HCBS Training

Using a Tiered Model for Implementing Person-Centered Practices

Triangle for All People, Some, Few

Organizations that employ a tiered approach for person-centered practices use a triangle to represent everyone related to HCBS: people receiving services, family members, guardians, and friends, staff, supervisors and managers, administrators and leaders. Teams implement action plans that address what all people need to be person-centered, promote health and wellness, and achieve an optimal quality of life. Some people may need a little more support in order improve their lives and address minor issues.  A few people who are experiencing more significant challenges may need a more individualized and intensive approach. 

Tier 1

At Tier 1, universal strategies are used to improve social interactions and quality of life for all people. A team approach is used to assess policies and procedures, change new staff and ongoing staff training, and create coaching and mentoring so that staff can learn to use person-centered and positive support skills. Teams assess how resources are used, and consider issues that impact quality of life for everyone providing or receiving services. Universal strategies are used to teach, practice, and reinforce social and relationship skills. Positive supports at Tier 1 also help people build coping skills to manage their emotions and stress levels. The team that forms within an organization works with everyone in the setting to create positive and predictable home and work settings that promote person-centered interactions.

The triangle on this page is used to explain that even when we implement universal person-centered practices, some people may need a little more support to improve the quality of their lives. The strategies we use increase in intensity from Tier 1 to Tier 3. It is important to monitor each person’s planning process receiving HCBS and to identify as early as possible any problems related to improving quality of life.  At Tier 2, simple quality of life changes are made to improve health and wellness. Social and communication skills can be added at Tier 2 to provide a person with new ways to connect with other people. A number of positive supports can be helpful at Tier 2 to support emotional health outcomes and improve quality of life.

Tier 2

At Tier 2, a team forms to include a small group of staff who monitor quality of life, incidents that are challenging to people, and workforce data. These data are used to make sure that each person receiving supports can achieve their desires and goals. The team identifies minor problems that occur and acts quickly to support people. Examples of strategies include adding social learning opportunities and teaching emotional coping skills. Positive changes can be made to home and work settings to improve quality of life or to problem solve when a person’s home life is not ideal. Other actions may be to help people explore new jobs, hobbies, or events in their community. 

There are times when more intensive and individualized plans are needed for a few people who need more support to improve the quality of their lives. At Tier 3, a person may need a more intensive and formalized person-centered planning process. There are different examples of person-centered planning models that can be used. Visit the Minnesota Positive Support Practices website page called Learn More About Different Types of Person-Centered Plans for examples of these models.​ Additional individualized positive support practices are often integrated into the person-centered plan as needed. You can visit the Minnesota Positive Support Practices website to learn more about some positive support practices that are common in Minnesota.​

Tier 3

The final tier (Tier 3) is the most intensive and requires more resources because individualized planning may be needed to support a person. The goal is to build skills among staff within an organization so that each person who needs it can be part of a more intensive person-centered planning process. Person-centered plans help people to celebrate their strengths and create an action plan to help them achieve their best lives. Each person guides their own team and works together with everyone to solve problems. The team creates an action plan, schedules regular meetings, reviews progress, and celebrates successes over time. Positive support strategies are often identified and included in the plan at Tier 3. Trauma-focused cognitive behavior therapy, applied behavior analysis, and positive behavior support are all examples of practices that might be integrated with person-centered planning.

This model shows how to organize person-centered practices across a continuum with strategies that increase in the level of effort and resources needed starting from simple to more complex efforts that depend upon the needs of each person. Using this continuum can streamline how services are provided and create a more informed way to add additional supports when they are needed.