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

Abstract

BackgroundApproximately 18% of adults with intellectual disabilities living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy in-patient stays. AimsTo identify and describe the geographical distribution and characteristics of ISTs, and to develop a typology of IST service models in England. MethodWe undertook a national cross-sectional survey of 73 ISTs. A hierarchical cluster analysis was performed based on six prespecified grouping factors (mode of referrals, size of case-load, 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. ResultsCluster analysis identified two models of IST provision: (a) independent and (b) enhanced provision based around a community intellectual disability service. 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. ConclusionsThis is the first study to examine the delivery of intensive support to people with intellectual disability 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. Declaration of interestNone.

Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol

“…The research team will compare the two models, enhanced provision and independent provision, respectively, of ISTs already identified in phase 1 of the study. 20 The research assistant or clinical study officers will collect study participant-level outcomes at two assessment points (baseline and 9 months) and service-level outcomes over the same time period. The research assistant will also collect qualitative data to understand the experiences and views of key stakeholders, and stakeholder experiences of the different models.…”

“…Eight enhanced service provision ISTs and eight independent service provision ISTs ( table 1 ) will be selected at random from ISTs surveyed in phase 1 of the study. 20 Service users, either already under the care of the 16 ISTs or newly referred, and their caregivers will be identified by IST staff either at first clinical assessment or from the IST services caseloads and asked if they are interested in taking part in the study. Following an expression of interest, the researchers will contact them to provide information about the study and to obtain written or audio-recorded informed consent from those agreeing to undergo further research assessments.…”

“…The first phase of the study has been completed and reported. 20 The study has faced recruitment challenges which in the main included: reduced capacity to identify sufficient numbers of eligible participants due to small and static caseloads, services withdrawing or changing their remit halfway through the study, inadequate communication between ISTs and Clinical Research Networks which hampered research support. The number of ISTs was expanded to 23, 21 of which contributed participants to the study.…”

“…The first phase identified two IST service models 20 : enhanced provision (model 1) and independent provision (model 2) following an England-wide survey of ISTs (n=73). 20 The components of each model as reported by professionals in the survey are shown below ( table 1 ).…”

The development and evaluation of an integrated intensive support service

“…The NHS Benchmarking Network (2018) for LD report showed that only 44% of the 54 community LD services that had submitted data had an ISS. Hassiotis et al (2020) in a national cross-sectional survey of 73 intensive support teams (ISTs). identified two models of provision – independent of the main team and enhanced provision within the existing team.…”