Person-Centered Approaches

New Hampshire Department of Health and Human Services (DHHS) contracted with UNH Center on Aging and Community Living (CACL) to develop state-specific curriculum and competencies to support Person-Centered Options Counseling (PCOC). DHHS and CACL convened stakeholder focus groups comprised of ServiceLink Aging and Disability Resource Center staff to create a formal certification process for PCOC. The focus groups met multiple times over a six-month period to develop the certification procedure outlined in the documents below. 


Competency Framework

New Hampshire has developed the NWD Competency Framework for NH’s NWD System of Access. These competencies were developed by and for staff working in the New Hampshire No Wrong Door (NWD) Systems of Access for Long Term Services and Supports (LTSS). They reflect the knowledge, skills, and abilities that are needed for the delivery of high quality services and supports. They are intended to be used by staff involved in assisting individuals (and their families) who are seeking and accessing LTSS.

For more information contact Melissa Mandrell at

CACL created a toolkit to educate medical providers on the importance of providing person-centered care. The toolkit includes a tip sheet for providers to display and a four-minute video that teaches providers how to better provide person-centered care to their patients by taking a team approach, supporting choice, and communicating effectively. The video includes a short vignette about “Robin” and her person-centered care team.

The Art and Science of Person-Centered Thinking Video

Watch CACL's creative and informative six-minute video for a quick introduction to person-centered thinking!

CACL was contracted by the NH Bureau of Elderly and Adult Services (BEAS) to provide technical assistance on the Administration for Community Living Aging and Disability Resource Center Part A: Enhanced Options Counseling grant. CACL worked in partnership with BEAS and the ServiceLink Resource Center Network (SLRC) to create national certification of Person-Centered Options Counseling, identify required staff skills, and coordinate trainings for staff at the ServiceLink Resource Centers for both certification and ongoing professional development.

Care Transitions Models

Previous grant initiatives through the Administration on Community Living included grants to implement care transitions models in three SLRC communities. For more information on the grant work, read the Person-Centered Care Transitions Pilot Evaluation reports. Currently, formal care transitions models are being implemented in Cheshire County (Monadnock SLRC and Cheshire Medical Center/Dartmouth Hitchcock Keene), and Belknap County (Belknap County SLRC and Lakes Region General Healthcare). CACL provided technical assistance as needed in these communities and assisting other counties as they establish formal care transitions programs across care settings. Additionally, a work group continues to meet on a quarterly basis to discuss and collaborate on care transitions models being implemented throughout New Hampshire. If you are interested in attending the workgroup, email Laura Davie.

Community Living Guide

Under the ADRC grant, CACL and BEAS also developed the Community Living Guide, which was piloted by organizations throughout New Hampshire. The guide is designed for individuals to communicate important information and preferences about themselves to people who may provide them services in the community. The Community Living Guide can be used by professionals to generate conversations about community services and supports, or by informal caregivers who desire a better understanding of their loved one’s needs and goals. Covered topics include desired living situation and location, important person-specific preferences concerning caregiver qualities, personal care schedules, and the identification of personal and community relationships.

Veterans Directed Home and Community Based Program VIP

CACL worked with BEAS to provide technical assistance to the ServiceLink Aging & Disability Resource Centers for the implementation of the Veterans Directed Home & Community Based Services. Activities included building program infrastructure for statewide expansion.

The Look Back, Plan Forward Person-Centered Planning site was developed to help individuals with disabilities and people who are aging to capture their life stories in ways that can inform caregivers and service providers about the individual’s history, values, preferences, and support needs during the person-centered planning process. After creating a profile, site visitors can enter their personal history into a timeline format; print and share their history with family, friends, health care or home care providers, and others who can support them in the way they prefer; and save their history so they can update it over time.

Navigating Choice and Change in Later Life: Frameworks for Facilitating Person-Centered Planning is a curriculum and training manual adapting person-centered planning approaches to use with older adults. The manual advocates for a person-centered approach to long term services and supports. Person-centered planning trainings are offered several times a year.