Residential Services For People Research Articles

Residential supports for people with intellectual disabilities: Questions and challenges from the UK

This paper uses recent developments in services in the UK as a case study to identify some of the challenges facing the provision of residential supports to people with intellectual disabilities. Three main areas are discussed: (1) responding to existing levels of unmet need and increasing levels of demand; (2) reducing inequalities in access to and the quality of services; and (3) obtaining and demonstrating “best value”. In particular, discussion is focused on the relationships between needs, resources, process and outcomes in residential services for people with intellectual disabilities and the implications of these relationships for obtaining “best value”.

The determinants of staff and resident activity in residential services for people with severe intellectual disability: Moving beyond size, building design, location and number of staff

The replacement of institutional residential services for people with severe intellectual disability with community-based alternatives has progressed similarly in many of the countries of the developed world. In the first wave of reform, the idea of reversing institutional conditions provided a design brief for the alternative services which emphasised various structural characteristics of the settings: smallness of scale, typical housing design, homelike equipment, furnishings and decor, community location in typical residential areas, autonomy over household management and increased staff support. As the poor quality of existing services was widely seen as due to “institutionalisation”, there was an equally wide-spread belief that such reforms would lead automatically to high quality outcome. However, expectations for improved quality from the initial reforms, while partially met, were far from fully confirmed by research evidence. A decent, homelike, well located, reasonably staffed environment may be a necessary condition for good outcome, but these factors are not sufficient to guarantee it. The existing metaphor of institutionalisation needs further elaboration if it is to be useful, and the design brief for the alternative service requires expansion to include factors such as the orientation of staff and their working methods and training, which are shown by the research literature on the micro-organisation of settings to make a difference. Based on a review of the literature which inevitably but not exclusively favours British research on community alternatives to institutional care, the paper shows how the quality of staff and resident activity is dependent on an interaction between the structure, orientation and procedures followed within the setting.

A PASS 3 evaluation of community residences in Wales.

PASS 3 was used to evaluate 14 residential services for people with mental retardation. Residents had a broad range of abilities. Size of residences ranged from one to seven residents. PASS scores were generally associated with both resident's ability level and smaller size of living unit. Overall, the residences were shown to be well-located and reasonably home-like. However, residence personnel tended to lack organized means and competencies to promote resident development and experience. Administrative practices were also weak. Attention must be given to factors other than residence size, location, building characteristics, and staffing parameters when services are commissioned and when service contracts are specified and reviewed.

CHALLENGING BEHAVIOUR AND COMMUNITY SERVICES: 5. Structuring staff and client activity

This paper describes important programmatic components of small, community based, residential services for people with severe mental handicaps and challenging behaviours. The approach described advocates the use of procedures to plan staff activity in considerable detail in order to achieve goals in the areas of supporting people's engagement in functional, age‐appropriate activities and managing inappropriate behaviour.

Reviews

Book reviewed in this article:Therapeutic horticulture Rosemary HagedornGetting employed, staying employed. Job development and training for persons with severe handicaps Caven S. McLoughlin, J. Bradley Garner, Michael CallahanQuality, costs and “an ordinary life” Comparing the cost and quality of different residential services for people with mental handicap Linda M. DaviesA basic attainments programme for young mentally handicapped children Bill Gillham

Assessing the quality of residential services for people with mental handicap

Between 1984 and 1987 the South Western Regional Health Authority funded research to compare the costs and quality of alternative residential services for people with learning difficulties (mental handicap). During this period, 14 residential services were evaluated. The services covered a wide range of models of care and included: small homes run on ‘ordinary life’ principles based in the community, funded and/or managed by health authorities and social services departments; small (health authority) homes in, or adjacent to, mental handicap hospital grounds; traditional mental handicap hospitals; and private or voluntary sector hostels for up to 12 people.