James. Mansell

Outcomes in Different Residential Settings for People with Intellectual Disability: A Systematic Review.

Large-scale reviews of research in deinstitutionalization and community living were last conducted about 10 years ago. Here we surveyed research from 1997 to 2007. Articles were included if the researchers based the study on original research, provided information on the participants and methodology, compared residential arrangements for adults with intellectual disability, and were published in English-language peer-reviewed journals. Sixty-eight articles were found. In 7 of 10 domains, the majority of studies show that community-based services are superior to congregate arrangements. These studies provide more evidence of the benefits of deinstitutionalization and community living and continue to indicate variability in results, suggesting that factors other than the basic model of care are important in determining outcomes.

Dispersed or clustered housing for adults with intellectual disability: A systematic review

Abstract Backgroundu2003The purpose of this review was to evaluate the available research on the quality and costs of dispersed community-based housing when compared with clustered housing. Methodsu2003Searches against specified criteria yielded 19 papers based on 10 studies presenting data comparing dispersed housing with some kind of clustered housing (village communities, residential campuses, or clusters of houses). The studies reported the experience of nearly 2,500 people from four different countries. Resultsu2003In five of eight quality of life domains there were no studies reporting benefits of clustered settings. In respect of interpersonal relations, emotional, and physical well-being, clustered settings had some advantages. However, in many of these cases the better results refer only to village communities and not to campus housing or clustered housing. In terms of costs, clustered housing was usually less expensive because of lower staffing levels. In two of the three studies that examined costs controlling for user characteristics, there was no statistically significant difference. Conclusionu2003Dispersed housing appears to be superior to clustered housing on the majority of quality indicators studied. The only exception to this is that village communities for people with less severe disabilities have some benefits; this is not, however, a model which can be feasibly provided for everyone. Clustered housing is usually less expensive than dispersed housing but this is because it provides fewer staff hours per person. There is no evidence that clustered housing can deliver the same quality of life as dispersed housing at a lower cost.

Practice leadership and active support in residential services for people with intellectual disabilities: an exploratory study

BACKGROUNDnWe hypothesised that a key factor determining the quality of active support was practice leadership - provided by the first-line manager to focus staff attention and develop staff skills in providing direct support to enable people with intellectual disabilities to have a good quality of life. This exploratory study focused on what levels of practice leadership were found and its role in explaining variation in active support.nnnMETHODnRelevant aspects of management, including practice leadership, were assessed by questionnaires administered to staff in residential settings alongside observational measures of active support and resident engagement in meaningful activity. Relationships between these variables were explored using regression and post hoc group comparisons.nnnRESULTSnThere was wide variation, with average levels of practice leadership being low, though improving over the period studied. Practice leadership had a significant impact on active support, but was fully mediated by the effect of quality of management. When the quality of management was higher better practice leadership did produce a significant difference in active support. However, higher quality of management on its own did not produce better active support.nnnCONCLUSIONSnA number of limitations are acknowledged and further research is required. Practice leadership appears to be an important factor in enabling staff to provide active support but as part of generally good management. Given the rather low levels found, attention needs to be given to the training, career development and support of practice leaders and also to how to protect their time from their many other responsibilities.

Are partnership boards really valuing people

Observations were conducted in three county councils to find out whether the government’s ambition to develop Learning Disability Partnership Boards (as expressed in the White Paper Valuing people) are being realized. All the partnerships practiced various inclusive activities in order to involve people with learning disabilities in public service strategies. However, there appeared to be limited opportunities for citizens to be involved in recommendations or decision‐making for their area. This concurs with other research elsewhere on the involvement of citizens in state provision, i.e. public participation in civic affairs remains in the control of public sector managers. The lack of opportunities for citizens to direct the allocation of resources and strategies at a local level, regardless of their ability to process information, emphasises the limits of New Labour’s citizen–public sector partnerships.