Assessment and treatment units for people with intellectual disabilities and challenging behaviour in England: an exploratory survey.
Assessment and treatment units in England have become accidental long-stay homes for people who should be in the community.
01Research in Context
What this study did
The team mailed a short form to every assessment and treatment unit in England.
Thirty-eight units replied. Together they held 333 adults with intellectual disability.
The survey asked who lived there, why they came, and when they might leave.
What they found
Most residents had mild or moderate disability, not the severe group the units were built for.
One in four had stayed longer than two years. Only four in ten had a discharge plan.
Units also reported blocked beds, staffing gaps, and people admitted who did not need inpatient care.
How this fits with other research
Fournier et al. (2004) showed that adults in specialist units get better faster than those in generic wards. Yet Edwards et al. (2007) now find the same units filling up with the wrong clients and keeping them too long. The difference is the admission filter: without strict entry rules, beds clog.
Tassé et al. (2013) priced the next step. They counted the cost of keeping people close to home versus out-of-area. Local placements cost more per day but give better quality of life. The 2007 survey hints why out-of-area moves happen: no local exit plan.
McConkey et al. (2010) add medical risk. Canadian adults with ID are hospitalized for preventable problems six times more often than everyone else. When assessment units act as long-stay homes, they may hide those medical needs instead of treating them.
Why it matters
If you write behavior support plans, check the placement label. A client in an “assessment and treatment” bed may really be living there. Ask for the discharge date and the medical review schedule. Push for a step-down plan before behaviors stabilize. Your prompt can free a bed for someone who truly needs it.
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02At a glance
03Original abstract
BACKGROUND: Evaluative studies have shown that special units for people with intellectual disabilities (ID) who have challenging behaviour have advantages and disadvantages. There has been no survey of their number or characteristics for nearly 20 years. METHODS: A questionnaire was sent to all National Health Service trusts that had ID inpatient beds, and all private or voluntary healthcare establishments providing services for people with mental health problems or ID. This asked for information about the unit, its residents and the views of the unit manager. RESULTS: Forty-four agencies confirmed that they provided assessment and treatment units, of which 38 returned questionnaires. These units served 333 people, of whom 75% had mild or moderate ID. A quarter had been there for more than 2 years. Forty per cent of residents had a discharge plan, and 20% had this and the type of placement considered ideal for them in their home area. The main strengths of the units were identified as the knowledge and experience of the staff and having sufficient staff; the main problems as inappropriate admissions, bed-blocking and the relationship with other services; difficulties with recruiting and retaining staff; the location and environment of the unit; and the mix of residents. CONCLUSIONS: There has been an increasing rate of provision of special units, which now predominantly serve people with moderate or mild ID. This model of service provision is becoming more widespread, but the potential problems identified 20 years ago are still present. Areas are identified for further research.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2007.00963.x