Community placements for people with severe and profound learning disabilities and serious challenging behaviour: individual illustrations of issues and problems

Three individual cases of adults with severe or profound learning disabilities who moved from institutional care to individually-designed placements in small group homes are used in order to illustrate implications for good practice, management and policy-making. One case was of a successful placement which showed improved results over time; the second was a placement closed down to save money and the third was a placement which broke down in crisis with readmission to institutional care, but which was eventually recreated successfully. The cases show the need to work at three levels: the relationship between the individual and their immediate environment, the relationship between how this environment is delivered and how the placement is organised; and the relationship between the placement and the service system of which it is part.