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The Story of

Personal Profile Frames

Personal Profile Frames: MS Word Edition 2-09-05Reviewed: 1-11-11; Revised 9-13

Date:

Personal Profile Table of Contents

Personal Profile Meeting: Who is here?..............................................3

What is important to me, and What is important for me??.................4

Who are the people in my life?...........................................................5

Where do I go in the community?......................................................6

What is my life story?........................................................................7

What is my current health?................................................................8

What are my daily routines?..............................................................9

What choices and decisions do I get to make?.................................10

What gains and loses respect for me?...............................................11

What works for me and does not work for me?...............................12

What are our hopes and fears?.......................................(Optional)..13

What are the barriers and opportunities?………… …...(Optional).14

What are the major themes?.............................................................15

What do the team/others need to know/do to support me?..............16

What additional things should we know and do?............................17

What are the primary ways that I communicate?..........(Optional)..18

What are our short term goals for the future?...............(Optional)..19

To Do List…………………………………….…..……(Optional).20

Personal Profile Frames: MS Word Edition 2-09-05 2Reviewed: 1-11-11; Revised 9-13

Administrative Appendix.………………...…..………(Optional)

Personal Profile Meeting: Who is here?Personal Profile and Initial Short Term Goals – Valid for 60 days pending PATH

Name: Relationship to Focus Person

Length of Time of

Relationship

Contact Information: address, Phone, fax, email,

etc.


Place: Date:

What is Important To Me?Can relate to any of the Personal Outcome Measures®

What is Important For Me?Can relate to any of the Personal Outcome Measures®, especially People have the best

possible health, People are safe, and People are respected.


Who are the people in my life?

FamilyPeople are connected to natural support

networks. POM®

AgencyRelates to Supports in all POMs®


FriendsPeople have friends. People have intimate

relationships. POMs®

CommunityPeople interact with other members of the

community. POM®

Where do I go in the community?People exercise rights. People choose where and with whom they live, People choose where they work. People participate in the life of the community. People use their environments. People live in integrated environments. People perform different social roles. People are respected. POMs®


Home

School or Day Setting

Work

Community

What is my life story?Can include many POMs® such as:

People are connected to natural support networks. People experience continuity and security. People are free from abuse and neglect. People realize personal goals.


What is my current health?

People exercise rights. People have the best possible health. People are respected..POMs®


+ -

Medications

What are my daily routines?


Weekday

Weekend

What choices and decisions do I get to make?Can include many POMs® such as:


People exercise rights. People decide when to share personal information. People choose where and with whom they live. People choose where they work. People choose services. People choose personal goals. When Others make choices for the person, consider People are treated fairly and People are respected.]

Me

Others

What gains and loses respect for me?


People are respected. People perform different social roles. POM®

What gains respect for me?

What loses respect for me?

What works and does not work for me?


Consider POMs® in which the outcomes or supports are and are not present.

What works for me and needs to stay the same?

What does not work for me and needs to change?

What are our hopes and fears?


HopesPOM® People choose personal goals and any other POM® in which he/she has expressed a

wish for something different

FearsPOMs® People are safe, have the best possible

health, exercise rights, are treated fairly, are free from abuse and neglect, are respected.


What are the barriers and opportunities?

BarriersPOMs® in which outcomes and supports are not

present

OpportunitiesPOMs® in which outcomes and supports are

present

What are the major themes?


This can be any of the POMs® or combinations of them

What do the team and others need to know and do to support me?


Consider supports needed for all POMs® to be achieved.


What additional things should we know and do?● To help me stay healthy? POM® People have the best possible health.● To help me stay safe? POM® People are safe.● To help with communication?● To help with other things?

Communication Chart (Smull: ELP)What is happening at this time?

When ___________Does this…….

We think itmeans……..

And, we should…….


What are the primary ways that I communicate with other people?

1. What are the general expressive communication strategies that are used by or are available to the person? These might include vocal speech, signs/gestures, communication boards/books, electronic devices, etc. How consistently are the strategies used?

2. On the chart below, indicate (by placing a “Y” for Yes) what behaviors the person uses to achieve the communicative outcomes that are listed.

CommunicativeFunctions

Com

plex

spee

ch (s

ente

nces

)

Mul

tiple

wor

d ph

rase

s

One

wor

d ut

tera

nces

Ech

olal

ia

Oth

er v

ocal

izin

g

Com

plex

sign

ing

Oth

er v

ocal

izin

g

Sing

le si

gns

Poi

ntin

g

Lea

ding

Shak

es H

ead

Gra

b/re

ach

Giv

es o

bjec

ts

Incr

ease

d m

ovem

ent

Mov

es c

lose

to y

ou

Mov

es a

way

or

leav

es

Fixe

d ga

ze F

acia

l exp

ress

ion

Agg

ress

ion

Self-

Inju

ry

Oth

er

Request attention

Request help

Request preferred food/objects/activities

Request break

Show you something or some place

Indicate physical pain (headache, illness)

Indicate confusion or unhappiness

Protest or reject a situation or activity

Alternate Communication Chart


What are our short terms goals for the future?Personal Profile Meeting (for use when Personal PATH is scheduled later)

Include Timeframe & ResponsibilityHome

School or Day Setting

Work

Community


Name of Consumer: Name of Facilitator: Date of Plan:

ON#

What will be done COLPS

Who will do itName: Relationship:Context:

By When DateCompleted


ON = Opportunity Number

CO = Category of Opportunity

L = Learning

P = Part icipation

S = Support

To Do ListNote: To Do List rows enabled for unlimited text entry capacity. MS Word Form

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