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

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.

Evaluating and increasing in-home leisure activity among adults with severe disabilities in supported independent living

Observations were conducted of the in-home leisure activity of three adults with severe disabilities in three supported independent living (SIL) sites. Results indicated a lack of leisure engagement. Potentially preferred, typical leisure activities were then identified by consulting lists of common leisure activities, surveying adults in surrounding communities, and interviewing support staff and family members. Next, in-home staffs were trained to provide the identified leisure activities in a repeated, paired-choice manner. Results indicated increased leisure engagement for each participant when staff provided leisure choices along with brief prompting. Social validation surveys suggested the choice procedures were well received by the staff and participants. Comparison observations of nine adults in other SIL arrangements in two states indicated the low levels of engagement initially observed in the three target homes may be quite common among people with severe disabilities in SIL. Results are discussed regarding use of behavioral procedures to evaluate and improve aspects of quality of life in SIL. Future research needs noted focus on how to impact staff performance and consumer lifestyles in residential settings in which supervision is infrequent.