Emerson, E., & Hatton, C.,

1996,

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

Aims of Review

To review UK literature on the effects on quality of life of the move from NHS Learning Disability Hospital to community-based supported accommodation.

Methodology / Critical Appraisal

Qualitative systematic review.

Search Strategy

On-line searches of Social Sciences Citation Index and PsychLIT 1980-1994 supplemented by 'following up references cited in published reports, and discussion with active research groups in the UK '. 

Data Extraction

Qualitative summaries of findings across research areas supplemented by categorisation of outcome as 'improvement', 'no change' or 'deterioration' based on statistical significance or, for qualitative studies, 'presence of an unqualified and unambiguous statement concerning differences between the service models'.

Inclusion Criteria

Published or accepted for publication in peer reviewed academic journals.

Reliability

No report of assessment of reliability of data extraction.

Key Findings

71 papers identified from 46 separate research projects. Participants - approximately 2,350 people with learning disabilities.

Summarised results indicated the move to smaller community-based supported accommodation was generally, though not inevitably, associated with:

• increased user engagement in everyday activities;
• increased support from staff;
• increased use of community-based facilities;
• increases in independence;
• reductions in observed challenging behaviour (primarily stereotypes);
• increased opportunities for choice;
• increased contact with family and friends;
• a better material standard of living;
• increased acceptance by the community;
• no change in reported levels of challenging behaviour.

Results also highlighted the considerable variation in quality within community-based supported accommodation.

Social Work Practice/ Policy Implications

Results are generally supportive of the move toward smaller, more person centred and more community-based forms of supported accommodation. They also highlight two issues of concern.  First, type of supported accommodation (traditional institution versus community-based) is unrelated to reported levels of challenging behaviour, suggesting that social and health care services will need to work together to actively intervene to help people overcome their challenging behaviour. Second, the variation in quality within community-based supported accommodation highlights the need for the integration of effective quality assurance and enhancement within the commissioning process.