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

doi:10.1136/bmjopen-2020-043358

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

^*Corresponding author for this work

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

5 Citations (Scopus)

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).

Original language	English
Article number	e043358
Journal	BMJ Open
Volume	11
Issue number	3
DOIs	https://doi.org/10.1136/bmjopen-2020-043358
Publication status	Published - 30 Mar 2021

Keywords

adult psychiatry
delirium & cognitive disorders
organisation of health services
psychiatry

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10.1136/bmjopen-2020-043358

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Hassiotis, A., Kouroupa, A., Jones, R., Morant, N., Courtenay, K., Hall, I., Crossey, V., Romeo, R., Taggart, L., Langdon, P., Ratti, V., Kirchner, V., & Lloyd-Evans, B. (2021). Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: A comparative cohort study protocol. BMJ Open, 11(3), Article e043358. https://doi.org/10.1136/bmjopen-2020-043358

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

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",

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

note = "Funding Information: Funding The study is funded by the National Institute of Health Research (NIHR) Health Services and Delivery Research (HS&DH) programme (project reference: 16/01/24). This publication presents independent research funded by the NIHR. Funding Information: Our dissemination plan was developed in close collaboration with PPI representatives. Our dissemination and impact activities will include open-access academic publications in high-impact journals, presentations at academic and non-academic conferences, hosting a free public webinar about the study and producing briefings for carer groups, charities and NHS services. A news-letter about the study progress will be sent to participants every 6 months and also available on the study website (https://www.ucl.ac.uk/psychiatry/research/epidemiology/pis/hassiotis-research-portfolio/intensive-support-teams). The research team will submit manuscripts to peer-reviewed publications, and authorship inclusion and order will be guided by levels of contribution. All publication material will acknowledge the funding contribution from the National Institute for Health Research. Requests for access to the anonymised data and statistical code should be addressed to the corresponding author once the study funder report and main papers are published. Publisher Copyright: {\textcopyright} Author(s) 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = mar,

day = "30",

doi = "10.1136/bmjopen-2020-043358",

language = "English",

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Hassiotis, A, Kouroupa, A, Jones, R, Morant, N, Courtenay, K, Hall, I, Crossey, V, Romeo, R, Taggart, L, Langdon, P, Ratti, V, Kirchner, V & Lloyd-Evans, B 2021, 'Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: A comparative cohort study protocol', BMJ Open, vol. 11, no. 3, e043358. https://doi.org/10.1136/bmjopen-2020-043358

TY - JOUR

T1 - Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour

T2 - A comparative cohort study protocol

AU - Hassiotis, Angela

AU - Kouroupa, Athanasia

AU - Jones, Rebecca

AU - Morant, Nicola

AU - Courtenay, Ken

AU - Hall, Ian

AU - Crossey, Vicky

AU - Romeo, Renee

AU - Taggart, Laurence

AU - Langdon, Peter

AU - Ratti, Victoria

AU - Kirchner, Vincent

AU - Lloyd-Evans, Brynmor

N1 - Funding Information: Funding The study is funded by the National Institute of Health Research (NIHR) Health Services and Delivery Research (HS&DH) programme (project reference: 16/01/24). This publication presents independent research funded by the NIHR. Funding Information: Our dissemination plan was developed in close collaboration with PPI representatives. Our dissemination and impact activities will include open-access academic publications in high-impact journals, presentations at academic and non-academic conferences, hosting a free public webinar about the study and producing briefings for carer groups, charities and NHS services. A news-letter about the study progress will be sent to participants every 6 months and also available on the study website (https://www.ucl.ac.uk/psychiatry/research/epidemiology/pis/hassiotis-research-portfolio/intensive-support-teams). The research team will submit manuscripts to peer-reviewed publications, and authorship inclusion and order will be guided by levels of contribution. All publication material will acknowledge the funding contribution from the National Institute for Health Research. Requests for access to the anonymised data and statistical code should be addressed to the corresponding author once the study funder report and main papers are published. Publisher Copyright: © Author(s) 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/3/30

Y1 - 2021/3/30

N2 - 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).

AB - 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).

KW - adult psychiatry

KW - delirium & cognitive disorders

KW - organisation of health services

KW - psychiatry

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DO - 10.1136/bmjopen-2020-043358

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JO - BMJ Open

JF - BMJ Open

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ER -

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

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