Living in own home offered choices to people with learning disabilities but location predictive of support related choices


Choice is one of the four fundamental principles of Valuing People, the white paper produced in 2001 to guide development of support for people with learning disabilities in England.

This US study looks at this principle in practice using data from the 2008–2009 National Core Indicators Project. They looked at the impact of a number of factors on the number of everyday choices made by 8,892 adults with learning disabilities and support-related choices made by 6,179 adults receiving services from 19 state agencies.

What they found was that when they controlled for physical and sensory impairment, age, behavioural support, communication, and the state in which people lived, people in residential settings with 16 or more people had less everyday choice than those in other living arrangements.

They found that those with mild and moderate learning disabilities had more control over everyday choices if they lived in their own homes. Those with severe and profound learning disabilities however, were found to have more control when they lived agency homes of 3 or fewer residents.

When it came to living in institutional settings, the level of learning disability was not a factor affecting choice. They found that irrespective of the level of learning people disability, if people lived in settings supporting 16 or more residents they were offered the lowest levels of everyday choice.

However, using the same approach to controlling all other variables, they found that if people lived in their own homes and irrespective of their level of learning disability, they had significantly more support-related choices than those in any other residential arrangement.

It also seemed from the data that where people lived impacted on the amount of choice they had, as when the researchers controlled for all other characteristics relating to the individual and their residential setting, the state in which people lived still was still a clear predictor of support-related choice.

Interestingly, the variables the study team tested for accounted for only 44% of the variability in everyday choice and 31% in support-related choice, which raises some interesting questions about what other factors are affecting variability in choice.
Correlates of Everyday Choice and Support-Related Choice for 8,892 Randomly Sampled Adults with Intellectual and Developmental Disabilities in 19 States, Tichá R et al, in Intellectual and Developmental Disabilities, 50, 6, 486-504.

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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