Person-centred practice

What is person-centred practice?

Person-centred practice is a way of planning and delivering disability support around what matters to the person, their rights, choices, goals and preferences, rather than around the provider's routines. The person directs their support as far as they can, and workers adapt to them. In the NDIS it underpins the Practice Standards, the Code of Conduct and the training expected of support workers.

The NDIS Commission's SIL Practice Standards glossary describes person-centred practice as an approach based on the fundamental human right to equality and self-determination, and on recognising what matters to the person. It calls it a holistic approach that prioritises wellbeing and quality of life, directed by the person's will, needs and preferences in the context of their world, including their environments, relationships, values and beliefs.

In everyday terms, person-centred practice asks three questions before any support is delivered:

• What does this person want? Their goals, routines, likes and dislikes, in their own words where possible.
• How do they want it done? Who supports them, when, in what order, and how they communicate.
• What matters to them about risk? The choices they want to make, including ones that carry some risk.

How person-centred practice works

Person-centred practice is not a single form or tool. It shows up across the whole cycle of support, from the first conversation to exit:

Communication sits underneath every step. Information has to be given in the language, mode of communication and terms the person is most likely to understand, which may mean easy read, pictures, objects, an interpreter or more time. Where a person needs help to make decisions, supported decision-making helps them make their own choices rather than having others decide for them. If a nominee or guardian is involved, the person's own will and preferences still guide what happens.

Person-centred practice also applies to risk. Under the Practice Standards, a participant's right to the dignity of risk is supported, and supports must not be built only around keeping the person safe at all costs. A participant risk assessment done with the person records the choice, the risks discussed and the agreed safeguards.

What the NDIS rules say

The term appears throughout the NDIS Practice Standards. The first outcome in the Core module is titled Person-centred supports: each participant accesses supports that promote, uphold and respect their legal and human rights and is enabled to exercise informed choice and control (Quality Indicators Guidelines). Other outcomes turn that into specific expectations:

The NDIS Code of Conduct applies to every NDIS provider and worker, registered or not. Its first element is to act with respect for individual rights to freedom of expression, self-determination and decision-making. The NDIS Commission has also published an evidence review on person-centred practice for providers who want the research behind it.

Person-centred practice vs related terms

Person-centred practice overlaps with several terms. The main differences are below.

A common confusion is between the participant's NDIS plan and a provider's support plan. The NDIS plan is the NDIA's funding document, built around the participant's NDIS goals. The provider's support plan is the day-to-day guide workers follow. Person-centred practice applies to both, but providers control the support plan, so that is where auditors look for it.

Active support is a closely related practice: it puts person-centred values into each everyday task by helping the person take part rather than doing things for them.

What it looks like in daily support

Person-centred practice is visible in small, ordinary decisions on every shift:

• The person decides when to get up, what to wear and what to eat, with support where needed.
• Workers follow the person's preferred order for personal care and respect privacy.
• House routines, such as meal times or outings, are set with residents, not for staff convenience.
• The person helps choose who supports them, and their preferences about worker gender are respected where possible.
• Progress notes describe the person's choices and experiences, in respectful language, not only tasks completed.
• Complaints and feedback from the person are welcomed and acted on.

When the person communicates without words

Person-centred practice does not depend on the person being able to say what they want. Workers learn how the person shows preference, enjoyment, pain or distress, through behaviour, sounds, gestures or where they move. Families, long-standing workers and a communication assessment can help build a picture, and the support plan should record it so that a new worker can read the signs on their first shift. Offering two real options and watching the response is a simple, everyday way to give choice.

Common mistakes

• Writing "person-centred" in policies while rosters, meal times and outings are set around staff shifts.
• Copying support plans between participants with only the name changed.
• Asking family or staff about preferences without asking the person first.
• Using risk as a reason to say no, instead of planning how the person can do what they want safely.
• Providing information only in long written documents the person cannot easily read.
• Reviewing plans only when the annual date comes around, not when the person's needs or wishes change.

To check how your organisation measures up, try the NDIS Practice Standards self-assessment, which covers the person-centred outcomes alongside the other Core module standards.