Virginia

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Virginias Person Centered Planning Process
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The Four Phases of Planning
Sharing Information
Getting ready for planning
Keeping Track
Planning Together
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Sharing Information
Essential Information
As a first step you share your essential
information, which includes your standard
assessment. This is completed by your support
coordinator when you first seek paid supports in
Virginia.
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Profile
Sharing Information
Essential Information
Profile

• The Profile questions help describe your life.
• The Agenda questions lead to your vision of the
  future.
• Anyone you choose can help to complete your
  Profile.

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Profile Questions Agenda Questions
1. What are your gifts and talents? What gifts and talents would you like to use more? share with others?
2. Tell us about the community where you live. What would make your community life better?
3. Tell us about the people you know. Are there any relationships you would like to change? Develop?
4. What is your home like? What changes are needed and what other changes Might improve your living arrangement?
5. Do you think that you have enough privacy? Would you like more or less privacy?
6. What things do you enjoy doing most? What would you like to do more often?
7. What things do you least enjoy doing? Which of these things would you like to change and how?
8. What do you do for fun and relaxation? What might improve your ability to have fun and relax (and with whom)?
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The Planning Partner
Sharing Information
Essential Information
Profile
Planning Partner
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Getting ready for planning
Essential Information
Once the essential information and the profile
are complete, its time to get ready for
planning.
Profile
Planning Partner
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Getting ready for planning
Essential Information
Profile
Planning Partner
An Agenda
Agenda
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Agenda Agenda
Agenda Items Consider what was identified with the agenda questions. Which topics do you want to discuss at the meeting? Leave out any items you do not wish to discuss at that time. Decided before planning meeting. Action Taken Discussion record, routine supports, achieving goals or health and safety supports. Decided during planning meeting.
1. Review of the profile, standard assessment and positive description of the person. 1. Review of the profile, standard assessment and positive description of the person.

2. Personal Goals, change if needed. 2. Personal Goals, change if needed.




Additional Topics Additional Topics

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Getting ready for planning
Essential Information
The Personal Topics List
Profile
Planning Partner
Agenda
Personal Topics
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Personal Topics Personal Topics
Topics not for the meeting Consider each specific point identified in the Profile that will NOT be on the agenda. Action Taken Discussion record, added to routine supports, plan for achieving goals or health and safety supports. .
Personal topics not added to the Planning agenda and how resolved Personal topics not added to the Planning agenda and how resolved



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Planning Together
Essential Information
Profile
Planning Partner
Now that the agenda and personal topics list are
complete, its time to schedule planning.
Agenda
Personal Topics
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Planning Together
Essential Information
If needed, your planning partner can help you to
schedule your meeting.
Profile
Planning Partner
Agenda
Personal Topics
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Planning Together
Essential Information
Once the meeting is set, you invite others
including friends, family and all providers.
Profile
Planning Partner
Agenda
Personal Topics
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Planning Together
Your team reviews your essential information and
profile to determine routine and health and
safety supports. Your team will also work
together in action planning.
Essential Information
Profile
Planning Partner
Agenda
Personal Topics
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Planning Together
Essential Information
Profile
From the agenda the team chooses one of four
options for their response.
Planning Partner
Agenda
Personal Topics
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routine supports or
health and safety supports or
action plans or
the discussion record
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Action Plan for Achieving Goals Action Plan for Achieving Goals Action Plan for Achieving Goals Action Plan for Achieving Goals
Plan begin date ___________________Plan Plan begin date ___________________Plan Plan begin date ___________________Plan Plan begin date ___________________Plan
Desired Outcome
What would it take for anyone to achieve this outcome?
Supports currently in place
Supports needed
Support or Action Steps Who will do what to achieve this outcome? Whos Responsible How Often or By When Date Completed



Comments Comments Comments Comments
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Discussion Record (Completed for an agenda item when a plan may not be necessary)
Topic
Discussion
Decision
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Planning Together
Essential Information
Profile
Planning Partner
Planning Questions
Agenda
Personal Topics
Action Plan
Discussion Record
Planning Questions
Individual and Team
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Yes No Individual Planning Questions Does my plan match - (If any item is marked no, discuss at the meeting).
What makes me happy?
My dreams?
People that I like?
Where I want to live?
Things I like to do?
Ways to travel?
Having my own money?
My checking account?
How I contribute?
New things I want to learn?
My work?
Support I need?
People who support me?
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Yes No Team planning questions If any item is marked yes, please address at the planning meeting.
Are there any unfinished tasks from my plan that are not yet completed?
Are there any current actions and supports that are in conflict with whats most important to me?
Are there any conflicts in my plan that create a health and safety concern?
Does any team member have an objection to any actions or supports in my plan?
Do I need financial planning or benefits counseling in order to maximize resources?
Am I at risk of exceeding financial resource limits?
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Planning Together
Essential Information
Profile
Planning Partner
The Agreement
Agenda
Personal Topics
Action Plan
Discussion Record
Planning Questions
Agreement
Plus absent contributors
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Agreement Page Agreement Page Agreement Page
Signatures of team members who agree to help me with my plans as decided this day Signatures of team members who agree to help me with my plans as decided this day Signatures of team members who agree to help me with my plans as decided this day
Individual Individual Date
Case Manager Case Manager Date
Guardian/ Authorized Representative Guardian/ Authorized Representative Date
Team Member Relationship Date
Team Member Relationship Date
Team Member Relationship Date
Team Member Relationship Date
Team Member Relationship Date
Names of team members who contributed to my plans and were not here for planning Names of team members who contributed to my plans and were not here for planning Names of team members who contributed to my plans and were not here for planning



Comments Comments Comments
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Planning Together
Essential Information
Profile
Planning Partner
The Support Summary
Agenda
Personal Topics
Action Plan
Discussion Record
Planning Questions
Agreement
Support Summary
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Provider Support Summary Plan Dates _________to_______ Provider ___________ NPI ____________ Date Revised_________________ Provider Support Summary Plan Dates _________to_______ Provider ___________ NPI ____________ Date Revised_________________ Provider Support Summary Plan Dates _________to_______ Provider ___________ NPI ____________ Date Revised_________________ Provider Support Summary Plan Dates _________to_______ Provider ___________ NPI ____________ Date Revised_________________ Provider Support Summary Plan Dates _________to_______ Provider ___________ NPI ____________ Date Revised_________________
Support provided How to provide supports When? days How long per day? Weekly total minutes or hours
Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports


Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports


Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals


Total weekly hours Total additional hours if approved Grand Total Total weekly hours Total additional hours if approved Grand Total Total weekly hours Total additional hours if approved Grand Total Total weekly hours Total additional hours if approved Grand Total ______hours ______hours ______hours
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Keeping Track
Essential Information
Now that the plan is ready, your team works
together to help you stay on track with achieving
your goals.
Profile
Planning Partner
Agenda
Personal Topics
Action Plan
Discussion Record
Planning Questions
Agreement
Support Summary
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Keeping Track
Essential Information
Profile
Planning Partner
The Support Summary Checklist
Agenda
Personal Topics
Action Plan
Discussion Record
Planning Questions
Agreement
Support Summary
Support Summary Checklist
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Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________ Provider Support Summary Checklist Month ___________ Year _________ Provider _________________ NPI ___________ Date Revised ____________
Plan How Often?
Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports Routine Supports



Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports Health and Safety Supports


Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals Achieving Goals




Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________ Key x support provided n not provided by DSP c chose not to participate a absent o incident (see supporting documentation) Support Provider Signatures and initials ___________________________________________ ________ _____________________________________ ________ ___________________________________________ ________ _____________________________________ ________
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Keeping Track
Essential Information
Profile
Planning Partner
The Plan Change and Quarterly Review Tool
Agenda
Personal Topics
Action Plan
Discussion Record
Planning Questions
Agreement
Support Summary
Support Summary Checklist
Plan Change and Quarterly Review Tool
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ISP Changes and Quarterly Review Tool ISP Changes and Quarterly Review Tool ISP Changes and Quarterly Review Tool
Provider ___________ NPI ___________ Provider ___________ NPI ___________ Provider ___________ NPI ___________
Plan Dates Review Dates Plan Dates Review Dates Plan Dates Review Dates
Is this being completed for a ISP change or quarterly review? Check one ISP Changes or Quarterly Review 1st 2nd 3rd 4th Is this being completed for a ISP change or quarterly review? Check one ISP Changes or Quarterly Review 1st 2nd 3rd 4th Is this being completed for a ISP change or quarterly review? Check one ISP Changes or Quarterly Review 1st 2nd 3rd 4th
Description of the person Description of the person Description of the person
Health update (medications/appointments) Health update (medications/appointments) Health update (medications/appointments)
Significant events (celebrations/struggles) Significant events (celebrations/struggles) Significant events (celebrations/struggles)
Review of desired outcomes for health and safety and achieving goals Review of desired outcomes for health and safety and achieving goals Review of desired outcomes for health and safety and achieving goals
Desired outcomes Outcome achieved? Describe progress or changes
1. Yes No
2. Yes No
3. Yes No
Have any changes occurred during the past quarter? Yes No (If yes, briefly summarize changes).
Are any additional changes needed or requested at this review? Yes No (If yes, include change notes with review and update provider summary and checklist).
Does the individual continue to be pleased with all plans? Yes No
Signatures Signatures Date
Individual Individual
Guardian/Authorized Representative Guardian/Authorized Representative
Case Manager Case Manager
Initiating/Completing Provider Initiating/Completing Provider Initiating/Completing Provider
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Keeping Track
Essential Information
Profile
Planning Partner
The Daily and Learning Logs
Agenda
Personal Topics
Action Plan
Discussion Record
Planning Questions
Agreement
Support Summary
Support Summary Checklist
Plan Change and Quarterly Review Tool
Daily and Learning Logs
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Daily Log for ____________________________ Daily Log for ____________________________
Date Event








Learning Log Learning Log Learning Log Learning Log Learning Log
Date What did the person do? (what, where, when, how long?) What was there? (name of people supporting the person, friends and others) What did you learn about what worked well? What did the person like about the activity? What needs to stay the same? What did you learn about what didnt work? What did the person not like about the activity? What needs to be different?





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Keeping Track
This concludes the planning process review. You
may contact your Community Resource Consultant
with any questions you have during the planning
process.
Essential Information
Profile
Planning Partner
Agenda
Any questions?
Personal Topics
Action Plan
Discussion Record
Planning Questions
Agreement
Support Summary
Support Summary Checklist
Plan Change and Quarterly Review Tool
Daily and Learning Logs