{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T02:27:45Z","timestamp":1775528865643,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T00:00:00Z","timestamp":1617062400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","award":["Health Services and Delivery Research (16\/01\/24)"],"award-info":[{"award-number":["Health Services and Delivery Research (16\/01\/24)"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,3,2]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Approximately 17% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays in England. We have identified two models of ISTs (model 1: enhanced provision and model 2: independent provision). This study aims to investigate the clinical and cost-effectiveness of the two models of ISTs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A cohort of 226 adults with ID displaying behaviour that challenges who receive support from ISTs from each model will be recruited and assessed at baseline and 9 months later to compare the clinical and cost-effectiveness between models. The primary outcome is reduction in challenging behaviour measured by the Aberrant Behaviour Checklist-Community (ABC-C). The mean difference in change in ABC score between the two IST models will be estimated from a multilevel linear regression model. Secondary outcomes include mental health status, clinical risk, quality of life, health-related quality of life, level of functioning and service use. We will undertake a cost-effectiveness analysis taking both a health and social care and wider societal perspective. Semistructured interviews will be conducted with multiple stakeholders (ie, service users, paid\/family carers, IST managers\/staff) to investigate the experience of IST care as well as an online survey of referrers to capture their contact with the teams.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by the London\u2013Bromley Research Ethics Committee (REC reference: 18\/LO\/0890). Informed consent will be obtained from the person with ID, or a family\/nominated consultee for those lacking capacity and from his\/her caregivers. The findings of the study will be disseminated to academic audiences, professionals, experts by experience and arm\u2019s-length bodies and policymakers via publications, seminars and digital platforms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Registry (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03586375\">NCT03586375<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-043358","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T13:05:11Z","timestamp":1617109511000},"page":"e043358","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct03586375","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Angela","family":"Hassiotis","sequence":"first","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-160X","authenticated-orcid":false,"given":"Athanasia","family":"Kouroupa","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4022-8133","authenticated-orcid":false,"given":"Nicola","family":"Morant","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Courtenay","sequence":"additional","affiliation":[{"name":"Assessment and Intervention Team, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Hall","sequence":"additional","affiliation":[{"name":"Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicky","family":"Crossey","sequence":"additional","affiliation":[{"name":"South West Community Learning Disability Team & Mental Health Intensive Support and Treatment Team, NHS Lothian, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renee","family":"Romeo","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurence","family":"Taggart","sequence":"additional","affiliation":[{"name":"Institute of Nursing and Health Research, University of Ulster, Antrim, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7745-1825","authenticated-orcid":false,"given":"Peter","family":"Langdon","sequence":"additional","affiliation":[{"name":"Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Ratti","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Kirchner","sequence":"additional","affiliation":[{"name":"Medical Director, Camden and Islington NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brynmor","family":"Lloyd-Evans","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,30]]},"reference":[{"key":"2025121604242171000_11.3.e043358.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ridd.2010.12.018"},{"key":"2025121604242171000_11.3.e043358.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.2006.00948.x"},{"key":"2025121604242171000_11.3.e043358.3","unstructured":"NHS England . 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