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Background A 26-item Resident Choice Scale was designed to assess service practices for promoting resident choice. Method The staff working with 560 UK/Irish adults with intellectual disability were interviewed. Specific examples of practices promoting resident choice were requested and independently rated by the interviewer. Results The interrater reliability of Resident Choice items was found to be acceptable (subsample n = 50). The psychometric properties of the Resident Choice Scale total score and scores on eight subscales were also acceptable. Consistently strong associations were found between greater resident choice and greater resident ability and, to a lesser extent, fewer resident challenging behaviours. Few associations were found between resident choice and autism or mental health problems. Even when controlling for resident ability and challenging behaviour, consistent associations were found between greater resident choice and the concurrent variables of greater community presence, fewer institutional practices, and greater user self-reported satisfaction (subsample n = 50). Conclusions Taken together, this pattern of results indicates that the Resident Choice Scale shows promise as a measure of the environmental opportunities available for adults with intellectual disability to exercise self-determination. Areas for future research testing the reliability and validity of the Resident Choice Scale are outlined.

In recent years, a growing volume of research evidence has been generated about the relative cost-effectiveness of various types of community-based residential supports for people with intellectual disability (ID) in the UK. However, few reliable data are available to inform planners, commissioners or service providers about the quality and costs of providing support within residential or village communities. Methods The evaluation described in the present paper aimed to fill some of the gaps in knowledge by examining the comparative costs of supporting people in village community settings, in National Health Service (NHS) residential campuses and in dispersed, community-based housing schemes. The complete service package received by each study participant was described and costed, and a series of statistical analyses was undertaken to identify factors associated with variations in the cost of support. The analyses reported in the present paper were based on comparisons of 86 people living in village communities, 133 in residential campuses and 281 in dispersed housing schemes. Results Wide variations in cost were found, not only between models of accommodation, but between individual organizations, settings and service users. Multivariate analysis revealed that higher costs were associated with supports for people with higher levels of ID and more severe challenging behaviour. The cost of support was affected by the size of the residential setting, with smaller facilities likely to be more expensive. Associations were also found between increased costs, and services for younger users, male users and people who had not moved from a NHS hospital. Generally, more sophisticated service processes within the setting were associated with higher costs; although systematic arrangements for supervision and training of staff had a negative effect on cost. Conclusions The cost findings should be considered alongside evidence on outcomes. A comparison of village communities and

Information was collected on the social networks of 500 adults with mental retardation receiving different types of residential supports. Results indicated that (a) the reported median size of participants' social networks (excluding staff) was 2 people; (b) 83% of participants were reported to have a staff member; 72%, a member of their family; 54%, another person with mental retardation; and 30%, a person who did not fit into any of these categories in their social network; (c) variation in the size and composition of participants' social networks was associated with a range of variables, including the personal characteristics of residents (age, autism, ability, and challenging behavior), the type of previous and current accommodation, staffing ratios, institutional climate, and the implementation of “active support.”

Information was collected on 63 adults in supported living residences, 55 adults in small group homes, and 152 adults in large group homes. Results indicated that (a) there were no statistically significant differences in service costs once these had been adjusted to take account of participant characteristics; (b) compared with participants living in small group homes, those in supported living residences had greater choice, participated in more community-based activities, experienced fewer scheduled activities, were more likely to have had their home vandalized, and were considered at greater risk of exploitation; (c) compared with participants living in large group homes, those in small group homes had larger social networks, more people in their social networks who were not staff, not family, and did not have mental retardation. These residents were considered at less risk of abuse.

The costs, nature and benefits of residential supports were examined for 20 adults with severe and complex disabilities living in newly built residential campuses and 20 adults living in small community-based dispersed housing schemes. Results indicated that participants living in dispersed housing schemes enjoyed a significantly greater quality of care and quality of life than participants living in residential campuses. The total costs of provision in dispersed housing schemes were significantly greater than the total costs of provision in residential campuses. These differences were accounted for by significantly greater direct staffing costs in the community-based services.

Information was collected on the social networks of  adults with mental retardation receiving different types of residential support. The results indicated that: () the reported median size of the participants’ social networks (excluding staff) was two people; () % of participants were reported to have a member of staff, % a member of their family, % another person with mental retardation and % a person who did not fit into any of these categories in their social network; and () variation in the size and composition of participants’ social networks was associated with a range of variables including the personal characteristics of residents (i.e. age, autism, ability and challenging behaviour), the type of previous and current accommodation, staffing ratios, institutional climate, and the implementation of ‘active support’.

The costs, nature and benefits of residential support were examined for 63 adults living in supported living schemes, 55 adults living in one- to three-person small group homes and 152 adults living in four- to six-person large group homes. The results indicate that: (1) there were no significant differences between the adjusted costs of provision; (2) there were marginal differences between supported living schemes and small group homes, and between small and large group homes in quality of care provided; (3) residents in supported living schemes made more choices and took part in more community-based activity than those in small group homes; (4) residents in supported living schemes experienced fewer hours and days per week of scheduled activity, were more likely to have had their home vandalized and were seen to be at greater risk of exploitation than those living in small group homes; and (5) when compared with participants living in large group homes, those in small group homes had larger social networks, more staff in their social networks, more people in their social networks who were neither staff, family members nor people with mental retardation, and were considered to be at less risk of abuse.