Services in the community for adults with psychosis and intellectual disabilities: a Delphi consultation of professionals' views.
Expert consensus gives you a 32-item shopping list for community care of adults with both psychosis and ID—use it to spot missing pieces in your service.
01Research in Context
What this study did
Stichter et al. (2009) asked UK experts what community services adults with both psychosis and intellectual disability must have. They used a Delphi survey: three rounds of anonymous voting until the group agreed. The panel reached consensus on 32 essential parts of care.
What they found
The final list mixes illness care with everyday life supports. Key items are quick crisis help, trained ID staff, and access to social or leisure activities. The experts said services must treat mental-health symptoms and also help the person stay connected to the community.
How this fits with other research
Lineberry et al. (2023) ran a similar Delphi on autistic adults and got 11 must-have supports. Both studies show large gaps: less than 40% of adults get any follow-up after diagnosis. The two papers use the same method and agree that routine health access is missing.
Torelli et al. (2023) went beyond lists. They tracked 22,000 adults and found that when service plans reflect personal goals, well-being goes up. Their numbers back the 2009 call for individualized, crisis-ready care.
Bassette et al. (2023) interviewed adults, families, and staff six months after moving to community homes. People felt happier and more independent, yet some old medical-model habits linger. Their lived experience supports the 2009 checklist, but warns that having the parts on paper is not enough; teams must also change culture.
Why it matters
Use the 32-item list as a quick audit tool. Pull it up at your next team meeting and tick off what your program already offers. Any unchecked box is a gap you can write into the next funding bid. Pair the list with person-centred planning to make sure the pieces fit the individual, not just the form.
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02At a glance
03Original abstract
BACKGROUND: There remains a severe lack of evidence on the effectiveness of community services for adults with psychosis and intellectual disabilities (ID). There has been little consensus even of what services should provide for this service user group. METHOD: A consultation of multidisciplinary professionals was carried out by using a three-round Delphi exercise. Participants were recruited nationally. They rated their views on the importance of 139 items for the care of adults with psychosis and ID. These included 85 routine service components, 23 service user characteristics for those needing a more intensive service and 31 more intensive service components. RESULTS: Forty-nine out of 52 participants completed all three rounds of the Delphi consultation. Consensus of opinion (> or = 80% agreement as essential) was obtained on 18 of the routine service components, nine of the service user characteristics and five of the more intensive service components. The routine service components considered essential can be broadly considered under a need for a focused approach on the service user and their illness (e.g. monitoring of mental state) and the added need to work within the wider context of the service user with psychosis and ID (e.g. access to social, leisure or occupational activities). Five of the more intensive service components were considered to be essential (e.g. can react to a crisis that day). However, the routine service components considered essential already contained many components such as out-of-hours support and crisis plans also relevant to more intensive services. CONCLUSION: These findings can be used to develop further the evidence base for services in the community for this user group and to assist in the preparation of much needed service evaluation studies.
Journal of intellectual disability research : JIDR, 2009 · doi:10.1111/j.1365-2788.2008.01146.x