Is Small Really Beautiful?

As part of a general move to community care and concurrent closure of a 280 bedded hospital, West Dorset Health Authority, as an interim measure two years ago, moved 17 clients with severe learning difficulties and challenging behaviours to three smaller residential units together with two ladies who also showed frequent challenging behaviours. As part of a continuing evaluation of the quality of provision for this group of clients, the authors looked at the present levels of skills of the residents compared with those in evidence three years ago when the 17 were on a secure ward with attendance at a special day care unit. In addition, measures were taken of engagement levels and of the number and type (whether positive or negative) of interactions between staff and residents. For all parameters, significant improvements were evident, supporting the view that small units facilitate the learning of new skills and provide a better quality of life for the residents.