Friday, October 21, 2016

The IPP: A Changing Document


The IPP (Individual Program Plan) is the core of active treatment, both formal and informal, for any Intermediate Care Facility (ICF).   For the most part the IPP, developed at the annual staffing, details the needs of the person as projected over the next year.  The goal of the IDTeam (Interdisciplinary Team) is to help the person develop an IPP that meets his or her needs and helps advance the person toward greater independence.  In a perfect world that IPP would be reviewed and updated at the next annual staffing.  Unfortunately, we do not live in a perfect world.

As you might imagine there is a lot that can go into an IPP.  Depending on the abilities of the person served an IPP might cover basic areas such as getting up in the morning and getting dressed to taking a bus to work at a local job placement.  The most important aspect of the IPP is that it has to be considered a "Changing Document".  That is to say that it must be flexible, or alive, for the IDTeam and for the person it is designed to serve.

When I have said that an IPP must be a "Changing Document" to staff and others, I have sometimes seen a blank stare returned to me.  It's the stare that says, "What?"  I have had people ask me if this means we must change it monthly, or weekly.  I have had others ask if we musth change it quarterly.  The changing of an IPP is naturally dependent on several issues. Those issues that make the document a "Changing Document" are as follows:

1.  The changing abilities of the person served - you may design an IPP to teach a person how to use a washing machine.  The person may have an IPP designed to spend a year learning the washing machine; however, he or she masters the use of the washing machine in six months.  At this point the IDTeam must consider that the individual's abilities have changed and that he or she now needs to progress to something else.  It may be a move to the dryer, ironing, or even hanging up clothing.  Whatever the IPP changes to will depend on the IDTeam's review and assessment of the person's abilities.

2.  The changing of the person's environment - perhaps the individual has a job at a local restaurant.  The IPP may address this with a service goal that says something like, "Johnny will attend to his part time job at the local restaurant each assigned day that he is on shift."  Maybe for some unforeseen reason Johnny has a change in jobs.  Maybe he stops working at the restaurant, maybe he gets a different job with a lawn company, or maybe he is fired.  Whatever has happened, Johnny will need to have his IPP changed or modified to meet the changing environment that he has now found himself living in with regards to his IPP.

3.  The changing of a person's needs - This could happen in several ways.  Maybe the individual has never needed glasses, or hearing devices, or a walker before in his life.  Suddenly, a change in his needs means that he now needs - just for example - glasses.  Although the IPP has never addressed adaptive equipment before and the staffing may still be four months away, the change in the person's needs now supports a change in the IPP.  Assessments must be completed and the IDTeam must determine how the IPP will address the new adaptive equipment.

5.  A change in the person's behavior management needs - the fact of the matter is we all have "behaviors".  Some behaviors are good, some are bad.  Sometimes we may have no negative, or bad, behaviors at all and then for some reason we start having negative behaviors.  When this happens, the IDTeam should follow a strict review process and implement the least, intrusive, corrective measure possible.  For example, the individual might start being physically aggressive.  The IPP would need to be modified to address those changes.  This modification could include new informal goals, new formal goals, a behavior intervention plan of some sort, additional supervision or possibly psychiatric medications.  Whatever intervention may come, the IPP should be modified to handle the changes and needs of the individual.

Now if you are paying close attention, you may have noticed that I skipped number four above.  Number four is that mysterious factor - just as mysteriously it is missing in the list.  It's what I like to refer to as the following:

4.  Anything else mysterious, unforeseen or unexpected that the IDTeam may encounter - there are any number of possible factors here that can affect the unexpected or unforeseen.  Maybe the person served suffers a loss of a parent - the IPP might need to be modified to incorporate counseling for the person.  Maybe the person has some other life-changing event that the IDTeam has not considered.  Whatever that unexpected or unforeseen "Anything Else" might be, the IPP should address it in some way.    Hopefully, the unforeseen will be something as simple as a need to brush teeth better and not something major of life altering.   However, if the unknown or unexpected happens, the IDTeam has a responsibility to remember that the IPP stands ready as a "Changing Document" to meet the person's new needs.