Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: The IST-ID mixed methods study

Angela Hassiotis, athanasia kouroupa, Leila Hamza, Louise Marston, Renee Romeo, Nahel Yaziji, Ian Hall, Peter Langdon, Ken Courtenay, Laurence Taggart, Nicola Morant, Vicky Crossey, Brynmor Lloyd-Evans

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Abstract

Background Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England. Aims To investigate the clinical and cost-effectiveness of IST models. Method We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2. Results We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI -6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: -0.0088 to 0.0508) and costs (£3409.95; 95% CI -£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.

Original languageEnglish
Number of pages8
JournalBJPsych Open
Volume9
Issue number4
Early online date26 Jun 2023
DOIs
Publication statusPublished (in print/issue) - 1 Jul 2023

Bibliographical note

Funding Information:
This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (reference number 16/01/24). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. A full version of the IST-ID study that this is part of has been published in https://www.journalslibrary.nihr.ac.uk/hsdr/CHDC1642/#/full-report .

Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Keywords

  • Intellectual disability
  • developmental disorders
  • cost-effectiveness
  • outcome studies
  • intensive support

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