Person-centered Planning Research Articles

Examining the effectiveness, feasibility, and acceptability of an advocacy program for Latinx families of transition-aged autistic youth.

To support Latinx families of autistic youth navigate school-based transition services and adult disability services, we provided a family advocacy program entitled, ASISTIR (Apoyando a nueStros hIjo/as con autiSmo obTener servIcios de tRansición; Supporting our Children with Autism to Obtain Transition Services). The ASISTIR program consisted of six, two-hour sessions and included the following topics: school-based transition planning, person-centered planning, Supplemental Security Income, Vocational Rehabilitation, and Home and Community-Based Medicaid Waiver. Twenty-nine Latinx family members completed the cohort-based ASISTIR program. After participating family members demonstrated increased knowledge of school-based transition planning and adult disability services. Participants also demonstrated increased empowerment and advocacy.

The Integrated Care Team: A primary care based-approach to support older adults with complex health needs.

Many older adults have complex needs and experience high rates of acute care use and institutionalization. Comprehensive Geriatric Assessment (CGA) is a specialized multidimensional interprofessional intervention to prevent such outcomes, but access to CGA in the community is limited. The Integrated Care Team (ICT) is a proactive case-finding intervention to support older adults with complex needs in primary care. The ICT provides nurse practitioner-led shared-care supported by a pharmacist, family physician, and geriatrician. Patients undergo a CGA, and a person-centred plan of care is implemented. We conducted a mixed-methods evaluation of the ICT. Patients were 81 ± 9.2years old, 71% were women. Patients had a high burden of dementia and multimorbidity and received 12.8 ± 5.8 prescriptions daily. The ICT improved prescribing and reduced emergency department visits by 49.5% (P = 0.0001). Patients, care partners, and referring physicians reported high satisfaction with care. The ICT is currently being expanded to support additional primary care providers.

Home and Community-Based Services: A Systematic Review and Evidence Map.

Many adults aged 60years or older have functional limitations and require home and community-based services (HCBS) to support their independence and delay the transition to an institutionalized setting. This systematic review provides an evidence map of the existing literature on HCBS identifying evidence gaps for policy and research. A comprehensive literature search of multiple databases including Medline, Embase, and Scopus was conducted through December 7, 2023. Interviews with various stakeholders were conducted to solicit additional perspectives. Narrative and thematic synthesis was conducted to evaluate HCBS in terms of populations, interventions, outcomes, person-centeredness, and relevant quality measures. We identified 27 primary studies and 29 quality measures. Populations of HCBS studies can be categorized as those with functional disability, cognitive impairment, high-risk/frail conditions, and disease-specific conditions (Parkinson's disease, Alzheimer's disease, and post-stroke). HCBS interventions targeted optimization of person-centered planning, nonpharmacological approaches for dementia care, physical rehabilitation, self-directed home care, geriatric resources for practical support at home, and interdisciplinary care coordination for high-risk conditions. Person-centered planning and self-direction of HCBS services were not explicitly described in many studies and very few studies focused on addressing health-related social needs, whereas the majority reported primary clinical outcomes. Numerous quality measures exist for HCBS, some of which were validated, addressed multiple person-centered domains, and may apply across various conditions and populations. Key challenges in the literature on HCBS include limited numberof randomized trials, inadequate descriptions of interventions to determine person-centeredness, limited information on facilitators and barriers, and limited information on workforce challenges in recruiting, retaining, and training personnel delivering HCBS. This evidence map describes the current state of HCBS and identifies evidence gaps for future research and policy decisions.

Rise Up: A Person-Centered Planning Program to Improve Job Skill Performance for Individuals With Intellectual & Developmental Disabilities

Abstract Date Presented 03/21/24 Individuals with intellectual and developmental disabilities (IDD) have increased need for support to maintain employment. This presentation will educate practitioners on a client-centered approach to improve skill performance for the population with IDD. Primary Author and Speaker: Rachel Dowell Contributing Authors: Retta Martin

The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada

BackgroundPerson-centred planning refers to a model of care in which programs and services are developed in collaboration with persons receiving care (i.e., persons-supported) and tailored to their unique needs and goals. In recent decades, governments around the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery. Although regional mandates provide a framework for directing care, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. This study aims to address a gap in the literature by describing how person-centred care plans are implemented in community-care organizations.MethodsWe conducted semi-structured interviews with administrators from community-care organizations in Ontario, Canada. We asked participants about their organization’s approach to developing and updating person-centred care plans, including relevant supports and barriers. We analyzed the data thematically using a pragmatic, qualitative, descriptive approach.ResultsWe interviewed administrators from 12 community-care organizations. We identified three overarching categories or processes related to organizational characteristics and person-centred planning: (1) organizational context, (2) organizational culture, and (3) the design and delivery of person-centred care plans. The context of care and the types of services offered by the organization were directly informed by the needs and characteristics of the population served. The culture of the organization (e.g., their values, attitudes and beliefs surrounding persons-supported) was a key influence in the development and implementation of person-centred care plans. Participants described the person-centred planning process as being iterative and collaborative, involving initial and continued consultations with persons-supported and their close family and friends, while also citing implementation challenges in cases where persons had difficulty communicating, and in cases where they preferred not to have a formal plan in place.ConclusionsThe person-centred planning process is largely informed by organizational context and culture. There are ongoing challenges in the implementation of person-centred care plans, highlighting a gap between policy and practice and suggesting a need for comprehensive guidance and enhanced adaptability in current regulations. Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan.

Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel etal., 2021; Kenny etal., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.

An observational investigation of unemployment, underemployment, and competitive integrated employment of people with intellectual and developmental disabilities in 2021-2022

BackgroundEmployment is an important component of community living, and a precursor to economic stability and independence. Despite this, research consistently demonstrates people with intellectual and developmental disabilities (IDD) have low rates of community-based employment. However, little research has been conducted to quantify competitive integrated employment, and which individuals have better employment outcomes as it relates to competitive integrated employment. ObjectiveThis study aims to explore the ways in which key service-related and demographic characteristics of individuals with IDD are associated with participation in competitive integrated employment. MethodsWe used the 2021–2022 National Core Indicators Intellectual and Developmental Disabilities In-Person Survey dataset. We conducted bivariate and multivariate analyses, using chi-square and generalized linear models, to examine the cross-sectional relationship between employment and demographic and service-related characteristics for 4629 individuals with IDD. ResultsOverall, 42% of the sample was unemployed but wanted a job, while 39% were underemployed and just 21% have competitive integrated employment. Several demographic and service-related characteristics were significantly associated with employment. After controlling for demographic and service-related correlates of employment, having an employment-related goal in one's service plan was associated with 4.5 (95% CI: 3.6–5.5) times higher odds of competitive integrated employment relative to unemployment. ConclusionsThis study underscores the value of person-centered planning for improved employment outcomes. Further research is needed to fully understand potential inequities in employment and system-level factors that are associated with competitive, integrated employment, as well as solutions to improve access to customized individual employment supports for all people with IDD.

Outcomes of Person-Centered Planning in Medicaid Home- and Community-Based Services.

Person-centered planning (PCP) allows recipients of home- and community-based service (HCBS) to plan services and supports according to their preferences and needs. The extent to which HCBS systems engage in PCP and evidence for the relationship between PCP and beneficiary outcomes are limited. We examine the prevalence of PCP among HCBS recipients and the relationship between PCP and person-reported outcomes. We used the 2018-2019 National Core Indicators-Aging and Disability survey, collected among adult Medicaid HCBS recipients in 12 states (n = 5,849). We examined 2 general PCP measures (1 on decision making and another on whether service plans reflected preferences/choices). We also constructed a scale to assess the fidelity of recipients' service planning meeting to the PCP process. Outcomes included unmet service needs and community living (i.e., participation, control, and satisfaction). We examined recipient characteristics associated with PCP and used adjusted logistic regression models to assess the relationship between PCP and outcomes. About 72% of HCBS recipients were involved in decision making, 72% reported their service plan reflected their preferences/choices, and 47% had meetings that scored "high fidelity" on the PCP fidelity scale. PCP measures were consistently related to lower likelihood of unmet service needs and greater likelihood of experiencing community living outcomes. Findings suggest PCP is important for adequately meeting service needs and ensuring community living among HCBS beneficiaries. Additional standardized measures should be developed to facilitate quality improvement and accountability for delivering person-centered HCBS.

Nurturing the Seeds of Participation: Unveiling the Foundational Path for Understanding Aging in Place Barriers and Facilitators From the Perspective of Older Adults Using Mixed Methods and Translational Science.

Participation in society is a cornerstone for quality of life, active aging, and aging in place. While the majority of older adults prefer aging in place, health and financial challenges can hinder this vision. Conducted in suburban South Jersey, this study utilized mixed methods, including surveys and interviews with older adult participants. Surveys indicated that satisfaction with participation in the community is influenced by functional ability, healthcare service availability, and information access. Interviewees identified suggestions to overcome barriers (e.g., improve access to community and address ageism). Combined results provide a theory of change which suggests older adults' empowerment in community participation hinges on home living support, participation options aligning with ability and interest, and accessible information on community events. This person-centered planning approach emphasizes the importance of older adult and stakeholder participation in foundational community planning, offering translational foundational tools for evidence-based strategies to engage them in future community action plans (CAPs).

PREPARATION OF INTELLECTUALLY DISABLED AND/OR AUTISTIC YOUNG PEOPLE FOR LEAVING CARE IN SOUTH AFRICA

Research on the transition of intellectually disabled and/or autistic care-leavers is still in its infancy globally and there have been no studies on this population in South Africa. This article, therefore, aims to illuminate the experiences of this overlooked group in South Africa, with a focus on how well they are prepared for the transition from residential childcare facilities to young adulthood. Semi-structured interviews were conducted with eight intellectually disabled and/or autistic young people who were about to disengage from Child and Youth Care Centres in the Cape Peninsula, and their caregivers. Data were analysed using thematic analysis. Four themes emerged: person-centred planning for care-leaving; opportunities for extended care and gradual exits from care; support for interdependent living aftercare; and addressing loss and anxiety related to moving on during the transition. The study highlights implications for policy and practice, including the need for a clear policy framework to support aftercare provision and improvements in care-leaving preparation with a stronger focus on interdependence. Keywords: aging out, autism, care-leaving preparation, intellectual disability, leaving care, transition

MEASURING QUALITY IN LONG-TERM SERVICES AND SUPPORTS THROUGH PERSON-REPORTED OUTCOMES: VALUE OF NCI DATA

Abstract Long-Term Services and Supports (LTSS) include medical, social, and personal care services that people may need to perform activities of daily living due to physical or cognitive impairments. Measuring the quality of LTSS is essential for improving the care and outcomes of people with disabilities and older adults and ensuring that services meet consumer needs. Several frameworks have been developed to measure LTSS quality, including the National Quality Forum’s LTSS Framework. Yet, few data sources are available to measure person-reported quality in HCBS. This symposium will provide an overview of National Core Indicators (NCI) as a unique data source to address this gap. It also includes presentations from researchers from organizations in two states who utilize NCI data – Minnesota and Massachusetts – who will share their perspectives about the value of the data, results from empirical analyses, and how they use and plan to use the data to inform policy. Researchers from the Lurie Institute for Disability Policy will present findings on the association between person-centered planning and key person-reported outcomes in Medicaid HCBS. Researchers from the University of Minnesota School of Public Health and Brown University will share findings from national NCI data on unmet needs among older adults by dementia status and race/ethnicity. They will also share results of analyses in MN, linking person-reported HCBS plan quality and healthcare utilization, using claims data. Collectively, this symposium will address the gap in measurement of HCBS quality nationally and identify key directions for policy and future research.

FOSTERING PRACTICE CHANGE BY INTEGRATING INTERPROFESSIONAL EDUCATION IN A COMMUNITY HEALTH COLLABORATION

Abstract NJGWEP undertook an interprofessional community/public health initiative collaborating with Rutgers University School of Nursing-Camden, Stockton University, NJ Housing and Mortgage Finance Agency, and four affordable housing sites located in underserved communities, with a potential to reach approximately 600 older residents. An IPE curriculum delivered to faculty, students, and staff from multiple health professions disciplines prepares them for assessing residents with chronic health problems using the 4Ms framework (What Matters, Mind, Medications, Mobility), adding the Geriatric 5th M for multi-complexity. Using a Resident Health Risk Assessment (RHRA) to assess residents’ health/biopsychosocial needs by capturing critical information needed to support “aging in place,” students and staff develop person-centered plans of care that address maintenance of independence, health, and referral to needed services/supports to delay or prevent institutional placement. From 2019-2022, 84 students from multiple disciplines (i.e., nursing, social work, counseling, OT) participated in community-based rotations, completed 279 RHRAs, and developed 101 IPE case reviews and person-centered plans of care. Evaluating residents’ co-morbid conditions (Hypertension 46%, Diabetes Mellitus 42%, Mental Health 40%; 8.6 medications per/resident, 44% Mini-Cog < 3; 19% PHQ+, 51% + Falls Screen; 48% TUG>12; 58% ADL/IADL deficits) highlighted the 5th M, Multi-Complexity. IPE is a sustainable venue for training a health care workforce that acknowledges/values the person-centered approach and encourages learning the roles and responsibilities of other disciplines. Implementation of a customized database in 2022 facilitates longitudinal tracking of outcomes related to resident needs, referrals, interventions, access to services to support aging in place, and informs policy and practice change.

BUILDING CLINICAL JUDGMENT IN THE HEALTH CARE WORKFORCE BY ADDRESSING THE 4MS AND MULTICOMPLEXITY

Abstract Since 2019, NJGWEP, Rutgers School of Nursing-Camden and Fair Share Support Services, Inc. partnered in an affordable housing site in an underserved, disadvantaged community to support aging in place. Senior nursing students conduct Resident Health Risk Assessments (RHRAs) using the 4Ms framework to build assessment skills, sharpen clinical judgment, and address the Geriatric 5th M in a multi-complex resident population. Nursing students, working in teams with social service and community health workers, completed 92 RHRAs incorporating the 4Ms (What Matters, Mind, Medication, Mobility). On average, residents had > 3 risk factors related to the 4Ms (M=3.31); 25% +screen for depression, 25% +screen for cognitive impairment, 64% w/mobility deficits, 83% w/polypharmacy, and 80% on 1 or more high-risk medications. There were 53% w/diabetes, 65% w/hypertension and other biopsychosocial factors related to social determinants of health; 91% could be characterized as multi-complex (the Geriatric 5th M) and in need of services/supports to age in place. The 4Ms framework, with the addition of the 5th M, provides curricular structure for development of clinical judgment through focused assessment, analysis, flagging of key assessment data, prioritization of problems, and developing person-centered plans of care. Interprofessional (IP) case studies of increasing levels of difficulty experienced by affordable housing residents build cultural competence, foster development of critical thinking, clinical reasoning, and, when supplemented by weekly IP case reviews, facilitate shared decision-making and care planning. The process is further supported by a customized electronic database that permits monitoring person-centered recommendations and outcomes over time, gauging impact.

Preparing adults with intellectual disabilities for their future: How do support services staff view their role?

Person-centred service delivery underpins current approaches to working with individuals with intellectual disabilities. We investigated views of staff from a service organisation regarding their roles in creating desired futures for adults with intellectual disabilities. Data were gathered from staff of a large organisation that provided a range of services to adults with intellectual disabilities. Respondents were asked to describe their role in assisting an individual with intellectual disability to meet their goals for the future. Responses were analysed using a text analysis programme. Two major themes were identified: 'Support for self-determination' and 'Business-as-usual'. These themes were not entirely separate but had some overlap. There were indications that staff experienced competing demands in their role(s). Although central to person-centred planning, staff who work with adults with intellectual disabilities may not see support of self-determination as a key factor in creating a desired future.

Ethical Prescribing of Psychotropic Medications for People with Neurodevelopmental Disorders

ObjectivesPeople with neurodevelopmental disorders (NDDs) such as intellectual and developmental disabilities (IDD) and autism are subjected to restrictive practices like physical restraint and the overuse of psychotropic medications for challenging behaviour in the absence of a psychiatric disorder. This practice may lead to human rights violations. Rational and evidence-based shared decision-making for person-centred planning will help reduce this practice.MethodsWe have discussed in this paper the issue of the overmedication of people with NDD, explaining how this practice may violate the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD).ResultsWe have discussed how the following UN CRPD Articles may be affected by overmedication, including Article 15 (degrading treatment or punishment), 16 (abuse), 17 (the integrity of the person), and 25 (health). The other Articles that may be indirectly affected by this practice are 5 (equality and non-discrimination), 9 (accessibility), 19 (independent living and community inclusion), 21 (access to information), 24 (education), 26 (rehabilitation), 27 (work and employment), 28 (adequate living standard), and 30 (participation in recreation and leisure).ConclusionsOvermedication of people with NDD, particularly the off-licence use of psychotropics for challenging behaviour, the side effects of these medications impacting the person’s quality of life are likely to violet several UN Articles on Rights of Persons with Disabilities. Following the right guidelines may help reduce these human rights violations.

Emergency COVID-19 Pandemic Changes to Home- and Community-Based Services for People With Intellectual and Developmental Disabilities

Abstract The COVID-19 pandemic significantly disrupted Home- and Community-Based Services (HCBS) for people with intellectual and developmental disabilities (IDD). The aim of this study was to examine the emergency amendments states made to their HCBS waivers for people with IDD during the COVID-19 pandemic. To do so, we analyzed 294 Appendix K: Emergency Preparedness and Response Waivers, which states used to amend HCBS 1915(c) waivers for people with IDD. States’ waiver amendments fell into the following categories: access and eligibility, assessments and person-centered planning, services, settings, providers, reimbursement rates, and safeguards and oversight. These temporary changes made to HCBS IDD waivers aimed to ensure people with IDD’s access to services and maintain the quality of those services during the pandemic.

Abortion assistance fund staff and volunteers as patient navigators following an abortion ban in Texas.

Abortion assistance funds constitute an important part of the healthcare safety net by covering some of abortion patients' out-of-pocket costs. Few studies have examined the other ways abortion assistance fund staff and volunteers support callers who need help obtaining care. Between June and September 2020, we conducted in-depth interviews with 23 staff and volunteers at 11 local abortion assistance funds that helped Texans seeking abortion care following a March 2020 state executive order that prohibited most abortions. Interviewers explored respondents' experiences with callers whose appointments had been canceled or who traveled out of state and subsequent operational changes. We used both inductive and deductive codes in the thematic analysis. Abortion assistance fund staff and volunteers bridged callers' information gaps about the services and financial resources available and helped create plans to secure care that accounted for callers' specific needs. They provided emotional support so callers felt it was possible to overcome logistical hurdles to get an abortion, even if that required out-of-state travel. Respondents described greater collaboration between Texas-based abortion assistance funds and out-of-state organizations to support callers' more complex logistical needs and increased costs. Some callers who encountered multiple barriers to care, including interpersonal violence, were unable to obtain an abortion, even with additional supports. Local abortion assistance funds worked with Texas callers to co-create person-centered plans for care and expanded inter-organization collaborations. Initiatives that bolster local assistance funds' infrastructure and capacity will be needed as the abortion access landscape becomes further restricted and complex.

Beggars can’t be choosers: the rhetoric and reality of person-centered disability services in the United States

This article examines the gap between the theory and practice of person-centered services for adults with intellectual disabilities in the United States. It explores the rhetoric of personalized services—it gives a history of social care, rehearses the logic of person-centered planning and outlines the tension of conflicting disability policies. Then it defines the nature of choice and explains how limited alternatives undermine choice. Next the article describes the reality of restricted service options, summarizing the conclusions of a survey of American families and a meta-review of the effectiveness of person-centered planning. After recapping the contrast between rhetoric and reality, objections to the analysis are addressed. Finally, the article offers solutions for service system transformation. While the thesis pertains to the United States, its lessons are applicable to other nations.

Prevalence and Factors Associated with Impairment in Intrinsic Capacity among Community-Dwelling Older Adults: An Observational Study from South India.

Intrinsic capacity (IC) is conceptualized by World Health Organization (WHO) with a focus on healthy aging. Identifying impairment could help in making a person-centred plan for the care of older adults. Establish the prevalence of IC among community-dwelling older adults age >60, the prevalence of impairment in each domain, and identify factors associated with an impairment in IC. This cross-sectional observational study in the community setting included 1000 older adults aged 60 years and above in two-year study period. The 6 domains of IC including cognition, locomotor capacity, psychological, vitality, hearing, and vision were derived from the comprehensive geriatric assessment. The IC composite score was calculated based on these domains, and a higher IC score indicated greater IC. During the study period, 1000 older adults, with the median age of 66.5 (IQR-63-73) were included, and 629 (62.9%) were women. Only in 157 (15.7%) community-dwelling older adults, all 6 domains were intact. Impairment in one, two, and three domains was seen in 442 (42.2%), 305 (30.5%), and 91 (9.1%), respectively. The most prevalent impaired domain was locomotor (593, 59.3%), followed by vision (441, 44.1%), hearing (193, 19.3%), cognition (106, 10.6%), mood (38, 3.8%), and vitality (37, 3.7%). The factors associated with lower IC included increasing age (β-coefficient -0.01, 95% CI: -0.02 to -0.01, p value = 0.002), impaired activities of daily living (β-coefficient -0.13, 95% CI: -0.49 to -0.18, p value <0.001), and chronic neurologic illness (β-coefficient -0.10, 95% CI: -0.77 to -0.18, p value = 0.001). In conclusion, we found that impairment in IC was frequent in community-dwelling older adults, and it is associated with age, presence of chronic neurologic illness, and declining functionality. The adoption of IC should be seen as an opportunity to disseminate geriatric care in our healthcare systems which lack the necessary attention to the needs of older persons.

Facilitators and barriers to person-centered planning from the perspectives of individuals receiving medicaid home and community-based services and care managers

BackgroundWhile person-centered planning is required within Medicaid Home and Community-Based Services (HCBS) programs, we know little about the extent to which it is being implemented and best approaches to measuring quality. ObjectiveOur study explored the experiences of individuals receiving Medicaid HCBS and care managers facilitating person-centered planning in three states to learn from their perspectives of facilitators and barriers. MethodsWe partnered with a national health plan and affiliated health plans in three states for recruitment. We used a semi-structured interview guide to conduct remote interviews with 13 individuals receiving HCBS and 31 care managers. To triangulate our findings, we reviewed assessment instruments from the three states and the person-centered care plans of HCBS recipients. ResultsFrom the perspectives of individuals receiving HCBS, facilitators to person-centered planning included: choice and control, personal goals and strengths, and relational communication. Care managers similarly identified the importance of relational communication, but also identified the development of measurable goals. Barriers from the perspectives of individuals receiving HCBS included: medical orientation of care plan, administrative and systemic barriers, and competencies of care managers. Care managers similarly identified administrative and systemic barriers. ConclusionsThis exploratory study provides important perspectives on implementation of person-centered planning. Findings can help inform improvements in policy and practice, as well as guide future directions in quality measure development and assessment.