Abstract

Information was collected on the social networks of 500 adults with mental retardation receiving different types of residential supports. Results indicated that (a) the reported median size of participants' social networks (excluding staff) was 2 people; (b) 83% of participants were reported to have a staff member; 72%, a member of their family; 54%, another person with mental retardation; and 30%, a person who did not fit into any of these categories in their social network; (c) variation in the size and composition of participants' social networks was associated with a range of variables, including the personal characteristics of residents (age, autism, ability, and challenging behavior), the type of previous and current accommodation, staffing ratios, institutional climate, and the implementation of “active support.”

Notions of inclusion have been at the center of the ideologies and policies that have shaped services for people with mental retardation in the United Kingdom, North America, and Australasia over the past 3 decades. Specifically, the replacement of traditional forms of institutional residences with small community-based residential supports was frequently recommended on the basis that such services are likely to facilitate the inclusion or integration of people with mental retardation within their local communities (e.g., Heal, Haney, & Novak Amado, 1988; Mansell & Ericsson, 1996; Meyer, Peck, & Brown, 1991; Taylor, Biklen, & Knoll, 1987). It is now clear, however, that only modest progress has been made toward achieving these aims (cf. Emerson & Hatton, 1996a; Newton, Horner, Ard, LeBarron, & Sappington, 1994; Young, Sigafoos, Suttie, Ashman, & Grevell, 1998). It is possible to identify three main issues in the literature in which researchers have investigated the social networks of people with mental retardation receiving residential supports.

First, there is substantial evidence to suggest that peoples' social networks are highly restricted with regard to friendships (Donnelly et al., 1994; Evans, Todd, Beyer, Felce, & Perry, 1994; Knapp et al., 1992; Lowe & de Paiva, 1991; Newton & Horner, 1993; Raynes, Sumpton, & Flynn, 1987; Rosen & Burchard, 1990; Stancliffe & Lakin, 1999) and, in particular, likely to involve very few meaningful relationships with people who do not have mental retardation, are not relatives, and who are not paid to support them (Jahoda, Cattermole, & Markova, 1990; Romer, & Heller, 1983; Stancliffe & Lakin, 1999).

Second, although there is some evidence to suggest that people in smaller community-based residential settings may experience more friendships and have more frequent contact with friends than do people residing in larger, more institutional settings (Evans et al., 1994; Lowe & de Paiva, 1991; Raynes et al., 1987), it is also clear that this is far from an inevitable result of deinstitutionalization (Donnelly et al., 1994; Knapp et al., 1992; Taylor et al., 1987). In addition, there is little evidence that friendships show signs of developing over time in community-based living situations (Evans et al., 1994; Lowe & de Paiva, 1991).

Finally, although the majority of people receiving residential supports are reported to be in contact with a family member (e.g., Flynn, 1989; Malin, 1982; Raynes et al., 1987), for the majority of people such contact may be infrequent or sporadic (e.g., Jahoda et al., 1990; Lowe & de Paiva, 1991). Information concerning factors associated with variation in family contact is sparse, but factors that appear to increase family contact include living near the family member (Felce, Lunt, & Kushlick, 1980; Rawlings, 1985), being younger (Dagnan & Ruddick, 1997; Rawlings, 1985); not having a highly visible disability and being socially responsive (Colledge, 1980), and living in smaller community-based residences (Booth, Simons, & Booth, 1990; Felce, 1989; Felce et al., 1980; Raynes et al., 1987).

The data presented in the present paper were collected in the context of a larger project evaluating the quality and costs of village communities (e.g., campus-style facilities operated by charitable organizations), state-operated residential campuses, and community-based residences for 500 adults with mental retardation in the United Kingdom (Emerson, Robertson, Gregory, Kessissoglou, Hatton, Hallam, Knapp et al., 2000; Emerson, Robertson, Gregory, Kessissoglou, Hatton, Hallam, Järbrink et al., 2000; Gregory, Robertson, Kessissoglou, Emerson, & Hatton, in press; Robertson, Emerson, Gregory, Hatton, & Kessissoglou, 2000; Robertson, Emerson, Gregory, Hatton, Turner et al., 2000). In other publications we have examined the associations between these models of residential support and participants' social networks. In summary, the results suggest that (a) people living in either village communities or community-based residences had larger social networks than did people living in state-operated residential campuses; (b) people living in community-based residences had more people with mental retardation in their social networks than did people living in state-operated residential campuses; (c) people living in community-based residences had more people who did not have mental retardation, were not family members, and were not staff members in their social networks than did people living in either village communities or state-operated residential campuses; (d) people living in smaller community-based services had larger social networks and more people who did not have mental retardation, were not family members, and were not staff members in their social networks than did people living in larger community-based services; (e) respondents with mental retardation expressed greater satisfaction with their friendships and relationships if they had a greater number and proportion of people with mental retardation in their social network.

In the present paper we have provided more detailed descriptive information on the social networks of participants and identified those personal and environmental factors associated with variation in the size and composition of participants' networks.

Method

Design

In this study we employed a cross-sectional design and sought to collect information on a target sample of 540 adults with mental retardation. The participants were (a) three samples of 30 adults randomly selected from the residents of three village communities; (b) five samples of 30 adults randomly selected from among the residents of five National Health Services residential campuses; (c) 10 samples of 30 adults randomly selected from the people supported by 10 different organizations providing community-based residential supports.

In the category of residential campuses and village communities, we included all forms of long-term residential settings that provided 24-hour support in a campus-style setting, defined as a setting in which housing for people with mental retardation was clustered together on one site and shared some central facilities (e.g., day center, church, shops). In the category of community-based residential supports, we included all forms of long-term residential supports that provided 24-hour support in dispersed domestic-style housing for no more than 8 people.

Power analysis was conducted to establish the suitability of the target sample size for the parent project (a comparison of the multiple aspects of the quality and costs of different approaches to providing residential supports—Emerson et al., in press), with the following results. (a) For outcome measures that can be expressed as percentage rates, 95% confidence intervals on the rates within each model will be plus or minus 6% on a base rate of 50%, and plus or minus 3% on a base of 10%. When comparing between models, there is at least 80% power of true differences in rates of the order of 12% or more (on a base of 50%) being detected at the 5% level of significance. (b) For interval level variables, sample means will have 95% confidence intervals equal to plus or minus 11% of the sample standard deviation (SD); and 80% power exists of detecting a difference in true means between the models equal to 23% of the SD. (c) With regard to relationships between interval variables within each model, the sample size is such that at 80% power, true correlations of .13 or above will be identified as statistically significant.

Potential services were identified through a process of consultation with organizations and advocacy groups representing the interests of parents of people with mental retardation, service providers, and the research and development community. The aim of the consultation was to identify services that were considered by key informants to be examples of “good” or “better practice” within that particular model of residential support. Of the services initially nominated, three village communities chose not to participate. These were replaced following further consultation.

At the time of completion of data collection, information had been collected on 500 participants across 18 services (93% of the target sample of 540 participants). These included 86 participants in three village communities (96% of target), 133 participants in five National Health Services residential campuses (89% of target), and 281 participants in 10 community-based residential supports (94% of target).

The organizations

The three village communities were operated by charitable organizations. None of these services had been developed as a direct result of the downsizing or closure of state-operated institutions for people with mental retardation. All organizations expressed an aim of providing a partially self-contained community for their residents. The number of long-term residents supported on-site ranged from 28 to 179. The mean number of residents per living unit ranged from 7 to 8. In two of the village communities, the majority of living units were free-standing buildings grouped in close proximity to centralized day and leisure facilities. In the third community, 17 of the participants lived in a house for 25 people; the remainder, in houses for 2 to 5 people, which were clustered around the central facility.

The five residential campuses were all operated by the National Health Services. They had been developed as a direct result of the closure of state-operated institutions for people with mental retardation. The number of long-term residents supported on-site ranged from 94 to 144. The mean number of residents per living unit ranged from 7 to 10. In all five residential campuses, the majority of living units were free-standing buildings grouped in close proximity to centralized day and leisure facilities.

Community-based residential supports included a mixture of group homes or staffed houses (e.g., Felce, 1989) and examples of supported living (Simons, 1997). The number of long-term residents supported by organizations ranged from 22 to 161. The number of residents per living unit size were 32 participants living alone; 28 participants, in services for 2 people; 58 participants, in services for 3 people; 58 participants, for 4 people; 21 participants, for 5 people; 73 participants, for 6 people; 7 participants, for 7 people; and 4 participants supported in services for 8 people.

Procedure

The procedure for data-collection was similar for each of the 18 participating services. A sampling frame was constructed comprised of all adults (age 18+) receiving 24-hour long-term residential support (i.e., excluding people receiving short-term care or assessment and treatment on a residential basis). From this group, a random sample of 30 potential participants was selected.

Written informed consent was sought from each potential participant. If they were unable to give informed consent, agreement for participation was obtained from either (a) the individual's independent advocate, (b) the closest family member who was in regular contact with the person, or (c) the chief executive or medical director of the provider organization. If consent was not obtained, a further potential participant was selected from the sampling frame.

The provider organization was supplied with 30 copies of the questionnaires (see later discussion), which were distributed to members of staff who knew the participant. Research staff then visited the service and completed structured interviews with the participant (wherever appropriate) and a member of the care staff who acted as key informant. Finally, research staff from the Centre for the Economics of Mental Health visited the service to obtain cost information from agency accounts.

Instruments

Information about the setting in which participants were supported was collected by a combination of interview with the supervisor of the person's support team (or equivalently knowledgeable key informant) and ratings completed by research staff. A modified version of the Residential Services Setting Questionnaire (Emerson, Alborz, Felce, & Lowe, 1995) was used to collect information on the size and location of the setting, the age and gender of the participant served, and the number and qualifications of staff employed within the setting. No information is available on the psychometric properties of this questionnaire. The Architectural Features Scale (Thompson, Robinson, Graff, & Ingenmey, 1990) was used to collect information on aspects of the physical environment. Use of this scale by naive raters has been shown to discriminate between residential facilities for people with mental retardation and private households (Thompson et al., 1990). Internal consistency of the Architectural Features Scale in the present study was considered acceptable, Cronbach's α=.68. The Residential Services Working Practices Scale (Felce, Lowe, & Emerson, 1995) was used to collect information on the extent to which services implemented an “active support” approach to organizing the care environment (Emerson & Hatton, 1994; Felce, 1996; Felce et al., 2000; Jones et al., 1999; McGill & Toogood, 1994). This approach involves procedures within the setting regarding individual planning, assessment, and teaching; the planning of daily and weekly activity; arranging staff support for resident activity; and the training and supervision of staff. No information is available on the psychometric properties of this questionnaire. The Group Home Management Interview (Pratt, Luszcz, & Brown, 1980) was used to rate the extent to which the setting embodied the cardinal features of total institutions, namely, block treatment, depersonalization, rigidity of routines, and social distance. Previous investigators have reported high internal consistency for the this instrument, α>.80 (Pratt et al., 1980). Internal consistency of the Group Home Management Interview in the present study was considered acceptable, Cronbach's α=.56 to .76 for the four subscales.

Information about the participants and the specific support they received was collected by a combination of questionnaire and interview with a member of the participant's support team who knew him or her well. Part 1 of the Adaptive Behavior Scale–Residential and Community (Nihira, Leland, & Lambert, 1993) was used to collect information on the abilities and skills of the person and the presence of additional physical and sensory impairments. The Aberrant Behavior Checklist (Aman, Burrow, & Wolford, 1995) was used to provide a quantitative measure of the severity of challenging behavior. The PAS-ADD Checklist (Moss, Prosser, Costello, Simpson, & Patel, 1996; Moss et al., 1998) and the Autism Screening Questionnaire (Howlin, 1996) were used to screen for the presence of psychiatric disorders and autism spectrum disorders. Internal consistency of the Autism Screening Questionnaire in the present study was considered good, Cronbach's α=.81 for the full scale. The PAS-ADD Checklist has been shown to possess acceptable levels of interrater reliability (83% agreement on case identification), good internal consistency, Cronbach's α=.87 for the full scale, and acceptable levels of agreement with clinical diagnoses (Moss et al., 1998).

A modified version of the Social Network Map (Tracy & Abell, 1994; Tracy & Whittaker, 1990) was used to collect information about the person's social networks and social support available to them. No information is available on the psychometric properties of this questionnaire. The instrument was completed by interview with a key informant. It provides information on the composition of an individual's currently active social network. Membership is defined as those people who are considered to be important in the target individual's life and who have interacted with the target individual in the month preceding the interview. For each identified member, information is collected on the type of relationship (e.g., family member, staff, neighbor, workmate), whether they also have mental retardation, the type of support offered (emotional, practical, informational), the degree of reciprocity in the relationship, and the closeness of the relationship.

Service Costing Methodology

The costs of service packages unique to each study participant were determined. Details of the procedures used are provided in Emerson, Robertson, Gregory, Kessissoglou, Hatton, Hallam, Knapp et al. (2000).

Participant Characteristics

Data pertaining to the characteristics of participants are summarized in Table 1. There were robust differences between the groups with regard to adaptive behavior, health needs, age, and residential history (Emerson, Robertson, Gregory, Kessissoglou, Hatton, Hallam, Knapp et al., 2000). In particular, participants living in village communities had significantly more adaptive skills then did those living in community-based residential supports who, in turn, had significantly more adaptive skills than did participants living in residential campuses.

Table 1

Participant Characteristics

Participant Characteristics
Participant Characteristics

Results

Size, Nature, and Composition of Participants' Social Networks

Overall, the reported median size of participants' social networks was 5 people, range = 0 (5.2% of participants) to 20. Approximately 25% of participants were reported to have 3 or fewer, and 75% to have 8 or fewer people in their social networks. Of the 3,051 network members identified, 1,341 (44%) were staff members. When staff members were excluded, the reported median size of participants' social networks was 2 people, range = 0 (13% of participants) to 13. Approximately 25% of participants were reported to have 1 or fewer, and 75% to have 5 or fewer people in their social networks.

Eighty-three percent of all participants were reported to have a staff member, 72% a member of their family, 54% another person with mental retardation, and 30% a person who did not fit into any of these categories in their social network. Of the 580 people with mental retardation identified as network members, 343 (59%) were co-residents, 54 (9%) were neighbors, 30 (5%) were coworkers, 7 (1%) were relatives, 6 (1%) were from formal clubs/organizations, and the remaining 140 (24%) were from other areas of the person's life. Of the 275 people identified as network members who were not paid staff, not relatives, and did not have mental retardation, 3 (1%) were co-residents, 17 (6%) were neighbors, 22 (8%) were co-workers, 30 (11%) were from formal clubs/organizations, 15 (5%) were from formal services, and the remaining 188 (68%) were from other areas of the person's life. Only 3% of participants had a neighbor who did not have mental retardation in their social network.

Among the 281 participants in community-based residences, the reported median size of participants' social networks was six people, range = 0 (3.2% of participants) to 20. Approximately 25% of participants were reported to have three or fewer and 75% to have nine or fewer people in their social networks. Of the 1,730 network members identified, 778 (45%) were staff members. When they were excluded, the reported median size of participants' social networks was three people, range = 0 (10% of participants) to 13. Approximately 25% of participants were reported to have two or fewer and 75% to have six or fewer people in their social networks.

Among participants in community-based residences, 85% of participants were reported to have a staff member, 71% a member of their family, 61% another person with mental retardation, and 44% a person who did not fit into any of these categories in their social network. Of the 384 people with mental retardation identified as network members, 206 (54%) were co-residents, 18 (5%) were neighbors, 24 (6%) were coworkers, 4 (1%) were relatives, 6 (2%) were from formal clubs/organizations, and the remaining 126 (33%) were from other areas of the person's life. Of the 239 people identified as network members who were not paid staff, not relatives, and did not have mental retardation, 3 (1%) were co-residents, 16 (7%) were neighbors, 17 (7%) were coworkers, 28 (12%) were from formal clubs/organizations, 14 (6%) were from formal services, and the remaining 161 (67%) were from other areas of the person's life. Only 4% of participants had a neighbor who did not have mental retardation in their social network.

Information on the reported nature of the relationship between the participant and the first-named person with mental retardation; first-named family member; first-named staff member; and the first-named person who was not a paid staff member, not a relative, and did not have mental retardation is presented in Table 2. As can be seen, staff and family members were reported to provide the main sources of informational, practical, and emotional support to participants. In addition, participants with mental retardation were extremely rarely seen as predominantly providing support to others.

Table 2

Nature of Relationship With First-Named Person by Category in Participants' Social Network (in %)

Nature of Relationship With First-Named Person by Category in Participants' Social Network (in %)
Nature of Relationship With First-Named Person by Category in Participants' Social Network (in %)

Predictors of the Reported Closeness of Relationships

Nonparametric correlations and chi-square tests were employed to identify correlates of the reported closeness of the relationship between the person and the first-named member in their social networks for each of the categories presented in Table 2. Increased reported closeness with relatives was associated with increased frequency of contact, r =.27, p <. 01, and with relatives providing more frequent emotional, r =.25, p <.01, and informational, r =.25, p <.01, support. Increased reported closeness with a friend with mental retardation was associated, with friends providing more frequent emotional and informational support, rs =.40 and .20, respectively, ps <.001. Increased reported closeness with staff members was associated with staff providing more frequent practical, emotional, and informational support, rs =.20, .27, and .21, respectively, ps <.001, increased reciprocity, χ2(1, N = 422) = 8.7, p <.01, and with the participant being a woman, r =.15, p <.01. Increased reported closeness with “others” was associated with others providing more frequent practical, r =.46, p <.001, emotional, r =.46, p <.001, and informational, r =.50, p <.001, support and with the participant knowing the person for longer, r =.28, p <.01.

Predictors of Variation in the Size and Composition of Social Networks

Linear regression (for total network size) and logistic regression (for presence/absence of network members) were undertaken to identify variables associated with the personal characteristics of participants and supports received, which were predictive of variation in the composition and size of participants' social networks. Both approaches used stepwise conditional variable entry for the set of candidate predictor variables, which are listed in Table 3. In order to reduce confounds, we inspected the between-variable correlation matrix to identify pairs of variables with over 6. For each separate analysis and each separate confounded pair, the paired variable with the lowest correlation with the dependent variable was excluded. The results of these analyses are presented in Table 4 for the complete sample and Table 5 for the subsample of 281 participants who were living in community-based residences.

Table 3

Candidate Predictor Variables for Logistic Regression

Candidate Predictor Variables for Logistic Regression
Candidate Predictor Variables for Logistic Regression
Table 4

Predictors of Variation in Size and Composition of Social Networks for the Full Sample

Predictors of Variation in Size and Composition of Social Networks for the Full Sample
Predictors of Variation in Size and Composition of Social Networks for the Full Sample
Table 5

Predictors of Variation in the Size and Composition of Social Networks for Participants Receiving Community-Based Supports

Predictors of Variation in the Size and Composition of Social Networks for Participants Receiving Community-Based Supports
Predictors of Variation in the Size and Composition of Social Networks for Participants Receiving Community-Based Supports

As can be seen, four personal characteristics of participants were associated with variation in the size and composition of their social networks. These associations were as follows: (a) Younger participants had a larger social network (full sample), a relative in their social network (full and community sample), and a person who was not a staff member, a relative, or a person with mental retardation in their social network (full sample). (b) People with autism had smaller social networks (full sample). (c) Higher functioning participants were more likely to have a person who was not a staff member, a relative, or a person with mental retardation in their network (full and community samples). (d) Participants with less severe challenging behavior were more likely to have a person with mental retardation in their network (full sample).

The type of participants' previous and current living circumstances was associated with variation in the size and composition of social networks in six of the eight analyses. These associations were that people having moved to their current setting from their family home had larger social networks (community sample) and were more likely to have a relative in the social network (full and community samples); people living in group homes for 3 or fewer people had larger social networks (full sample) and were more likely to have a person who was not a staff member, a relative, or a person with mental retardation in their social network (community sample); people living in a supported-living scheme, and people not living in registered residential care homes were more likely to have a person who was not a staff member, a relative, or a person with mental retardation in their social network (full sample); people who had not moved from a National Health Services mental handicap hospital were more likely to have a person with mental retardation in their network (community sample).

Staffing resources were associated with variation in the size and composition of social networks in two of the eight analyses. These associations were as follows: Lower overall staffing ratios were associated with relatives being involved in participants' social networks (full sample), and higher ratios of senior staff were associated with participants' being more likely to have a person who was not a staff member, a relative, or a person with mental retardation in their social network (full sample).

Aspects of the organization of the care environment were associated with variation in the size and composition of social networks in seven of the eight analyses. People supported in settings that were less institution-like had larger social networks (depersonalization and social distance for both full and community sample); were more likely to have a relative in their social network (depersonalization for full and community sample); and were more likely to have a person who was not a staff member, a relative, or a person with mental retardation in their social network (block treatment for full sample and community sample). In the community-based sample different aspects of institutionalization had opposing effects. Increased social distance between staff and residents was associated with a reduced probability of participants having a relative in their social network. However, increased rigidity of routines was associated with an increased probability of participants having a relative in their social network. In the full sample, better quality procedures for supporting staff were associated with an increased probability of participants having a person with mental retardation and a person who was not a staff member, a relative, or a person with mental retardation in their social network. In the community sample, better quality procedures for activity planning were associated with increased size of social networks and an increased probability of participants having a person with mental retardation in their social network. In both samples, better quality procedures for allocating staff to support residents were associated with a decreased probability of participants having a person with mental retardation in their social network.

Discussion

The results just presented indicate that (a) the reported median size of participants' social networks (excluding staff) was 2 people; (b) 83% of participants were reported to have a staff member, 72% a member of their family, 54% another person with mental retardation, and 30% a person who did not fit into any of these categories in their social network; (c) variation in the size and composition of participants' social networks was associated with a range of variables, including the residents' personal characteristics (age, autism, ability, and challenging behavior), the type of previous and current accommodation, staffing ratios, institutional climate, and the implementation of an active-support approach to organizing the care environment.

A number of limitations of the present study need to be considered when interpreting the results. First, we did not employ a random or stratified random sample of organizations, facilities, or residents in the United Kingdom. Rather, organizations were identified by key informants as representing exemplars of “good” or “better” practice within their respective fields. Comparison with available national data suggests that our participants were representative in terms of age (45.1 years in the present study, 45.4 years in the United Kingdom 1991 Census—Emerson & Hatton, 1996b), contained a slight preponderance of men (60% in the present study, 55% in the United Kingdom 1991 Census—Emerson, & Hatton, 1996b), and were living in slightly smaller living units (6.7 in the present study, 9.1 for voluntary sector residences in England in 1996—Staton, 1996).

Second, relatively few exemplars of each type of model were included within the project (3 village communities, 5 residential campuses, and 10 community-based residential support schemes). Although we are confident that by selecting a random sample of 30 people within each service, we have been able to describe the participating services in appropriate detail, the small number of involved organizations does limit the extent to which these results may be generalized with confidence to the wider universe of village communities, residential campuses, and community-based residential supports.

Third, given the severity of mental retardation of these participants, we relied on information provided by residential support staff members to describe the extent and nature of participants' social networks. The reliability and validity of such information from proxy respondents is not known. It would appear plausible to assume, however, that the resulting data may be more accurate for social networks based on the participants' home than for those social networks based on their day programs.

Nevertheless, the findings identify a number of significant issues. First, the data are consistent with previous research in which investigators have documented the marginalization and social exclusion of people with mental retardation in first world nations (cf. Emerson, & Hatton, 1996a; Newton, Horner, Ard, LeBaron, & Sappington, 1994; Young et al., 1998). In the present project, for example, 50% of participants supported in nominated “better” providers of smaller community-based settings had three or fewer people in their social networks (once paid staff had been excluded), and 10% had nobody. Only 4% of these participants had a neighbor in their social network who did not have mental retardation. Staff members and family members were reported to provide the main sources of informational, practical, and emotional support to participants. In addition, it was extremely rare for participants with mental retardation to be reported as predominantly providing support to others or to be involved in reciprocal relationships. These data on the size and composition of participants' social networks are not dissimilar to those reported for people with mental retardation receiving community-based supports in Minnesota (Stancliffe & Lakin, 1999). Recognition and documentation of the actual outcomes associated with service residences provide an essential foundation for the development of corrective action.

Second, once paid staff and family members had been excluded, participants' social networks tended to be dominated by other people with mental retardation. The importance of such relationships is indicated by (a) the relative longevity of these relationships (nearly 75% of relationships having lasted for more than 5 years); (b) the extent to which they involved reciprocal relationships (67% being reciprocal); (c) the association between expressed satisfaction with friendships and relationships, the number of people with mental retardation in participants' social networks, and the extent to which participants' social networks were dominated by other people with mental retardation (Gregory et al., in press).

Third, the results of the multivariate analyses, although correlational, suggest three areas in which intervention could impact upon the social networks of adults with mental retardation receiving residential supports. First, four characteristics of participants were associated with variation in the size and composition of their social networks. Younger participants had larger social networks and were more likely to have a relative and a person who was not a staff member, a relative, or a person with mental retardation in their social network. Although age is hardly amenable to intervention, these data do highlight the increased risk of social exclusion faced by older adults with mental retardation. In three other areas, however, personal characteristics or behaviors that are appropriate targets for intervention (adaptive behavior, challenging behavior, and indicators of autism) were associated with either the size or composition of participants' social networks. Thus, people with autism had smaller social networks; participants with higher skill levels were more likely to have a person who was not a staff member, a relative, or a person with mental retardation in their network; and participants with less severe challenging behavior were more likely to have a person with mental retardation in their network. Ensuring that people receiving residential supports have access to technologies for reducing challenging behaviors (e.g., Carr et al., 1999) or establishing prosocial behaviors (e.g., Haring, 1991) should form a key component of any systemic approach to decreasing social exclusion among people with mental retardation.

Second, structural aspects of participants' current living circumstances were associated with variation in the size and composition of social networks. Specifically, people supported in smaller community-based settings and supported living schemes had larger and more inclusive social networks. These data are consistent with the existing literature on the association between size and outcomes in community-based supports (e.g., Stancliffe, 1997; Tøssebro, 1995) and the positive outcomes associated with supported living (Emerson et al., in press; Howe, Horner, & Newton, 1998).

Finally, the data suggest that aspects of the organization of the care environment, rather than resources per se, were widely associated with variation in the size and composition of social networks. In general, people supported in less institutional settings and in settings that implemented an active-support approach to organizing care (Emerson & Hatton, 1994; Felce, 1996; Felce et al., 2000; Jones et al., 1999; McGill & Toogood, 1994) had larger and more inclusive social networks (though one contradictory result was evident). The association between institutional climate and social networks is not, perhaps, surprising. That indicators of institutional climate were associated with social networks in all four analyses conducted on the community-based sample, does, however, provide a timely reminder that institutional processes are also likely to be evident in small-scale community-based residences (cf. Landesman-Dwyer, 1981).

The associations between the implementation of an active-support approach to organizing care and social networks provides further evidence that the use of such procedures is linked to a range of positive outcomes for adults with mental retardation. Previous research has indicated that active support is associated with increased levels of engagement in everyday activities (Emerson & Hatton, 1994; Felce, 1996; Jones et al., 1999), more effective staff support (Felce et al., 2000), more equitable distribution of staff support (Jones et al., 1999), greater environmental opportunities for self-determination, and higher levels of expressed satisfaction among residents (Gregory et al., in press). The structural characteristics of settings and the resources available within them provide an opportunity framework. Careful management and organization of those resources enable us to translate this opportunity into reality for the people supported.

References

References
Aman
,
M. G.
,
W. H.
Burrow
, and
P. L.
Wolford
.
1990
.
The Aberrant Behavior Checklist-Community: Factor validity and effect of subject variables for adults in group homes.
American Journal on Mental Retardation
100
:
283
292
.
Booth
,
T.
,
K.
Simons
, and
W.
Booth
.
1990
.
Outward bound: Relocation and community care for people with learning difficulties.
Milton Keynes, UK: Open University Press
.
Carr
,
E. G.
,
R. H.
Horner
,
A. P.
Turnbull
,
J. G.
Marquis
,
D. M.
McLaughlin
,
M. L.
McAtee
,
C. E.
Smith
,
K. A.
Ryan
,
M. B.
Ruef
, and
A.
Doolabh
.
1999
.
Positive behavior support for people with developmental disabilities.
Washington, DC: American Association on Mental Retardation
.
Colledge
,
J.
1980
.
Visiting the mentally handicapped in residential care.
British Journal of Psychiatry
137
:
313
318
.
Dagnan
,
D.
and
L.
Ruddick
.
1997
.
The social networks of older people with learning disabilities living in staffed community based homes.
British Journal of Learning Disabilities
43
:
43
53
.
Donnelly
,
M.
,
S.
McGilloway
,
N.
Mays
,
S.
Perry
,
M.
Knapp
,
S.
Kavanagh
,
J.
Beecham
,
A.
Fenyo
, and
J.
Astin
.
1994
.
Opening new doors: An evaluation of community care for people discharged from psychiatric and mental handicap hospitals.
London: HMSO
.
Emerson
,
E.
,
A.
Alborz
,
D.
Felce
, and
K.
Lowe
.
1995
.
Residential Services Setting Questionnaire.
Manchester, England: University of Manchester, Hester Adrian Research Centre
.
Emerson
,
E.
and
C.
Hatton
.
1994
.
Moving out: The impact of relocation from hospital to community on the quality of life of people with learning disabilities.
London: HMSO
.
Emerson
,
E.
and
C.
Hatton
.
1996a
.
Deinstitutionalization in the United Kingdom: Outcomes for service users.
Journal of Intellectual and Developmental Disability
21
:
17
37
.
Emerson
,
E.
and
C.
Hatton
.
1996b
.
Residential residences for people with learning disabilities: An analysis of the 1991 Census.
Manchester, England: University of Manchester, Hester Adrian Research Centre
.
Emerson
,
E.
,
J.
Robertson
,
N.
Gregory
,
C.
Hatton
,
S.
Kessissoglou
,
A.
Hallam
, and
J.
Hillery
.
2000
.
The treatment and management of challenging behaviours in residential settings.
Journal of Applied Research in Intellectual Disabilities
13
:
197
215
.
Emerson
,
E.
,
J.
Robertson
,
N.
Gregory
,
S.
Kessissoglou
,
C.
Hatton
,
A.
Hallam
,
K.
Järbrink
,
M.
Knapp
,
A.
Netten
, and
C.
Linehan
.
2000
.
The quality and costs of community-based residential supports and residential campuses for people with severe and complex disabilities.
Journal of Intellectual and Developmental Disabilities
25
:
265
281
.
Emerson
,
E.
,
J.
Robertson
,
N.
Gregory
,
S.
Kessissoglou
,
C.
Hatton
,
A.
Hallam
,
M.
Knapp
,
K.
Järbrink
,
P.
Walsh
, and
A.
Netten
.
2000
.
The quality and costs of village communities, residential campuses and community-based residential supports in the United Kingdom.
American Journal of Mental Retardation
105
:
81
102
.
Emerson
,
E.
,
J.
Robertson
,
N.
Gregory
,
C.
Hatton
,
S.
Kessissoglou
,
A.
Hallam
,
K.
Järbrink
,
M.
Knapp
,
A.
Netten
, and
P.
Walsh
.
in press
.
The quality and costs of supported living schemes and group homes in the United Kingdom.
American Journal on Mental Retardation.
.
Evans
,
G.
,
S.
Todd
,
S.
Beyer
,
D.
Felce
, and
J.
Perry
.
1994
.
Assessing the impact of the All-Wales Mental Handicap Strategy: A survey of four districts.
Journal of Intellectual Disability Research
38
:
109
133
.
Felce
,
D.
1989
.
The Andover Project: Staffed housing for adults with severe or profound mental handicaps.
Kidderminster, England: British Institute for Mental Handicap
.
Felce
,
D.
1996
.
The quality of support for ordinary living: Staff:resident interactions and resident activity.
In J. Mansell & K. Ericsson (Eds.), Deinstitutionalization and community living: Intellectual disability services in Britain, Scandinavia and the USA. London: Chapman & Hall
.
Felce
,
D.
,
C.
Bowley
,
H.
Baxter
,
E.
Jones
,
C.
Lowe
, and
E.
Emerson
.
2000
.
The effectiveness of staff support: Evaluating active support training using a conditional probability approach.
Research in Developmental Disabilities
21
:
243
255
.
Felce
,
D.
,
K.
Lowe
, and
E.
Emerson
.
1995
.
Residential Services Working Practices Scale.
Cardiff: University of Wales, Welsh Centre on Learning Disabilities Applied Research Unit
.
Felce
,
D.
,
B.
Lunt
, and
A.
Kushlick
.
1980
.
Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Family contact.
Advances in Behaviour Research and Therapy
3
:
19
23
.
Flynn
,
M. C.
1989
.
Independent living for adults with mental handicap: A place of my own.
London: Cassell
.
Gregory
,
N.
,
J.
Robertson
,
S.
Kessissoglou
,
E.
Emerson
, and
C.
Hatton
.
in press
.
Predictors of expressed satisfaction among people with intellectual disabilities receiving residential supports.
Journal of Intellectual Disability Research.
.
Haring
,
G.
1991
.
Social relationships.
In L. H. Meyer, C. A. Peck, & L. Brown (Eds.), Critical issues in the lives of people with severe disabilities. Baltimore: Brookes
.
Heal
,
L. W.
,
J. I.
Haney
, and
A. R.
Novak Amado
.
1988
.
Integration of developmentally disabled individuals into the community.
Baltimore: Brookes
.
Howe
,
J.
,
R. H.
Horner
, and
J. S.
Newton
.
1998
.
Comparison of supported living and traditional residential services in the state of Oregon.
Mental Retardation
36
:
1
11
.
Howlin
,
P.
1996
.
Autism Screening Questionnaire.
London: St George's Medical School
.
Jahoda
,
A.
,
M.
Cattermole
, and
I.
Markova
.
1990
.
Moving out: An opportunity for friendship and broadening social horizons?
Journal of Mental Deficiency Research
34
:
127
139
.
Jones
,
E.
,
J.
Perry
,
K.
Lowe
,
D.
Felce
,
S.
Toogood
,
F.
Dunstan
,
D.
Allen
, and
J.
Pagler
.
1999
.
Opportunity and the promotion of activity among adults with severe intellectual disability living in community residences: The impact of training in active support.
Journal of Intellectual Disability Research
43
:
164
178
.
Knapp
,
M.
,
P.
Cambridge
,
C.
Thomason
,
J.
Beecham
,
C.
Allen
, and
R.
Darton
.
1992
.
Care in the community: Challenge and demonstration.
Aldershot: Ashgate
.
Landesman-Dwyer
,
S.
1981
.
Living in the community.
American Journal of Mental Retardation
86
:
223
234
.
Lowe
,
K.
and
S.
de Paiva
.
1991
.
Clients' community and social contacts: Results of a 5-year longitudinal study.
Journal of Mental Deficiency Research
35
:
308
323
.
Malin
,
N. A.
1982
.
Group homes for mentally handicapped adults: Residents' views on contact and support.
British Journal of Mental Subnormality
28
:
29
34
.
Mansell
,
J.
and
K.
Ericsson
.
1996
.
Deinstitutionalization and community living: Intellectual disability services in Britain, Scandinavia and the USA.
London: Chapman & Hall
.
McGill
,
P.
and
S.
Toogood
.
1994
.
Organising community placements.
In E. Emerson, P. McGill, & J. Mansell (Eds.), Severe learning disabilities and challenging behaviours: Designing high quality services. London: Chapman & Hall
.
Meyer
,
L. H.
,
C. A.
Peck
, and
L.
Brown
.
1991
.
Critical issues in the lives of people with severe disabilities.
Baltimore: Brookes
.
Moss
,
S. C.
,
H.
Prosser
,
H.
Costello
,
N.
Simpson
, and
P.
Patel
.
1996
.
PAS-ADD Checklist.
Manchester: Manchester, England: University of Manchester, Hester Adrian Research Centre
.
Moss
,
S. C.
,
H.
Prosser
,
H.
Costello
,
N.
Simpson
,
P.
Patel
,
S.
Rowe
,
S.
Turner
, and
C.
Hatton
.
1998
.
Reliability and validity of the PAS-ADD Checklist for detecting psychiatric disorders in adults with intellectual disabilities.
Journal of Intellectual Disability Research
42
:
173
183
.
Newton
,
J. S.
and
R. H.
Horner
.
1993
.
Using a social guide to improve social relationships of people with severe disabilities.
Journal of the Association for Persons with Severe Handicaps
18
:
36
45
.
Newton
,
J. S.
,
R. H.
Horner
,
W. R.
Ard
,
N.
LeBaron
, and
G.
Sappington
.
1994
.
A conceptual model for improving the social life of individuals with mental retardation.
Mental Retardation
32
:
393
402
.
Nihira
,
K.
,
H.
Leland
, and
N.
Lambert
.
1993
.
Adaptive Behavior Scale—Residential and Community (2nd ed.).
Pro-Ed: Austin, TX
.
Pratt
,
M. W.
,
M. A.
Luszcz
, and
M. E.
Brown
.
1980
.
Measuring the dimensions of the quality of care in small community residences.
American Journal of Mental Deficiency
85
:
188
194
.
Rawlings
,
S. A.
1985
.
Life-styles of severely retarded non-communicating adults in hospitals and small residential homes.
British Journal of Social Work
15
:
281
293
.
Raynes
,
N. V.
,
R. C.
Sumpton
, and
M. C.
Flynn
.
1987
.
Homes for mentally handicapped people.
London: Tavistock
.
Robertson
,
J.
,
E.
Emerson
,
N.
Gregory
,
C.
Hatton
, and
S.
Kessissoglou
.
2000
.
Receipt of psychotropic medication by people with intellectual disabilities in residential settings.
Journal of Intellectual Disability Research
44
:
666
676
.
Robertson
,
J.
,
E.
Emerson
,
N.
Gregory
,
C.
Hatton
,
S.
Turner
,
S.
Kessissoglou
, and
A.
Hallam
.
2000
.
Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities.
Research in Developmental Disabilities
21
:
469
486
.
Romer
,
T.
and
T.
Heller
.
1983
.
Social adaptation of mentally retarded adults in community settings: A social-ecological approach.
Applied Research in Mental Retardation
4
:
303
314
.
Rosen
,
J. W.
and
S. N.
Burchard
.
1990
.
Community activities and social support networks: A social comparison of adults with and without mental retardation.
Education and Training in Mental Retardation
25
:
193
204
.
Simons
,
K.
1997
.
A foot in the door: The early years of supported living for people with learning difficulties in the United Kingdom.
Manchester: National Development Team
.
Stancliffe
,
R. J.
1997
.
Community living-unit size, staff presence, and residents' choice-making.
Mental Retardation
35
:
1
9
.
Stancliffe
,
R. J.
and
K. C.
Lakin
.
1999
.
A longitudinal comparison of day program services and outcomes of people who left institutions and those who stayed.
Journal of the Association for Persons with Severe Handicaps
24
:
44
57
.
Staton
,
R.
1996
.
Residential accommodation: Detailed statistics on residential care homes and local authority supported residents, England 1995.
London: Department of Health
.
Taylor
,
S. J.
,
D.
Biklen
, and
J.
Knoll
.
1988
.
Community integration for people with severe disabilities.
Baltimore: Brookes
.
Thompson
,
T.
,
J.
Robinson
,
M.
Graff
, and
R.
Ingenmey
.
1990
.
Home-like architectural features of residential environments.
American Journal on Mental Retardation
95
:
328
341
.
Tøssebro
,
J.
1995
.
Impact of size revisited: Relation of number of residents to self-determination and deprivitazation.
American Journal on Mental Retardation
100
:
59
67
.
Tracy
,
E. M.
and
N.
Abell
.
1994
.
Social network map: Some further refinements on administration.
Social Work Research
18
:
56
60
.
Tracy
,
E. M.
and
J. K.
Whittaker
.
1990
.
The Social Network Map: Assessing social support in clinical practice.
Families in Society
71
:
461
470
.
Young
,
I.
,
J.
Sigafoos
,
J.
Suttie
,
A.
Ashman
, and
P.
Grevell
.
1998
.
Deinstitutionalisation of persons with intellectual disabilities: A review of Australian studies.
Journal of Intellectual and Developmental Disabilities
23
:
155
170
.

Author notes

Authors:Janet Robertson, PhD, Eric Emerson, PhD, Nicky Gregory, BA, Chris Hatton, PhD, and Sophia Kessissoglou, PhD, Institute for Health Research, Lancaster University, Lancaster LA1 4YT, UK. Angela Hallam, MSc, Centre for the Economics of Mental Health, Institute of Psychiatry, 7 Windsor Walk, London SE5 8BB, UK. Christine Linehan, MA, National Research Agency, 14 Stoneview Place, Dun Laoghaire, Co. Dublin, Ireland.