Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol

Angela Hassiotis, Athanasia Kouroupa, Rebecca Jones, Nicola Morant, Ken Courtenay, Ian Hall, Vicky Crossey, Renee Romeo, Laurence Taggart, Peter Langdon, Victoria Ratti, Vincent Kirchner, Brynmor Lloyd-Evans, Angela Hassiotis, Athanasia Kouroupa, Rebecca Jones, Nicola Morant, Ken Courtenay, Ian Hall, Vicky Crossey, Renee Romeo, Laurence Taggart, Peter Langdon, Victoria Ratti, Vincent Kirchner, Brynmor Lloyd-Evans

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).

Keywords: adult psychiatry; delirium & cognitive disorders; organisation of health services; psychiatry.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Study participant flow chart.

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