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

2001,

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 63 adults in supported living, 55 adults in small homes (1-3 people) and 152 adults in larger (4-6 place) homes.

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 is actually collected within the study (though psychometric properties of measures was specified).

Key Findings

• there were no statistically significant differences between the comprehensive total costs of provision once these had been adjusted to take account of between-group differences in ability, challenging behaviour and age;
• there were only marginal differences between supported living schemes and small group homes, and between small and large group homes in the quality of care provided to participants;
• participants living in supported living schemes experienced greater choice and participated in a greater number of community-based activities than participants living in small group homes;
• participants living in supported living schemes experienced fewer hours and days per week of scheduled activity, were more likely to have had their home vandalised and were considered at greater risk of exploitation from people in the local community than participants living in small group homes;
• when compared with participants living in large group homes, participants in small group homes had larger social networks, more people in their social networks who were not staff, not family and did not have learning disabilities, and were considered at less risk of abuse from co-residents.

Social Work Practice/ Policy Implications

The results are generally supportive of the move towards supported living (see also Howe, J., Horner, R.H., & Newton , J.S. [1998]. Comparison of supported living and traditional residential services in the State of Oregon . Mental Retardation, 36, 1-11.) in that for equivalent costs, supported living is associated with greater choice and social inclusion.

However, results also highlighted some risks associated with supported living, including having a less structured week. This, in turn, was associated with lower user satisfaction (Gregory, N., Robertson, J., Kessissoglou, S., Emerson, E., & Hatton, C. [2001]. Predictors of expressed satisfaction among people with intellectual disabilities receiving residential supports. Journal of Intellectual Disability Research 45, 279-292.).

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 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.