Howe, J., Horner, R. H. & Newton , J. S.,

1998,

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

Methodology

Quasi-experimental USA-based comparison study. Information collected by interview on costs, services and supports received and outcomes for 20 adults in supported living and a group of 20 adults receiving 'traditional' supported accommodation services who were matched for age and severity of learning disability (mild or moderate).

Critical Appraisal

Selection strategy (recruitment from people receiving services in Oregon ) indicates that the results may not be applicable to 'typical' provision in UK . Use of quasi-experimental comparison design involves possibility of selection bias which may not have been accounted for by use of matching. Matching criteria were rather crude. No information provided on reliability of information as actually collected within the study (though psychometric properties of some of the measures was specified). Supported living and traditional services differed significantly with regard to size, a factor which some (but not all) studies have shown to be related to outcomes.

Key Findings

There were no differences in cost between supported living and traditional services. Participants in supported living schemes were more likely to:

• own or rent their home;
• have their preferences reflected in the establishment of the home and who they lived with;
• have control over daily activities;
• live with fewer people;
• be supported by staff who reported they spent more time on supervision/support and less time on instruction/training;
• of community-based activities that offered opportunities for social inclusion;
• participate in a greater number and wider range of social activities.

However, there were no differences between supported living and traditional services with regard to:

• whether people had their preferences reflected in where they lived, the nature of daily activities, support received, use of natural support networks; and
• participation in social activities with important people.

Social Work Practice/ Policy Implications

The results are generally supportive of the move towards supported living in that for equivalent costs supported living is associated with greater choice and social inclusion.

(see also Emerson, E., Robertson, J., Gregory, N., Hatton, C., Kessissoglou, S., Hallam, A., Järbrink, K., Knapp, M., Netten, A., & Walsh, P. (2001). The quality and costs of supported living residences and group homes in the United Kingdom . American Journal of Mental Retardation 106, 401-415).