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Purpose The purpose of this paper is to present the service model and evaluation of Southwark Enhanced Intervention Service (EIS). EIS is an intensive community service for adults with intellectual disabilities whose behaviours challenge in the context of the Transforming Care agenda. Design/methodology/approach The service model is described and the following evaluation data over four years are presented: key performance indicators, descriptive data, clinical outcomes, financial outcomes and qualitative feedback on users’ experience. Findings The EIS has demonstrated good outcomes for a small number of adults with complex needs by supporting them at crisis point locally and preventing hospital admission or a move to a restrictive environment out of area. EIS has also supported the successful transition back to area of a small number of adults with complex needs. The evaluation has shown improvements in behaviour, wellbeing and quality of life as well as demonstrating financial savings. Families’ and providers’ qualitative feedback indicates that the service has been highly valued and in particular the access to timely multidisciplinary coordination of input. Originality/value The service was developed around the same time as the start of the Transforming Care agenda. It presents findings of a four-year evaluation at a time when there is limited evaluation of such service models focusing on the Transforming Care aims. The paper presents significant findings in support of guidance and recommendations published more recently as well as reflections on components of effective service delivery.

Background A gap prevails between the conceptualization of good practice in challenging behaviour management and its implementation in intellectual disability services. This study aimed to investigate staff members’ perspectives of managing clients with challenging behaviours in residential services. Materials and Methods Semi-structured interviews were conducted with eleven staff in two services. Additionally, service documents on challenging behaviour management were examined in these services. A qualitative methodology was used to investigate staff members’ immediate responses to clients’ difficult behaviours and their decision-making processes. Results The immediate responses of staff were conceptualized as the result of complex appraisals shaped by their service context involving the core processes of making the right choice and prioritizing the best interests of all involved. Conclusions Staff members’ responses were understood as a dynamic and retroactive process, where their past and current challenging behaviour management experiences in the service influenced their responses to clients in the future.