Targeted support and telecare in staffed housing for people with intellectual disabilities: impact on staffing levels and objective lifestyle indicators.

BACKGROUND: Increased provision of out-of-family residential support is required because of demographic changes within the intellectual disabilities population. Residential support now has to be provided in a climate requiring both financial constraint and high quality service outcomes. The aim was to evaluate the quality of life consequences of living with less intensive staff support, resulting from the introduction of more targeted staff allocation coupled with telecare. METHODS: The study comprised 91 participants who lived in 33 settings. The targeted support/telecare intervention was implemented at staggered intervals in 25 of these settings (63 participants). Data on a range of participant and setting descriptors, quality of care, and a range of objective lifestyle indicators were collected at four points in time over 2 years. Impact of the intervention was evaluated using within-group comparisons over time. RESULTS: Comparison between pre- and post-intervention showed that staffing levels were significantly reduced by 23%, whereas they were constant in the absence of intervention. One health indicator improved in the absence of intervention and another improved following intervention. There were no significant changes in any other lifestyle indicators (safety, money, social and community activity, independence or choice). CONCLUSIONS: A combination of targeted support and telecare had no adverse short-term affect on participants' quality of life, but reduced staff input so it seems that they have a role to play in the strategic development of out-of-family placements for adults with intellectual disabilities. Further research is needed to explore in more detail how efficiency is achieved in practice.

Outcomes and costs of community living: semi-independent living and fully staffed group homes.

In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes, and costs. There were no differences in the majority of lifestyle outcome measures. Fully staffed participants had better outcomes in money management and some health indicators. Semi-independent living participants had better outcomes for choice and community activities undertaken without staff support. Costs for semi-independent living were less. On balance, semi-independent living could offer certain cost-effective lifestyle advantages provided that sufficient attention is given to health, living, and financial well-being.

The use of the nominal group technique as an evaluative tool in the teaching and summative assessment of the inter-personal skills of student mental health nurses.

Nominal group technique is a semi-quantitative/qualitative evaluative methodology. It has been used in health care education for generating ideas to develop curricula and find solutions to problems in programme delivery. This paper aims to describe the use of nominal group technique and present the data from nominal group evaluations of a developing module which used novel approaches to the teaching and assessment of interpersonal skills. Evaluations took place over 3 years. Thirty-six students took part in annual groups. Analysis of the data produced the following themes based on items generated in the groups: role play, marking, course content, teaching style and user involvement. Findings indicate that students valued the role play, feedback from service users and emphasis on engagement and collaboration elements of the module. The areas which participants found difficult and desired change included anxiety during experiential practice, the "snap shot" nature of assessment and the use of specific interventions. Indications are also given regarding the impact of changes made by teaching staff over the 3 year evaluation period. The findings support themes within the existing literature on the teaching of interpersonal skills and may to some extent point the way toward best practice in this area. The paper discusses these findings and their implications for nurse education.

Rational resourcing and productivity: relationships among staff input, resident characteristics, and group home quality.

Relationships among staff input per resident, resident characteristics, setting characteristics, and service quality were investigated. Data were obtained from 51 group homes in Wales on (a) resident numbers, ages, gender, adaptive behavior, challenging behavior, and additional disabilities; (b) allocated staff hours and actual staff costs; (c) provider agency, date of provision, and internal operational arrangements; and (d) resident receipt of staff attention and resident activity. Variation in staff input was related to resident challenging behavior, smaller residence size, and provider agency or date of provision. Staffing input was associated with resident receipt of attention, as were operational arrangements. Resident activity was related to resident adaptive behavior and receipt of attention but not resource input. Cost-effectiveness implications are discussed.

Subjective and objective quality of life assessment: responsiveness, response bias, and resident:proxy concordance.

Low language ability and response bias are frequently cited as impediments to valid responding to items on interview schedules. Structured interviews with a random sample of 154 adults with mental retardation showed that around two thirds of respondents were either unable to respond or exhibited response bias. There was a significant difference in scores on the Adaptive Behavior Scale between those who exhibited response bias and those who did not. In cases of nonresponse or response bias, the substitution of the respondent with a proxy respondent has been proposed as an alternative method of gathering subjective data. In this study concordance between individuals' responses and those of proxies was low on a subjective measure and high on an objective scale.