The effects of deinstitutionalization on adults with learning disabilities.

Lerman et al. (1995) tracked adults with learning disabilities who left large state institutions. The team measured daily-living and social skills for two-and-a-half years after the move.

They used a quasi-experimental design: no random assignment, just before-and-after scores on standard adaptive-behavior checklists.

Skills went up slightly during the first six months, then flat-lined. Gains were modest—enough to notice, but not life-changing.

After the early bump, scores stayed level for the remaining two years. Community living helped, but only a little.

Moss et al. (2008) show the same historical wave: large-institution use dropped 70 % while small community homes grew fifteen-fold. Lerman et al. (1995) sit inside that tide, giving the micro picture of what happens to the people who actually move.

Cohen-Almeida et al. (2000) followed a similar Scottish cohort for twenty years and found half still in the same setting five years after the target study ended. Together the two papers warn that early adaptive gains can stall if no further supports are added.

McKenzie et al. (2016) seem to contradict the rosy view: frail adults with IDD living in the community are twice as likely to end up back in an institution. The clash is only on the surface—C et al. measured short-term skill change, while Katherine et al. tracked long-term medical risk. Both are true: community life helps at first, but health monitoring keeps people there.

For BCBAs, the takeaway is to front-load skill programs right after the move and keep frailty screens on the calendar. Plan intense teaching in months 0–6, then schedule health and behavior check-ins every quarter so the early gains don’t slip away.