Mapping 15-year trends of day service provision for people with intellectual disabilities in Ireland – is policy-driven individualisation a reality yet?

Background Person-centred plans, individualised supports and personal budgets have been at the leading edge of a global paradigm shift in day services for people with intellectual disabilities. Their objective is to empower... [ view full abstract ]

Background
Person-centred plans, individualised supports and personal budgets have been at the leading edge of a global paradigm shift in day services for people with intellectual disabilities. Their objective is to empower people to lead a self-directed life.

Aim and objective of the study
The study involved a trend mapping exercise designed to assess changes in day service provision in Ireland, against a backdrop of international best practice and policy development.

Methods
Secondary data were sourced from the National Intellectual Disability Database over a 15 year period (1998–2013). Data were mapped according to the most popular day services used. Upton's chi-square was used to test for statistically significant differences.

Findings
During the 15-year period, there was: a significant decrease in people availing of day services as a proportion of the general population (0.58% to 0.53% (p <0.001); a significant increase in male service users (5.3% to 8.7%, p <0.001); a downward trend in younger people (aged <35) availing of services; and an emerging urban/rural divide. The type of day service provision did not change dramatically, although service uptake did not necessarily reflect demand. Finally, the use of person-centred plans more than doubled from 37.1% to 78.7%.

Conclusions and implication
Emergent trends are important in informing the future direction of disability services and the allocation of funds. The urban/rural divide reported here should be monitored closely and services adjusted, if necessary, to meet demographic changes. For example, services/supports should aim to meet individual needs rather than population-based needs. While person-centred plans are a popular mechanism for individualising supports, ongoing specialised staff training is also required. Governments should consider re-directing funding from inflexible traditional services, towards individualised budgeting initiatives. Policy decisions should also be based on evidence that incorporates the ‘lived experience’ of individuals receiving individualised funding and supports in Ireland.