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What is standard care for people with learning disabilities and behaviour that challenges and what does it cost?
- Authors:
- IEMMI Valentina, et al
- Journal article citation:
- British Journal of Learning Disabilities, 44 (4), 2016, pp.309-321.
- Publisher:
- Wiley
Background: This article describes current care arrangements in England for children, young people and adults with learning disabilities and behaviour that challenges, and estimate their comparative costs. Materials and Methods: A two-round Delphi exercise was performed in March and April 2014, followed by a costing exercise. Results: The study finds a mixed picture: participants reported that 60-87% of children, 66-88% of young people and 34-47% of adults were likely to be living within the community. Annual cost of care would range between £39 612 and £74 876 for children, between £35 235 and £52 832 for young people and between £81 478 and £94 799 for adults. Conclusion: While residential-based care may continue to be necessary for respite or for individuals with particular needs, community-based care may be an economically attractive alternative, supporting the inclusion of people with learning disabilities and behaviour that challenges within their communities, potentially at a lower cost. (Edited publisher abstract)
Failing to plan is planning to fail: out-of-area placements for people with learning disabilities
- Author:
- ALLEN David
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 2(3), September 2008, pp.3-6.
- Publisher:
- Emerald
Being placed in out-of-area services can be one of the most significant forms of transition experience by people with learning disabilities. This paper reviews the extent of such provision, identifies who is most at risk of being placed out of area, briefly explores the effects of such placement and concludes with a discussion of possible strategic solutions.
Individual characteristics and service expenditure on challenging behaviour for adults with intellectual disabilities
- Authors:
- HASSIOTIS Angela, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 21(5), September 2008, pp.438-445.
- Publisher:
- Wiley
English policy argues that people with intellectual disabilities should be supported in their local communities. There is considerable evidence that this aspiration is not being achieved. This paper seeks to look at the subsection of people with intellectual disabilities who have expensive care needs because of challenging behaviour, to identify the decision-making processes that have led to current service provision and expenditure and to suggest improvements. A survey was carried out within five North London boroughs to investigate the characteristics of a cohort of people with intellectual disabilities and challenging behaviour in high-cost accommodation (over £70 000/annum). Postal questionnaires and face-to-face interviews were conducted with stakeholders with intellectual disabilities and patterns of current costs were estimated from existing data provided by the commissioning authorities in the five boroughs. Two hundred and five individuals with intellectual disabilities and challenging behaviour were identified. They were accommodated in placements provided by 97 separate providers, both in and out-of-area. Those more likely to be placed out-of-area were younger, had multiple health problems, significant challenging behaviour and mental health problems including autistic spectrum disorders. The local community intellectual disabilities teams identified a number of difficulties in meeting the needs of those service users. Expenditure on all placements for service users with intellectual disabilities is significant. There is a notable lack of investment in local service development. A coherent approach is required, often across service boundaries. The authors suggest a model for targeted investment aimed at supporting effective local services, and reducing the need for and expense of out-of-area placements.
Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour
- Authors:
- ALLEN D.G., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 51(6), June 2007, pp.409-416.
- Publisher:
- Wiley
Out of area placements for people with challenging behaviour represent an expensive and often ineffective strategy for meeting the needs of this service user group. More than 800 agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Detailed data on identified individuals and the services they received were collected by interviewing key informants. Univariate and multivariate statistics were employed to identify predictors of out of area placement. In total, 1458 people were identified. Full data were available for 901 participants, 97 of whom were placed out of area. Predictors of out of area placement included behaviours resulting in physical injury and exclusion from service settings, a history of formal detention under the mental health act, the presence of mental health problems, a diagnosis of autism and higher total score on the Adaptive Behaviour Scale. Out of area placements were typically of high cost, and associated with only limited evidence of improved service quality. Identifying predictors for out of area placement can be used to highlight deficiencies in local services and individuals at increased risk of exclusion from local services.
Quality and costs of community-based residential support for people with learning difficulties and challenging behaviour
- Authors:
- ROBERTSON Janet, et al
- Publisher:
- University of Lancaster. Institute for Health Research
- Publication year:
- 2002
- Pagination:
- 24p.
- Place of publication:
- Lancaster
The aim was to compare the quality and costs of two approaches to providing community-based residential supports to people with learning disabilities and challenging behaviour: non-congregate settings where the minority of residents have challenging behaviour; and congregate settings where the majority of residents have challenging behaviour. Congregate care was associated with higher costs, higher staffing ratios, and better quality internal working practices. However, these inputs did not translate to better outcomes for residents. Non-congregate care was associated with greater access to day activities, less reliance of medication and physical restraint to control challenging behaviour, and less risk. Levels of staff contact and participant engagement were low across both models of care.
Consumer behaviour analysis and non-adoption of behavioural interventions: implications for managerial action
- Author:
- NTINAS Konstantinos M.
- Journal article citation:
- Tizard Learning Disability Review, 24(3), 2019, pp.101-107.
- Publisher:
- Emerald
Purpose: Direct care staff may be resistant to the use of behavioural interventions. Whilst some research suggests that resistance to the cost of behavioural interventions is one factor of influence, there is lack of research exploring why staff are influenced by the cost. The purpose of this paper is to explore this issue. Design/methodology/approach: In this paper, the phenomenon of resistance is analysed with the help of behavioural economics and of the behavioural perspective model (BPM). Findings: The resistance to the cost of behavioural interventions is correlated with the low quality of the working environment and ways in which staff might attend to factors which protect their own well-being. Practical implications: Services might need to focus on the ways in which behavioural interventions protect staff’s well-being. Originality/value: This paper explores the use of the BPM and of behavioural economics as conceptual tools for the analysis of the factors leading to non-adoption of behavioural interventions. (Edited publisher abstract)
Positive behavioural support for children and adolescents with learning disabilities and behaviour that challenges: an initial exploration of service use and costs
- Authors:
- IEMMI Valentina, et al
- Journal article citation:
- Tizard Learning Disability Review, 21(4), 2016, pp.169-180.
- Publisher:
- Emerald
Purpose: Positive behavioural support has been considered as a valuable alternative to residential care for children and adolescents with learning disabilities and behaviour that challenges. While recent evidence suggests it has a positive impact on behaviour and carer ability to cope, there is little evidence of its economic costs or benefits. The paper aims to discuss this issue. Design/methodology/approach: An exploratory cross-sectional study was conducted to evaluate the cost of providing positive behavioural support to ten children and adolescents with learning disabilities and behaviour that challenges living in the community in Ealing, West London. Comparison was also made with the cost estimate of possible alternative support packages for children and adolescents with learning disabilities and behaviour that challenges in the UK, as obtained through a Delphi exercise. Findings: Total cost of services per child was £1,454 per week for young people supported short-term, and £1,402 supported long-term. Children and adolescents were making use of a range of social care, education and health services. Over the full sample, half of the total cost was accounted for by education services. The Delphi exercise estimated the weekly cost of residential-based care as more expensive than the cost of community-based care for children and adolescents with learning disabilities and behaviour that challenges. At the end of the ITSBS, all ten children and adolescents initially at risk of imminent residential placement were living in the community with less service-intensive and less expensive support. This suggests that avoiding residential-based care could reduce costs in the long term. Originality/value: Positive behavioural support has potential to support people with learning disabilities and behaviour that challenges in the community, leading to potential cost advantages. However, this is a small study and more robust research is needed. (Publisher abstract)
Urban adolescents with intellectual disability and challenging behaviour: costs and characteristics during transition to adult services
- Authors:
- BARRON Diana A., et al
- Journal article citation:
- Health and Social Care in the Community, 21(3), 2013, pp.283-292.
- Publisher:
- Wiley
Young persons with intellectual disabilities and challenging behaviour in transition usually have complex needs, which may not be served well within existing resources. In this article, we present a survey of all the young people, between 16 and 18 years of age with intellectual disabilities and challenging behaviour identified in one inner London borough. They were in transition to adult services at the time of the study (between 2006 and 2008). The objective was to examine their socio-demographic and clinical characteristics, pattern of service use and associated costs of care. An assessment toolkit was devised to measure the mental and physical health, challenging behaviour and service use of the sample. Instruments within the toolkit included the Strengths and Difficulties Questionnaire, challenging behaviour scale, Client Service Receipt Inventory (CSRI) and socio-demographic data form. Twenty-seven individuals in transition to adult services had challenging behaviour, 23 of whom had mental health diagnoses and 18 of whom had physical diagnoses. Severity of challenging behaviour did not correlate with cost of care. Informal care accounted for the highest proportion of the total cost of care (66%) with education being the second largest contributor at 22%. Evidence on transition outcomes for young people with complex needs and intellectual disabilities and associated costs is lacking. This article illustrates some of the relevant issues in this area. Further research is required to investigate these aspects and guide commissioning of appropriate services. (Publisher abstract)
Exploring the relationships between costs and quality of services for adults with severe intellectual disabilities and the most severe challenging behaviours in Wales: a multivariate regression analysis
- Authors:
- FELCE David, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 25(4), December 2000, pp.307-326.
- Publisher:
- Taylor and Francis
A survey in Wales of people with severe intellectual disabilities and the most severe challenging behaviour identified adults living in new specialist community housing and 19 in traditional services. This study explored the relationships between resident characteristics, service characteristics, service processes, quality of life outcome and costs in a series of mutivariate regression analyses.
Children with learning disabilities whose behaviours challenge: what do we know from national data?
- Author:
- PINNEY Anne
- Publisher:
- Challenging Behaviour Foundation
- Publication year:
- 2014
- Pagination:
- 34
- Place of publication:
- Chatham
This data supplement, written to accompany the briefing paper 'Early intervention for children with learning disabilities whose behaviours challenge', presents the findings and recommendations from an analysis of all the available national data on children with learning disabilities and behaviour that challenges in England, in 2013. It draws on SEN (Special Educational Needs) data collected by the Department for Education (DfE) and the Learning Disabilities Census, which provides information children and young people with a learning disability, autistic spectrum disorder and/or behaviour that challenges, who were in-patients in assessment and treatment centres in September 2013. For school data the report analyses information on the number of children with learning difficulties or autistic spectrum disorders and their individual characteristics; types of schools attended; residential and 'out of area' placements; trends in special school placements and costs. The Learning Disabilities Census analysis provides information on the number of children who were in-patients in assessment and treatment centres and the use of anti-psychotic medication and incidents of concern. Recommendations for improving national data in relation to residential placements, independent schools and cost data are then provided. (Edited publisher abstract)