Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

Angela Hassiotis; Athanasia Kouroupa; Leila Hamza; Louise Marston; Renee Romeo; Nahel Yaziji; Ian Hall; Peter E. Langdon; Ken Courtenay; Laurence Taggart; Nicola Morant; Vicky Crossey; Brynmor Lloyd-Evans

doi:10.1192/bjo.2023.74

Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

Angela Hassiotis, Athanasia Kouroupa, Leila Hamza, Louise Marston, Renee Romeo, Nahel Yaziji, Ian Hall, Peter E. Langdon, Ken Courtenay, Laurence Taggart, Nicola Morant, Vicky Crossey, Brynmor Lloyd-Evans

Norwich Medical School

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1 Citation (Scopus)

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Abstract

Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England.

Aims: To investigate the clinical and cost-effectiveness of IST models.

Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2.

Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable.

Conclusions: The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.

Original language	English
Article number	e116
Journal	BJPsych Open
Volume	9
Issue number	4
Early online date	26 Jun 2023
DOIs	https://doi.org/10.1192/bjo.2023.74
Publication status	Published - Jul 2023

Keywords

Intellectual disability
cost-effectiveness
developmental disorders
intensive support
outcome studies

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Hassiotis_etal_2023_BJPsychOpenFinal published version, 564 KBLicence: CC BY

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Hassiotis, A., Kouroupa, A., Hamza, L., Marston, L., Romeo, R., Yaziji, N., Hall, I., Langdon, P. E., Courtenay, K., Taggart, L., Morant, N., Crossey, V., & Lloyd-Evans, B. (2023). Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study. BJPsych Open, 9(4), Article e116. https://doi.org/10.1192/bjo.2023.74

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title = "Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study",

abstract = "Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England. Aims: To investigate the clinical and cost-effectiveness of IST models. Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2. Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable. Conclusions: The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.",

keywords = "Intellectual disability, cost-effectiveness, developmental disorders, intensive support, outcome studies",

author = "Angela Hassiotis and Athanasia Kouroupa and Leila Hamza and Louise Marston and Renee Romeo and Nahel Yaziji and Ian Hall and Langdon, {Peter E.} and Ken Courtenay and Laurence Taggart and Nicola Morant and Vicky Crossey and Brynmor Lloyd-Evans",

note = "Funding information: This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (reference number 16/01/24). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. A full version of the IST-ID study that this is part of has been published in https://www.journalslibrary.nihr.ac.uk/hsdr/CHDC1642/#/full-report.",

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month = jul,

doi = "10.1192/bjo.2023.74",

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Hassiotis, A, Kouroupa, A, Hamza, L, Marston, L, Romeo, R, Yaziji, N, Hall, I, Langdon, PE, Courtenay, K, Taggart, L, Morant, N, Crossey, V & Lloyd-Evans, B 2023, 'Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study', BJPsych Open, vol. 9, no. 4, e116. https://doi.org/10.1192/bjo.2023.74

Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study. / Hassiotis, Angela; Kouroupa, Athanasia; Hamza, Leila et al.
In: BJPsych Open, Vol. 9, No. 4, e116, 07.2023.

Research output: Contribution to journal › Article › peer-review

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T1 - Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

AU - Hassiotis, Angela

AU - Kouroupa, Athanasia

AU - Hamza, Leila

AU - Marston, Louise

AU - Romeo, Renee

AU - Yaziji, Nahel

AU - Hall, Ian

AU - Langdon, Peter E.

AU - Courtenay, Ken

AU - Taggart, Laurence

AU - Morant, Nicola

AU - Crossey, Vicky

AU - Lloyd-Evans, Brynmor

N1 - Funding information: This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (reference number 16/01/24). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. A full version of the IST-ID study that this is part of has been published in https://www.journalslibrary.nihr.ac.uk/hsdr/CHDC1642/#/full-report.

PY - 2023/7

Y1 - 2023/7

N2 - Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England. Aims: To investigate the clinical and cost-effectiveness of IST models. Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2. Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable. Conclusions: The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.

AB - Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England. Aims: To investigate the clinical and cost-effectiveness of IST models. Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2. Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable. Conclusions: The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.

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KW - cost-effectiveness

KW - developmental disorders

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ER -

Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

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Keywords

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