Evaluation of a staffed ordinary house for children with severe learning difficulties

The concept of living in an ordinary house in an ordinary street is becoming well accepted by those providing services to people with mental handicaps. Numerous examples have been described, but little in the way of service evaluation has been done. It is important to demonstrate that the quality of life is better in 'smaller units' and that institutional patterns of care are not being reproduced in the community. An observational study of small homely units for adults with mental handicaps has been carried out and has shown that the quality of life is better. This paper reports an observational study of the quality of care in a small staffed house for children with severe learning difficulties. The rate and content of naturally occurring interaction patterns were observed. The Child Management Practices Questionnaire was also administered. The results show that these children are enjoying a better standard of care than that found in hospital studies. However, some management practices were found to be institutionally orientated. For example, there was restricted access to some areas of the house, a lack of personal possessions and staff served and supervised meals rather than eating with the children. The implications of the findings are discussed in relation to recent policy trends and alternative forms of care in the community.