Predicting Placement Breakdown: Individual and Environmental Factors Associated with the Success or Failure of Community Residential Placements for Adults with Intellectual Disabilities

Background Individuals with intellectual disabilities are more likely to experience a breakdown in their community residential placement if they display 'challenging' behaviour. However, some individuals with behaviour that poses a severe challenge live successfully in community services long-term, indicating that other factors are also important. This study seeks to test the validity of a proposed framework for placement breakdown that incorporates elements of Weiner's theory of helping behaviour, in particular, staff attributions of control about the causes of an individual's challenging behaviour. Method The study employed a between-subjects design with two non-experimental groups, controlling for the presence of challenging behaviour. One of these groups experienced a placement breakdown, whilst the other remained in the same placement. Staff completed questionnaires measuring a range of individual and service-related factors. Results No differences were found between the groups in overall levels of challenging behaviour, although the breakdown group displayed higher rates of 'intentional' antisocial behaviour. Breakdown was predicted by a combination of increased community self-sufficiency skills, attributions of a greater degree of control by the most senior members of staff, and lower levels of interaction and help from staff. Services in which a breakdown occurred were also of poorer overall quality, particularly in terms of staff resources and energy levels, the physical environment and administrative systems. Individuals experiencing breakdown were more likely to have had at least one acute behavioural or psychiatric admission. Conclusions Support was obtained for the proposed framework, indicating that staff attributions of control may play a mediating role between the challenging behaviour of an individual and the subsequent risk of placement breakdown. This has implications clinically in the identification of those at greater risk, given that this may not necessarily be those with the most severe challenging behaviour. Interventions to reduce this risk will need to address the way that staff think about challenging behaviour. Further research is required to test the validity of the framework.