title: Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour.
abstract: BACKGROUND
  Out of area placements for people with challenging behaviour represent an expensive and often ineffective strategy for meeting the needs of this service user group.
  
  
  METHODS
  More than 800 agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Detailed data on identified individuals and the services they received were collected by interviewing key informants. Univariate and multivariate statistics were employed to identify predictors of out of area placement.
  
  
  RESULTS
  In total, 1458 people were identified. Full data were available for 901 participants, 97 of whom were placed out of area. Predictors of out of area placement included behaviours resulting in physical injury and exclusion from service settings, a history of formal detention under the mental health act, the presence of mental health problems, a diagnosis of autism and higher total score on the Adaptive Behaviour Scale. Out of area placements were typically of high cost, and associated with only limited evidence of improved service quality.
  
  
  CONCLUSIONS
  Identifying predictors for out of area placement can be used to highlight deficiencies in local services and individuals at increased risk of exclusion from local services.
authors.affiliation: Bro Morgannwg NHS Trust, Cardiff, UK. david.allen@bromor-tr-wales.nhs.uk
authors.forename: D G
authors.initials: DG
authors.lastname: Allen
authors.forename: K
authors.initials: K
authors.lastname: Lowe
authors.forename: K
authors.initials: K
authors.lastname: Moore
authors.forename: S
authors.initials: S
authors.lastname: Brophy
mesh_terms: D000328:Adult; D002391:Catchment Area, Health / Q000191:economics / Q000706:statistics & numerical data; D002648:Child; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology / Q000534:rehabilitation*; D007407:Interviews as Topic; D007859:Learning Disabilities / Q000628:therapy; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D020380:Needs Assessment; D011237:Predictive Value of Tests; D018570:Risk Assessment; D017062:Small-Area Analysis; D011795:Surveys and Questionnaires; D014852:Wales