Exploring the relationships between costs and quality of services for adults with severe intellectual disabilities and the most severe challenging behaviours in Wales: A multivariate regression analysis

A survey in Wales of people with severe intellectual disabilities and the most severe challenging behaviour identified 17 adults living in new specialist community housing and 19 in traditional services. With the omission of two people from the latter group, this study explored the relationships between resident characteristics, service characteristics, service processes, quality of life outcome and costs in a series of mutivariate regression analyses. Higher accommodation costs were associated with lower resident ability and community services. Costs were inversely associated with setting size when the variable representing service model was omitted, but setting size did not otherwise add to explanation. Resident autonomy was associated with higher resident ability, community services or smaller setting size, and lower staff:resident ratios. Participation in domestic life was associated with higher resident ability and community services or smaller scale. More frequent community involvement was associated with higher resident ability and smaller setting size, with lower levels of challenging behaviour and greater individual orientation as subsidiary influences. Higher resident engagement in activity was associated with higher resident ability and the extent of interaction between staff and residents which, in turn, was primarily associated with service model. Variation in the various quality of life indicators measured did not contribute to the explanation of accommodation costs. Variation in accommodation costs did not contribute to the explanation of the level of staff:resident interaction or quality of life, neither did staff:resident ratios, after control for service model