The behavioral and social ecology of community houses.

The team watched adults with severe intellectual disability in three places. One place was a big state institution. Another was large community houses that held 16 people. The last was small community homes with 6 or fewer people.

They counted how the adults dressed, cooked, and talked. They also timed how often staff helped or chatted with them.

Adults in the small homes did more daily tasks on their own. Staff in these homes talked with clients three times more often than in the big places.

The small homes beat both the institution and the larger community houses on every measure.

Pilowsky et al. (1998) saw the same win for small settings when they compared nursing homes to community houses. Young (2006) tracked people for years and still found the small homes came out on top.

McSweeney et al. (1993) looked like a contradiction at first. They saw adaptive gains but also a jump in problem behavior when people left the hospital. The key difference is stress during a move. Hassin-Herman et al. (1992) studied folks who had already settled, so they showed only the good side.

Michael (1995) adds that even adults with serious challenging behavior do better in small homes if you add extra staff at the start.

If you place adults with ID, push for homes with six or fewer residents. The size alone lifts adaptive skills and staff attention. When you must move someone from an institution, plan extra behavioral support at first to avoid the temporary spike K et al. saw.