Felce, D., Lowe, K., Perry, J., Baxter, H., Jones, E., Hallam, A. & Beecham, J.,

1998,

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

Methodology

National survey of the living situation of 41 adults with the 'most severe' challenging behaviour in Wales . Information collected by interview and direct non-participant observation on the personal characteristics of participants, services and supports received, costs and outcomes.

Critical Appraisal

Well-constructed study. Sampling strategy may have led to under-identification of people whose challenging behaviour did not pose direct threat to others (e.g., severe self-injury). Information provided on reliability of information as actually collected within the study.

Key Findings

Results indicated that, when compared with more traditional services, smaller community-based services for people with severe challenging behaviour:

• offered more opportunities for participation in community-based activities that provide opportunities for social inclusion;
• were more person centred;
• provided more personal support to residents;
• led to greater user involvement in domestic activity and more opportunity for self-determination;
• cost approximately twice as much. Analysis of the association between the characteristics of participants, services and supports received, costs and outcomes indicated that:
• costs were unrelated to participant ability;
• costs were unrelated to any aspect of process or outcome;
• greater participant ability was consistently associated with better outcomes.

Social Work Practice/Policy Implications

Results are generally supportive of the move away from traditional forms of provision to smaller community-based supported accommodation, even for people with severe challenging behaviour (see also Mansell, J., McGill, P., & Emerson, E. [2001]. Development and evaluation of innovative residential services for people with severe intellectual disability and serious challenging behaviour. In L.M. Glidden [Ed.] International Review of Research in Mental Retardation . New York : Academic Press.).

The observed lack of association between costs and indicators of need suggests that commissioning agencies need to pay careful attention to the 'rationality' of resource allocation in supported accommodation.

The results point out the importance of participant characteristics (in particular participant ability or adaptive behaviour) in predicting positive outcomes. This suggests that:

• services should pay close attention to providing opportunities for people with learning disabilities to develop and use independent skills;
• commissioners and managers should play particular attention to issues of quality in services supporting people with more severe disabilities and the use of this information in the commissioning process to drive up the quality of provision