Perry, J., & Felce, D,

2003,

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

Methodology

Survey of the relationship between resident characteristics, care practices and outcomes across 47 small sized supported accommodation settings (average of 3.3 residents per setting) provided by statutory, voluntary sector and private organisations. Information collected by interview and observation.

Critical Appraisal

Well constructed study with clear and appropriate sampling strategy. Small sample (of settings) means that caution needs to be exercised in generalising results.

Key Findings

Results indicated that:

• there were no differences on any indicator of participant need (e.g., ability, challenging behaviour, mental health, social impairment) across sectors with the exception of age;
• average number of residents in voluntary sector provision was greater than in the statutory and private sector;
• voluntary sector provision showed a greater degree of structure in internal planning and management than the statutory and private sector;
• people living in voluntary sector provision received more attention from staff and had more choice than people living in private sector provision;
• there were no differences between sectors with regard to physical structure and location of homes, staffing ratios, extent of person-centred practices, resident engagement in constructive activity, resident social interactions within the homes, social and community activities.

Across all sectors staffing ratios were significantly associated with resident ability and there was considerable variability with regard to the quality of care practices and outcomes. Variation was notably greater for 'objective' measures than for subjective measures of resident satisfaction.

Social Work Practice/ Policy Implications

There were only a few (and weak) associations between provision sector and the quality of care practices or outcomes for people with learning disabilities. As a result, sector of provision does not provide a useful indicator of quality and should not play an important role in the commissioning process.

The extensive variation in quality within sectors indicates that commissioners and managers should pay particular attention to issues of quality in services and use this information in the commissioning process to drive up the quality of provision.