Adults with intellectual disabilities and challenging behaviour: the costs and outcomes of in- and out-of-area placements
- PMID: 22471517
- DOI: 10.1111/j.1365-2788.2012.01558.x
Adults with intellectual disabilities and challenging behaviour: the costs and outcomes of in- and out-of-area placements
Abstract
Background: People with severe challenging behaviour are vulnerable to exclusion from local services and removal to out-of-area placements if locally available supported accommodation is insufficient to meet their needs. There are concerns about the high costs and potentially poorer outcomes of out-of-area placements but relatively little is known about how costs and outcomes compare with provision for a similar population placed locally.
Methods: Costs, quality of care and a wide range of quality of life outcomes for 38 people with intellectual disabilities and challenging behaviour living in-area and 38 similar people living out-of-area were compared. The two groups were matched as far as possible on risk factors for out-of-area placement. The out-of-area group represented two-thirds of the total number of people who originated from the territory served by the largest specialist health service in Wales and were placed in residential settings at least 10 miles beyond its boundaries.
Results: There was a mixed pattern of quality of care and quality of outcome advantages between the two types of setting, although in-area placements had a greater number of advantages than out-of-area placements. Unexpectedly, out-of-area placements had lower total costs, accommodation costs and daytime activity costs.
Conclusions: No overall conclusion could be reached about cost-effectiveness. A number of potential reasons for the differences in cost were identified. Although additional resources may be needed to provide in-area services for those currently placed out-of-area, government policy to provide comprehensively for those who want to live locally, irrespective of their needs, appears to be attainable.
© 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.
Similar articles
-
High cost residential placements for adults with intellectual disabilities.J Appl Res Intellect Disabil. 2012 Nov;25(6):584-7. doi: 10.1111/j.1468-3148.2012.00689.x. Epub 2012 May 10. J Appl Res Intellect Disabil. 2012. PMID: 23055291
-
Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour.J Intellect Disabil Res. 2007 Jun;51(Pt. 6):409-16. doi: 10.1111/j.1365-2788.2006.00877.x. J Intellect Disabil Res. 2007. PMID: 17493024
-
Out-of-area provision for adults with intellectual disabilities and challenging behaviour in England: policy perspectives and clinical reality.J Intellect Disabil Res. 2011 Sep;55(9):832-43. doi: 10.1111/j.1365-2788.2011.01405.x. Epub 2011 May 9. J Intellect Disabil Res. 2011. PMID: 21554465 Review.
-
Urban adolescents with intellectual disability and challenging behaviour: costs and characteristics during transition to adult services.Health Soc Care Community. 2013 May;21(3):283-92. doi: 10.1111/hsc.12015. Epub 2013 Feb 11. Health Soc Care Community. 2013. PMID: 23398559
-
Service development for intellectual disability mental health: a human rights approach.J Intellect Disabil Res. 2012 Nov;56(11):1098-109. doi: 10.1111/j.1365-2788.2012.01636.x. J Intellect Disabil Res. 2012. PMID: 23106753 Review.
Cited by
-
Transitions for older people with intellectual disabilities and behaviours that challenge others: A rapid scoping review.J Appl Res Intellect Disabil. 2023 Mar;36(2):207-229. doi: 10.1111/jar.13054. Epub 2022 Nov 26. J Appl Res Intellect Disabil. 2023. PMID: 36433739 Free PMC article.
-
Comorbid Symptomology in Adults with Autism Spectrum Disorder and Intellectual Disability.J Autism Dev Disord. 2015 Dec;45(12):3961-70. doi: 10.1007/s10803-015-2553-z. J Autism Dev Disord. 2015. PMID: 26254894
-
Chronic Health Conditions in Aging Individuals with Intellectual Disabilities.Int J Environ Res Public Health. 2020 Apr 30;17(9):3126. doi: 10.3390/ijerph17093126. Int J Environ Res Public Health. 2020. PMID: 32365862 Free PMC article.
MeSH terms
LinkOut - more resources
Full Text Sources
Medical