Person Centered Care Planning – Creating Individualized Interventions
by Debbie Hommel, ACC/MC/EDU, CTRS

A therapeutic care plan includes identification of needs and concerns, specific goals to address those concerns or need and staff interventions to address the needs and concerns. Important aspects of basic care planning are to remember that that the goal is always something the client will do (action, response, behavior) and the interventions are actions the staff takes to assist the resident/client to achieve the defined goal. While every part of the care plan is important, defining specific and individualized staff interventions are crucial to the individualized nature of the care plan.

Characteristics of care plan interventions include:
Specific – activity types and locations; specific adaptations and special approaches to meet special needs and limitations of individual residents; content of sensory approaches and content of room visits; specific materials to utilize, if using specific materials for a resident.
Individualized – The person’s past interest and history should be reflected in the interventions. Specific types of music, hobbies, television shows, diversional tasks, routines, coping mechanisms, motivational approaches and leisure preferences should be noted.
Relate to resident need and problem – The interventions should be specific to the problem, not generic additions to the care plan

A good hint to keep in mind is: Add what you are doing for this person that you are doing for no other.

Interventions are NOT:
* Typical approaches that are standardized and offered to the general population.
* Standard of practice approaches which are part of professional technique for all residents (i.e. “encourage attendance”, “provide calendar”, “and praise participation”).

The activity professional can intervene in many interdisciplinary issues such as….
Communication: Adaptations for programming and 1-1 visits for activity communication; special approaches we may use in activities to foster improved communication; specific adaptive tools that may be introduced to enhance communication.
Behavior: Participating in the process to understand what the behavior is trying to communicate; specific diversional tasks and activities that may assist in minimizing or diverting the behavior. If any activity or situation causes or contributes to a behavior, it should be included also, as something to avoid.
Falls: If the falls are occurring during daytime and in the program areas, involving the resident in activities for diversion and supervision. Specific tasks which could be offered to distract the resident during non-activity periods.
Cognitive: Specific types of activities that may provide needed routine and support; methods to adapt and approach the resident; how the activity needs to be broken down and adapted for success; signs to look for in determining cognitive or sensory overload.
Pain: Relaxation and soothing activities, diversional tasks and any activity that can distract the resident from chronic pain.
Ambulation and need to improve physical functioning: Physical activities to attend; define the area of the body that will be focused on and how the activity will be adapted to allow use of the body.
ADL functioning: Physical activities that may exercise the part of the body that needs strengthening; introducing ADL sensory approach to the more cognitively impaired; inviting to grooming activities; activities that allow problem solving and decision making.
Mood and psycho-social wellbeing: Inviting to activities that will allow interaction and development of peer relationships; inviting to activities that allow accomplishment and expression.
Visual or hearing impairments: Adaptive tools and approaches to compensate for visual and hearing losses; specific communication techniques to enable greater success in programming.

While reviewing the care plan, it is helpful to look at every problem and think how activities services can assist with the goal, in any way to resolve the identified problem or need. The care planning process is a means to communicate with the interdisciplinary team. Person centered care planning is a team effort stressing interdisciplinary involvement in quality of life. The care plan is a means to involve and guide the team in person centered care.

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