Assessing the impact of the All-Wales Mental Handicap Strategy: a survey of four districts.
Big service reforms can move people into better houses yet still leave their personal goals and friendships behind.
01Research in Context
What this study did
The team mailed surveys to staff in four Welsh districts. They asked how services for people with intellectual disability had changed since the All-Wales Strategy began.
Questions covered housing, day programs, family support, and individual planning. The goal was to see if the strategy’s promise of "ordinary life" was happening.
What they found
More people now lived in small homes, not big institutions. Family support teams were in place.
Yet most people still lacked real individual plans. Few had friends outside staff or family. Housing moved faster than social life.
How this fits with other research
Bennett et al. (1998) zoomed in on the same Welsh areas four years later. They found the same shift to small community houses and higher staff ratios. The move away from large facilities was real and lasting.
Friedman (2017) looked at U.S. Medicaid waivers decades later. Only half offered self-advocacy services. The Welsh gap in individual choice is part of a wider pattern.
Schott et al. (2021) surveyed autistic adults stuck on waiver waitlists. Two-thirds still lacked vocational or mental-health help. The unmet needs G et al. saw in 1994 are still echoing today.
Why it matters
You can push for small homes and still miss the person’s own goals. Use the individual plan as the lever, not the afterthought. Ask each client: "What friend, job, or club do you want?" Then write that into the behavior plan and track it like any other target.
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02At a glance
03Original abstract
The All-Wales Mental Handicap Strategy (AWS) pledged government leadership and additional resources for the task of developing community based residential, domiciliary, respite, daycare and professional services for people with mental handicaps and their families throughout Wales. Ultimately, the authors of the AWS sought to affect for the better the extent to which people with mental handicaps experience typical community life. A large random sample of people with mental handicaps in four diverse districts was used to track changes in services received, professional input, involvement in individual planning, the number of community activities pursued, and the size and range of individuals' social networks across the middle 4 years of the AWS. The balance between private housing and service residence remained unchanged although, with the ageing of the cohort, there was a decrease in the proportion living with parents and an increase in those living independently or in another family situation. There was an increase in the availability of residential services in the form of ordinary housing and an associated contraction in large congregate care facilities. However, not all moves were towards more ordinary living. Some people moved from large statutory sector specialist facilities to other atypical forms of residence, as did some people from family homes. Family support services in the form of family aides and short-term care increased significantly, but indicators still suggest that an expansion of these services is merited. Day services diversified slightly, but without affecting the major role of the traditional centre. There was a decrease in the numbers receiving a fulltime service. Only a third of the sample received regular individual plan reviews of the services they received and the developmental goals set in their name. In general, individuals were involved in a greater number of community activities that brought them into contact with other citizens. However, such an increase has not led to significant changes in the size or composition of people's friendship networks. Overall, the changes in service provision and family and user experience have been in line with the direction set by the AWS. However, the degree of change still required before the new pattern of services envisaged by the AWS is substantially in existence, or the experience of people with mental handicaps conforms with the guiding principles which underpin it, is considerably greater than that achieved after 7 of its initial 10 years.
Journal of intellectual disability research : JIDR, 1994 · doi:10.1111/j.1365-2788.1994.tb00368.x