1️⃣ Analytical summary

From support in establishments to a pathway logic

Since the 2002 law and the UN Convention ratified by France in 2010, the aspiration of people with disabilities to live "like others and with them" has inspired a series of texts: Piveteau report "zero without solution" (2014), approach "A supported response for all" (DGCS circular 2017), plan " Ambition transformation 2019-2022". The medico-social sector, long organised around the place in institutions, is invited to shift towards a pathway logic centred on the life project. ANAP documents this shift based on twelve "pioneering" structures and a working group. Target audiences: management teams of ESMS and managing organisations engaged in a conversion, as well as support professionals whose profession is transforming.

Five projects and a toolbox to lead the conversion

The first booklet sets out the principles (individualisation, breaking down barriers, priority to common law, cooperation) and what the platform is not: neither a standard organisation, nor a fixed catalogue, nor an isolated structure. The second outlines five sequenced projects — self-determination, new practices and postures, territorial dynamics, coordination functions, reorganisation into service poles — illustrated with concrete cases, job sheets, graduated postures, points of vigilance and verbatims. It also includes a method for change management in four steps and six reflexes. The FALC version makes the whole accessible to the people concerned. The contribution is methodological and inspirational rather than normative: the document offers transferable benchmarks, not a unique model or measured evidence of effectiveness.

2️⃣ Key points of the document

1️⃣ A model defined as much by what it is not.The platform individualises the pathways and necessarily cooperates with a network: it is neither a standard organisation, nor a catalogue of fixed services, nor an isolated structure. It rests on seven key principles (booklet 1, p. 4-5; guide, p. 8).

2️⃣ A new role of "coordinator." Nine of the twelve structures have created this role, whose primary mission is to support the person and their family in developing the life project (present in 8 of the analysed job descriptions). Its positioning in an independent transversal pole promotes customised pathways (p. 31-34).

3️⃣ A fine gradation of support postures. Bel’Attitudes has formalised five postures, from distant monitoring to guidance, according to the level of difficulty of the person: a common framework that equips the relationship without standardising it (p. 24).

4️⃣ Territorial cooperation as a condition, not as an option. Mapping of resources, multi-partner bodies (CDAPH), inter-ESMS collectives — Handicap 22 brings together seventeen structures, or 80% of the offer in Côtes-d’Armor, and shares waiting lists — and networks of independent health professionals (p. 25-28).

5️⃣ Serafin-PH established as a common language, a long and hampered conversion. The Serafin-PH nomenclature structures the mapping of needs/services, the single file and, ultimately, an analytical accounting by service (p. 14, 38, 42). The transformation takes on average seven years (p. 45) and remains hampered by a regulatory framework still focused on the establishment (p. 50).

3️⃣ Action points for local actors

1️⃣ Map the internal offer and the resources of the territory. Establish a shared contact database and a directory of needs/services based on Serafin-PH to identify duplicates and unmet needs before creating an internal response (p. 26, 38).

2️⃣ Equip the expression of the life project. Allow the person to choose the location and time of the first interview, gather their wishes in unedited verbatim, and propose a tool for collecting needs shared between entities (p. 12-14).

3️⃣ Make information accessible. Develop FALC supports co-validated with supported individuals and harmonise pictograms and tools between entities — an explicit point of vigilance in the guide (p. 14, 30).

4️⃣ Gradually formalise support postures. Draw inspiration from the five postures of Bel’Attitudes to equip teams with a common framework, clearly distinguishing the occasional support of the coordinator from daily support (p. 24, 32).

5️⃣ Secure the management of change. Establish a steering committee including professionals, families, and partners, set milestones, and define from the outset quantitative indicators (active file, time in ordinary settings, situations "without solution ") and qualitative (p. 46-49).

6️⃣ Involve the supervisory authorities and the MDPH early. Register the approach in the CPOM to globalise allocations and secure a functioning not yet recognised by regulations, and define with the MDPH the modalities for referral to the platform (p. 48).

4️⃣ Additional references

Three external references post-2024, complementary and updating directly the booklets from 2020 (URLs noted by indexing, to be rechecked at publication) :

ANAP — « Transform your health and social care offer: towards a coordinated service offer » (guide, self-diagnosis and toolkit, December 2025; FALC and audio versions available). Direct and updated successor to the two booklets from 2020. https://www.anap.fr/s/article/transformer-offre-services-coordonnes-guide-pratique-boite-outils

IGAS — « Disability: how to transform the social and health and social care offer to better meet the expectations of individuals? » (report no. 2024-017R, March 2025). National framework and diagnosis of barriers. https://igas.gouv.fr/sites/igas/files/2025-03/2024-017R%20rapport%20.pdf

HAS — « Supporting the development of self-determination and the power to act of individuals in ESSMS » (framework note, March 2025). Deepens the project no. 1. Reserve V4: at the date of this analysis, only the framework note is published; the recommendations for good practices were under development. https://www.has-sante.fr/jcms/p_3598052/fr/l-accompagnement-au-developpement-de-l-autodetermination-et-du-pouvoir-d-agir-des-personnes-en-essms-note-de-cadrage

Internal references (Health Practices): no article from pratiquesensante.com strictly focused on coordinated service platforms / the transformation of the disability offer has been confirmed by indexing. Two thematically adjacent articles exist (social inclusion and citizen participation; health and social care funding via the FIR) — [MANUAL VERIFICATION REQUIRED before inserting an internal link].

5️⃣ Frequently Asked Questions (FAQ)

1️⃣ What is a coordinated service platform? A bringing together of establishments and services in a territory to offer a modular range centred on the life project — not a unique structure nor a fixed catalogue (booklet 1, p. 4-5; guide, p. 8).

2️⃣ How is the role of the support worker changing? We move from the ‘ reference educator’ to ‘support to be provided’: expanded titles, more autonomy and transversality, emergence of coordinators (p. 18-19).

3️⃣ Who is the ‘coordinator’ and what do they do? Function created by nine of the twelve structures; occasional support focused on the life project and resource mobilisation; often positioned in an independent transversal hub (p. 31-36).

4️⃣ How to involve the person in governance? Seats on the board of directors, self-representation techniques, facilitator, accessible documents; Gapas has created a Central Council of supported individuals (p. 16).

5️⃣ How to finance and secure the approach? Own reserves, OPCO, European funds or sponsorship, pooling; the CPOM allows for the formalisation of support from authorities and to consolidate the allocations (p. 23, 48).

6️⃣ How long does the conversion take? Seven years on average for structures still in transformation; direct conversion (two years) or passing through a transitional stage of type device (more than five years) depending on the case (p. 39, 45).

7️⃣ What are the persistent barriers? Funding and evaluations attached to the establishment, MDPH orientations towards authorised ESMS, absence of legal recognition of the platform and in collective agreements (p. 50).

6️⃣ Rewriting in FALC (Easy to Read and Understand)

What is this document about?

• Previously, people with disabilities often lived in institutions.

• Today, they want to live like others and with others.

• They want to choose their life.

• The health and social care sector is changing its way of helping.

• It creates “service platforms.”

• A platform is a group of establishments that work together.

• They help the person to realise their life project.

What the document teaches us

• The document tells the experience of 12 structures.

• These structures have changed their way of working.

• They first listen to the desires of the person.

• They help the person to make their choices.

• They work with schools, sports, housing and care.

• They create a new profession: the coordinator.

• The coordinator helps the person. They bring the right partners around them.

• This change takes time. Often several years.

• But the person and the professionals benefit.

7️⃣ Cross-analysis — values of Health Practices

Literacy: yes — the document values easy-to-read formats and alternative communication, with co-validation of materials by the people supported (p. 14, 30).

Empowerment: central — collection of desires in verbatim, choice of associated third parties, possibility to test choices and to go back (p. 12-15).

Participation : described — seats on the board of directors, Central Council of supported individuals, families acting as trainers (p. 16, 22).

Community health: partial — the collective dimension is mainly territorial (networks, mobilisation of city actors) rather than community in the strict sense (p. 25-28).

Ethics: present — respect for confidentiality, concern not to bias wishes; but cultural or social biases are not explicitly addressed (p. 13).

Human rights : foundation — the argument is based on the UN Convention and the right to live like others; equity and inclusion structure the whole (booklet 1, p. 2).

Intersectorality : strong — explicit breaking down of barriers between the medico-social, social, health, early childhood, education and integration (p. 25).

Partnership: formalised — agreements (remuneration of freelancers, inclusive apartments), inter-ESMS collectives, Permanent orientation system (p. 27-29).

Fight against discrimination: implicit — inclusion in ordinary settings aims to change perceptions of disability; non-judgment is apparent but not thematised as such (p. 28).

8️⃣ Evaluation of the reliability of the resource

Scientific relevance: institutional reference publisher (ANAP), explicit method (call for applications, site visits, group of twenty-seven members). But qualitative and non representative data — the structures were chosen for their precedence and the variety of their projects, not as a statistical sample. No impact assessment or outcome indicators: the stated benefits ("double win approach") rely on testimonials and declared satisfaction. Seniority: September/November 2020; the national framework has since evolved (IGAS report of March 2025, new guide and decree ANAP end 2025).

Operational relevance: high — directly transferable benchmarks (sequenced projects, job descriptions, graduated positions, change management method, points of vigilance). Caveat: several levers depend on a regulatory and financial framework that the document itself indicates as unstable (p. 50). To be cross-referenced with the 2025 publications for updates.

9️⃣ Strategic hashtags

#TransformationOffer #ServicePlatform #SelfDetermination #DisabilityInclusion #MediSocial #PathwayCoordination #SerafinPH #healthpractices