Intensive support for adults with intellectual disability and behaviours that challenge: A survey of provision and service typologies in England

Angela Hassiotis, Amy Walsh , Jessica Budgett , Isobel Harrison , Rebecca Jones, Nicola Morant , Ken Courtenay , Elisabeth Victoria Crossey, Ian Hall , Renee Romeo , Laurence Taggart, Peter E Langdon , Victoria Ratti , Vincent Kirchner , Brynmor Lloyd-Evans

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Abstract

Background
Approximately 18% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive Support Teams (IST) have been recommended to provide high quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays.

Aims
To identify and describe the geographical distribution and characteristics of ISTs, and to develop a typology of IST service models in England.

Method
National cross-sectional survey of 73 ISTs. A hierarchical cluster analysis was performed based on six pre-specified grouping factors (mode of referrals, size of caseload, use of outcome measures, staff composition, hours of operation, and setting of service). A simplified form of thematic analysis was used to explore free text responses.

Results
Cluster analysis identified two models of IST provision: 1. Independent and 2. Enhanced Provision based around a Community Intellectual Disability Service (CIDS). ISTs aspire to adopt person-centred care, mostly use the framework of Positive Behaviour Support for behaviour that challenges and report concerns about organisational and wider context issues.

Conclusions
This is the first study to examine the delivery of intensive support to people with ID and behaviour that challenges. A two-cluster model of ISTs was found to have statistical validity and clinical utility. The clinical heterogeneity indicates that further evaluation of these service models is needed to establish their clinical and cost effectiveness.
Original languageEnglish
Number of pages8
JournalBJPsych Open
Volume6
Issue number2
Early online date11 Feb 2020
DOIs
Publication statusE-pub ahead of print - 11 Feb 2020

Keywords

  • Intellectual disabilities
  • intensive support
  • behaviour that challenges
  • adults
  • ID services

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    Hassiotis, A., Walsh , A., Budgett , J., Harrison , I., Jones, R., Morant , N., Courtenay , K., Crossey, E. V., Hall , I., Romeo , R., Taggart, L., Langdon , P. E., Ratti , V., Kirchner , V., & Lloyd-Evans , B. (2020). Intensive support for adults with intellectual disability and behaviours that challenge: A survey of provision and service typologies in England. BJPsych Open, 6(2). https://doi.org/10.1192/bjo.2020.2