Person-Centred Planning and Self-Determination in Ontario: A Family Guide

If you’re supporting an adult with a developmental disability in Ontario, you’ve probably been handed a “plan” at some point — and wondered whether it will actually change anything. This guide explains the difference between planning that starts from a person’s gifts and dreams and planning that just fills out a form, walks through the main planning approaches families can ask for, and is honest about where the system helps and where it gets in the way. Every figure, date, and source is kept so you can check it yourself.

The short version

• Self-determination is the philosophy; person-centred planning is the method. Self-determination means a person acts as the “primary causal agent” in their own life — making choices and decisions about how they live, free from undue external control (Michael Wehmeyer’s functional model of self-determination, 1992/1999). Person-centred planning (PCP) is the family of practical planning approaches that starts from a person’s gifts, preferences, and vision rather than from a deficit checklist or the program slots that happen to be open.
• It replaced an older professional-directed, deficit-focused model in which professionals assessed what was “wrong” and assigned people to available services. The shift has roots in the self-advocacy / People First movement (from 1974) and in Wolf Wolfensberger’s normalization (1972) and Social Role Valorization (1983). This is the same Self-Advocacy for Adults with Developmental Disabilities in Ontario: A Plain-Language Guide tradition that insists nothing about a person be decided without them.
• The four classic approaches each do a different job. PATH and MAPS (Marsha Forest, Jack Pearpoint, John O’Brien; Inclusion Press, Toronto) are group, graphic, vision-driven processes; Essential Lifestyle Planning (Michael Smull & Susan Burke-Harrison, late 1980s) is a detailed everyday-living blueprint; Personal Futures Planning (Beth Mount & John O’Brien, 1980s) maps a desirable future around O’Brien’s “five accomplishments.”
• In Ontario, two things are NOT the same. The mandatory Individual Support Plan (ISP) required of funded agencies under O. Reg. 299/10 is a compliance document; person-directed planning (the term Ontario adopted, funded through Passport up to $2,500/year) is the genuine, person-led process. MCCSS’s own guidance states plainly that “an individual support plan is not the same as a person-directed plan.”
• The honest verdict from the research: PCP has a positive but moderate effect on some outcomes (community participation, daily choice-making), the evidence base is weak, and PCP repeatedly collapses into paperwork when the system lacks the money, staffing, and authority to act on the plan. A plan changes a life only when someone has the power and resources to make it real.

What every family should know

1. The point of planning is a life, not a document. Every originator says this. Michael Smull: “A person centred plan is a means and not an end. The life that the person wants is the outcome, not the plan that describes it.” A plan on a shelf is a failure of the process, not a completion of it.

2. You (or your family member) are the author, not the subject. The paradigm shift is from being planned for to planning with / directing. Ontario adopted the term “person-directed planning” specifically because People First self-advocates pointed out that “person-centred” meetings were often held without the person even in the room.

3. Different tools for different moments. Use PATH or MAPS for a big transition, a vision reset, or building a team; use Essential Lifestyle Planning to make daily support match the person’s real routines and non-negotiables; use Personal Futures Planning to map a longer arc toward community roles. They can be combined.

4. Know who really holds the power. In Ontario’s resource-constrained system, control over money, staffing, and choices often sits with the funder (MCCSS), the agency, or a waitlist algorithm — not the person. Independent facilitation and self-managed Passport funding exist precisely to move authority back toward the person and family.

5. The evidence is real but modest — and honest sources say so. Do not expect a plan alone to transform a life. Expect it to improve the odds on specific things (community participation, choice) if it is backed by action and resources.

What self-determination actually means

Self-determination in the disability field is most influentially defined by Michael Wehmeyer (University of Kansas). In his functional model of self-determination (proposed 1992; fully articulated in “A Functional Model of Self-Determination,” Focus on Autism and Other Developmental Disabilities, 1999), “self-determined behavior refers to volitional actions that enable one to act as the primary causal agent in one’s life and to maintain or improve one’s quality of life. A causal agent is someone who makes or causes things to happen in his or her life.” Wehmeyer identifies four essential characteristics: autonomy, self-regulation, psychological empowerment, and self-realization. In 2015, Wehmeyer, Shogren and Palmer reformulated this into Causal Agency Theory (Shogren, Wehmeyer & Palmer, 2015), which aligns the functional model with self-determination theory from motivational psychology (Deci & Ryan) and positive psychology.

Here’s a finding worth holding onto: self-determination is limited less by a person’s disability than by their environment. Wehmeyer and Bolding’s work found that adults with intellectual disability living or working in congregate / segregated settings showed lower self-determination than matched peers in more integrated settings — evidence that opportunity, not impairment, is often the binding constraint.

Where the philosophy comes from. Two streams feed it:

• The self-advocacy / People First movement. The movement traces to Sweden in the late 1960s, where Bengt Nirje organized clubs and, in 1969, delivered “Towards Independence,” describing people with developmental disabilities learning to run their own meetings and make their own decisions. The name “People First” was coined at a 1974 convention in Salem, Oregon, when a self-advocate said, “I want to be known as a person first.” The movement reframed the “disability problem” from something in the person to be fixed to a demand for equality and control.
• Normalization and Social Role Valorization (SRV). Wolf Wolfensberger published The Principle of Normalization in Human Services (Toronto: National Institute on Mental Retardation, 1972), then in 1983 proposed replacing “normalization” with “Social Role Valorization” (“Social Role Valorization: A Proposed New Term for the Principle of Normalization,” Mental Retardation, 21(6), 234–239). SRV’s core idea: the good things in life flow to people who hold valued social roles, so services should enable, establish, and defend valued roles for people at risk of social devaluation, by enhancing both their social image and their competencies.

Old model vs. new model. The older professional-directed, deficit-focused (medical) model locates the “problem” inside the individual as a set of functional deficits to be diagnosed, remediated, or managed by experts; the person is a patient / client slotted into whatever program exists. The self-determination / social model locates much of the disability in the environment and in the absence of valued roles and opportunities; the person is a citizen and the author of their own life, and services exist to support the person’s own goals. PCP is the practical expression of this shift: planning starts from gifts, preferences, and a desired future rather than from a needs-and-deficits inventory and a menu of available slots.

What person-centred planning is

Person-centred planning is not a single tool but “a family of approaches” (John O’Brien’s phrase, adopted verbatim in Ontario’s MCCSS guidance) for discovering what is most important to a person and organizing supports, opportunities, and community connections around that. It was developed in the 1980s by a small, overlapping group — John O’Brien and Connie Lyle O’Brien, Beth Mount, Marsha Forest, Jack Pearpoint, and Michael Smull among them — as a way to help people move out of institutions and segregated settings into ordinary community life.

The paradigm shift, stated plainly: traditional planning asks “What services do we have, and which does this person qualify for?” Person-centred planning asks “Who is this person, what is a good life for them, and what would it take to build it?” As the Inclusion Press materials put it, PCP produces documentation — “these are only footprints: the path is made by walking.” One can master the technical style, “but if the ‘heart and soul’ of the process are missing, it is not Person-Centered Planning.”

The four planning approaches — and when to use each

PATH — Planning Alternative Tomorrows with Hope. Originators: Jack Pearpoint, John O’Brien, and Marsha Forest; first PATH Workbook 1993/1995 (Inclusion Press, Toronto). What it is: a creative, graphically-facilitated group process that “starts in the future and works backwards” — beginning with a “North Star” of dreams and highest purpose, then a positive-but-possible vision, then working back in steps to first actions. Uses two facilitators (a process facilitator and a graphic facilitator who draws the plan). Good for: transitions, team-building, mediating stuck situations, energizing a circle around a concrete action sequence. “PATH is not for the faint of heart. It is very results oriented.”

MAPS — Making Action Plans (originally the McGill Action Planning System). Originators: Marsha Forest, Jack Pearpoint, and Judith Snow (with John O’Brien); developed in the 1980s. What it is: a story-based group process that “had its origins in schools, to replace the medicalized files with stories” — it builds a portrait of the person through their history, dreams, gifts, and what it would take to include them, then moves to an action plan. Good for: getting to know a person richly, especially at a life transition (e.g., school to adult life), and building shared understanding in a circle.

Essential Lifestyle Planning (ELP). Originators: Michael Smull and Susan Burke-Harrison, late 1980s / early 1990s at the University of Maryland, developed while helping people labelled “not ready” return to communities from institutions. What it is: a detailed, guided process for learning how a person wants to live day-to-day and translating it into a working blueprint for support staff. Its signature discipline is separating what is important to a person (their choices, routines, relationships) from what is important for a person (health and safety), and finding the balance — the same “important to / important for” idea that runs through Dignity of Risk and Safeguarding in Ontario: A Guide for Families and Staff. Good for: making everyday support consistent and respectful, especially in residential / day-support contexts and for people with significant communication differences or “challenging” reputations. ELP is a “snapshot of how someone wants to live today,” meant to be updated as the person tries new things.

Personal Futures Planning (PFP). Originators: Beth Mount (with John O’Brien); 1980s, developed through Mount’s work (Graphic Futures, Inc.). What it is: a mapping process that builds a picture of the person’s life now (relationships, places, choices, gifts) and then charts a desirable future, using O’Brien’s five accomplishments / valued experiences as the compass: community presence, community participation (relationships), valued social roles / respect, choice / autonomy, and competence (John O’Brien, 1987/1989). Good for: longer-horizon change, deepening relationships and community roles, and giving an agency a “job description” for what a good life should include.

How they differ, and when to use which. PATH and MAPS are group, graphic, vision-first processes best for transitions and team alignment (MAPS builds the story / portrait; PATH drives backward from a vision to an action plan). ELP is the most granular and operational — it governs daily support. PFP sits between vision and operations, mapping current life and future direction around the five accomplishments. All four share the same values; most Ontario facilitators are trained primarily in Personal Futures Planning as a foundation and take separate 3-day facilitator trainings for ELP or PATH. A note on vintage: the foundational texts are 1980s–1990s. The core methods have not been superseded; the main updates are the 3rd-edition PATHS & MAPS Handbook (O’Brien, Pearpoint & Kahn, 2017) and Smull / Sanderson’s Essential Lifestyle Planning for Everyone. John O’Brien, the field’s central theorist, died June 27, 2025 (1946–2025).

Ontario’s two kinds of “plan”: ISP vs. person-directed planning

The legislation. Ontario’s developmental services are governed by the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA). Its quality standards are set out in Ontario Regulation 299/10 (Quality Assurance Measures), approved July 7, 2010; effective for service agencies January 1, 2011 and for application entities July 1, 2011.

The Individual Support Plan (ISP) — a mandated, compliance-driven document. O. Reg. 299/10 defines an ISP as “a written document that is developed by a service agency that identifies specific strategies that are to be undertaken to help a person with a developmental disability to achieve their goals, and the services and supports that are to be provided to the person” (s. 1(1)). Section 5 requires every funded agency to develop an ISP for each person that “addresses the person’s goals, preferences and needs,” to review it annually with the person and any persons acting on their behalf, and to ensure the person “is supported to participate as fully as possible in the development and annual review of their individual support plan” (s. 5(2)). The plan must be based “on information contained in the application form, the needs assessment used by the application entity, the stated goals and preferences of the person … and other relevant clinical assessments” (s. 5(3)), and must identify short- and long-term goals and expected outcomes, community resources, funded services and supports, the actions required and who is responsible for them, safeguards to protect health and safety, the amount of allocated resources, and the level of support the person requires to manage day-to-day finances (s. 5(4)(a)–(k)). MCCSS enforces this through annual compliance inspections by Program Advisors using a DS Compliance Inspection indicator list.

Person-directed planning — Ontario’s term for genuine PCP. SIPDDA separately defines person-directed planning as “services and supports to assist persons with developmental disabilities in identifying their life vision and goals and finding and using services and supports to meet their identified goals with the help of their families or significant others of their choice.” MCCSS’s Person-Directed Planning and Facilitation Guide (November 2013) states that person-directed planning is “rooted in person-centred planning” and shares the same core values. Ontario deliberately chose “person-directed” over “person-centred” — a change driven by People First of Windsor / Ontario and its then-President Richard Ruston, who observed that person-centred meetings were sometimes held without the person present, so individuals were being “‘planned for’ without being present.”

The honest connection — and disconnect. The same MCCSS guide is blunt: “It is essential to understand that an individual support plan is not the same as a person-directed plan.” The ISP is what the agency must produce to satisfy the regulator; the person-directed plan is what the person leads to shape their own life. In principle they should feed each other — the ISP is legally required to be based on and reflect the person’s stated goals and preferences. In practice, the ISP can become a compliance artifact completed to pass inspection, while genuine person-direction happens (or fails to happen) separately. Funding reflects this split: Passport funds person-directed planning up to $2,500 per year, purchasable from independent planners, facilitators, or developmental services agencies (Passport Guidelines, effective April 1, 2023).

Passport, DSO, and access. Passport is the MCCSS program that funds community participation, activities of daily living, caregiver respite, and person-directed planning for adults (18+) with a developmental disability as defined under SIPDDA. Eligibility runs through Developmental Services Ontario (DSO), the application entity that assesses support needs and determines eligibility. Every eligible adult is entitled to a minimum of $5,500/year, with additional funding based on assessed need, priority, and available resources up to a maximum of $44,275 per year (MCCSS Passport Program Guidelines, effective April 1, 2023).

Who’s involved

• The person, at the centre (and ideally directing). Everything begins and ends with the person’s own vision, gifts, and preferences.
• The circle of support / personal network. MCCSS defines a circle of support as “a group of non-paid people who connect on a regular basis to help a person with a developmental disability to undertake a planning process to accomplish their personal goals,” which also assists with safeguards. A personal support network is broader — the wider web of relationships (kinship, friendship, work, community). Most network members are unpaid and there “because they care about you.”
• Independent facilitators. A neutral person, arms-length from service delivery, who helps the person create a vision and next steps. The key safeguard is independence: an unencumbered facilitator is not part of an organization that provides the person’s residential / day supports and has no role in assessment, eligibility, or funding decisions — removing the conflict of interest between “the way supports have been delivered in the past and the vision the person and family have for the future.” In Ontario, independent facilitation is not a regulated profession; the Ontario Independent Facilitation Network (OIFN) provides mentoring, a community of practice, and a code of ethics. In Waterloo Region, Bridges to Belonging provides person-directed planning and independent facilitation; its facilitators describe their role as “to guide the process of planning, but not direct it” — the individual is “the boss.”
• Paid staff — role and limits. Paid support workers and agency staff can contribute knowledge and carry out actions, but the originators and Ontario guidance are clear that staff should support, not control. ELP’s discipline of separating “important to” from “important for” exists precisely to keep staff priorities (often safety and routine) from overriding the person’s own priorities. Because agency staff have inherent conflicts of interest (they represent existing services), genuine direction is best safeguarded when the person also has independent, unpaid, or arms-length allies.

From plan to real life

The recurring failure mode is the “implementation gap” — plans that are written but never carried through (Mansell & Beadle-Brown, 2004). A plan becomes real change only when three things exist beyond the document: (a) authority — someone (ideally the person, family, circle, or an independent facilitator) has the standing to make things happen; (b) resources — money and staffing to act; and (c) ongoing listening and iteration — Helen Sanderson’s fifth feature of PCP: “the plan results in ongoing listening, learning, and further action.” The distinction the field draws is between person-centred planning and person-centred action (Mansell & Beadle-Brown’s 2004 title). A document on file changes nothing; a life shifts when the plan is connected to real decisions about where and how a person lives, works, and spends their days.

Everyday choices count too

Self-determination is not only the big annual plan; it is the texture of daily choice-making — what to eat, wear, do, and whom to see. Research on autonomy in the lives of adults with intellectual disability finds these everyday choices are frequently constrained by staff routines, organizational risk-aversion, and family concerns rather than by the person’s capability. Supported decision-making — where a person chooses trusted people to help them understand information and options while the decision remains theirs — is an important enabler of both everyday and larger choices. Informal supported decision-making “can be implemented independently of legislation” and happens constantly in families and support relationships. The legal dimensions of supported decision-making, legal capacity, and guardianship (including Ontario’s substitute-decision-making law and Article 12 of the UN CRPD) are covered in a separate legal-capacity document and are not treated in depth here.

Where families get stuck

• Where authority actually lives. In Ontario’s system, real control over money, staffing, and placement frequently rests not with the person but with MCCSS (funding envelopes), DSO (eligibility and prioritization), a priority-scoring algorithm (whose criteria are not fully disclosed and which determines waitlist placement), and agencies (which have finite capacity). Families report that individuals “have little choice regarding where they receive their services and are more or less at the mercy of where DSO places them.”
• The money is not keeping pace. Community Living Ontario (2025 Pre-Budget Recommendations, December 2024) reports that “developmental service organizations have seen cumulative base funding increases of less than 7% over the course of the past thirty years,” while “the cost of living has increased by almost 70%” — including only about a 3% base increase in the 2024 provincial budget.
• More than 50,000 people are waiting. The #WaitingToBelong campaign, led by Community Living Ontario with OASIS, reports more than 50,000 people with a developmental disability on waitlists for services (2024–25). The Financial Accountability Office of Ontario (FAO) found that in 2023–24 fewer than 18,000 people were receiving provincially-funded supportive-living (residential) services while more than 28,000 were eligible and waiting — more people waiting than receiving.
• Passport demand vastly outstrips full funding. Per the FAO (MCCSS Spending Plan Review, report FA2305; interim figures as of December 2023), the number of Passport recipients receiving their full allocation rose only “at an average annual rate of 1.5 per cent from 32,041 in 2018-19 to 34,479 in 2023-24,” while the number receiving less than their full allocation (mostly people getting the $5,500 minimum while waiting for more) “grew at an average annual rate of 15.4 per cent” — from 14,973 in 2018-19 to 30,667 in 2023-24, roughly a doubling.
• The result: person-centred rhetoric collides with a service system that cannot always deliver the choices the plan identifies. “Limited alternatives undermine choice” — when the only real options are the programs that exist, “choice” is nominal. (For how to compare the options that do exist, see Life After School in Ontario: The Full Menu of Options for Adults with Developmental Disabilities.)

Grey areas and points of confusion

• Thin and modest outcome evidence. The most-cited systematic reviews are candid. Claes, Van Hove, Vandevelde, Van Loon & Schalock (2010, Intellectual and Developmental Disabilities, 48(6), 432–453) found the evidence base “still scant,” with effects most apparent for reductions in challenging behaviour, social networks, and community involvement. Ratti, Hassiotis, Crabtree, Deb, Gallagher & Unwin (2016, Research in Developmental Disabilities, 57, 63–84) reviewed 16 studies (7 quantitative, 5 qualitative, 4 mixed-methods) and concluded the evidence was “low but suggestive that PCP may have a positive, yet moderate, impact on some outcomes … particularly community-participation, participation in activities and daily choice-making,” while findings for employment were inconsistent. Their bottom line: the evidence “does not demonstrate that PCP can achieve radical transformations in the lives of people with ID,” and “clearer descriptions of PCP and its components are needed.” An earlier review (Rudkin & Rowe, 1999) found no quantitative evidence for Essential Lifestyle Planning specifically. Caveat: much of the strongest primary evidence predates 2016; a 2025 Ontario qualitative study (Journal of Applied Research in Intellectual Disabilities) continues to note there is still “no consensus on the definition of person-centred planning.”

• Rhetoric vs. practice. Multiple sources describe a gap between the promise and the delivery of person-centred services. Mansell & Beadle-Brown (2004) warned that system-wide adoption of PCP without changes to “system architecture” — ensuring those doing the planning have “the authority or resources to achieve the plan’s goals” — risks PCP becoming “another fad … characterised by rhetoric rather than meaningful action.” A 2024 qualitative study of Ontario community-care organizations found “ongoing challenges in the implementation of person-centred care plans, highlighting a gap between policy and practice.”

• Mandated planning vs. genuine PCP. The core tension in Ontario: the regulatory ISP is a minimum compliance standard enforced by inspection, whereas genuine person-direction is values-driven and person-led. The risk is that “person-centred” becomes a box to tick. MCCSS’s own guidance tries to hold the line by insisting the two are distinct — but the system funds and inspects the ISP far more robustly than it funds independent facilitation and person-directed planning.

• Exclusion of people with the most complex needs. PCP has been criticised for being harder to deliver well for people with severe / profound intellectual disability and significant communication differences — the very people it was partly designed to serve. Whether a given process genuinely captures a non-speaking person’s voice depends heavily on skilled facilitation and time.

Concrete next steps

If you’re a family or self-advocate just starting out:

1. Separate the two planning tracks in your mind. Expect the agency to produce an ISP for compliance; do not mistake it for your own person-directed plan. Ask your agency to show you how your stated goals appear in the ISP (this is legally required under O. Reg. 299/10 s. 5).
2. Claim your person-directed planning dollars. If you have Passport funding, you can spend up to $2,500/year on person-directed planning / facilitation. Request it through DSO; it must be initiated by the person and/or family.
3. Match the tool to the moment. For a major transition or a stuck situation, ask for a PATH or MAPS. For getting daily support right, ask for Essential Lifestyle Planning. For a longer-term vision and community roles, ask for Personal Futures Planning.

If you’re a family seeking deeper control: 4. Consider an independent facilitator (e.g., through OIFN-affiliated organizations such as Bridges to Belonging in Waterloo Region) specifically because they are free of the agency conflict of interest. Ask about their training and independence, since the role is unregulated. 5. Build a circle of support / personal network of unpaid allies. Research and Ontario guidance both treat this as the single most durable safeguard — it outlasts any staff member or funding cycle. 6. Where possible, self-manage funding to shift authority over money and staffing toward the person and family (some families formalize this via a Microboard).

If you’re a provider or support worker: 7. Treat the plan as a commitment to action, not a filing requirement. Build in the “ongoing listening, learning, and further action” loop; audit whether plan goals actually translate into changed schedules, roles, and community connections. 8. Use the “important to / important for” discipline so safety and routine do not silently override the person’s own priorities.

What would change this advice: if MCCSS were to fund independent facilitation and person-directed planning at parity with (and inspect it as rigorously as) the ISP; if the Passport full-allocation waitlist shrank rather than grew; or if base funding rose to track cost-of-living — the balance of power would shift toward the person, and families could rely more on the system and less on self-organized safeguards. Watch the annual FAO MCCSS spending reviews and Community Living Ontario budget submissions for these signals.

How current is this, and what to double-check

• Source vintage. The foundational PCP and self-determination literature is genuinely old: Wolfensberger’s normalization (1972) and SRV (1983); O’Brien’s five accomplishments (1987); ELP, MAPS, and PFP (late 1980s); PATH (1993); Wehmeyer’s functional model (1992/1999). These remain the authoritative primary sources and have not been superseded, but treat them as foundational theory rather than current empirical proof. The most substantive modern update to the theory is Causal Agency Theory (Shogren, Wehmeyer & Palmer, 2015).
• John O’Brien died June 27, 2025. His body of work is now closed; expect tributes and retrospectives (e.g., the 2025 Journal of Awareness-Based Systems Change tribute) rather than new primary work from him.
• Ontario policy currency. O. Reg. 299/10 is current (the consolidated version shows no amendments to the ISP provisions since 2011; a 2024 consultation proposed only narrow amendments about behaviour analysts). The Passport figures ($5,500 minimum; $44,275 maximum; $2,500 planning cap; April 1, 2023 guidelines) and the FAO waitlist data (interim as of December 2023) are the most recent available as of this writing; verify current Passport guideline amounts before relying on them, as MCCSS updates them periodically.
• Terminology. This guide uses person-first language (“adults with a developmental disability”) as the family-facing default while honouring identity-first where communities prefer it (e.g., “autistic person”). Ontario’s legal / funding system uses “developmental disability”; the advocacy / research sector often uses “intellectual disability.” “High/low-functioning” and “special needs” are avoided.
• Independent facilitation is unregulated in Ontario. There is no licensing body; quality depends on training, mentoring (via OIFN), and the facilitator’s adherence to a voluntary code of ethics. Families should ask about a facilitator’s training and independence.
• What’s covered elsewhere. Legal supported decision-making / capacity / guardianship, dignity of risk vs. safeguarding, lifetime / succession planning for aging caregivers, and day-program quality evaluation are each addressed in separate AIM guides and are only flagged here. This is general information, not legal or financial advice.

Related: Self-Advocacy for Adults with Developmental Disabilities in Ontario: A Plain-Language Guide · Dignity of Risk and Safeguarding in Ontario: A Guide for Families and Staff · Life After School in Ontario: The Full Menu of Options for Adults with Developmental Disabilities