Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour.
In South Wales, injury-causing behaviours plus autism or mental-health history are red flags for expensive out-of-area placements—use this profile to advocate for enhanced local services before placement is considered.
01Research in Context
What this study did
Neuringer et al. (2007) looked at every adult with intellectual disability and challenging behaviour in South Wales.
They asked which traits sent people to costly out-of-area placements.
Injury-causing behaviour, autism label, mental-health history and higher daily-living scores were the red flags.
What they found
The four red flags predicted moves to far-away homes that cost more but gave little extra help.
Local services stayed the same or shrank after the move.
In short, people left, bills rose, quality stayed flat.
How this fits with other research
Dinora et al. (2020) later showed that sponsored residential homes, not large campuses, give more community participation for the same high-need group.
Barrett et al. (2015) found the same cost driver in UK teens: autism plus lower adaptive skills meant the biggest school bills.
Sayers et al. (1995) had already proven that strong local support can cut behaviour and keep costs down—an early hint that moving people away is not the only answer.
Why it matters
If your client has self-injury, autism, or past mental-health care, flag the case early.
Use the data to ask commissioners for more hours, better training, or crisis beds before a distant placement is even floated.
Keeping people local saves money and keeps families close.
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Join Free →Add a ‘G-2007 risk line’ to your next report: tick injury-causing behaviour, autism, mental-health history, high adaptive scores—then list local supports needed to keep the person close.
02At a glance
03Original abstract
BACKGROUND: Out of area placements for people with challenging behaviour represent an expensive and often ineffective strategy for meeting the needs of this service user group. METHODS: More than 800 agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Detailed data on identified individuals and the services they received were collected by interviewing key informants. Univariate and multivariate statistics were employed to identify predictors of out of area placement. RESULTS: In total, 1458 people were identified. Full data were available for 901 participants, 97 of whom were placed out of area. Predictors of out of area placement included behaviours resulting in physical injury and exclusion from service settings, a history of formal detention under the mental health act, the presence of mental health problems, a diagnosis of autism and higher total score on the Adaptive Behaviour Scale. Out of area placements were typically of high cost, and associated with only limited evidence of improved service quality. CONCLUSIONS: Identifying predictors for out of area placement can be used to highlight deficiencies in local services and individuals at increased risk of exclusion from local services.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2006.00877.x