The resources linked below are presented with a brief summary, an indication of the content areas and links to access the source documents. Inclusion of the resource on this page does not imply a specific endorsement of any one approach to ensure that supports and services are person-centered.
This resource page will be regularly updated. To suggest additional documents, please email NCAPPS@hsri.org
Education and Awareness
Technical Assistance & Training
Policy & Research
Quality & Service Delivery
This guide is for team members within the State Health Insurance Assistance Program (SHIP), Senior Medicare Patrol (SMP) and the Medicare Improvement for Patients and Providers Act (MIPPA) programs. The guide provides an overview of the concept and practices of cultural humility.
This tipsheet was developed for team members within the State Health Insurance Assistance Program (SHIP), Senior Medicare Patrol (SMP), and Medicaid Improvements for Patients and Providers Act (MIPPA) programs to help them gather demographic information from beneficiaries. This includes age, gender identity, sexual orientation, race, primary language, and income.
This resource was created for state human service agency administrators interested in improving processes for identifying, documenting, implementing, and phasing out modifications in compliance with the person-centered planning requirements of the Home and Community-Based Services Final Rule within provider-owned and controlled settings. This resource outlines seven recommended steps for human service administrators to pursue in collaboration with community partners and advocates.
To identify approaches for addressing gaps in cultural humility among the Senior Medicare Patrol (SMP), State Health Insurance Assistance Program (SHIP) and Medicaid Improvements for Patients and Providers Act (MIPPA) network, staff from the Human Services Research Institute who administer NCAPPS conducted a review of grey- and peer-reviewed literature on how cultural humility is defined, its importance, how it shows up in person-centered practices, and its application.
This resource provides an overview of how Senior Medicare Patrol (SMP), State Health Insurance Assistance Program (SHIP) and Medicaid Improvements for Patients and Providers Act (MIPPA) team members can use existing demographic data to better understand their communities and in turn, provide more person-centered support to beneficiaries.
Michael Smull and his partners at Support Development Associates describe nine components that work in concert to make up a person-centered human services system in a series of blogs:
Despite progress, states continue to grapple with how to effectively implement person-centered planning in a way that aligns with the Home and Community-Based Services Final Rule requirements. Many states continue to seek technical assistance to support maintaining or coming into compliance with the requirements. This environmental scan seeks to understand common themes across those states that continue to need technical assistance around person-centered planning.
Despite consensus regarding the content and conduct of person-centered plans (such as the person-centered planning requirements in the Home and Community-Based Services Final Rule), there has been less promising practice guidance on how to tailor the duration and extent of the planning process to the needs and wishes of the person. To be truly person-centered, the content and extent of the planning process should be tailored to the person's unique life circumstances. The intent of this resource is to reinforce the importance of aligning person-centered planning approaches with the wishes and needs of the person for whom the plan is being developed, rather than adopting a one-size-fits-all approach.
Created for team members within the State Health Insurance Assistance Program (SHIP), Senior Medicare Patrol (SMP) and the Medicare Improvement for Patients and Providers Act (MIPPA) programs, this resource provides an overview of person-centered thinking, actionable ideas for how team members can implement person-centered practices in their day-to-day work and outlines a variety of person-centered tools and resources for use. Team members can use this toolkit on their own for personal reflection, with their coworkers to engage in interactive skill-building and are encouraged to incorporate the content of the toolkit into initial and ongoing training for team members.
Self-direction gives people with disabilities and older adults the ability to manage the long-term services and supports that they need to live lives of their choosing. While self-direction is an option in virtually every state, it is still a relatively small component of most public systems. In order to grow the number of people who can take advantage of self-direction, many public managers and advocacy organizations are looking for specific steps they can take to make the option more available and accessible. Developed through the NCAPPS Self-Direction Learning Collaborative, this guide offers a road map to strategic targets that are linked to the key drivers of a robust self-direction option within public programs. It lays out a series of decision points beginning with the selection of overarching goal(s) to pursue, aspects of the goal to tackle, and action steps to pursue. The road map includes a: strategy diagram that identifies strategies that will support the overarching global aim of enhancing the availability and quality of self-direction; descriptions and action steps for each strategy; and resources and examples of best practice.
The person-centered plan is a written individualized plan based on the person’s needs, goals, and preferences that helps them reach their vision of a good life. But what exactly does a “good” person-centered plan include or look like? What are some outcomes we might anticipate for the person? This resource outlines promising practices for person-centered plan documentation and describes indicators of truly person-centered plans for quality monitoring purposes.
Nicole LeBlanc considers how opportunities stemming from the COVID-19 pandemic can be used to develop a more equal, robust person-centered mental health system and culture that is free of stigma.
Acknowledging and understanding a person’s racial and cultural identities is essential for providing person-centered supports. In the NCAPPS Culture and Person-Centered Practices shorts, NCAPPS community members share their thoughts on how their racial and cultural identities shape their expectations and views of support systems. NCAPPS has created a companion guide to the series which provides themes and quotes to facilitate selection of the videos to use in trainings and as conversation starters.
In recognition of National Disability Employment Awareness Month, Nicole LeBlanc reflects on 2022’s theme: “disability is part of the equity equation” and how to ensure that people with disabilities are included in disability, equity, and inclusion initiatives.
Self-Determination is the right of all people to participate in and approve of the design of their personal support systems, to fully engage in their communities, and to make choices in their daily lives. Though the ultimate exercise of self-determination is having people direct their own supports, not every individual receiving Home and Community-Based Services (HCBS) may be eligible for or interested in the self-directed services available where they live. Provider-directed services, such as community-based group homes, structured employment, day programs, or shared living will continue to be part of the array of options available to people needing support. Human services providers, however, can infuse self-determination in every aspect of service delivery by helping people exert greater control over their environments and make choices about their everyday lives. Created through NCAPPS technical assistance, this guide contains strategies and resources to assist HCBS providers in championing self-determination among the people they serve.
Nicole LeBlanc reflects on the need to emphasize strengths, not just weaknesses or cures, when portraying kids and adults with autism.
To reduce the restrictions on choice and rights that are the outcomes of guardianship, a national movement is growing to advance supported decision-making (SDM) as an alternative to guardianship. The purpose of this publication is to introduce SDM and to suggest ways that more people can benefit by relying on supporters to help make decisions and to reduce reliance on guardianship. The strategies discussed are intended for use by a range of audiences interested in increasing people’s ability to make informed decisions.
Nicole LeBlanc explores how house call visits may be a way of providing more inclusive healthcare through interviews with two doctors and an advocate.
The National Core Indicators-Intellectual and Development Disabilities (NCI-IDD) and National Core Indicators for Aging and Disability (NCI-AD) can be used to assess in greater depth the experience of people who receive supports as it relates to person-centered practices and supports. In this brief, questions from the NCI-IDD and NCI-AD surveys are organized into the four main principles of person-centered practices that emerged from a national environmental scan of articles, policy statements, regulations, and websites of national aging, disability, and mental health organizations, created by NCAPPS.
This case study provides a hypothetical example of how one state in the US used National Core Indicator (NCI) data to monitor person-centered planning and practices and alignment with the Settings Rule.
In celebration of National Disability Employment Awareness Month (NDEAM), Nicole LeBlanc reflects on the critical need for people with disabilities to have full access to employment and community inclusion opportunities as they recover from the COVID-19 pandemic.
This issue paper explores some strategies that providers can employ to increase recruitment and retention of Direct Support Professionals.
This presentation provides an overview of why measuring person-centered practices (PCP) is important, different perspectives on how to measure PCP, a framework for multiple measures of PCP and measures of PCP for quality improvement.
NCAPPS subject matter experts have created a tool – the Health Care Person-Centered Profile – to communicate a person’s wants and needs if they are hospitalized without the direct support of their caregivers, family, neighbors, or friends.
The tool has two pages. The first page can be used to capture brief and vital information about the person’s health status. The second page contains the Person-Centered Profile, a one-page brief description of the things that can assist medical staff in providing more tailored and person-centered care. You can use the accompanying instructions to fill out the template for yourself, someone you love, or someone you’re caring for. We have also created examples that show how the tool can be used by people with a range of different backgrounds and concerns.
This paper explores themes from a series of short videos created by members of the NCAPPS community in the early days of the pandemic. The themes are organized in four levels:
The paper discusses both specific factors within each of the levels and the complex interplay between each of the factors at four levels.
This presentation and accompanying brief provide an overview of racial disparities in access to health care broadly, and recognition and treatment of brain injury more specifically. NCAPPS Brain Injury Learning Collaborative faculty Monica Lichi and Eric Washington discuss the importance of understanding implicit biases, and engaging in self-advocacy and collaboration.
This paper summarizes and analyzes seven common themes that emerged from the technical assistance applications at the inception of the National Center on Advancing Person-Centered Practices and Systems (NCAPPS), providing a unique window into human service system administrators' priorities for achieving more person-centered human service systems and the conditions that may promote or hinder systems change.
In 2012, Janis Tondora and colleagues authored an article outlining the Top Ten Concerns about Person-Centered Care Planning in Mental Health Systems. In this brief, Martha Barbone, a member of the NCAPPS Person-Centered Advisory and Leadership Group, describes the role peer support can play in addressing each concern.
NCAPPS Person-Centered Advisory (PAL) group coordinator, Nicole LeBlanc, shares her reflections on how the COVID-19 pandemic has been impacting the disability community, and prompts us to take this crisis as an opportunity for improvement and innovation.
Training competent direct support professionals (DSPs) and maintaining the DSP workforce can greatly influence quality of life for people with disabilities who receive long-term services and supports. This issue brief prepared by Valerie Bradley discusses considerations for ensuring a training regimen will increase direct support staff expertise and improve the quality of services and supports.
This resource, which builds from foundational approaches to person-centered planning and the 2020 National Quality Forum Person-Centered Planning and Practice Final Report, describes five skill areas, or domains, that facilitators should possess to support a fully person-centered planning process: A. Strengths-Based, Culturally Informed, Whole Person-Focused; B. Cultivating Connections Inside the System and Out; C. Rights, Choice, and Control; D. Partnership, Teamwork, Communication, and Facilitation; and E. Documentation, Implementation, and Monitoring.
Developed as part of NCAPPS technical assistance, this Self-Assessment is designed to help leadership at human service agencies in States, Tribes, and Territories to measure their progress in developing a more person-centered system. It contains questions about observable practices across eight system domains: Leadership; Person-Centered Culture; Eligibility & Service Access; Person-Centered Service Planning & Monitoring; Finance; Workforce Capacity & Capabilities; Collaboration & Partnership; and Quality & Innovation.
NCAPPS PAL Group Coordinator, Nicole Leblanc, has a new publication which we are releasing on the NCAPPS website: “Dignity of Risk and Person-Centered Planning During COVID-19: Balancing Risk and Embracing Opportunity in the Face of Grave Challenges”. Check it out for a thoughtful discussion of her experiences during the COVID-19 pandemic and how this relates to risk and living a life that includes dignity of risk. “It might take some creativity, but I think people can still be doing things that allow them to take chances and grow. This is a good time to explore interests and try learning new skills.”
Although there are now a range of strong national definitions of person-centered thinking, planning, and practice, many state human service agencies find it important to develop their own local definitions for use in policy statements and implementation protocols. This environmental scan serves as a starting point for state, tribal, and territory human service agencies as they operationalize person-centered approaches in their local contexts.
Description: In July 2020, the National Quality Forum completed a report that drew upon multi-stakeholder expertise to refine the definition of Person Centered Planning, establish a list of core competencies for person-centered-planning facilitation, and help establish a framework for measuring quality in person centered planning.
This best practice guide is designed to assist human service systems to fully and effectively include people who receive services in system planning and improvement efforts. It is relevant for all systems that support older adults and people with disabilities and was created as part of NCAPPS technical assistance activities.
Asset Mapping is process of mapping out (e.g., with visuals or lists) stakeholders and how they are already engaged by an agency and/or its allies. Developing an Asset Map provides the opportunity to identify existing groups, communication practices, trusted relationships, and products to springboard from as opposed to starting the engagement process from scratch. This toolkit contains a variety of resources – frequently asked questions, a glossary of terms, step-by-step instructions, facilitator tools, and example Asset Maps and Engagement Plans – to support human service agencies in their stakeholder engagement efforts.
This resource shares the lessons from the journeys of members of the Traumatic Brain Injury (TBI) Advisory and Leadership Group (TAL-Group) as brain injury survivor who are active in advocacy work. The TAL-Group guides the priorities and assists with the activities of the TBI Technical Assistance and Resource Center (TBI-TARC).
This overview of person-centered plan facilitation services explores the experience of states that have specifically included plan facilitators in their HCBS waivers, the circumstance under which the states deploy plan facilitators, the rates paid, and training requirements.
To guide the technical assistance provided as part of the National Center on Advancing Person-Centered Practices and Systems (NCAPPS), the Human Services Research Institute prepared a national overview of person-centered principles across aging and disability systems, including mental health systems.
To guide the technical assistance provided as part of the National Center on Advancing Person-Centered Practices and Systems (NCAPPS), the Human Services Research Institute conducted a national review of indicators that may be used to assess person-centered principles in aging and disability systems, including mental health systems.
This resource, created as part of NCAPPS technical assistance, provides an annotated summary description of foundational resources and approaches for person-centered thinking, planning, and practice.
This resource provides tips on making the most of lived experience when people with brain injury and professionals are working together on a team.
Nicole LeBlanc, coordinator of the Person-Centered Advisory and Leadership Group for NCAPPS worked with the NCAPPS team to develop a lessons-learned guide to help make virtual meetings more accessible for all.