Abstract:

The replacement of institutional residential services for people with severe intellectual disability with community-based alternatives has progressed similarly in many countries of the developed world. In the 1st wave of reform, the idea of reversing institutional conditions provided a design brief for the alternative services which emphasized various structural characteristics of the settings (e.g., smallness of scale, typical housing design, location in typical residential areas, increased staff support). As the poor quality of existing services was widely seen as due to institutionalization, there was an equally widespread belief that such reforms would lead to high-quality outcome. However, expectations for improved quality from the initial reforms, while partially met, were far from fully confirmed by research evidence. A decent, homelike, well located, reasonably staffed environment was a necessary but not sufficient condition for good outcome. The design brief for the alternative service needs to include factors such as the orientation of staff and their working methods and training. A literature review shows how the quality of staff and resident activity is dependent on an interaction between the structure, orientation and procedures followed within the setting.