financial Power of Attorney, Trusts, Representative Payee, and Limited and Full Conservatorship.They also discuss how supported decision-making can be used to provide support for people to make financial decisions.
URL: https://www.youtube.com/watch?v=aevZ8i_wMHo


Person-Centered Care Planning in the States
Document Type: Website
Source: Justice in Aging
Description: An article that outlines person-centered planning rights under the Medicaid Home and Community Based Services Final Rule.
URL: https://www.justiceinaging.org/resources-for-advocates/mltss-in-managed-care-toolkit/person-centered-care-planning/


Person-Centered Care: The Business Case
Document Type: Report (PDF)
Source: The SCAN Foundation, June 2016
Description: A report that discusses the business case for a person-centered approach to health care and community-based service delivery for older adults with chronic illnesses and functional limitations.
URL: https://www.thescanfoundation.org/sites/default/files/business_case_for_pcc_full_report_june_2016.pdf


The Fundamentals of Person-Centered Care for Individuals with Dementia
Document Type: Article (Web)
Source: The Gerontologist 2018, Vol. 58, No. S1, S10-S19
Description: This review article outlines the history, components, and impact of person-centered care practice for people living with dementia.
URL: https://academic.oup.com/gerontologist/article/58/suppl_1/S10/4816735


Person-Centered Care: A Definition and Essential Elements
Document Type: Article (Web)
Source: Journal of the American Geriatrics Society, January 2016-Vol. 64, No. 1
Description: In this article, the American Geriatrics Society (AGS) in collaboration with a research and clinical team from the Keck School of Medicine of the University of Southern California provide an evidence base to support a definition of person‐centered care and its essential elements.
URL: https://onlinelibrary.wiley.com/doi/10.1111/jgs.13866


Key Elements of a No Wrong Door System of Access to Long-Term Services and Supports for All Populations and Payers
Document Type: Report (PDF)
Source: Administration for Community Living, Centers for Medicare and Medicaid Services and the Veterans Health Administration
Description: This report provides a look at the key elements of a No Wrong Door system, a coordinated system of access to make it easier for consumers to learn about and access LTSS.
URL: https://acl.gov/sites/default/files/programs/2016-10/nwd-national-elements.pdf


Person-Centered Care Starts With a Conversation
Document Type: Article (Web)
Source: Peter Notarstefano for LeadingAge Magazine, March-April 2018, Vol. 08, Number 02
Description: This article describes how a LeadingAge member uses purposeful conversations and a measurement tool to understand the preferences of residents and clients in all levels of care.
URL: https://www.leadingage.org/magazine/march-april-2018/Person-Centered-Care-Starts-with-a-Conversation-V8N2


Person-Centeredness in the Care of Older Adults: A Systematic Review of Questionnaire-based Scales and their Measurement Properties
Document Type: Research Article(Web)
Source: Wilberforce et al. BMC Geriatrics (2016) 16:63
Description: A research article on person-centeredness for older adults, including a systematic review of measures of person-centeredness.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782329/pdf/12877_2016_Article_229.pdf


Achieving Person-Centered Care: The Five Pillars of System Transformation
Document Type: Policy Brief (PDF)
Source: The SCAN Foundation, Policy Brief No. 7, September 2012
Description: This policy brief establishes a basis for the critical system transformation activities necessary to produce a high-quality, person-centered system of care for older adults and people with disabilities.
URL: https://www.thescanfoundation.org/media/2019/07/tsf_policy_brief_7_five_pillars-sep-2012.pdf


Principles for Person-Directed Services and Supports during Serious Illness
Document Type: White Paper (PDF)
Source: Administration for Community Living
Description: A paper that outlines the Administration for Community Living's person-directed principles, describing how their stakeholders believe health care and the long-term services and supports systems would work best for them when they are seriously ill.
URL: https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/Serious%20Illness%20Principles%208-30-17%20508%20compliant.pdf


What Does It Mean to Be Age-Friendly?
Document Type: Quick Reference Guide
Source: The Institute for Healthcare Improvement
Description: A one-page guide on the 4Ms framework of Age-Friendly Health Systems: What Matters, Medication, Mentation and Mobility. The guide includes actions for adopting the 4Ms in both hospital and other settings.
URL: http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Documents/AgeFriendly_4MsBySetting_FullGraphic.pdf


Assistive Technology for Older Persons
Document Type: Handbook (PDF)
Source: Idaho Assistive Technology Center
Description: This handbook is designed as a guide for older citizens who, as they age, wish to preserve their independence, autonomy, productivity, and dignity. It is intended to provide information about assistive technology, home modifications, and the many service options available to older people.
URL: http://idahoat.org/Portals/60/Documents/Services/Resources/AT_OlderPersonsHandbook.pdf


Assistive Technology Industry Association (ATiA) Research Articles and Tools
Document Type: Website
Source: Assistive Technology Industry Association
Description: A list of research articles and tools on assistive technology.
URL: https://www.atia.org/at-resources/research-articles-tools/


The Power of Technology for People with Disabilities
Document Type: Website
Source: Microsoft Corporation
Description: A collection of articles that highlight the impact technology can have in helping people with disabilities.
URL: https://news.microsoft.com/features/the-power-of-technology-for-people-with-disabilities/


The Institute for Matching Person and Technology Inc.
Document Type: Website
Source: The Institute for Matching Person and Technology Inc.
Description: The main homepage of the Institute for Matching Person and Technology. The Institute for Matching Person & Technology was created to match users of technologies with the most appropriate devices for their use.
URL: https://sites.google.com/view/matchingpersontechnology/home


A Process for Care Planning for Resident Choice
Document Type: Report (PDF)
Source: Rothschild Person-Centered Care Planning Task Force
Description: Report on the results of stakeholder and expert examination of the challenges faced by care communities around choice and risk in the implementation of elements of person-centered care.
URL: https://www.pioneernetwork.net/wp-content/uploads/2016/10/Process-for-Care-Planning-for-Resident-Choice-.pdf

Effectiveness of person-centered care for people experiencing dementia
Document Type: Article
Source: National Center for Biotechnology Information at the National Institutes for Health (NIH)
Description: A systematic literature review and meta-analysis looking at the effectiveness of person-centered care for people with dementia. The article details aspects of the meta-analysis that confirmed the beneficial effect of Person-Centered Care (PCC) in reducing agitation in people experiencing dementia.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322939/#:~:text=In%20clinical%20practice%2C%20PCC%20includes,and%20the%20individual%20with%20dementia

Dementia Care: Person-Centered Care Planning and Practice Recommendations
Document Type: Transcript (PDF)
Source: CMS; Medicare Learning Network
Description: Transcript of a presentation moderated by Leah Nguyen on March 20, 2018.
URL: https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2018-03-20-Dementia-Care-Improvement-Transcript.pdf


Alzheimer's Association Dementia Care Practice Recommendations
Document Type: Journal Article (Web)
Source: Alzheimer's Association and The Gerontologist
Description: Article that illustrates the goals of quality care for people experiencing dementia in the areas of person-centered care, detection and diagnosis, assessment and care planning, medical management, education and support, ongoing care for behavioral and psychological symptoms, support for activities of daily living (ADL), staffing, supportive and therapeutic environments, and transitions and coordination of services.
URL: https://www.alz.org/media/Documents/alzheimers-dementia-care-practice-recommendations.pdf


The Fundamentals of Person-Centered Care for Individuals With Dementia
Document Type: Journal Article (Web)
Source: The Gerontologist, The Gerontological Society of America
Description: Article detailing the fundamentals of person-centered care for people diagnosed with dementia. The article reviews the origins, selfhood, and relationships of person-centered care. It also looks at key components of person-centered care for people diagnosed with dementia. Scenarios are provided as examples of person-centered care for people experiencing different stages of Alzheimer's disease or related dementia.
URL: https://academic.oup.com/gerontologist/article/58/suppl_1/S10/4816735?login=false


Person-Centered Assessment and Care Planning
Document Type: Journal Article (Web)
Source: The Gerontologist, The Gerontological Society of America
Description: Article that provides guidance for person-centered assessment and care planning that are applicable to all settings and for people experiencing different stages of dementia.
URL: https://academic.oup.com/gerontologist/article/58/suppl_1/S32/4816742?login=false


Meeting the Informational, Educational, and Psychosocial Support Needs of Persons Living With Dementia and Their Family Caregivers
Document Type: Journal Article (Web)
Source: The Gerontologist, The Gerontological Society of America
Description: Article reviewing the educational, informational, and support needs of people diagnosed with dementia and their caregivers across the three stages of Alzheimer's (early, middle, and late stages). A description of specific services and program models that have been developed and tested that ensure people diagnosed with Alzheimer's disease or other types of dementia and their families have effective person-centered and family-centered support.
URL: https://academic.oup.com/gerontologist/article/58/suppl_1/S58/4816739?login=false


Electronic Dementia Guide for Excellence (EDGE) Project: Strength Based Care Planning
Document Type: Website
Source: New York State Department of Health
Description: Website that provides information on strength-based care planning for people experiencing dementia. It includes tools and worksheets to help develop strength-based care planning skills.
URL: https://www.health.ny.gov/diseases/conditions/dementia/edge/strength/index.htm


Electronic Dementia Guide for Excellence (EDGE) Project: BASICS
Document Type: Website
Source: New York State Department of Health
Description: Website that provides information on BASICS, a biopsychosocial model that assists staff in planning care for people experiencing dementia. BASICS is an acronym for each level in a hierarchy of needs: Biological, Activities of daily living, Societal, Inter-personal, Creative, and Symbolic. It includes tools and detailed information to help people apply the BASICS model. Also included are examples of each level of BASICS:

  1. Biological  (PDF)
  2. Activities of Daily Living  (PDF)
  3. Societal  (PDF)
  4. Interpersonal  (PDF)
  5. Creative  (PDF)
  6. Symbolic  (PDF)
URL: https://www.health.ny.gov/diseases/conditions/dementia/edge/basics/index.htm


Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances
Document Type: Article (Web)
Source: Centers for Medicare and Medicaid Services (CMS)
Description: A medical policy article that addresses the skilled nursing care category, teaching and training activities. The article provides sample scenarios and provides potential interventions for the scenarios.
URL: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52845&ver=4&Cntrctr=272


FAQs concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior
Document Type: Frequently Asked Questions (PDF)
Source: Centers for Medicare and Medicaid Services (CMS)
Description: FAQs addressing best practices when working with people who are at risk of unsafe wandering or exit-seeking behaviors.
URL: https://www.medicaid.gov/federal-policy-guidance/downloads/faq121516.pdf

What Is WRAP? - Wellness Recovery Action Plan
Document Type: Website
Source: Advocates for Human Potential, Inc., Human Potential Press
Description: A website where you will find information about Wellness Recovery Action Planning (WRAP), WRAP resources, and a powerful search function to help you find articles and other information.
URL: https://www.wellnessrecoveryactionplan.com/what-is-wrap/


Person-centered Care Planning and Service Engagement: A Study Protocol for a Randomized Controlled Trial
Document Type: Research Article (Web)
Source: National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health Stanhope et al. Trials (2015) 16:180
Description: A research article on a study conducted to assess the effectiveness of person-centered care planning for service engagement in the mental health system.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409728/


Person-centered Planning in Mental Health: A Transatlantic Collaboration to Tackle Implementation Barriers
Document Type: Research Article (Web)
Source: National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health Miller, Stanhope, Restrepo-Toro, Tondora. Psychiatric Rehabilitation Journal. 2017; 20(3): 251–267.
Description: This article reviews international efforts to promote person-centered care planning (PCCP) in the context of a randomized clinical trial in the United States and in the ‘Meaningful and Measurable' initiative, a collaborative action research project involving diverse provider organizations in Scotland.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800658/


Improving Cultural Competence: KAP Keys for Clinicians
Document Type: Manual (PDF)
Source: Substance Abuse and Mental Health Services Administration (SAMHSA)
Description: A manual for professional care providers and administrators that describes the influence of culture on the delivery of substance use and mental health services.
URL: https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4933.pdf


Helping Individuals Consider Employment: Tips for Mental Health Practitioners
Document Type: Worksheet (PDF)
Source: The IPS Employment Center at the Rockville Institute, July 1, 2016
Description: This document includes tips and a worksheet for mental health practitioners to help guide discussions about employment. The document also includes discussion and planning strategies.
URL: https://ipsworks.org/wp-content/uploads/2017/10/Helping-Individuals-Consider-Employment.pdf


SAMHSA's Working Definition of Recovery: 10 Guiding Principles of Recovery
Document Type: Pamphlet (PDF)
Source: Substance Abuse and Mental Health Services Administration (SAMHSA)
Description: A resource guide pamphlet on SAMHSA's Working Definition of Recovery and descriptions of the 10 Guiding Principles of Recovery.
URL: https://store.samhsa.gov/sites/default/files/d7/priv/pep12-recdef.pdf


Learn The Eight Dimensions of Wellness
Document Type: One-Page Poster (PDF)
Source: Substance Abuse and Mental Health Services Administration (SAMHSA)
Description: A one-page poster with an overview of the eight dimensions of wellness and a link to the initiative website.
URL: https://store.samhsa.gov/sites/default/files/sma16-4953.pdf


The Four Walls
Document Type: Article
Source: Mark Ragins, Recovery Stories
Description: An article written on the four walls to person-centeredness.
URL: https://www.recoverystories.info/the-four-walls-by-mark-ragins/


SMART Goals and Mental Health
Document Type: Fact Sheet
Source: Mental Health & Developmental Disabilities National Training Center
Description: A resource with information regarding goal setting and self-determination for individuals who experience both developmental disabilities and mental health concerns.
URL: https://www.mhddcenter.org/wp-content/uploads/2021/01/SMART-Goals-Mental-Health.pdf


The Many Flavors of Medicaid Waivers
Document Type: Podcast
Source: Navigating Life as we Know It
Description: This podcast episode discusses Medicaid Waivers, with a focus on person-centered-planning (PCP) and the proper use of two assessment tools associated with person centered planning process: the Supports Intensity Scale (SIS) and the Psycho-Social Assessment (PSA). Please note that these are Michigan waivers and not all characteristics of these programs are the same in New York. They are included as examples of how waiver services can involve person-centered planning and can help people. Please click on the link titled ‘Play' near the top of the page to listen to the podcast. Listeners do not have to subscribe to listen to the podcast.
URL: https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5idXp6c3Byb3V0LmNvbS8xMjc4MjI0LnJzcw/episode/QnV6enNwcm91dC05NDgwMTM5


The Social Work Podcast: Person-Centered Therapy
Document Type: Podcast
Source: The Social Work Podcast
Description: Podcast host, Jonathan B. Singer, Ph.D., LCSW, talks about Carl Rogers and his revolutionary approach to psychotherapy - Person-Centered Therapy. The humanistic assumptions at the core of Person-Centered therapy stand in stark contrast to the problem-centered, expert-oriented approach of what was then the dominant model of psychotherapy - Freudian Psychoanalysis.
URL: https://podcasts.google.com/feed/aHR0cDovL3d3dy5zb2NpYWx3b3JrcG9kY2FzdC5jb20vc29jaWFsd29ya3BvZGNhc3QueG1s/episode/aHR0cHM6Ly9zb2NpYWx3b3JrcG9kY2FzdC5jb20vMjAwNy8wMi9wZXJzb24tY2VudGVyZWQtdGhlcmFweS5odG1s?sa=X&ved=0CAIQuIEEahgKEwjAy-qcmaf9AhUAAAAAHQAAAAAQkgE

The Many Flavors of Medicaid Waivers 301 - Children's Waivers & Independent Facilitation
Document Type: Podcast
Source: Navigating Life as we Know It
Description: This episode is about two Medicaid Waivers in Michigan (The Michigan Waiver for Children and the Michigan Waiver for Children with Serious Emotional Disorders (SED)), and how they provide valuable supports to children in the state. Please note that these are Michigan waivers and not all characteristics of these programs are the same in New York. They are included as examples of how waiver services can involve person-centered planning and can help people. Please click on the link titled ‘Play' near the top of the page to listen to the podcast. Listeners do not have to subscribe to listen to the podcast.
URL: https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5idXp6c3Byb3V0LmNvbS8xMjc4MjI0LnJzcw/episode/QnV6enNwcm91dC05NTY5Njgy?sa=X&ved=0CAUQkfYCahcKEwiwqpDoiLz2AhUAAAAAHQAAAAAQLQ


A Family-Centered Approach to Early Intervention
Document Type: Journal Article (PDF)
Source: WestEd's R&D Alert,® Fall 2011, Vol. 12, No. 3.
Description: A Journal Article that describes a family-centered approach to early intervention.
URL: https://www.wested.org/wp-content/uploads/2016/11/1372729797article_familycenteredapproach_2011-3.pdf


Family-Centered Practices in Early Childhood Intervention: Values, Paradigms, Principles and Practices
Document Type: Presentation (PDF)
Source: Carl J. Dunst, Ph.D. Orelena Hawks Puckett Institute
Description: A presentation that describes the role of values in early childhood intervention and how family-centered beliefs can be used as the foundation for parent, family, and child capacity-building intervention practices.
URL: http://www.puckett.org/presentations/Family-Centered%20Practices%20in%20Early%20Childhood%20Intervention.pdf


What is Family Centered Practice?
Document Type: Website
Source: The National Resource Center for Family Centered Practice, The University of Iowa, School of Social Work
Description: The website for the National Resource Center for Family Centered Practice, which provides a description of family centered practice and its components.
URL: https://clas.uiowa.edu/nrcfcp/what-family-centered-practice


The Institute for Person-Centered Care Podcast - Brain Health In School Age Children
Document Type: Podcast
Source: The Institute for Person-Centered Care Podcast
Description: Host Ann Garton welcomes Lynne Miller who works with children who are experiencing some kind of grief, loss, or trauma; Kamie Montoya, a principal at an elementary school; and Angela Kight, a peer support supervisor to discuss brain health in school age children.
URL: https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy50cmFuc2lzdG9yLmZtL3RoZS1pbnN0aXR1dGUtZm9yLXBlcnNvbi1jZW50ZXJlZC1jYXJlLXBvZGNhc3Q/episode/NDk0Y2JhMjAtMWNkYy00ZDBiLWJiZmUtYmExOTQ5NTgxMDkw?sa=X&ved=0CAUQkfYCahcKEwio-ZzploD-AhUAAAAAHQAAAAAQAQ


Getting Person-Centred Care Right: Good Practice Models of Integrating HIV and Other Health Needs
Document Type: Video
Source: International AIDS Society
Description: This is a recording of the AIDS 2022 satellite session of the 24th International AIDS Conference, presented on July 31, 2022. This satellite session provides an introduction to person-centered care and good practice models of person-centered care with presentations shared by implementers from various settings and regions. The slides used in this session can be found here.
URL: https://www.youtube.com/watch?v=At0kbj3zsk4


The Institute for Person-Centered Care Podcast - World AIDS Day 2022
Document Type: Podcast
Source: The Institute for Person-Centered Care Podcast
Description: Host Ann Garton welcomes three guests to offer a global perspective, for World AIDS Day 2022. The guests include: Annamore Mutisi, MD, MPH, a medical doctor and public health specialist based in Zimbabwe, who is a Technical Advisor on a PEPFAR-funded, CDC-supported HIV Prevention, Care, and Treatment Project; Tsitsi Monera-Penduka, PhD, AAHIVP, a Clinical Pharmacologist from Zimbabwe who is currently in the United Kingdom, whose work has been mainly in academia, conducting research, and training healthcare professional students in HIV; and Jessica Posner, MPH, from the Eastern United States who has twenty years of experience in a range of global health technical areas.
URL: https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy50cmFuc2lzdG9yLmZtL3RoZS1pbnN0aXR1dGUtZm9yLXBlcnNvbi1jZW50ZXJlZC1jYXJlLXBvZGNhc3Q/episode/Yjg3YTE5YjUtYjczNC00ZTA2LWI5N2ItNjk3MWU3MjM3YTA0?sa=X&ved=0CAYQkfYCahcKEwjQppyPoaf9AhUAAAAAHQAAAAAQAQ


PEPFAR Client-Centered HIV Services Fact Sheet
Document Type: Fact Sheet
Source: U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
Description: PEPFAR reports it is the largest commitment by any nation to address a single disease in history, enabled by strong bipartisan support. This 2020 fact sheet details strategies being implemented by PEPFAR to support continuous, client-centered HIV services and to design programs to remove all barriers to continuous HIV care, including stigma and discrimination, and maximize convenience and responsiveness to client needs and preferences.
URL: https://www.state.gov/wp-content/uploads/2020/07/PEPFAR_Client-Centered-HIV-Services_Fact-Sheet_2020.pdf


People First Charter
Document Type: Website
Source: People First Charter
Description: The People First Charter was launched in July 2021, during the Berlin International AIDS Society Conference, to promote person first HIV & Sexual Health language. Their mission is based on the idea that language matters, people living with or at risk of HIV experience stigma & discrimination, and the wrong language perpetuates stigma & marginalizes people.  This website contains terminology guidance in English, Arabic, Hausa, and Spanish.
URL: https://peoplefirstcharter.org/

Future Planning 101
Document Type: Website
Source: The Arc Center for Future Planning
Description: An informational website that describes what Future Planning is and provides guidance about the Future Planning process. Future plans are guides that people develop to lead a good life as independently as possible. There is a short informational video available and a free tool for people to build their own future plan.
URL: https://futureplanning.thearc.org/pages/learn/future-planning-101

Medical Monday Ep 39: Person Centered Thinking
Document Type: Podcast
Source: Friends For Life Podcast
Description: On this episode of Medical Monday, Craig Escude M.D. explains person centered thinking for individuals with developmental disabilities. You can listen to this podcast episode by clicking on the large arrow on the left side of the page. You can also listen to the podcast on Spotify or Apple Podcasts. Listeners do not have to subscribe to listen to the podcast.
URL: https://friendsforlifepodcast.libsyn.com/medical-monday-ep-39-person-centered-thinking


Office for People with Developmental Disabilities (OPWDD) Person-Centered Planning
Document Type: Website
Source: Office for People with Developmental Disabilities (OPWDD)
Description: A resource page that provides an overview of person-centered planning, an introduction to person-centered outcomes, and a video featuring one individual's person-centered planning story.
URL: https://opwdd.ny.gov/providers/person-centered-planning


Best Practice, Expected Practice, and the Challenge of Scale
Document Type: Article (PDF)
Source: NASDDDS, Michael W. Smull, Mary Lou Bourne & Helen Sanderson (2010)
Description: This article provides insight in taking best practices on person-centered planning to scale across systems to create positive pressure for change.
URL: https://allenshea.com/wp-content/uploads/2017/03/BestPracticeExpectedPractice.pdf


Reconnecting Hearts and Minds: A Paradigm day of conversation about ensuring good support with and for people with learning disabilities
Document Type: Conference Notes (PDF)
Source: John O'Brien
Description: This document is a compilation of John O'Brien's notes based on large group discussions from the conference, ‘Reconnecting Hearts and Minds: A Paradigm day of conversation about ensuring good support with and for people with learning disabilities.'
URL: https://paradigm-uk.org/wp-content/uploads/2019/11/Hearts-and-Mind-John-OBrien-.pdf


The State of Tech: Getting and Communicating Information
Document Type: Article (Web)
Source: Ohio Developmental Disabilities Council
Description: An article that discusses the impact of technology advances and the digital divide for people with disabilities.
URL: https://ddc.ohio.gov/the-state-of-tech-2


Ohio Technology First
Document Type: Website
Source: Ohio Department of Developmental Disabilities
Description: The Ohio Technology First website provides extensive resources on assistive technology for people with disabilities.
URL: https://dodd.ohio.gov/wps/portal/gov/dodd/about-us/resources/tech-first/tech-first


Technology First
Document Type: Website
Source: Missouri Department of Mental Health
Description: The Missouri Technology First website includes multiple resources for assistive technology, including success stories and multiple resource links for providers, products, and more.
URL: https://dmh.mo.gov/dev-disabilities/technology-first


DIDD's Enabling Technology Program
Document Type: Website
Source: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)
Description: A library of video features on individuals that use the Tennessee Enabling Technology Program.
URL: https://www.tn.gov/didd/for-consumers/enabling-technology.html


White Paper: Use of Remote Support in Ohio and Emerging Technologies on the Horizon
Document Type: White Paper (PDF)
Source: Ohio Department of Developmental Disabilities (DODD), Jordan B. Wagner, Marc J. Tass©, Daniel K. Davies, & Steven E. Stock. Nisonger Center, The Ohio State University, May 1, 2018.
Description: A white paper on the use of remote support and emerging technologies for individuals with disabilities in Ohio.
URL: https://nisonger.osu.edu/wp-content/uploads/2017/02/White-Paper-Use-of-Remote-Support-in-Ohio-and-Emerging-Technologies-on-the-Horizon.pdf


Technology First: The Missouri Division of Developmental Disabilities' Assistive Technology Initiative
Document Type: Presentation (PDF)
Source: Missouri Division of Developmental Disabilities and Missouri Inclusive Housing Development Corporation
Description: A presentation on Missouri's assistive technology initiative, including an overview of assistive technology, considerations for the use of assistive technology, and individual stories.
URL: https://dmh.mo.gov/sites/dmh/files/media/pdf/2019/08/technology-first-webinar-presentation-02052019.pdf


State Roles in Promoting Community Life Engagement: Themes from the State Employment Leadership Network's Working Group
Document Type: Journal Publication (PDF)
Source: ENGAGE, Issue No. 8, 2018, State Employment Leadership Network
Description: A journal article that discusses states' role in supporting person-centered community engagement, with a focus on integrated employment.
URL: https://scholarworks.umb.edu/cgi/viewcontent.cgi?article=1035&context=thinkwork


How Guardianship and SDM Can Coexist
Document Type: Recorded Webinar
Source: The Arc New York
Description: Recording of a 2022 Guardianship Training Symposium session in which a panel of experts discusses guardianship in relation to supported decision-making.
URL: https://www.youtube.com/watch?v=Xs4fJZpds0w&list=PLDJdjG31RT7zNCYBaUUertMzN72S515gs&index=6

Why Being Brain Injury Informed Is a Critical Component of Person-Centered Thinking, Planning, and Practice
Document Type: Recorded Webinar
Source: The National Center on Advancing Person-Centered Practices and Systems (NCAPPS), Administration for Community Living
Description: This webinar features presenters from the National Association of State Head Injury Administrators (NASHIA) and two individuals with lived experience of brain injury. The webinar's key points of focus include how brain injury considerations and person-centered practices differ from plans supporting other disability popolations; and accommodations and strategies for addressing brain injury-related cognitive, behavioral and social issues with regard to person-centered plan development. (On the page, navigate to August 2019 under "Past NCAPPS Webinars")
URL: https://ncapps.acl.gov/webinars.html


3-Part Webinar Series: Person-Centered Planning: From Dreams to Reality
Document Type: Recorded Webinars
Source: National Association of State Head Injury Administrators
Description: This 3-part webinar series has been developed to address person-centered planning as a critical component of the delivery of brain injury services. The webinars include: Webinar 1: An Introduction to Person-Centered Thinking; Webinar 2: From Person-Centered Thinking to Creating the Plan; and, Webinar 3: Applying Person-Centered Planning and Thinking Principles in the Delivery of Supports & Services for Persons Living with a Traumatic Brain Injury.
URL: https://www.nashia.org/trainings/3-part-webinar-series-person-centered-planning-from-dreams-to-reality


Person-Centered Approaches
Document Type: Recording
Source: The Center on Brain Injury Research and Training
Description: Recording from Person-Centered Approaches conference held November 12, 2021, in Washington State. Includes recordings of people sharing stories of lived experiences of TBI and person-centered care and veterans' perspective for person-centered practices and approaches.
URL: https://cbirt.org/person-centered-approaches


Person-Centered Care is Personal: Why Practicing Cultural Humility is Integral to Comprehensive Care
Document Type: Article
Source: Brain Injury Association of America
Description: This article looks at what do we mean by "person-centered" and the notion of individualizing treatment plans and discusses that the answer lies in the dignity and independence of culturally appropriate settings and clinical pathways.
URL: https://www.biausa.org/public-affairs/media/person-centered-care-is-personal-why-practicing-cultural-humility-is-integral-to-comprehensive-care


Person-centered, Participation-oriented Brain Injury Rehabilitation
Document Type: Article
Source: Brain Injury Association of America
Description: This article looks at how person-centered, participation-oriented rehabilitation (PCPO) addresses the needs of the whole person as communicated by the person with brain injury and his or her close others rather than as prescribed by the person's provider.
URL: https://www.biausa.org/public-affairs/media/person-centered-participation-oriented-brain-injury-rehabilitation


Person Centered Planning: Individuals with TBI
Document Type: PowerPoint Presentation
Source: Mount Sinai School of Medicine, Department of Rehabilitation Medicine
Description: This training presentation, developed by Mary R. Hibbard, Ph.D., ABPP, focuses on Person-Centered Planning and how it is needed to address unique Traumatic Brain Injury (TBI) challenges. The presentation references the work of Beth Mount, a Learning Institute faculty member for the Person-Centered Planning Training Initiative.
URL: https://portal.ct.gov/-/media/Departments-and-Agencies/DSS/Health-and-Home-Care/Community-Options/Information-for-Traumatic-Brain-Injury-Implementation/personcenteredplanning2006.pdf


Considering Brain Injury: Why being brain injury-informed is critical for person-centered planning
Document Type: PowerPoint Presentation
Source: National Center on Advancing Person-Centered Practices and Systems (NCAPPS)
Description: This presentation from August 12, 2019, addresses person-centered supports for people with brain injury and the need for brain injury-specific information and understanding to guide person-centered practices.
URL: https://www.hsri.org/files/uploads/publications/NCAPPS_BIPCPwebinar_FINAL_190812.pdf


Strategies for Person-Centered Approach to Mild TBI: An Interprofessional Perspective
Document Type: Article
Source: The American Speech-Language-Hearing Association (ASHA) in ASHA Wire
Description: This article by the Joint Committee on Interprofessional Relations of ASHA and the American Psychological Association (APA) suggests strategies that take a person-centered approach to treatment that focuses on education, counseling, and use of compensatory strategies to help patients re-engage in meaningful daily activities.
URL: https://leader.pubs.asha.org/do/10.1044/strategies-for-person-centered-approach-to-mild-tbi-an-interprofessional-perspective/full/


TBI Consumer Report: Person-Centered Planning
Document Type: Article
Source: Brainline: All about Brain Injury and PTSD
Description: Article from Mount Sinai Medical Center looking at person-centered planning for people who have experienced a brain injury. The article emphasizes both the differences and similarities between people who have experienced a brain injury, and the frustration that they feel when others try to help by fitting them into a mold.
URL: https://www.brainline.org/article/tbi-consumer-report-person-centered-planning

Federal Register, Vol. 79, No. 11, Rules and Regulations, Thursday, January 16, 2014, 441.725 Person-centered service plan (page 3036)
Document Type: Regulatory Document (PDF)
Source: Centers for Medicare and Medicaid Services
Description: The regulatory language on page 3036 outlines requirements for states for developing and approving person-centered service plans, in a process driven by the individual.
URL: https://www.govinfo.gov/content/pkg/FR-2014-01-16/pdf/2014-00487.pdf


Final Rule Medicaid HCBS
Document Type: Presentation (PDF)
Source: Centers for Medicare and Medicaid Services
Description: Pages 29-40 of this document outline the requirements for person-centered service plans under the Home and Community-Based Services Final Rule.
URL: https://www.medicaid.gov/sites/default/files/2019-12/final-rule-slides-01292014.pdf


Person-Centered Service Planning Provisions and Modifications to HCBS Settings Criteria
Document Type: Question and Answer Document (PDF) (Web)
Source: Centers for Medicare and Medicaid Services
Description: A question and answer document for providers regarding the person-centered planning provisions of the HCBS Final Rule.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/docs/provisions.pdf


Key Message and Tips for Providers: Person-Centered Service Plans
Document Type: One-Pager (PDF)
Source: Centers for Medicare and Medicaid Services, August 2015
Description: A message and tips for providers regarding guidelines for person-centered service plans.
URL: https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/key-messages-Person-Centered-Service-Plans-[September-2015].pdf


Fact Sheet: Home and Community Based Services
Document Type: Fact Sheet (Web)
Source: Centers for Medicare and Medicaid Services
Description: This fact sheet provides an overview and describes key provisions of the Home and Community Based Services Final Rule, including person-centered planning.
URL: https://www.cms.gov/newsroom/fact-sheets/home-and-community-based-services


Guidance to HHS Agencies for Implementing Principles of Section 2402(a) of the Affordable Care Act: Standards for Person-Centered Planning and Self-Direction in Home and Community-Based Services Programs
Document Type: Guidance Document (PDF)
Source: Centers for Medicare and Medicaid Services
Description: This guidance document outlines the standards for person-centered planning and self-direction that should be reflected in all HHS programs that fund or provide HCBS.
URL: https://acl.gov/sites/default/files/programs/2017-03/2402-a-Guidance.pdf


Steps to Creating a Statewide Person-Centered Service Planning System
Document Type: Presentation (PDF)
Source: Centers for Medicare and Medicaid Services
Description: This training presentation provides guidance to states for creating a person-centered service planning system, including an approach to systems change and specific state examples.
URL: https://www.medicaid.gov/sites/default/files/2019-12/steps-creating-a-person-centered-planning-system.pdf


System-Wide Person-Centered Planning
Document Type: Presentation (PDF)
Source: Centers for Medicare and Medicaid Services
Description: This training presentation provides guidance to states on system-wide person-centered planning, focusing on the differences between traditional service systems and person-centered systems, including case examples.
URL: https://www.medicaid.gov/sites/default/files/2019-12/system-wide-person-centered-planning.pdf


Thinking Differently About Person-Centered Planning
Document Type: Presentation (PDF) (Web)
Source: Money Follows the Person Technical Assistance Project, Centers for Medicare and Medicaid Services and New Editions Consulting, Inc.
Description: This training presentation covers a brief look at the history of person-centered planning and practice, an overview of the Home and Community-Based Services Final Rule, and an introduction to person-centered planning.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/docs/think_different.pdf

Person Centered Service Plan Template for Social Adult Day Care (SADC) and Social Adult Day Services (SADS) Usage
Document Type: Plan Template (DOCX)
Source: New York State Department of Health
Description: Person Centered Service Plan (PCSP) template created in accordance with person-centered planning requirements for Social Adult Day Care (SADC) and Social Adult Day Services (SADS).
URL: https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/mltc_policy/sadc/docs/sadc-sads_pcsp_template.docx


Person-Centered Service Plan Template
Document Type: Plan Template (PDF)
Source: New York State Department of Health
Description: Plan of Care Template created in accordance with Person-Centered Service Planning Guidelines and provided for guidance.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/hcbs/docs/pcp_template.pdf


Nursing Home Transition and Diversion (NHTD) Initial Service Plan
Document Type: Plan Template (PDF)
Source: New York State Department of Health
Description: Initial service plan for the Home and Community Based Services Medicaid Waiver Nursing Home Transition and Diversion (NHTD) program
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/docs/nhtd.pdf


Assisted Living Resident Service Plan
Document Type: Plan Template (PDF)
Source: New York State Department of Health
Description: Resident Service Plan for the Division of Assisted Living
URL: https://www.health.ny.gov/health_care/medicaid/redesign/person-centered_planning/providers/docs/alrs.pdf


Adult Behavioral Health HCBS Plan of Care
Document Type: Plan Template (PDF)
Source: New York State Department of Health/Office of Mental Health
Description: Adult Behavioral Health Home and Community Based Services Plan of Care
URL: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/hcbs_poc_template.pdf


The Life Plan
Document Type: Website
Source: New York State Office for People with Developmental Disabilities
Description: The Life Plan development is driven by the person, with input and participation of all members of the care-planning team.
URL: https://opwdd.ny.gov/providers/what-life-plan

Person-Centered Service Planning - Home and Community-Based Services (HCBS) Final Rule Implementation
Document Type: Webinar
Source: New York State Department of Health
Description: This webinar introduces the person-centered service planning requirements under the HCBS Final Rule for recipients of Medicaid funded Home and Community-Based Services (HCBS). The trainers present the person-centered planning process in New York State, which supports people in directing and accessing services and supports in a way that meets their preferences, goals, and needs. This training also includes information on the additional requirements for settings where people receiving HCBS live and/or receive services.
URL: https://www.youtube.com/watch?v=TcDSj8mdRfo


OPWDD HCBS Settings Toolkit
Document Type: Website
Source: New York State Office for People With Developmental Disabilities (OPWDD)
Description: Webpage developed by OPWDD providing stakeholders with up-to-date information on New York States' HCBS Settings Transition Plan and resources for providers and people receiving HCBS.
URL: https://opwdd.ny.gov/providers/hcbs-settings-toolkit


Person-Centered Service Planning Guidelines For Medicaid Managed Care Organizations, Local Departments of Social Services, and Health Homes
Document Type: Guidance Document
Source: New York State Department of Health
Description: These guidelines are intended to provide information regarding the requirements for the Person-Centered Service Planning process for enrollees in Medicaid Managed Care, and individuals receiving services through fee for service from Local Departments of Social Services.
URL: https://www.health.ny.gov/health_care/medicaid/redesign/hcbs/pcp_guidance.htm


Adult Behavioral Health Home And Community Based Services (BH HCBS) Plan of Care
Document Type: Guidance Document (PDF)
Source:  New York State Department of Health
Description: Guidance on the complete process to access Adult Behavioral Health Home and Community-Based Services, including the person-centered Plan of Care requirements.
URL: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/workflow_guidance.htm


Person-Centered Planning and Community Inclusion
Document Type: Website
Source: Office for People with Developmental Disabilities
Description: Resources to support the planning process and the delivery of exceptional care in the most integrated community settings, including the Strengths and Risk Inventory Tool.
URL: https://opwdd.ny.gov/providers/person-centered-planning-and-community-inclusion


Person-Centered Planning: Addition of New 14 NYCRR Part 636, Amendments to 14 NYCRR Parts 633, 635, 671, & 686 FINAL REGULATIONS
Document Type: Regulatory Document (PDF)
Source: Office for People with Developmental Disabilities
Description: Person-centered planning regulations found at 14 NYCRR § 636, subpart 636-1 Person-Centered Planning, effective November 1, 2015.
URL: https://opwdd.ny.gov/system/files/documents/2020/01/person-centered-planning-text.pdf


Person-Centered Planning Practice and Resources - A Handbook for Rehabilitation and Recovery
Document Type: Website
Source: New York State Office of Mental Health
Description: This handbook for Rehabilitation and Recovery has been developed as a comprehensive tool for implementing person centered recovery planning in Personalized Recovery Oriented Services (PROS).
URL: https://www.omh.ny.gov/omhweb/pros/person_centered_workbook/


Federal Adult Behavioral Health Home and Community-Based (HCBS) Services Plan of Care (POC) Documentation Requirements
Document Type: Website
Source: New York State Department of Health
Description: A checklist for the Federal Adult Behavioral Health HCBS Plan of Care (POC) Documentation Requirements.
URL: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/bh_hcbs_checklists.htm


Person-Centered Addiction Treatment Services
Document Type: Training Video
Source: New York State Office of Addiction Services and Supports
Description: A video on person-centered addiction treatment services, including an overview of updates to Office of Addiction Services and Supports regulations plus newly released guidance documents regarding Medication-Assisted Treatment (MAT).
URL: https://www.oasas.ny.gov/person-centered-addiction-treatment-services


Recovery-Oriented Systems of Care: The Foundation for Recovery in New York State
Document Type: Website
Source: New York State Office of Addiction Services and Supports
Description: An online resource on recovery-oriented systems of care, including information on system development, person-centered care, and recovery activities and resources.
URL: https://www.oasas.ny.gov/providers/recovery-oriented-systems-care


Core Skills Refresher, Options Counseling (OC), and Person-Centered Counseling (PCC)
Document Type: Presentation (PowerPoint) and Video Presentation Recording
Source: New York State Office for the Aging
Description: NY Connects Information & Assistance (I&A): Part 1 of this session is a core skills refresher for existing staff who were previously trained on I&A and formal training for new staff who are delivering I&A. Part 2 of this session is a skills-based interactive training on options counseling and an introduction to person-centered counseling.
URL: https://aging.ny.gov/ny-connects-information-and-assistance-ia