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A case study analysis of Person-Centred-Planning for people with intellectual disability following their transfer from institutional care. [Ph.D. thesis] / by Donal Fitzsimsons
Fitzsimons, Donal
Person centred planning (PCP) has an essential part to play in ensuring self determination for the lives of people with intellectual disability. It is typically taken as an indicator to the quality of services and it is regarded as especially important when considering its effectiveness in impacting on the lives of people with intellectual disability. Robertson’s et al (2005) six indices of PCP efficacy of social networks, community involvement, scheduled day services, contact with friends, contact with family and choice are regarded as a standard measure. This research examined the PCP process and its impact on the reality of the life of the person with intellectual disability. It considered the understanding of various stakeholders in the PCP process and investigated whether PCP brings added value to the lives of people with intellectual disability in community settings. Finally, it explored the relationship between the theory, policy, and outcomes of PCP for ongoing practice. Using a qualitative case study approach this study examined the lives of ten people who were selected from a list of people with intellectual disability who were removed from their families and placed in institutional settings and later transferred to community residences. Semi-structured face-to-face interviews based on Robertson’s six indices of PCP efficacy took place with the three stakeholder groups including the person with intellectual disability, their family member and their key worker (thirty interviews). For each focus individual further information was collected from relevant professionals such as day service staff, social workers, psychologists and speech and language therapists. Finally, one PCP meeting was attended for each individual (10 in total). This informed a descriptive account of each case which were based on the following structure: background and content, current status, the PCP process and comment and anlaysis which resulted in an individual case study for each of the ten people with intellectual disability of this study. Recurring themes emerged from a detailed cross case study analysis. A key theme that emerged was the legacy of institutional care and practices. The study found the structure of the PCP meeting to be over formal with a limited understanding of the aims and impact of PCP by all concerned. Different factors led to resource limitations for each of the stakeholders resulting in a reliance of special services combined with a fear of additional costs and routine activities in PCP. This study also found that there was an emphasis on duty of care that led to risk aversion in PCP goal setting with individual differences and local variations impacting on the efficacy of PCP. The PCP’s in this study were found to promote community presence but did not lead to community participation. This study also found that there are some positive impacts to having a PCP in place for people with intellectual disability. This study did not find evidence for true person centeredness in the community residences but it found that the community residence service model (which is in affect a smaller version of the institutional model) still lacks flexibility in providing people with intellectual disability lives of their own determination. In considering PCP this study found that the community based residence model acted as a barrier to Robertson’s standards of PCP efficacy as the goals of the PCP simply 5 did not include actions that would lead to community participation, enduring family involvement or any element of real choice. It did find that when people with intellectual disability moved from the institution to a community setting the PCP delivered on an increased range of hobby activities, typically in the context of special service settings and special service networks. This study found the need to introduce a fresh look at improving the PCP by in service training on the philosophical basis of PCP, guidance for families, accessible formats for the people with intellectual disability to take on ownership of their PCP’s, deeper consultation with families as well as introducing standard measures and ongoing monitoring of PCP. This is important as we know from the National Intellectual Disability Database (NIDD, 2010) that 26,484 people with intellectual disability are in receipt of services. In addition there are over 4000 Irish citizens with intellectual disability who continue to languish in large institutions who need to transfer to a community setting (HSE, 2011) while a further 4,088 individuals reside in community residences. As well as concluding that the PCP’s examined in this study were flawed it is also evident that there is a need to challenge the premise of the congregate care model of service provision as inherent in this is segregation and lack of valued social roles. Optimal individual service design (OISD) is one such way of challenging the outdated 20th Century service model which is perpetuated ...
Publication Date:
Type: Doctoral thesis
Peer-Reviewed: Unknown
Language(s): English
Institution: Lenus
Publisher(s): University of Dublin (Trinity College)
Supervisor(s): Midland Regional Hospital, Tullamore
First Indexed: 2014-04-03 06:34:45 Last Updated: 2017-05-12 06:09:37