Hassiotis, Angela , Kouroupa, Athanasia, Jones, Rebecca, Morant, Nicola, Courtenay, Ken, Hall, Ian, Crossey, Vicky, Romeo, Renee, Taggart, Laurence, Langdon, Peter E., Ratti, Victoria, Kirchner, Vincent and Lloyd-Evans, Brynmor (2021) Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour : a comparative cohort study protocol. BMJ Open, 11 (3). e043358. doi:10.1136/bmjopen-2020-043358

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Abstract

Introduction: Approximately 17% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays in England. We have identified two models of ISTs (model 1: enhanced provision and model 2: independent provision). This study aims to investigate the clinical and cost-effectiveness of the two models of ISTs.

Methods and analysis: A cohort of 226 adults with ID displaying behaviour that challenges who receive support from ISTs from each model will be recruited and assessed at baseline and 9 months later to compare the clinical and cost-effectiveness between models. The primary outcome is reduction in challenging behaviour measured by the Aberrant Behaviour Checklist-Community (ABC-C). The mean difference in change in ABC score between the two IST models will be estimated from a multilevel linear regression model. Secondary outcomes include mental health status, clinical risk, quality of life, health-related quality of life, level of functioning and service use. We will undertake a cost-effectiveness analysis taking both a health and social care and wider societal perspective. Semistructured interviews will be conducted with multiple stakeholders (ie, service users, paid/family carers, IST managers/staff) to investigate the experience of IST care as well as an online survey of referrers to capture their contact with the teams.

Ethics and dissemination: The study was approved by the London–Bromley Research Ethics Committee (REC reference: 18/LO/0890). Informed consent will be obtained from the person with ID, or a family/nominated consultee for those lacking capacity and from his/her caregivers. The findings of the study will be disseminated to academic audiences, professionals, experts by experience and arm’s-length bodies and policymakers via publications, seminars and digital platforms.

Trial registration number: ClinicalTrials.gov Registry (NCT03586375).

Item Type:	Journal Article
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RC Internal medicine
Divisions:	Faculty of Social Sciences > Centre for Educational Development, Appraisal and Research (CEDAR)
Library of Congress Subject Headings (LCSH):	Intellectual disability , Developmental disabilities, People with mental disabilities -- Services for -- Cost effectiveness
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	30 March 2021
Dates:	Date Event 30 March 2021 Published 30 March 2021 Available 2 March 2021 Accepted
Volume:	11
Number:	3
Article Number:	e043358
DOI:	10.1136/bmjopen-2020-043358
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID 16/01/24 [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272

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