Emerson, E., Robertson, J., Gregory, N., Kessissoglou, S., Hatton, C., Hallam, A., Knapp, M., Järbrink, K., Walsh, P., & Netten, A.,

2000,

Reviewed by Eric Emerson,
Professor of Clinical Psychology,
Institute for Health Research, Lancaster University  

Methodology

Quasi-experimental UK-based comparison study. Participants were randomly selected from nominated 'better' providers of supported accommodation. Information collected by interview and postal questionnaire on costs, services and supports received and outcomes for 86 adults living in village communities, 133 adults living in new NHS campus-style accommodation and 281 adults living in smaller community-based provision.

Critical Appraisal

Selection strategy (recruitment from small number of 'better providers') indicates that the results may not be applicable to 'typical' provision in UK . Authors note that participants were representative of age of wider population of people with learning disabilities in supported accommodation, but contained greater proportion of men and people living in smaller settings. Use of quasi-experimental comparison design involves possibility of selection bias which may not have been accounted for by use of statistical methods used by authors. No information provided on reliability of information as actually collected within the study (though psychometric properties of measures was specified).

Key Findings

Results indicated that:

• the adjusted comprehensive costs of provision in community-based supported accommodation were 15% higher than in NHS residential campuses and 20% higher than in village communities;
• community-based supported accommodation and village communities offered a significantly greater quality of care than residential campuses;
• there appeared to be distinct patterns of quality of life benefits associated with community-based supported accommodation and village communities, with both approaches offering a greater quality of life than residential campuses.

Social Work Practice/ Policy Implications

Results are generally supportive of the move away from institutional NHS provision to smaller community-based supported accommodation. However, they also indicate that village communities offer a distinct pattern of benefits to users, suggesting that professional opposition to placement in village communities (which was reported by a significant minority of respondents) was misplaced. Data suggests that NHS residential campuses offer a poor quality of care and a poor quality of life for people with learning disabilities.

Overall, the study indicates that different 'models' of supported accommodation have particular strengths and weaknesses, and that no one model can guarantee quality. In turn, it points to the need for careful monitoring of the actual quality of supported accommodation and the use of this information in the commissioning process to drive up the quality of provision