Views of family carers to the future accommodation and support needs of their relatives with intellectual disabilities

Objectives: The demand for places in supported accommodation is likely to rise due to the increasing longevity of people with intellectual disabilities and as their parents become unavailable or unable to care for them. However few attempts have been made to ascertain carer's views on alternative accommodation.

Method: Four studies were undertaken in Northern Ireland to ascertain carer's views using three different methods. In all, 387 carers participated with the response being greatest for individual interviews conducted in the family home and least for self-completed questionnaires and attendance at group meetings.

Results: The majority of carers envisaged the person continuing to be cared for within the family. The most commonly chosen out-of-home provision was in residential or nursing homes, living with support in a house of their own and in homes for small groups of people. Few carers chose living with another family. However only small numbers of carers envisaged alternative provision being needed in the next two years and few had made any plans for alternative living arrangements.

Conclusions: The implications for service planning are noted, primarily the need for individual reviews of future needs through person-centred planning; improved information to carers about various residential options and their differential benefits, along with more services aimed at improving the quality of life of people living with family carers. These need to be underpinned by a commitment of statutory agencies to partnership working with family carers. The implications for mental health services are noted.

Social inclusion of people with intellectual disabilities: the impact of place of residence

Objectives: People with intellectual disabilities are increasingly living in more domestic style accommodation, either in housing provided within a specialised campus setting or in ordinary houses in community settings. The main objective of the study was to determine if the extent of residents' involvement with their families and with the local community varied when they resided in campus settings (n = 55) or community housing (n = 51) and to investigate the main predictors of this involvement.

Method: With the resident's permission, their key-workers – mainly nurses – completed standard questionnaires that covered resident characteristics, contact with families and a range of life experiences.

Results: Although the type of accommodation did have a significant effect on residents' social inclusion in families and communities, the best predictor of this was the individual's level of dependency in personal self-care. Those who were more dependent tended to be more excluded.

Conclusions: Staff working with more dependent residents need to proactively promote their social inclusion although this could be harder to achieve for those living in campus style settings.

Parental adaptation to out-of-home placement of a child with severe or profound developmental disabilities

Utilizing grounded theory qualitative research methods, a model was developed for describing parental adaptation after voluntary placement of a child with severe or profound developmental disabilities in out-of-home care. Interviews of parents from 20 families were analyzed. Parents' cognitive appraisals of placement outcomes were classified as either inducing emotional stress (i.e., guilt, sadness, fear and worry, anger and frustration, and uncertainty) or relief. Parental appraisals of responses to placement by children, extended family, and friends were identified as factors affecting the parents' adaptation to placement. The primary coping methods used by parents to decrease emotional stress and increase relief consisted of reappraisals regarding the necessity of placement, involvement in the child's life, psychotherapy, and the passage of time.

Characteristics, supports, and quality of life of Irish adults with intellectual disability in life-sharing residential communities

BACKGROUND

Few empirical studies have compared quality and outcomes for residents with intellectual disability across intentional communities such as those organised by the Camphill communities in Ireland.

METHOD

Using a multi-element research protocol developed for an earlier large study, data were gathered about the characteristics of N = 29 participants living in life-sharing residences organised by Camphill, management procedures, and outcomes for residents. Comparable data were available for N = 125 adults in group homes or campus residences.

RESULTS

Camphill residents reported a smaller size of household, higher staffing ratios, homely living areas, low levels of institutionalised practices such as social distance, reciprocal relationships with houseparents, and well-developed management procedures, as well as less choice, but were not found to be better on a range of other objective measures.

CONCLUSION

Although modest in scale, present findings suggest that the value of applying distinctive benefits of life-sharing communities in more typical residential settings for people with intellectual disability should be investigated further to inform current policy debates.

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

BACKGROUND

The 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.

METHODS

Searches 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.

RESULTS

In 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.

CONCLUSION

Dispersed 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.

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.

People with learning disabilities in 'out-of-area' residential placements: 2. Reasons for and effects of placement

BACKGROUND

Official guidance on out-of-area placements creates incentives that could lead to people being placed against their own best interests, with negative consequences for them and for the 'receiving' authorities.

METHOD

Information was collected for 30 people through interviews with them, their families, home managers and care managers. Interviews concerned resident needs, reasons for placement, the homes, care management arrangements, resident quality of life and social inclusion. Information on care standards was abstracted from official records.

RESULTS

The main reasons for out-of-area placement were insufficient local services of acceptable quality, financial incentives and loss of family contact through prior institutionalization. The effects varied, with the most disabled people experiencing worst outcomes. Some aspects were worse than comparison studies (choice, community involvement, number of homes meeting all the national minimum standards), some were the same (participation, family visiting and other contact), and one was better (visits to families). Variation was also evident in the involvement of social services staff from the placing authority and in ease of access to local healthcare resources.

CONCLUSIONS

Social services and health authorities should develop services locally that can support people with the full range of individual needs. Perverse incentives should be removed, perhaps by increasing the application of direct payments and personalized budgets.

Looking at the future and seeing the past: the challenge of the middle years of parenting a child with intellectual disabilities

BACKGROUND

This paper seeks to understand and conceptualize the experience of mothers of adolescents with intellectual disabilities (IDs) at a time in their lives which others have characterized as 'mid-life' or the 'middle years of parenting'. The concerns of the paper are the lifecourse concerns in mothers' own lives and with biographical elements of becoming and being such a parent.

METHODS

Qualitative interviews were conducted with mothers of adolescents with IDs. The average age of mothers was 48 years. Typically parents were interviewed on two to three occasions.

RESULTS

The data suggest that despite the difficulties they faced, these parents had constructed a 'life-as-ordinary' in the early phase of their parental careers. They saw themselves as 'ordinary mothers'. However, the social content and events of the middle years of parenting prompt a realization that their lives and, for some, their sense of 'self', are undergoing considerable change. Mothers are forced to look over their lives to find the meaning and significance of these events. For some, there is biographical reinforcement. For others, there is only disruption.

DISCUSSION

The overall picture of these years is one of considerable changes and challenges, and underlines the need for a focus on the lifecourse concerns of parents as well as their children. The implications of the data for further research and service development are discussed in the context of identity theory.