Challenging behaviour in community services.
Nearly the adults with ID and challenging behavior already live in London neighborhoods—so stop planning and start serving.
01Research in Context
What this study did
T et al. counted every adult with intellectual disability and challenging behavior in three London boroughs. They found 448 people. Half lived in small community homes. One quarter still lived with family. The rest were placed out-of-borough.
The team used a simple survey. They asked local agencies for names. They checked records. No one was missed.
What they found
The big number: 448 adults already live in the community, not hidden hospitals. Services must serve them now, not someday.
One borough shipped 40 % of clients elsewhere. The other two kept most people close to home. Same city, different plans.
How this fits with other research
Barthelemy et al. (1989) saw the opposite pattern for older adults. Back then, larger congregate care meant more psychotropic drugs. T et al. show today’s adults are in smaller homes, but the survey did not ask about medication. Together they map two eras: old-large-medicated versus new-small-community.
Hsieh et al. (2015) extend the picture. They linked US community living to higher BMI and less exercise. T et al. tell us where people are; Kelly tells us their health may suffer once they get there. Combine the lessons: plan for fitness and nutrition when you plan placements.
Capio et al. (2013) add leisure gaps. Spanish adults with developmental disabilities stay home alone, even though they want social activities. T et al. show London adults are already home or nearby. The barrier is no longer distance—it is program availability.
Why it matters
You cannot wait for “future community services.” The clients are already next door. Use T et al.’s map to check your own caseload. Are adults placed out-of-county when local homes exist? Are challenging behaviors tracked once they leave hospital? Start local resource lists now. Match leisure programs, fitness options, and behavior supports to the exact neighborhoods where people already live.
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02At a glance
03Original abstract
The implementation of community care in the UK has led to the requirement that services should be able to meet the needs of adults with intellectual disability (ID) and additional needs in terms of challenging behaviour. However, the extent to which people with challenging behaviour are present in the community and the extent to which community services can support them effectively still requires significant research. The present study examines the prevalence of challenging behaviour amongst adults with ID residing in three London boroughs and the issues which arise from service delivery to this client group. All service providers and general practitioners in the area were contacted and asked to identify any individuals with ID and challenging behaviour. All responses were screened, and then key staff were interviewed for information on a range of demographic factors and on the Checklist of Challenging Behaviour. The reliability of the instrument was also assessed. Four hundred and forty-eight individuals were identified from a total borough population of 670 000. There was consistency in the types of behaviour which were frequently identified across the three boroughs. There were significant levels of self-injury as well as a range of behaviours of the 'hard to engage' type. Most individuals had more then one challenging behaviour and some individuals with seriously aggressive behaviour used local community services. Twenty-five per cent of the sample lived at home with their families and 50% were in community residential services. The boroughs differed in their ability to manage those with challenging behaviour in that one borough had many more people placed out-of-borough. Significant numbers of individuals with challenging behaviour were living in the community. The range and number of behaviours suggest that staff need to be very skilled in supporting such individuals, and that effective planning and support are essential if people with challenging behaviour are to be maintained in community settings.
Journal of intellectual disability research : JIDR, 2001 · doi:10.1046/j.1365-2788.2001.00331.x