High Cost Residential Placements for Adults with Intellectual Disabilities

Background Concern has been expressed repeatedly about the cost and quality of residential placements for adults with learning disabilities and additional needs. This study sought to identify characteristics of the highest cost placements in the South‐East of England. Method Lead learning disability commissioners in the South‐East of England were asked to provide information about the five highest cost residential placements that they commissioned for adults with learning disabilities. Results The average placement cost of £172k per annum disguised wide variation. Individuals placed were mainly young and male with high rates of challenging behaviour and/or autism spectrum disorder. Most placements were in out‐of‐area residential care. The highest costs were associated with hospital placements and placements for people presenting challenging behaviour. Conclusions Young, male adults with learning disability, challenging behaviour and/or autism continue to receive very high cost residential support, often in out‐of‐area residential care. There remains limited evidence of plans to redirect resources to more local service developments.     

Benefit Groups and Resource Groups for Adults with Intellectual Disabilities in Residential Accommodation

Service commissioning is now a more formalized activity, and both purchasers and providers employ a variety of tools to inform their decision‐making. The present paper examines whether ‘benefit groups’ and ‘resource groups’ can be developed so as to assist these decision‐making processes by using a survey of the characteristics of 2093 adults with intellectual disabilities (IDs) in residential accommodation (mainly National Health Service trusts), and a supplementary collection of data on service utilization and costs (for a subsample of 930 clients). The clients were classified, according to their needs benefit groups (BGs), and the services which they used were classified in terms of coherence as likely packages of care and similar consumption of resources as resource groups (RGs). It proved possible to construct nine BGs and 96 possible RGs which had both intuitive meaning and explanatory power. Statistical analysis showed that the resulting BGs and RGs are meaningful ways of classifying ID and challenging behaviour needs and costs.     

Adults with Intellectual Disabilities and Challenging Behaviour in Supported Employment: Initial Findings

A supported employment service for adults with intellectual disabilities and challenging behaviour was evaluated. Outcome measures of interest were related primarily to productivity although challenging behaviour/intervention use was also recorded. The results showed increases in productivity level and/or decreases in the number of prompts used although there was no consistent pattern of change for challenging behaviours. The implications of these findings are discussed.     

Feelings About Work: A Review of the Socio‐emotional Impact of Supported Employment on People with Intellectual Disabilities

Background Work is an aspiration for many people with intellectual disability and is regarded as a vital goal by policy‐makers in pursuit of social inclusion. The aim of this study was to consider the impact of supported employment on the socio‐emotional well‐being of people with intellectual disabilities. Method A systematic search was conducted. The review included case‐controlled and longitudinal studies measuring outcomes for: (1) quality of life (QOL), (2) social life and (3) autonomy. Results While results for QOL, well‐being and autonomy were largely positive, there was a lack of perceived social acceptance. The findings are interpreted in the light of methodological strengths and weaknesses. Conclusions Implications for the socio‐emotional support required by some individuals in employment, and directions for future research are discussed.     

Residential Provision for Adult Persons with Intellectual Disabilities in Ireland

Background The type of accommodation provided for persons with an intellectual disability is a major indicator of the social policy for this client group. This is likely to vary within and across countries; hence the importance of undertaking national and international comparisons. Estimations of future need are also required to assist service planning. Method A database of all persons in receipt of intellectual disability services has been operating in the Republic of Ireland since 1995. In Northern Ireland, regional databases were used to provide similar information. Results Around 10 000 people live in some form of residential provision: 56% in special settings, 35% in ordinary housing and 9% in hospitals. Most residents were classed as having ‘severe’ disabilities and were aged over 35 years. There were marked differences in the amount and type of provision provided in the two parts of the island. This was also mirrored in differences across health service areas within each country. The demand for future places was greater in Northern Ireland. Conclusions A planning target of 3.5 places per 1000 adult population is proposed although substantial investments in services is required to achieve this. Longitudinal surveys are an important way of monitoring the impact of new policy initiatives.     

Enabling Self‐determination for Older Workers with Intellectual Disabilities in Supported Employment in Australia

Background Promoting self‐determination is recognized to be an essential element of disability service provision; however, the extent to which older people with intellectual disability working in supported employment are enabled to make intentional decisions about retirement is not well understood. Methods This research explored the views of older people with disability and service providers to understand the elements that impact on people’s decision to retire. Seventy‐six people participated in semi‐structured interviews, including 33 older people with intellectual disability working in supported employment, 10 people who had retired and 30 service providers. Results Service providers strongly supported the right of people to retire; however, people with disability almost never reported the ability to make self‐determined choices about retirement. Barriers to self‐determination included an association between retirement, poor health and meaningless activities, which was perpetuated through structural service gaps. Conclusion Although disability services and service providers emphasize the importance of promoting self‐determination for people with disability, those working in supported employment are not currently enabled to make self‐directed choices about retirement. To address this requires more flexible services, better information about retirement, exposure to real experiences and assistance to express preferences and participate in problem solving throughout the lifespan.     

Religious Expression amongst Adults with Intellectual Disabilities

Background Although religion is an important part of many people's lives, little is known about the role of religion in the lives of people with intellectual disabilities. Method Semi‐structured face‐to‐face interviews were conducted with 29 people with intellectual disabilities of a range of faiths (various Christian denominations, Islam and Hindu dharma). Participants were asked about the meaning of religion for them, the role of religion in their lives and the attitudes of others towards religious expression. All interviews were audio‐recorded, transcribed and thematically analysed. Results Participants expressed strong religious identities. Prayer was a particularly popular form of religious expression, with other forms of religious expression often hindered by services or faith agencies. Some individuals expressed how their religious faith was not recognized by services or faith agencies. Conclusions Services and faith agencies need to recognize the importance of religion in the lives of many people with intellectual disabilities, and support religious expression in this group.     

Reactive Attachment Disorder Symptoms in Adults with Intellectual Disabilities

Background Studies with children suggest that reactive attachment disorder (RAD) is associated with pathogenic early care. Little is known about RAD in adults with intellectual disabilities, many of whom experience adversity and abuse in early life. We investigated whether RAD symptoms occur in this population, and explored whether hypothesized risk factors are associated with higher RAD symptom scores. Method Fifty adults with intellectual disabilities residing in long‐stay hospitals and their carers participated in a questionnaire survey of RAD symptoms, childhood experiences, and disabilities. Results Reactive attachment disorder symptoms were present in this sample, and symptom scores were independently associated with early childhood adversity, diminished with age, but were not associated with cognitive ability, gender, other disabilities, nor number of childhood years in institutional care. Conclusions As with children with RAD, it is possible that some maltreated adults with intellectual disabilities fail to develop stranger anxiety by the usual developmental age. Over decades, they may gradually learn.     

The Prevalence and Determinants of Obesity in Adults with Intellectual Disabilities

Background Obesity is a major public health concern internationally and this study aimed to measure the prevalence of obesity in adults with intellectual disabilities in comparison with general population data, and examine the factors associated with obesity. Methods This was a cross‐sectional study of all adults with intellectual disabilities, in a defined geographical area, in the context of a primary care health screening programme. A total of 945 adults with intellectual disabilities were involved, all of whom were living in the community. Body mass index (BMI), demographic characteristics, socio‐economic deprivation, level of intellectual disabilities and various health parameters were measured. Results Overall, 39.3% of women and 27.8% of men were obese, compared with 25.1% of women and 22.7% of men in the comparison general population. The mean BMI of women with intellectual disabilities (28.8, range 12.3–59, SD 7.8) was significantly greater than the mean BMI of men with intellectual disabilities (26.7, range 12.6–49, SD 5.9), and women were more likely to be obese than men with intellectual disabilities (χ² = 29.6, P < 0.001). Regression analyses showed that for both women and men, the risk of overweight and obesity reduced as the severity of intellectual disabilities increased, and Down syndrome was associated with an increased risk of overweight and obesity. Conclusions There is a need to carry out research to further our understanding of the reasons behind the increased prevalence of obesity in adults with intellectual disabilities. Effective weight management interventions and accessible clinical services are required to reduce the health inequalities experienced by adults with intellectual disabilities.