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Comparison of Community Residential Supports on Measures of 'Information & Planning'; 'Access to & Delivery of Supports'; 'Choice & Control'; 'Community Connections'; 'Satisfaction'; and, 'Overall Perception of Outcomes'

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Title: Comparison of Community Residential Supports on Measures of 'Information & Planning'; 'Access to & Delivery of Supports'; 'Choice & Control'; 'Community Connections'; 'Satisfaction'; and, 'Overall Perception of Outcomes'
Language: English
Authors: Stainton, T., Brown, J., Crawford, C., Hole, R., Charles, G.
Source: Journal of Intellectual Disability Research. Aug 2011 55(8):732-745.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 14
Publication Date: 2011
Document Type: Journal Articles
Reports - Research
Descriptors: Independent Living, Mental Retardation, Group Homes, Foreign Countries, Comparative Analysis, Residential Programs, Adults, Place of Residence, Planning, Access to Health Care, Access to Information, Locus of Control, Self Determination, Community Programs, Satisfaction, Attitude Measures
Geographic Terms: Canada
DOI: 10.1111/j.1365-2788.2010.01378.x
ISSN: 0964-2633
Abstract: Background: This paper reports on some of the findings of a large-scale survey (n = 852) of family members and support staff of adults with intellectual disabilities receiving community living services in British Columbia, Canada, concentrating on comparison of outcomes across four types of community residential settings: group homes, family model homes, independent home or apartment, and family home. Method: Comparisons were conducted on six domains: "information and planning"; "access to and delivery of supports"; "choice and control"; "community connections"; "satisfaction"; and, "overall perception of outcomes". Where applicable, further multivariate analyses were undertaken to determine the effect of the degree of help required by the residents and the respondent type. Results: Findings indicate that on all measures other than choice and control, group homes and family model homes showed better outcomes than either independent settings or family homes. Conclusion: The findings may indicate that the move to more independent living settings is not being accompanied by appropriate supports.
Abstractor: As Provided
Number of References: 21
Entry Date: 2011
Accession Number: EJ932668
Database: ERIC
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  Value: <anid>AN0062963322;eul01aug.11;2019Jun04.10:45;v2.2.500</anid> <title id="AN0062963322-1">Comparison of community residential supports on measures of information & planning; access to & delivery of supports; choice & control; community connections; satisfaction; and, overall perception of outcomes. </title> <p>Background  This paper reports on some of the findings of a large‐scale survey (n = 852) of family members and support staff of adults with intellectual disabilities receiving community living services in British Columbia, Canada, concentrating on comparison of outcomes across four types of community residential settings: group homes, family model homes, independent home or apartment, and family home. Method  Comparisons were conducted on six domains: information and planning; access to and delivery of supports; choice and control; community connections; satisfaction; and, overall perception of outcomes. Where applicable, further multivariate analyses were undertaken to determine the effect of the degree of help required by the residents and the respondent type. Results  Findings indicate that on all measures other than choice and control, group homes and family model homes showed better outcomes than either independent settings or family homes. Conclusion  The findings may indicate that the move to more independent living settings is not being accompanied by appropriate supports.</p> <p>Keywords: intellectual disability; residential supports; comparative outcomes</p> <p>The movement away from both institutional settings and larger community‐based residential supports is now well entrenched in most high‐income jurisdictions ([<reflink idref="bib3" id="ref1">3</reflink>]; [<reflink idref="bib14" id="ref2">14</reflink>]; [<reflink idref="bib1" id="ref3">1</reflink>]). While there is considerable research comparing outcomes between institutional and community‐based settings ([<reflink idref="bib6" id="ref4">6</reflink>]; [<reflink idref="bib21" id="ref5">21</reflink>]; [<reflink idref="bib11" id="ref6">11</reflink>]; [<reflink idref="bib14" id="ref7">14</reflink>]; [<reflink idref="bib12" id="ref8">12</reflink>]), there have been comparatively few studies that compare outcomes across community‐based residential supports. Several studies have compared supported living, group home and family settings ([<reflink idref="bib4" id="ref9">4</reflink>]; [<reflink idref="bib9" id="ref10">9</reflink>]; [<reflink idref="bib17" id="ref11">17</reflink>]; [<reflink idref="bib7" id="ref12">7</reflink>]; [<reflink idref="bib18" id="ref13">18</reflink>]). [<reflink idref="bib7" id="ref14">7</reflink>]) found that supported‐living residents, when compared with group home residents, had greater choice and took part in more community‐based activities. Unfavourable outcomes associated with supported living included fewer planned activities and greater risk of mistreatment. Residents in supported‐living arrangements were less likely than small group home residents to have a designated key worker, an Individualized Habilitation Plan, and consistent and effective access to assessment and teaching supports. [<reflink idref="bib13" id="ref15">13</reflink>]) found that adults strongly valued the independence, freedom and privacy associated with supported‐living arrangements. Concerns included 'the possible lack of support' from staff, potential boredom because of living alone and issues of safety. [<reflink idref="bib19" id="ref16">19</reflink>]) compared self‐reported levels of satisfaction and sense of well‐being in a sample of 1885 across community‐based services and intermediate care facilities in six US states reporting consistent benefits of small settings with choice of where and with whom to live and for individuals living with families. [<reflink idref="bib4" id="ref17">4</reflink>]) found lower levels of satisfaction and adjustment among group home residents than those in supported apartments but generally higher levels than in the family home (natural and foster). Social integration remained extremely limited for all residents regardless of living arrangements.</p> <p>This paper reports on some of the findings of a large‐scale survey conducted in British Columbia, Canada, and concentrates on comparing across four types of community residential settings: group homes, family model homes, independent home or apartment, and family home.1 Comparisons were conducted on six domains: <emph>information and planning; access to and delivery of supports; choice and control; community connections; satisfaction</emph>; and, <emph>overall perception of outcomes</emph>. Where applicable, further multivariate analyses were undertaken to determine the effect of the degree of help required by the residents and the respondent type.</p> <hd id="AN0062963322-2">Method</hd> <p> <emph>The Survey of Family Members of People with Disability Who Are Receiving Services from Community Living British Columbia</emph> ([<reflink idref="bib16" id="ref18">16</reflink>]) targeted family members of adults with intellectual disabilities (PWIDs). Potential participants were identified from the Community Living British Columbia's (CLBC) list of those receiving services. CLBC, a crown agency established in 2005, is responsible for providing and facilitating access to services and supports to 12 015 adult persons with intellectual disabilities (IDs) and their families. Of this number, 5291 were living in staffed homes or family model home arrangements, or living semi‐independently and receiving community inclusion supports ([<reflink idref="bib5" id="ref19">5</reflink>]). CLBC uses a baseline eligibility criterion of a DSM‐IV diagnosis of ID. CLBC divided the province into four regions. A stratified random sample of 2000 participants was selected according to these regions. CLBC mailed out surveys on our behalf to potential participants across British Columbia in the spring of 2008 with approximately 3 months to respond. Participants were provided the option of completing the paper questionnaire or accessing an identical questionnaire online. The surveys were returned directly to the research team and contained no identifying information on those completing the survey or the person receiving services. A total of 852 surveys were completed (80% by mail and 20% online). Twenty‐two respondents did not meet the age criteria of 19 for the PWID and were excluded from the analysis for a total number of 830. Given the open access to the online version of the survey, no specific response rate can be established; however, the relative response rate taken as a percentage of the 2000 mail‐out surveys approximates 42%, roughly equivalent to the anticipated response rate for the National Core Indicators (NCI) Family Survey of 40% ([<reflink idref="bib10" id="ref20">10</reflink>]). For the mail‐out survey, Table 1 compares the CLBC's service distribution with the sampling distribution by region.</p> <p>1 Sample distribution</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>CLBC service region</bold></th><th><bold>% total CLBC clientele</bold></th><th><bold>% survey's total sample</bold></th></tr></thead><tbody valign="top"><tr><td>Coast</td><td>46</td><td>49</td></tr><tr><td>Vancouver Island</td><td>22</td><td>24</td></tr><tr><td>Interior</td><td>24</td><td>20</td></tr><tr><td>North</td><td>8</td><td>7</td></tr></tbody></table> </ephtml> </p> <p>1 CLBC, Community Living British Columbia.</p> <p>The design of the 28‐page survey draws from two existing surveys: the <emph>Adult Family Surve</emph>y from the NCI project in the USA and Statistics Canada's <emph>Participation and Activity Limitation Survey</emph> (PALS). Both surveys use clear and straightforward questions, have been widely tested and revised and used successfully for many years ([<reflink idref="bib10" id="ref21">10</reflink>]; [<reflink idref="bib20" id="ref22">20</reflink>]). For the present research, we used most of the <emph>Adult Family Survey</emph> questions, with some minor modifications for language. We also drew from the adult component of the PALS of 2006. We drew from the PALS questions on sources of personal income and the frequency of receiving help in activities of everyday living ([<reflink idref="bib20" id="ref23">20</reflink>]). On some matters that were not addressed by the NCI or PALS, the research team developed additional questions.</p> <p>The survey was designed to have both discrete questions and clusters of questions indicative of a specific area of inquiry so that composite indices could be used to gain an overall score for each domain that was used in the analysis. The focus of this paper is on one particular section of the survey that asked participants about the services and supports they received with respect to the six key domains. All questions in this section were answered on a 3‐point scale from 1 (<emph>seldom or never</emph>) to 3 (<emph>always or usually</emph>) with <emph>don't know</emph> and <emph>not applicable</emph> options.</p> <p>The <emph>information and planning</emph> domain (internal consistency α = 0.93) consisted of 10 questions asking participants if they received information about available services and how helpful programme staff are in helping them develop service plans (e.g. 'Do you receive information about the services and supports that are available to your family?'). The second domain <emph>access to and delivery of supports</emph> (α = 0.83) consisted of 17 questions asking participants if supports are available when needed (e.g. health and dental), as well as if support staff are respectful. The third domain, <emph>choice and control</emph> (α = 0.86), consisted of 12 items. Participants were asked if they are allowed input in making decisions regarding services. The fourth domain, <emph>community connections</emph> (α = 0.84), had six questions that looked at use of typical services and activities in the community. The fifth domain, <emph>satisfaction with services</emph> (α = 0.82), had eight items (e.g. 'Overall, are you satisfied with the services and supports your family member currently receives?'). The final domain, <emph>overall perception of outcomes</emph> (α = 0.80), targeted the degree to which service and supports had a positive impact (e.g. 'Overall, do you feel that service and supports have made a positive difference in the life of your family member?').</p> <p>Although the survey primarily targeted family members of the PWID, a small percentage of surveys were completed by support workers and the PWID him/herself (see <emph>Description of the survey sample</emph> for details on the distribution). When necessary, the associations between participant type and the dependent variables of interest were examined.</p> <p>All data were analysed using spss 16.0. A standard decision criterion was used for all inferential statistics (i.e. α = 0.05). Prior to conducting the analyses, data were inspected for errors and to ensure they met the necessary assumptions of the parametric and non‐parametric statistical procedures used (e.g. normality). Ethical approval for the study was granted by the Behaviour Research Ethics Board of the University of British Columbia.</p> <hd id="AN0062963322-3">Results</hd> <p></p> <hd id="AN0062963322-4">Description of the survey sample</hd> <p>Participants ranged in age from 19 to 97 years (M = 56.48, SD = 12.45). The PWIDs who were being represented by the survey ranged in age from 19 to 90 years (M = 38.00, SD = 14.00). An overwhelming majority (79%) of PWIDs were reported to be Caucasian/White, while 8% were Asian, 7% were Aboriginal, and just over 6% were identified as being <emph>other</emph>. Fifty‐three per cent of the PWIDs were men and 47% were women.</p> <p>Across mail and online surveys, 73% (<emph>n</emph> = 607) of surveys were answered by family members, 23% (<emph>n</emph> = 191) by support staff, and 4% (<emph>n</emph> = 29) by PWIDs. In terms of the participants' relationship with the PWID, 72% reported being the primary caregiver, with 28% stating they were not. Specifically, 44% of respondents identified themselves as being the biological mother.</p> <p>In terms of performing daily activities, 34% of participants indicated the PWID required a moderate amount of help; whereas, 22%, 22% and 21% of PWIDs were identified as requiring complete, little or no help respectively. There was a significant association among the degree of help required and residential setting, χ<sups>2</sups>(<reflink idref="bib9" id="ref24">9</reflink>, _I_n_i_ = 728) = 76.14, <emph>P</emph> < 0.001. Complete help was reported for those living in group homes more than statistically expected. No help was reported more than statistically expected for those living in independent homes. For those in family model homes and living at home, the distribution was consistent with statistical expectations. Overall, PWIDs were said to be healthy, 66% were identified as being in good or very good health, while 22% were rated as being fair and 3% in poor health, the remainder indicated they did not know. PWIDs had an average of two (SD = 1.44, Mo = 2, Min = 0, Max = 8) additional diagnoses such as autism (18%), mental illness (21%), communication disorders (22%), physical disability (23%) or hearing or vision impairment (26%).</p> <hd id="AN0062963322-5">Residential settings</hd> <p>Analyses were conducted to assess differences in participants' responses to key domains according to PWIDs' residential setting (i.e. whether they lived in a group home, independent home or apartment, family model home, or they lived at home with their family). Within each domain further analysis was undertaken to determine the effects of <emph>degree of help</emph> and <emph>respondent type</emph> (family member and support worker). Table 2 provides a frequency distribution of the types of residential settings PWIDs live in.</p> <p>2 Frequency distribution of PWIDs' residential settings</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Residential setting</bold></th><th><bold>Frequency</bold></th><th><bold>% sample</bold></th></tr></thead><tbody valign="top"><tr><td>Group home</td><td>144</td><td>17.6</td></tr><tr><td>Agency‐owned apartment</td><td>10</td><td>1.2</td></tr><tr><td>Independent home or apartment</td><td>94</td><td>11.5</td></tr><tr><td>Family model home</td><td>66</td><td>8.1</td></tr><tr><td>Long‐term care or extended care facility</td><td>5</td><td>0.6</td></tr><tr><td>Other type of setting</td><td>31</td><td>3.8</td></tr><tr><td>Lives at home with family members</td><td>469</td><td>57.3</td></tr></tbody></table> </ephtml> </p> <p>2 PWID, adults with intellectual disabilities.</p> <p>For those living in an independent home/apartment, 49% said it was rented, 25% said it was owned by the respondent and 11% said it was owned by the PWID. For PWIDs not living at home, equal numbers (i.e. 21%) either lived alone or with three other people. Sixteen per cent lived with one other person, 15% lived with two people and 23% lived with four or more people.</p> <p>A significant association was found among age categories of PWIDs and their type of residential setting, χ<sups>2</sups>(<reflink idref="bib6" id="ref25">6</reflink>, _I_n_i_ = 801) = 68.71, <emph>P</emph> < 0.001. Looking at those who live at home with their family, far more PWIDs (<emph>n</emph> = 404) than expected were under the age of 50 years. Of those over the age of 50 years, more PWIDs than expected lived in group homes. Across the other residential settings, the age categories were consistently distributed given estimates projected according to the sample size and distribution.</p> <hd id="AN0062963322-6">Information and planning</hd> <p>Analyses were conducted to examine if responses to questions pertaining to information and planning were different according to whether the respondent was a family member (i.e. including PWID) or a support worker, as well as the type of residential setting the PWID lived in. Results from a mixed anova failed to indicate a significant interaction between type of respondent and residential setting on the index of information and planning, <emph>F</emph><subs>3,699</subs> = 0.23, <emph>P</emph> = 0.89. There was a main effect for type of respondent, <emph>F</emph><subs>1,699</subs> = 1.91, <emph>P</emph> < 0.01, which indicated that support workers (M = 20.18, SD = 8.68) rated information and planning higher than family members (M = 15.74, SD = 9.58) across all residential settings. There was also a main effect for residential setting, <emph>F</emph><subs>3,699</subs> = 7.69, <emph>P</emph> < 0.001, indicating that those living in group homes (M = 20.73, SD = 9.57) and family model homes (M = 20.25, SD = 8.57) reported higher degrees of information and planning than those living in independent (M = 14.80, SD = 9.91) or at home settings (M = 15.41, SD = 9.14).</p> <hd id="AN0062963322-7">Access to and delivery of supports</hd> <p></p> <hd id="AN0062963322-8">Degree of help comparisons</hd> <p>Differences among residential settings and the degree to which PWIDs needed (i.e. none, little, moderate, complete) help with daily activities on the index of access to and delivery of services were assessed. Results failed to find an interaction between residential setting and degree of help, <emph>F</emph><subs>9,703</subs> = 1.39, <emph>P</emph> = 0.19. A significant main effect for residential setting was found, <emph>F</emph><subs>3,703</subs> = 35.22, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses found those living in group homes (M = 34.27, SD = 8.58) reported greater access to and delivery of supports than both those in independent homes (M = 27.58, SD = 9.10) and those living at home (M = 25.03, SD = 9.13). Those in independent homes reported less access to and delivery of supports than those in family model homes (M = 32.02, SD = 8.93). Finally, those in family model homes reported more access to and delivery of supports than those living at home. A significant main effect was also found for the degree of help needed, <emph>F</emph><subs>3,703</subs> = 4.09, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses found those who needed no help (M = 24.44, SD = 9.89) reported less access to and delivery of supports than those needing moderate (28.67, SD = 9.24) or complete help (M = 28.67, SD = 9.24). Those needing little help (M = 25.84, SD = 9.13) reported less access to and delivery of supports than those needing moderate or complete help. Finally, those who needed moderate help reported lower levels than those needing complete help.</p> <hd id="AN0062963322-9">Access to and delivery of support by residential setting and type of respondent</hd> <p>A significant interaction between residential settings and type of respondent (i.e. family member/person with disability or support worker) was not found on the index of access to and delivery of support items, <emph>F</emph><subs>3,699</subs> = 1.91, <emph>P</emph> = 0.13. A significant main effect for residential setting was found, <emph>F</emph><subs>3,699</subs> = 21.50, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses found an identical trend to that reported in the above section in terms of the main effect for residential setting. A significant main effect also revealed that support workers (M = 31.59, SD = 9.09) reported greater access to and delivery of supports than family members (M = 26.52, SD = 9.65), <emph>F</emph><subs>3,699</subs> = 1.91, <emph>P</emph> = 0.02.</p> <p>Using the overall index of the access to and delivery of services items, differences according to residential type were found, <emph>F</emph><subs>6,799</subs> = 21.41, <emph>P</emph> < 0.001. Follow‐up analyses controlling for multiple comparisons revealed that those living at home reported less frequent access to and delivery of supports than those living in group homes and family model homes. Furthermore, those living in an independent home or apartment also reported less frequent access to and delivery of supports than those living in group homes and family model homes.</p> <p>In light of the main effect of residential setting on access to and delivery of supports identified above, additional analyses were conducted on the 17 individual items that comprised the index. After controlling for multiple comparisons (adjusted α = 0.003), differences according to residential setting were found on seven of the items. Table 3 provides the means, SDs and anova results for each of the individual items found to have a difference. The following describes which of the <emph>post hoc</emph> analyses were significant for each item listed in Table 3. Looking at item 1, <emph>post hoc</emph> analyses indicated those living in group homes reported significantly more assistance than those living at home. For item 2, those living at home reported getting the services needed significantly less frequently than those in group, independent and family model homes. For item 3, compared with those living at home, those living in group homes reported receiving emergency services significantly more frequently. For item 4, those living in group homes reported that staff were more frequently courteous than those living at home. For item 5, both those living in group and those in family model homes reported more frequently that their family member's setting was safe when compared with those living in independent homes. Please note that those living at home were excluded from this analysis. For item 6, those living in group homes reported more frequent access to support workers who can communicate with PWIDs who do not speak English than those living at home. For item 7, those living in group homes reported more frequent access to special equipment or accommodations than those living at home.</p> <p>3 Residential setting effects on access to and delivery of supports and services</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Individual question</bold></th><th><bold>Mean (SD) ratings</bold></th><th><bold><italic>F</italic>‐test results</bold></th></tr><tr><th><bold>Group home</bold></th><th><bold>Independent home</bold></th><th><bold>Family model home</bold></th><th><bold>Lives at home</bold></th><th><bold>d.f.</bold></th><th><italic><bold>F</bold></italic>*</th></tr></thead><tbody valign="top"><tr><td>1. When you ask the service/support coordinator for assistance, does he/she help you get what you want?</td><td>2.53 (0.69)</td><td>2.36 (0.67)</td><td>2.41 (0.79)</td><td>2.29 (0.75)</td><td>3, 562</td><td>7.41</td></tr><tr><td>2. Does your family member get the services and supports he/she needs?</td><td>2.64 (0.55)</td><td>2.36 (0.69)</td><td>2.45 (0.76)</td><td>2.02 (0.77)</td><td>3, 621</td><td>26.02</td></tr><tr><td>3. If you ever asked for services or supports in an emergency or crisis, was help provided to you right away?</td><td>2.49 (0.69)</td><td>2.11 (0.88)</td><td>2.34 (0.86)</td><td>2.04 (0.90)</td><td>3, 350</td><td>6.20</td></tr><tr><td>4. Are support staff generally respectful and courteous?</td><td>2.91 (0.31)</td><td>2.78 (0.51)</td><td>2.79 (0.46)</td><td>2.69 (0.54)</td><td>3, 592</td><td>6.64</td></tr><tr><td>5. If your family member doesn't live with you, do you feel his/her residential setting is a safe and healthy environment?</td><td>2.92 (0.32)</td><td>2.67 (0.66)</td><td>2.89 (0.38)</td><td>N/A</td><td>2, 245</td><td>6.82</td></tr><tr><td>6. If your family member does not speak English or uses a different way to communicate, are there enough support workers available who can communicate with him/her?</td><td>2.76 (0.47)</td><td>2.13 (0.64)</td><td>2.32 (0.89)</td><td>2.10 (0.76)</td><td>3, 185</td><td>10.66</td></tr><tr><td>7. Does your family member have access to the special equipment or accommodations that he/she needs (e.g. wheelchairs, ramps, communication boards)?</td><td>2.83 (0.50)</td><td>2.61 (0.63)</td><td>2.70 (0.56)</td><td>2.39 (0.78)</td><td>3, 251</td><td>7.20</td></tr></tbody></table> </ephtml> </p> <p>3 *  <emph>F</emph>‐statistics were significant after controlling for multiple comparisons (adjusted α = 0.003).</p> <hd id="AN0062963322-10">Choice and control</hd> <p></p> <hd id="AN0062963322-11">Degree of help comparisons</hd> <p>Analyses were conducted to see if there were differences among residential setting groups and the degree to which PWIDs needed (i.e. none, little, moderate, complete) help with daily activities on the index of choice and control. Results failed to find an interaction between residential setting and degree of help, <emph>F</emph><subs>9,700</subs> = 1.29, <emph>P</emph> = 0.23. A main effect for residential setting was found, <emph>F</emph><subs>3,700</subs> = 2.90, <emph>P</emph> = 0.03. However, despite finding this overall difference, <emph>post hoc</emph> analyses failed to identify any significant differences among those living in group homes (M = 6.31, SD = 4.78), independent homes (M = 6.49, SD = 5.78), family model homes (M = 8.25, SD = 5.70) and living at home (M = 6.48, SD = 5.06). A significant main effect was found for the degree of help required, <emph>F</emph><subs>3,700</subs> = 9.30, <emph>P</emph> < 0.001. Those requiring no help (M = 4.61, SD = 3.93) were found to report less choice and control than both those requiring moderate (M = 7.60, SD = 5.42) and those requiring complete help (M = 7.48, SD = 5.39). Finally, those requiring little help (M = 5.94, SD = 4.96) reported having significantly less choice and control than those requiring moderate help.</p> <hd id="AN0062963322-12">Choice and control by residential setting and type of respondent</hd> <p>No significant interaction between residential setting and type of respondent (i.e. family member/person with a disability or support worker) on the index of choice and control was found, <emph>F</emph><subs>3,695</subs> = 1.11, <emph>P</emph> = 0.34. These results indicate that there are no differences in reports of choice and control across the residential settings that are dependent on whether or not the respondents were families or support workers. Furthermore, there was no main effect for residential setting, indicating no significant differences among those living in group homes (M = 6.36, SD = 4.79), independent homes (M = 6.54, SD = 5.84), family model homes (M = 8.54, SD = 5.61) and living at home (M = 6.55, SD = 5.08), <emph>F</emph><subs>3,695</subs> = 2.40, <emph>P</emph> = 0.07. Furthermore, there was no significant main effect between family members (M = 6.67, SD = 4.48) and support workers (M = 6.70, SD = 5.08), <emph>F</emph><subs>1,695</subs> = 0.11, <emph>P</emph> = 0.74.</p> <hd id="AN0062963322-13">The effects of residential settings on the individual items for choice and control</hd> <p>Additional analyses were done on the individual items comprising the overall index. However, certain items were only asked of participants according to whether or not they lived at home with their family.2 Three of the choice and control index items were asked of all participants. Subsequently, no differences among residential settings were found on any of these items. Four of the items were only asked of participants living at home, and therefore, no residential setting group comparisons were made. Five items were asked of those participants not living at home. Residential setting group analyses on these items were conducted and differences were found on one item. When asked if participants had control and/or input in hiring and managing support workers, a significant difference was found, <emph>F</emph><subs>2,131</subs> = 8.06, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses revealed that those living in group homes (M = 1.35, SD = 0.61) reported having less frequent control than those living in independent (M = 1.92, SD = 0.61) and family model (M = 1.87, SD = 0.92) homes. There was no significant difference between independent and family model homes.</p> <hd id="AN0062963322-14">Community connections</hd> <p></p> <hd id="AN0062963322-15">Degree of help comparisons</hd> <p>Analyses were conducted to see if there were differences among residential setting groups and the degree to which PWIDs needed (i.e. none, little, moderate, complete) help with daily activities on the index of community connections. Results indicated a significant interaction between residential setting and degree of help on the frequency in which participants felt connections with the community, <emph>F</emph><subs>9,698</subs> = 2.13, <emph>P</emph> = 0.03. A main effect for residential setting was indicated, <emph>F</emph><subs>3,698</subs> = 31.34, <emph>P</emph> < 0.001. No main effect for degree of help was indicated, <emph>F</emph><subs>3,698</subs> = 0.36, <emph>P</emph> = 0.78. In light of the significant interaction, simple main effects for degree of help within each residential setting were investigated. Refer to Table 4 for the means and SDs. There was no simple main effect for degree of help within those living in group homes, <emph>F</emph><subs>3,134</subs> = 1.30, <emph>P</emph> = 0.28. There was no simple main effect for degree of help within those living in independent homes, <emph>F</emph><subs>3,83</subs> = 2.13, <emph>P</emph> = 0.10. There was no simple main effect found within family model homes, <emph>F</emph><subs>3,56</subs> = 0.89, <emph>P</emph> = 0.45. There was a simple main effect found within those living at home, <emph>F</emph><subs>3,425</subs> = 5.81, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses revealed that for those needing no help the frequency of community connections was significantly lower than for those needing moderate or complete help. No other comparisons were significant.</p> <p>4 Descriptive statistics for residential settings and the degree of help needed on the index of community connections</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Residential setting</bold></th><th><bold>Degree of help needed</bold></th></tr><tr><th><bold>None</bold></th><th><bold>Little</bold></th><th><bold>Moderate</bold></th><th><bold>Complete</bold></th><th><bold>Total</bold></th></tr></thead><tbody valign="top"><tr><td>Group home</td><td>14.73 (5.80)</td><td>11.00 (5.78)</td><td>12.17 (4.88)</td><td>11.92 (5.22)</td><td>12.08 (5.26)</td></tr><tr><td>Independent home</td><td>8.18 (5.13)</td><td>10.65 (4.91)</td><td>11.20 (5.72)</td><td>7.71 (4.39)</td><td>9.40 (5.22)</td></tr><tr><td>Family model home</td><td>11.88 (5.96)</td><td>10.86 (5.02)</td><td>10.79 (4.34)</td><td>13.50 (4.48)</td><td>11.40 (4.74)</td></tr><tr><td>Lives at home</td><td>6.60 (4.06)</td><td>7.52 (3.82)</td><td>8.34 (4.48)</td><td>9.09 (4.45)</td><td>7.95 (4.32)</td></tr><tr><td>Total</td><td>7.93 (5.13)</td><td>8.83 (4.69)</td><td>9.57 (4.88)</td><td>10.25 (4.95)</td><td>9.22 (4.96)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0062963322-16">Community connections by residential setting and type of respondent</hd> <p>There was no interaction between residential settings and type of respondent on the index of community connections, <emph>F</emph><subs>3,694</subs> = 1.74, <emph>P</emph> = 0.16. There was a main effect for residential setting, <emph>F</emph><subs>3,694</subs> = 14.93, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses revealed those living in group homes (M = 12.11, SD = 5.20) had more frequent community connections than both those in independent homes (M = 9.20, SD = 5.11) and those living at home (M = 7.96, SD = 4.34). Those living in independent homes reported less frequent community connections than those in family model homes (M = 11.40, SD = 4.70). Those in family model homes reported more frequent community connections than those living at home. Finally, a significant main effect for type of respondent was indicated, suggesting families (M = 8.30, SD = 4.62) reported less frequent community connections than support workers (M = 12.20, SD  = 4.83), <emph>F</emph><subs>1,694</subs> = 34.20, <emph>P</emph> < 0.001.</p> <hd id="AN0062963322-17">The effect of residential setting on individual community connections</hd> <p>Additional analyses were conducted to evaluate residential setting group differences on each of the items comprising the community connections index. Group differences were found on all of the individual items. Table 5 presents the descriptive statistics and each item's respective anova result. Please note that the decision criteria were adjusted to control for multiple comparisons. Consistent across items 1–5, those living at home reported significantly less opportunity to develop community connections than those living in group, independent and family model homes. As for items 1–3 and 5, no other comparisons were significant. For item 4, those living in independent homes reported less help with arranging support with family, friends or neighbours than those living in group homes. Finally on item 6, those living at home reported to have participated in community activities significantly less than those in group and family model homes. All other comparisons were not significant.</p> <p>5 Residential setting effects on community connections</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Individual question</bold></th><th><bold>Mean (SD) ratings</bold></th><th><bold><italic>F</italic>‐test results</bold></th></tr><tr><th><bold>Group home</bold></th><th><bold>Independent home</bold></th><th><bold>Family model home</bold></th><th><bold>Lives at home</bold></th><th><bold>d.f.</bold></th><th><italic><bold>F</bold></italic>*</th></tr></thead><tbody valign="top"><tr><td>1. If you want to use typical supports in your community, do either the staff who help you plan or who provide support help connect you to these supports?</td><td>2.54 (0.74)</td><td>2.18 (0.84)</td><td>2.21 (0.92)</td><td>1.75 (0.83)</td><td>3, 453</td><td>24.15</td></tr><tr><td>2. If your family member wants to use typical supports in your community, do either the staff who help plan or who provide support help connect him/her to these supports?</td><td>2.66 (0.61)</td><td>2.41 (0.75)</td><td>2.36 (0.87)</td><td>1.74 (0.80)</td><td>3, 468</td><td>43.68</td></tr><tr><td>3. If your family member would like to provide some of the supports he/she needs, do either the staff who help you plan or who provide support help him/her do this?</td><td>2.60 (0.69)</td><td>2.24 (0.83)</td><td>2.27 (0.90)</td><td>1.62 (0.81)</td><td>3, 424</td><td>39.14</td></tr><tr><td>4. If you would like to use family, friends or neighbours to provide some of the supports your family needs, do either the staff who help you plan or who provide support help you do this?</td><td>2.64 (0.67)</td><td>2.15 (0.86)</td><td>2.24 (0.87)</td><td>1.59 (0.81)</td><td>3, 398</td><td>39.52</td></tr><tr><td>5. Do you feel that your family member has access to community activities?</td><td>2.74 (0.53)</td><td>2.59 (0.62)</td><td>2.77 (0.53)</td><td>2.31 (0.69)</td><td>3, 652</td><td>20.93</td></tr><tr><td>6. Does your family member participate in community activities?</td><td>2.48 (0.64)</td><td>2.26 (0.73)</td><td>2.46 (0.68)</td><td>2.15 (0.73)</td><td>3, 659</td><td>8.70</td></tr></tbody></table> </ephtml> </p> <p>4 *  <emph>F</emph>‐statistics were significant after controlling for multiple comparisons (adjusted α = 0.008).</p> <hd id="AN0062963322-18">Satisfaction with services and supports</hd> <p></p> <hd id="AN0062963322-19">Degree of help comparisons</hd> <p>Analyses were conducted to see if there were differences among residential setting groups and the degree to which PWIDs needed (i.e. none, little, moderate, complete) help with daily activities on the index of satisfaction with services and supports. Table 6 provides the descriptive statistics for the following analyses. Results failed to find an interaction between residential setting and degree of help, <emph>F</emph><subs>9,692</subs> = 1.55, <emph>P</emph> = 0.13. A main effect for residential setting was found, <emph>F</emph><subs>3,692</subs> = 1.55, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses revealed that both those living in group (M = 14.98, SD = 6.30) and those living in family model (M = 14.97, SD = 5.77) homes had significantly greater satisfaction with services than those living in independent homes (M = 10.31, SD = 6.05) and living at home (M = 10.73, SD = 5.94). No other comparisons were significant. A significant main effect was also found for the degree to which PWIDs required help, <emph>F</emph><subs>3,692</subs> = 3.11, <emph>P</emph> = 0.03. <emph>Post hoc</emph> analyses found that those requiring either no (M = 9.97, SD = 6.32) or little (M = 10.73, SD = 5.95) help were less frequently satisfied than those requiring either moderate (M = 12.89, SD = 6.13) or complete (M = 13.13, SD = 6.35) help. No other comparisons were significant.</p> <p>6 Residential setting effects on individual items regarding satisfaction with services and supports</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Individual question</bold></th><th><bold>Mean (SD) ratings</bold></th><th><bold><italic>F</italic>‐test results</bold></th></tr><tr><th><bold>Group home</bold></th><th><bold>Independent home</bold></th><th><bold>Family model home</bold></th><th><bold>Lives at home</bold></th><th><bold>d.f.</bold></th><th><italic><bold>F</bold></italic>*</th></tr></thead><tbody valign="top"><tr><td>1. Are you satisfied with the day/employment services and supports your family receives?</td><td>1.36 (1.42)</td><td>1.29 (1.37)</td><td>1.80 (1.26)</td><td>1.69 (1.16)</td><td>3, 698</td><td>4.75</td></tr><tr><td>2. Are you satisfied with the day/employment services and supports that your family member receives?</td><td>2.28 (1.10)</td><td>1.59 (1.26)</td><td>2.30 (0.98)</td><td>1.98 (1.06)</td><td>3, 696</td><td>8.55</td></tr><tr><td>3. Are you satisfied with the residential services and supports your family receives?</td><td>1.57 (1.41)</td><td>1.04 (1.24)</td><td>1.71 (1.36)</td><td>0.92 (1.17)</td><td>3, 689</td><td>13.68</td></tr><tr><td>4. Are you satisfied with the residential services and supports your family member receives?</td><td>2.66 (0.74)</td><td>1.56 (1.28)</td><td>2.46 (0.95)</td><td>1.01 (1.21)</td><td>3, 687</td><td>89.35</td></tr><tr><td>5. Overall, are you satisfied with the services and supports your family member currently receives?</td><td>2.63 (0.75)</td><td>1.92 (1.12)</td><td>2.51 (0.73)</td><td>1.94 (0.95)</td><td>3, 698</td><td>24.09</td></tr><tr><td>6. Are you familiar with the process for filing a complaint or grievance regarding services you receive or staff who provide them?</td><td>1.55 (1.36)</td><td>0.99 (1.24)</td><td>1.38 (1.29)</td><td>0.93 (1.18)</td><td>3, 701</td><td>9.95</td></tr><tr><td>7. Are you satisfied with the way complaint/grievances are handled and resolved?</td><td>1.53 (1.35)</td><td>0.73 (1.17)</td><td>1.10 (1.23)</td><td>0.62 (1.02)</td><td>3, 694</td><td>23.52</td></tr></tbody></table> </ephtml> </p> <p>5 *  <emph>F</emph>‐statistics were significant after controlling for multiple comparisons (adjusted α = 0.006).</p> <hd id="AN0062963322-20">Satisfaction with services and supports by residential setting and type of respondent</hd> <p>An interaction on the index of satisfaction with services and supports items was found between residential settings and the type of respondent, <emph>F</emph><subs>3,689</subs> = 3.09, <emph>P</emph> = 0.03. A main effect was indicated for residential setting, <emph>F</emph><subs>3,689</subs> = 12.59, <emph>P</emph> < 0.001. A significant main effect was also indicated for respondent type, <emph>F</emph><subs>1,689</subs> = 10.49, <emph>P</emph> < 0.001. In light of the interaction, simple main effects of respondent type were examined within each residential setting. There was no simple main effect for respondent type with group homes [<emph>t</emph>(<reflink idref="bib133" id="ref26">133</reflink>) = −0.54, <emph>P</emph> = 0.59], independent homes [<emph>t</emph>(<reflink idref="bib83" id="ref27">83</reflink>) = −0.67, <emph>P</emph> = 0.50] or family model homes [<emph>t</emph>(<reflink idref="bib56" id="ref28">56</reflink>) = −1.57, <emph>P</emph> = 0.12]. Within those living at home, family members (M = 10.04, SD = 5.62) reported significantly less frequent satisfaction than support workers (M = 14.36, SD = 6.79), <emph>t</emph>(<reflink idref="bib417" id="ref29">417</reflink>) = −5.31, <emph>P</emph> < 0.001.</p> <hd id="AN0062963322-21">The effect of residential setting on individual items of satisfaction with services and suppo...</hd> <p>Further analyses were conducted on each of the individual items comprising the satisfaction index. Overall, the differences suggest that those living at home tend to be less satisfied than those living in group setting. Group differences were found on seven of the items. Table 6 presents the descriptive statistics and each item's respective anova result. Please note that the decision criteria were adjusted to control for multiple comparisons. <emph>Post hoc</emph> analyses revealed that on item 1, those living at home had more frequent satisfaction with day/employment services received by the family compared with those in group and independent home settings. In terms of day/employment services the PWID receives (i.e. item 2), those in either group or family model homes reported greater satisfaction than those in independent homes. Those living at home reported greater frequency of satisfaction than those living in independent homes. For item 3 and 5, those in group and family model homes were more satisfied than both those in independent homes and those living at home. For item 4, significantly more frequent satisfaction was found for those living in group and family model homes compared with independent and living‐at‐home situations. Furthermore, greater satisfaction was found in independent home settings than living at home. For item 6, more frequent satisfaction was reported in group homes compared with independent and living‐at‐home settings. Additionally, more frequent satisfaction was found in independent settings compared with living at home. Looking at item 7, group homes had more frequent satisfaction than those in independent and living‐at‐home settings. Finally, for those living in family model homes, more frequent satisfaction was reported than those living at home.</p> <hd id="AN0062963322-22">Overall perceptions of outcomes</hd> <p></p> <hd id="AN0062963322-23">Degree of help comparisons</hd> <p>An analysis was conducted to see if there were differences among residential setting groups and the degree to which PWIDs needed (i.e. none, little, moderate, complete) help with daily activities on the index of the frequency participants experienced positive outcomes from services. Results failed to find an interaction between residential setting and degree of help, <emph>F</emph><subs>9,690</subs> = 1.36, <emph>P</emph> = 0.20. A significant main effect for residential setting was found, <emph>F</emph><subs>3,690</subs> = 14.27, <emph>P</emph> < 0.001. <emph>Post hoc</emph> analyses revealed that both group (M = 12.96, SD = 4.72) and family model homes (M = 9.45, SD = 5.90) reported significantly more frequent positive outcomes than those either living in independent homes (M = 13.17, SD = 4.92) or living at home (M = 9.75, SD = 5.33). No other comparisons were significant. A significant main effect for degree of help was also indicated, <emph>F</emph><subs>3,690</subs> = 3.84, <emph>P</emph> = 0.01. <emph>Post hoc</emph> analyses revealed that those needing no help (M = 8.79, SD = 5.97) reported less frequent positive outcomes than those needing moderate (M = 11.42, SD = 5.17) or complete help (M = 11.54, SD = 5.29). No other comparisons were significant.</p> <hd id="AN0062963322-24">Perceived outcomes by residential setting and type of respondent</hd> <p>An interaction between residential settings and type of respondent was found on the index of perceived outcomes, <emph>F</emph><subs>3,687</subs> = 5.69, <emph>P</emph> < 0.001. A main effect was indicated for residential setting, <emph>F</emph><subs>3,687</subs> = 10.22, <emph>P</emph> < 0.001. No main effect was indicated for respondent type, <emph>F</emph><subs>1,687</subs> = 1.00, <emph>P</emph> = 0.32. Because of the interaction, simple main effects of respondent type were examined in each of residential settings. There were no differences between family or support worker respondents for those living in group homes [<emph>t</emph>(<reflink idref="bib133" id="ref30">133</reflink>) = 0.92, <emph>P</emph> = 0.36], independent homes [<emph>t</emph>(<reflink idref="bib82" id="ref31">82</reflink>) = 0.47, <emph>P</emph> = 0.64] and family model homes [<emph>t</emph>(<reflink idref="bib56" id="ref32">56</reflink>) = −0.21, <emph>P</emph> = 0.84]. For those living at home, support workers (M = 12.69, SD = 5.85) reported a significantly greater frequency of positive outcomes than family respondents (M = 9.22, SD = 5.10), <emph>t</emph>(<reflink idref="bib416" id="ref33">416</reflink>) = −4.75, <emph>P</emph> < 0.001.</p> <hd id="AN0062963322-25">The effect of residential setting on individual items of perceived outcomes</hd> <p>Analyses were conducted on each of the individual items comprising the outcomes index to identify differences according to residential setting groups. Six of the items were asked of all participants, whereas, two items were only asked of those participants whose family member lived at home. These two items were not assessed. Standard criteria judgment was adjusted to control for multiple comparisons. Table 7 provides the descriptive statistics and each item's respective anova result. Looking at item 1, those living at home reported more frequent positive outcomes from day/employment services for their family than those living in group and independent homes. Those living in family model homes also reported more positive outcomes than those living in independent homes. For item 2, those living in either group or family model homes reported more positive outcomes from day/employment services for PWIDs than those living in independent homes. Furthermore, those in independent homes reported more positive outcomes than those living at home. For item 3, those living in either group or family model homes reported more positive outcomes from residential services for their family than those in either independent homes or living at home. For item 4, those living at home were said to have less frequent positive outcomes from residential services for their family member than the other three settings. Furthermore, those in either group or family model homes had more positive outcomes than those living in independent homes. For item 5, those living in family model homes were reported to have more frequent overall positive outcomes for their family than those living in independent home or living at home. For item 6, those living in group homes were said to have more frequent overall positive outcomes for PWIDs than those in independent homes or living at home. Finally, those living in family model homes were said to have more positive outcomes than those living at home.</p> <p>7 Residential setting effects on individual items regarding perceived positive outcomes with services and supports</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Individual question</bold></th><th><bold>Mean (SD) ratings</bold></th><th><bold><italic>F</italic>‐test results</bold></th></tr><tr><th><bold>Group home</bold></th><th><bold>Independent home</bold></th><th><bold>Family model home</bold></th><th><bold>Lives at home</bold></th><th><bold>d.f.</bold></th><th><italic><bold>F</bold></italic>*</th></tr></thead><tbody valign="top"><tr><td>1. Do you feel that day/employment services and supports have made a positive difference in the life of your family?</td><td>1.44 (1.41)</td><td>1.28 (1.37)</td><td>1.90 (1.26)</td><td>1.92 (1.16)</td><td>3, 703</td><td>9.70</td></tr><tr><td>2. Do you feel that the day/employment services and supports have made a positive difference in the life of your family member?</td><td>2.29 (1.08)</td><td>1.66 (1.32)</td><td>2.30 (1.06)</td><td>1.13 (0.06)</td><td>3, 698</td><td>6.09</td></tr><tr><td>3. Do you feel that the residential services and supports have made a positive difference in the life of your family?</td><td>2.01 (1.33)</td><td>1.30 (1.36)</td><td>2.12 (1.29)</td><td>0.98 (1.23)</td><td>3, 686</td><td>30.65</td></tr><tr><td>4. Do you feel that the residential services and supports have made a positive difference in the life of your family member?</td><td>2.73 (0.64)</td><td>1.63 (1.36)</td><td>2.43 (1.11)</td><td>1.07 (1.28)</td><td>3, 683</td><td>78.77</td></tr><tr><td>5. Overall, do you feel that services and supports have made a positive difference in the life of your family?</td><td>1.96 (1.32)</td><td>1.72 (1.36)</td><td>2.39 (0.98)</td><td>1.87 (1.11)</td><td>3, 688</td><td>4.23</td></tr><tr><td>6. Overall, do you feel that services and support have made a positive difference in the life of your family member</td><td>2.70 (0.69)</td><td>2.07 (1.20)</td><td>2.48 (0.80)</td><td>2.04 (1.05)</td><td>3, 686</td><td>17.07</td></tr></tbody></table> </ephtml> </p> <p>6 *  <emph>F</emph>‐statistics were significant after controlling for multiple comparisons (adjusted α = 0.008).</p> <hd id="AN0062963322-26">Discussion</hd> <p></p> <hd id="AN0062963322-27">Key findings</hd> <p>The survey indicates a significant number of adults still residing with family and in group homes; however, a significant number (28%) were living in an independent home/apartment, 25% of which were owned by the respondents (largely family members) and 11% owned by the PWIDs themselves. This shows a significant trend toward more individualized residential options developed by individuals and families. The numbers within residential settings also suggest a move away from larger settings with only 23% living in settings with four or more persons. Overall satisfaction with residential supports was not particularly strong with only 58.8% indicating they were always or usually satisfied with the residential supports their family member receives.</p> <p>The data raise concerns about the access to supports and service delivery where there was a general trend of poorer results for those living in family homes and independent settings than those in group homes and family model homes. This was true not only of access to services but also of crisis support, respect from support staff, and health and safety. These results are somewhat surprising for the latter issues although previous studies have also found that access to supports was less in more independent settings ([<reflink idref="bib7" id="ref34">7</reflink>]). With regards to access to needed supports, this may reflects the fact that those at home or living more independently require less than those in more formal services. It should be noted, although, that what was asked was access to <emph>needed</emph> services indicating that this is perceived as a gap and not merely an absence of need.</p> <p>Similarly, satisfaction levels with residential supports and perception of positive outcomes of services and supports were generally lower among those living at home or independently than those in more formal services. This is somewhat surprising and at odds with previous research based on consumer surveys and mixed respondent surveys that found higher levels of satisfaction and well‐being in smaller settings ([<reflink idref="bib19" id="ref35">19</reflink>]) and higher levels of resident satisfaction for both independent and family home situations ([<reflink idref="bib4" id="ref36">4</reflink>]). Our results suggest that more attention needs to be paid to the availability and quality of supports to those not in group homes or family model homes. It also may suggest that many of those are not living in the family home by choice so much as a lack of other options.</p> <p>Also of concern was the residential comparisons related to community connections of those living in the family home and, to a lesser degree, those living in independent apartments. Both sets of respondents reported the PWID as having fewer community connections and receiving less assistance in making connections than those in group homes and family model homes. This is not completely surprising as previous research in other jurisdictions has found less access to planned activities in more independent settings ([<reflink idref="bib7" id="ref37">7</reflink>]), which may impact community connections. [<reflink idref="bib4" id="ref38">4</reflink>]) found poor social integration (activities with non‐disabled peers) in all types of residential settings but virtually non‐existent in group homes.</p> <p>Those living in the family home or independently did report more choice and control in hiring and managing staff. This confirms what would be expected of these settings and is consistent with other recent findings ([<reflink idref="bib7" id="ref39">7</reflink>]; [<reflink idref="bib8" id="ref40">8</reflink>]; [<reflink idref="bib19" id="ref41">19</reflink>]).</p> <p>Overall, the findings are generally consistent with previous findings on greater choice and control in smaller settings but variable outcomes for measures of satisfaction and access to supports ([<reflink idref="bib4" id="ref42">4</reflink>]; [<reflink idref="bib7" id="ref43">7</reflink>]; [<reflink idref="bib13" id="ref44">13</reflink>]). [<reflink idref="bib19" id="ref45">19</reflink>]), based on consumer surveys, also found poorer outcomes regarding perceiving staff to be 'nice' in family homes than in larger supported settings. [<reflink idref="bib7" id="ref46">7</reflink>]) found that supported‐living residents, when compared with group home residents, had greater choice and took part in more community‐based activities; the latter would be at odds with the present findings, but consistent with the current findings were unfavourable outcomes associated with supported living such as fewer planned activities and consistent and effective access to assessment and teaching supports.</p> <p>While there were differences on degree of help across residential types, which followed what would be expected (i.e. greater need correlating with more formal settings), more puzzling is the results that showed those requiring little or no support reported as having lower satisfaction and choice and control. The latter was true not only for out‐of‐home residence but also for PWID living at home. This is at odds with [<reflink idref="bib4" id="ref47">4</reflink>]), who found difference based on level of ID, but this was not sufficient to explain residence‐related differences. The reason for our findings are unclear but may be related to the fact that these were proxy respondents who may perceive greater choice where there is more support to assist in choice making or, conversely, the lack of supports may be impairing choice and control for more capable individuals.</p> <hd id="AN0062963322-28">Limitations</hd> <p>This study did not use formal measures of ID such as IQ or adaptive behaviour scores as this was not possible to obtain using a survey method (many families would not know these scores and many may not have had testing to establish these conclusively). The degree to which the current measures of <emph>degree of help required</emph> mirrors these measures is an open question; however, <emph>degree of help required</emph> provides a more general measure than the above and arguably is a better indicator of the level of service and support needs than the above. However, the measures employed in this study may not have sufficient sensitivity to fully identify the impact of different levels of ID or other measures such as challenging behaviour rates across settings.</p> <p>A further limitation is the use of proxy measures as opposed to self‐report. While the different types of proxies were allowed for in the analysis, it is unclear how well these reflect the actual experience of the PWID. [<reflink idref="bib2" id="ref48">2</reflink>]) report statistically different outcomes regarding quality of life but the nature of these difference varied, for example proxies rated levels of self‐determination lower than self‐respondents but reported higher levels of physical and emotional well‐being; however, the responses of support workers were found to be more positive generally than families in many cases.</p> <p>A final limitation is the lack of data regarding the specific level of service people received. While all respondents received some services, the study does not report comparative data on specific levels of service, which could influence several of the results on some measures, notably satisfaction.</p> <hd id="AN0062963322-29">Implications</hd> <p>The findings suggests that, if as research indicates that consumers prefer smaller settings and generally have greater outcomes with regards to satisfaction and well‐being ([<reflink idref="bib19" id="ref49">19</reflink>]), more attention needs to be given to ensure that effective supports are provided in these settings. The data may also suggests that service systems, while promoting more independent options, have failed to reorient their support to these settings from more formal services such as group homes and as a result may in fact be impairing choice and control for some individuals.</p> <hd id="AN0062963322-30">Acknowledgements</hd> <p>The authors wish to thank the British Columbia Ministry of Children and Family Development, Community Living British Columbia and the Human Services Research Institute for their support of this research. We would also like to thank the reviewers for their detailed comments on the manuscript.</p> <ref id="AN0062963322-31"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref3" type="bt">1</bibl> <bibtext> Those in independent settings would be receiving support of some form and hence would fall into the general 'supported living' category. 'Family model home' refers to adults living in the homes of non‐relatives who are paid to provide support (see Stainton <emph>et al</emph>. 2006 for definitions).</bibtext> </blist> <blist> <bibl id="bib2" idref="ref48" type="bt">2</bibl> <bibtext> Note this question streaming was controlled for when the overall index for choice and control was developed.</bibtext> </blist> </ref> <ref id="AN0062963322-32"> <title> References </title> <blist> <bibtext> Alba K., Prouty R., Scott N. & Lakin K. C. (2008) Changes in populations of residential settings for persons with intellectual and developmental disabilities over a 30‐year period, 1977–2007. Intellectual and Developmental Disabilities 46, 257 – 60.</bibtext> </blist> <blist> <bibtext> Bonham G. S., Basehart S., Schalock R. L., Marchand N. K. & Rumenap J. N. (2004) Consumer‐based quality of life assessment: The Maryland Ask Me! Project. Mental Retardation 42, 338 – 55.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref1" type="bt">3</bibl> <bibtext> Braddock D., Emerson E., Felce D. & Stancliffe R. J. (2001) Living circumstances of children and adults with mental retardation or developmental disabilities in the United States, Canada, England and Wales, and Australia. Mental Retardation and Developmental Disabilities Research Reviews 7, 115 – 21.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref9" type="bt">4</bibl> <bibtext> Burchard S. N., Hasazi J. S., Gordon L. R. & Yoe J. (1991) An Examination of lifestyle and adjustment in three community residential alternatives. Research in Developmental Disabilities 12, 127 – 42.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref19" type="bt">5</bibl> <bibtext> Community Living British Columbia (CLBC) (2009) Annual Report. CLBC, Vancouver, BC.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref4" type="bt">6</bibl> <bibtext> Emerson E. & Hatton C. (1994) Moving Out: Relocation from Hospital to Community. Her Majesty's Stationery Office, London.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref12" type="bt">7</bibl> <bibtext> Emerson E., Robertson J., Gregory N., Hatton C., Kessissoglou S., Hallam A. et al. (2001) Quality and costs of supported living residences and group homes in the United Kingdom. American Journal on Mental Retardation 106, 401 – 15.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref40" type="bt">8</bibl> <bibtext> Finlay W. M. L., Walton C. & Antaki C. (2008) Promoting choice and control in residential services for people with learning disabilities. Disability & Society 23, 349 – 60.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref10" type="bt">9</bibl> <bibtext> Howe J., Horner R. H. & Newton J. S. (1998) Comparison of supported living and traditional residential services in the state of Oregon. Mental Retardation 36, 1 – 11.</bibtext> </blist> <blist> <bibtext> Human Services Research Institute (HSRI) and National Association of State Directors of Developmental Disabilities Services (NASDDDS) (2001) Family Survey: Phase II Technical Report. HSRI and NASDDDS, Cambridge, MA; Alexandria, VA.</bibtext> </blist> <blist> <bibtext> Kim S., Larson S. A. & Lakin K. C. (2001) Behavioural outcomes of deinstitutionalisation for people with intellectual disability: a review of US studies conducted between 1980 and 1999. Journal of Intellectual & Developmental Disability 26, 35 – 50.</bibtext> </blist> <blist> <bibtext> Kozma A., Mansell J. & Beadle‐Brown J. (2009) Outcomes in different residential settings for people with intellectual disability: a systematic review. American Journal on Intellectual and Developmental Disabilties 114, 193 – 222.</bibtext> </blist> <blist> <bibtext> McConkey R., Sowney M., Milligan V. & Barr O. (2004) Views of people with intellectual disabilities of their present and future living arrangements. Journal of Policy and Practice in Intellectual Disabilities 1, 115 – 25.</bibtext> </blist> <blist> <bibtext> Mansell J. (2006) Deinstitutionalisation and community living: progress, problems and priorities. Journal of Intellectual & Developmental Disability 31, 65 – 76.</bibtext> </blist> <blist> <bibtext> Stainton T., Hole R., Charles G., Yodanis C., Powell S., Crawford C. et al. (2006) Residential Options for Adults with Developmental Disabilities: Quality and Cost Outcomes. University of British Columbia, Vancouver, BC.</bibtext> </blist> <blist> <bibtext> Stainton T., Hole R., Charles G., Yodanis C., Powell S., Crawford C. et al. (2010) The Survey of Family Members of People with Disability Who are Receiving Services from Community Living British Columbia. A Report. University of British Columbia, Vancouver, BC.</bibtext> </blist> <blist> <bibtext> Stancliffe R. J. & Keane S. (2000) Outcomes and costs of community living: a matched comparison of group homes and semi‐independent living. Journal of Intellectual & Developmental Disability 25, 281 – 305.</bibtext> </blist> <blist> <bibtext> Stancliffe R. J. & Lakin K. C. (2005) Context and issues in research on expenditures and outcomes of community supports. In: Costs and Outcomes of Community Services for People with Intellectual Disabilities (eds R. J. Stancliffe & K. C. Lakin), pp. 1 – 22. Paul H. Brookes Publishing Co., Baltimore, MD.</bibtext> </blist> <blist> <bibtext> Stancliffe R. J., Lakin K. C., Taub S., Chiri G. & Byun S. (2009) Satisfaction and sense of well being among Medicaid ICF/MR and HCBS recipients in six states. Intellectual and Developmental Disabilities 47, 62 – 83.</bibtext> </blist> <blist> <bibtext> Statistics Canada (2009) Participation and Activity Limitation Survey Public Use Microdata File User Guide. Minister of Industry, Ottawa, ON.</bibtext> </blist> <blist> <bibtext> Young L., Sigafoos J., Suttie J., Ashman A. & Grevell P. (1998) Deinstitutionalisation of persons with intellectual disabilities: a review of Australian studies. Journal of Intellectual & Developmental Disability 23, 155 – 70.</bibtext> </blist> </ref> <aug> <p>By T. Stainton; J. Brown; C. Crawford; R. Hole and G. Charles</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib14" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib21" firstref="ref5"></nolink> <nolink nlid="nl3" bibid="bib11" firstref="ref6"></nolink> <nolink nlid="nl4" bibid="bib12" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib17" firstref="ref11"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref13"></nolink> <nolink nlid="nl7" bibid="bib13" firstref="ref15"></nolink> <nolink nlid="nl8" bibid="bib19" firstref="ref16"></nolink> <nolink nlid="nl9" bibid="bib16" firstref="ref18"></nolink> <nolink nlid="nl10" bibid="bib10" firstref="ref20"></nolink> <nolink nlid="nl11" bibid="bib20" firstref="ref22"></nolink> <nolink nlid="nl12" bibid="bib133" firstref="ref26"></nolink> <nolink nlid="nl13" bibid="bib83" firstref="ref27"></nolink> <nolink nlid="nl14" bibid="bib56" firstref="ref28"></nolink> <nolink nlid="nl15" bibid="bib417" firstref="ref29"></nolink> <nolink nlid="nl16" bibid="bib82" firstref="ref31"></nolink> <nolink nlid="nl17" bibid="bib416" firstref="ref33"></nolink>
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  Data: Comparison of Community Residential Supports on Measures of 'Information & Planning'; 'Access to & Delivery of Supports'; 'Choice & Control'; 'Community Connections'; 'Satisfaction'; and, 'Overall Perception of Outcomes'
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  Data: <searchLink fieldCode="AR" term="%22Stainton%2C+T%2E%22">Stainton, T.</searchLink><br /><searchLink fieldCode="AR" term="%22Brown%2C+J%2E%22">Brown, J.</searchLink><br /><searchLink fieldCode="AR" term="%22Crawford%2C+C%2E%22">Crawford, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Hole%2C+R%2E%22">Hole, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Charles%2C+G%2E%22">Charles, G.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+Disability+Research%22"><i>Journal of Intellectual Disability Research</i></searchLink>. Aug 2011 55(8):732-745.
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  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Independent+Living%22">Independent Living</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Group+Homes%22">Group Homes</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+Analysis%22">Comparative Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Residential+Programs%22">Residential Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Place+of+Residence%22">Place of Residence</searchLink><br /><searchLink fieldCode="DE" term="%22Planning%22">Planning</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Information%22">Access to Information</searchLink><br /><searchLink fieldCode="DE" term="%22Locus+of+Control%22">Locus of Control</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Determination%22">Self Determination</searchLink><br /><searchLink fieldCode="DE" term="%22Community+Programs%22">Community Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Satisfaction%22">Satisfaction</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+Measures%22">Attitude Measures</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Canada%22">Canada</searchLink>
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  Data: 10.1111/j.1365-2788.2010.01378.x
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  Data: 0964-2633
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  Data: Background: This paper reports on some of the findings of a large-scale survey (n = 852) of family members and support staff of adults with intellectual disabilities receiving community living services in British Columbia, Canada, concentrating on comparison of outcomes across four types of community residential settings: group homes, family model homes, independent home or apartment, and family home. Method: Comparisons were conducted on six domains: "information and planning"; "access to and delivery of supports"; "choice and control"; "community connections"; "satisfaction"; and, "overall perception of outcomes". Where applicable, further multivariate analyses were undertaken to determine the effect of the degree of help required by the residents and the respondent type. Results: Findings indicate that on all measures other than choice and control, group homes and family model homes showed better outcomes than either independent settings or family homes. Conclusion: The findings may indicate that the move to more independent living settings is not being accompanied by appropriate supports.
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  Data: EJ932668
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        Value: 10.1111/j.1365-2788.2010.01378.x
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      – Text: English
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        PageCount: 14
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      – SubjectFull: Independent Living
        Type: general
      – SubjectFull: Mental Retardation
        Type: general
      – SubjectFull: Group Homes
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Comparative Analysis
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      – SubjectFull: Adults
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      – SubjectFull: Planning
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      – SubjectFull: Self Determination
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      – SubjectFull: Community Programs
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      – SubjectFull: Attitude Measures
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      – SubjectFull: Canada
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      – TitleFull: Comparison of Community Residential Supports on Measures of 'Information & Planning'; 'Access to & Delivery of Supports'; 'Choice & Control'; 'Community Connections'; 'Satisfaction'; and, 'Overall Perception of Outcomes'
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