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The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article “A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service”.

The author’s reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs.

The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families.

The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed.

The purpose of this paper is to present an update on the Ealing Intensive Therapeutic and Short Breaks Service (ITSBS).

The challenges the service has faced are reviewed, including the service’s response to those challenges. Also provided is a more detailed analysis of the outcomes of the service.

The ITSBS continues to succeed in supporting young people with intellectual disabilities and challenging behaviour to stay at home with their families.

Despite considerable challenges and adaptations to the model, the ITSBS is still achieving successful outcomes for vulnerable young people and is considered nationally to be a best-practice model. Few prior articles have provided an account of how innovative service models are maintained and evolve over time.

Positive behavioural support has been considered as a valuable alternative to residential care for children and adolescents with learning disabilities and behaviour that challenges. While recent evidence suggests it has a positive impact on behaviour and carer ability to cope, there is little evidence of its economic costs or benefits. The paper aims to discuss this issue.

An exploratory cross-sectional study was conducted to evaluate the cost of providing positive behavioural support to ten children and adolescents with learning disabilities and behaviour that challenges living in the community in Ealing, West London. Comparison was also made with the cost estimate of possible alternative support packages for children and adolescents with learning disabilities and behaviour that challenges in the UK, as obtained through a Delphi exercise.

Total cost of services per child was £1,454 per week for young people supported short-term, and £1,402 supported long-term. Children and adolescents were making use of a range of social care, education and health services. Over the full sample, half of the total cost was accounted for by education services. The Delphi exercise estimated the weekly cost of residential-based care as more expensive than the cost of community-based care for children and adolescents with learning disabilities and behaviour that challenges. At the end of the ITSBS, all ten children and adolescents initially at risk of imminent residential placement were living in the community with less service-intensive and less expensive support. This suggests that avoiding residential-based care could reduce costs in the long term.

Positive behavioural support has potential to support people with learning disabilities and behaviour that challenges in the community, leading to potential cost advantages. However, this is a small study and more robust research is needed.

The purpose of this paper is to present early outcomes and case examples from the Ealing Intensive Therapeutic and Short Break Service.

The service was piloted over a period of 3.5 years during which clinical data were collected for young people at risk of a move to residential care.

There were positive outcomes for young people with intellectual disabilities and challenging behaviour who were seen through the service with residential placements prevented in the vast majority of cases.

These early outcomes highlight the importance of providing intensive therapeutic intervention with short breaks in order to prevent family placement breakdown.

The purpose of this paper is to discuss how research can support a renewed focus on the promotion of independence and the prevention of avoidable dependency.

Narrative review and discussion.

Generating practice-based evidence, exploiting the possibilities of existing administrative data and learning from the world of public health may offer some ways forward.

Potential priorities for future research are identified.