Team Members The PCP Process requires, at a minimum, participation by the Person, the Guardian (if applicable), and the Case Manager. The Personal Plan must also include input from Agency Service Planners, the appointed Volunteer Correspondent (if applicable) and other members chosen by the Person. If the Person objects to any of these members, the Case Manager should work with the Person to find a comfortable way to get input from each team member. The Person is the key participant. The team needs to support the Person to understand their role in the process, as well as what to expect from others at each step in the process. The Person may also need coaching, practice and support in order to communicate his or her desires and take an active role in planning. It is the responsibility of the team to ensure that the Person is meaningfully involved in each stage of planning. For this to be most effective, it is
Document the Notification and the Person’s choice of whether to invite the Advocate in the Summary of Process Coordination on the Personal Plan Narrative. Sensitive Issues Some aspects of the Person’s life are, or should be, personal and private. The Person may want information regarding these issues shared with only certain people. The Person may not even want the whole Planning Team to be aware that there is an issue. The Person may have concerns about having information on sensitive issues documented in their plan. The Person identifies sensitive issues, not the Planning Team or any Team member. Sensitive issues often relate to diet and weight control, hygiene, medical conditions, sexuality, smoking, money, intimate relationships or behavior. What is sensitive is really up to the Person. Sometimes planning an agenda creates an opportunity for discussion with the Person about public vs. private information. The Person has the right to control how information about him or her is shared, and may need assistance to consider and exercise that right. When sensitive issues are identified, the Case Manager should assist the Person in considering options for addressing them. Some things to think about include: ♦ Who needs to know about this issue? ♦ How will it be addressed? ♦ How will it be monitored? ♦ How and where will it be documented? Some sensitive issues may be addressed as part of routine health care and be documented in the medical record. They may not need to be specifically identified in the PCP document. Others may be referred to only generally, e.g., “Marie will meet with the nurse for health information”, without
In the EIS PCP Assessment: There are many dimensions for each service. Paid services that a Person is receiving must be documented by the appropriate Service Agency with both a MaineCare Service Description Form and a Goal Description Sheet under the dimension with which they provide services. Personal Profile A personal profile presents the Person in positive and personal terms rather than clinically and objectively. A personal profile is not a clinical description. The profile is more concerned with a Person’s abilities and supports that enable him or her to succeed, than with his or her deficits or limitations. The profile looks at the Person in the context of their life and their relationships, as well the Person’s individual characteristics. The best profiles are created by or with the Person. A personal profile: Documents who the Person is, interests and what they want in life Paints a current picture of the Person’s life Presents the Person as they want to be seen Provides information about the people they know and how they spend time together Identifies the roles they play in their community Contains what the Person wants and needs to be healthy and safe Supports the Person needs or desires and new things they want to learn Describes the Person’s dreams for the future Identifies their strengths and capacities Documents their gifts and talents. A personal profile does not contain: Diagnoses and other labels Sensitive issues Medical and/or behavioral interventions