Past and present trends in residential treatment.

McClannahan et al. (1990) looked back at 200 years of residential care. They tracked how society moved people with autism and developmental delays out of big institutions.

The paper is a story-style review. It warns that rapid community placement can backfire if supports are weak.

The trend is clear: small homes beat large wards. Yet the authors worry that enthusiasm for "normal life" may overlook each person's real needs.

They predict that without careful planning, some people will bounce between failed placements.

Smith et al. (2011) later counted the shift: institutional beds dropped 28% while individual homes jumped 90%. The numbers back the trend E et al. saw.

Irvin et al. (1998) tested the worry. Adults who left nursing homes gained daily-living skills, supporting the move, but McSweeney et al. (1993) showed problem behavior can spike right after the move. Together they confirm E's caution: plan extra behavioral support during transition.

Friedman (2019) adds a new twist: provider-run group homes can copy old institutional limits. Community placement alone is not enough; the home must be truly individualized.

When you write a transition plan, pair any new home with a short-term behavior-contact increase. Use the data from K et al. to justify extra hours up front. Check the setting size: small homes (D et al. 1992) and supervised apartments (N et al. 1991) give better outcomes than large sites. Finally, keep advocating for autism-specific design; E et al. remind us that most houses are still built for general ID, not autism.