Decreases continue in out-of-home residential placements of children and youth with mental retardation

Cost comparisons of community and institutional residential settings: historical review of selected research

A review of the literature on cost comparisons between community settings and institutions for persons with mental retardation and developmental disabilities was conducted. We selected literature for review that was published in peer-reviewed journals and had either been cited in the area of cost comparisons or provided a novel approach to the area. Methodological problems were identified in most studies reviewed, although recent research employing multivariate methods promises to bring clarity to this research area. Findings do not support the unqualified position that community settings are less expensive than are institutions and suggest that staffing issues play a major role in any cost differences that are identified. Implications are discussed in light of the findings.

Behaviour/mental health problems in young adults with intellectual disability: the impact on families

BACKGROUND

The present authors studied the impact of dual diagnosis [i.e. intellectual disability (ID) and mental disorder] in young adults on their mothers' perceived levels of stress and decisions about placement.

METHODS

The mothers of 103 young adults with severe ID were interviewed using a 2-3-h in-depth protocol of measures designed to assess their child's adaptive functioning, maladaptive behaviour, mental health problems and negative impact on the family, as well as their own thoughts on out-of-home placement. The Scales of Independent Behavior--Revised Problem Behavior Scale assessed problem behaviours and the Reiss Screen assessed mental disorder.

RESULTS

These measures were highly correlated (r = 0.64), but tapped some different domains of maladaptive behaviour and proved to be most predictive when employed together. Behaviour and/or mental health (B/MH) problems significantly predicted the mothers' perceived negative impact of the young adult on the family, even after controlling for other young adult characteristics. These problems also predicted the family's steps toward seeking out-of-home placement, as did better young adult health and the mother's higher educational attainment; stress did not predict additional variance in placement once these variables were accounted for.

CONCLUSIONS

The discussion focuses on the implications for service provision to families of young adults with B/MH problems.

For better or worse? Impact of residential placement on families

Postplacement adaptation was studied in 106 families with a member living in a residential facility. Respondents reported on three broad areas of functioning: involvement with the member in placement, well-being, and perception of placement advantages and disadvantages. Although respondents readily reported both pros and cons of placement, more than 90% concluded that, on balance, the living arrangement was an advantage for themselves, the child, and other family members. Families with children under age 15, contrasted with families of adolescents and adults, visited more often, reported the highest stress and caretaking burden, as well as the lowest marital adjustment and advantage to placement. Families of adults, for whom living away from the natural home is normative, seemed to have adapted well postplacement.