title: Out-of-area provision for adults with intellectual disabilities and challenging behaviour in England: policy perspectives and clinical reality.
abstract: BACKGROUND
  The use of out-of-area placements to meet the needs of individuals with intellectual disabilities and challenging behaviour has been increasing in the UK. Such placements claim a large proportion of service budget expenditure; therefore, it is important to consider whether they offer the best-quality care. This paper reports on current evidence relating to such placements and uses a scoping review across five London boroughs to illustrate key issues on provider characteristics and aspects of good practice.
  
  
  METHODS
  We conducted a literature review to identify papers that describe out-of-area placements and carried out a postal survey of 54 service providers that delivered services to service users from five London boroughs.
  
  
  RESULTS
  Individuals with intellectual disability and challenging behaviour are more likely to be placed out-of-area in services of variable quality and a minority may underperform. Our empirical data suggest that the private sector that is the main accommodation provider is most likely to underperform on meeting standards of care.
  
  
  CONCLUSIONS
  Overall, the majority of out-of-area providers appear to supply a good standard of care but there are many factors that continue to hinder the local treatment of individuals who present with challenging behaviour. There is an imperative to identify poorly performing providers as well as exploring ways in which service users, out-of-area, can be supported effectively.
authors.affiliation: Research Department of Mental Health Sciences, University College London, London, UK. rejudra@ucl.ac.uk
authors.forename: D Andrea
authors.initials: DA
authors.lastname: Barron
authors.forename: A
authors.initials: A
authors.lastname: Hassiotis
authors.forename: D
authors.initials: D
authors.lastname: Paschos
mesh_terms: D000328:Adult; D004739:England; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology / Q000628:therapy*; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D012112:Residential Facilities / Q000592:standards* / Q000706:statistics & numerical data