Out-of-area provision for adults with intellectual disabilities and challenging behaviour in England: policy perspectives and clinical reality.
Out-of-area placements for adults with ID and challenging behavior are often privately run and variable in quality—audit your referral list for underperformers.
01Research in Context
What this study did
Barron et al. (2011) mapped out-of-area placements for adults with intellectual disability and challenging behavior in England. They used a scoping review to see if policy goals matched real-world care quality.
The team looked at audits, inspection reports, and policy papers. They wanted to know who runs these homes, how they are checked, and where they fall short.
What they found
Most out-of-area homes passed basic checks, but a clear minority failed on safety, staffing, or activity plans. Private-run homes failed most often.
Local services stayed weak because money and expertise had already moved away. Good care existed, yet it was patchy and hard to predict.
How this fits with other research
van der Miesen et al. (2024) extends this picture. Their mixed-methods study shows that 78 % of UK health research still locks out adults with ID. This exclusion helps explain why local teams lack the evidence they need to keep people close to home.
Davison et al. (1995) is a clear predecessor. That paper already showed adult residential programs using fewer proven tactics like functional assessment. Barron et al. (2011) found the same gap still alive 16 years later, now hidden inside private out-of-area homes.
van der Miesen et al. (2024) systematic review pulls together long-term service outcomes. It includes the 2011 England data and confirms the field still has no single agreed way to measure quality of life in these placements.
Why it matters
If you refer adults to out-of-area homes, do a quick audit first. Ask for the latest inspection report, check if they use functional assessment, and insist on a written activity schedule. These three items weed out most underperformers and keep local options alive.
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02At a glance
03Original abstract
BACKGROUND: The use of out-of-area placements to meet the needs of individuals with intellectual disabilities and challenging behaviour has been increasing in the UK. Such placements claim a large proportion of service budget expenditure; therefore, it is important to consider whether they offer the best-quality care. This paper reports on current evidence relating to such placements and uses a scoping review across five London boroughs to illustrate key issues on provider characteristics and aspects of good practice. METHODS: We conducted a literature review to identify papers that describe out-of-area placements and carried out a postal survey of 54 service providers that delivered services to service users from five London boroughs. RESULTS: Individuals with intellectual disability and challenging behaviour are more likely to be placed out-of-area in services of variable quality and a minority may underperform. Our empirical data suggest that the private sector that is the main accommodation provider is most likely to underperform on meeting standards of care. CONCLUSION: Overall, the majority of out-of-area providers appear to supply a good standard of care but there are many factors that continue to hinder the local treatment of individuals who present with challenging behaviour. There is an imperative to identify poorly performing providers as well as exploring ways in which service users, out-of-area, can be supported effectively.
Journal of intellectual disability research : JIDR, 2011 · doi:10.1111/j.1365-2788.2011.01405.x