The 12 high-impact person-centered protocol items

The following 12 items are covered in the Informed Choice, Person-Centered and Transition Protocol, DHS-3825 (PDF). Several of the protocol’s essential elements fall under these topics. When support planners address and document each item, they have a solid base for a person-centered support plan.

The Home and Community-Based Services (HCBS) Lead Agency Review team will look for evidence of each of these items when doing chart reviews. Information on each of these items should be in each support plan:

1. Details about what is important to the person
2. The person’s strengths
3. Opportunities for choice
4. Current physical, mental and/or chemical health status
5. Rituals and routines (quality, predictability and preferences)
6. The person’s dreams and aspirations
7. Preferred living setting
8. Preferred work/education/productive activities
9. Social, leisure or religious activities
10. Goals or skills related to person’s preferences
11. Action steps needed to achieve goals or skills
12. Identification of who is responsible to monitor the implementation of the plan.