Background Concern has been expressed repeatedly\ud about the cost and quality of residential placements for\ud adults with learning disabilities and additional needs.\ud This study sought to identify characteristics of the highest cost placements in the South-East of England.\ud Method Lead learning disability commissioners in the\ud South-East of England were asked to provide information\ud about the ﬁve highest cost residential placements that\ud they commissioned for adults with learning disabilities.\ud Results The average placement cost of £172k per annum\ud disguised wide variation. Individuals placed were\ud mainly young and male with high rates of challenging\ud behaviour and ⁄ or autism spectrum disorder. Most\ud placements were in out-of-area residential care. The\ud highest costs were associated with hospital placements\ud and placements for people presenting challenging\ud behaviour.\ud Conclusions Young, male adults with learning disability,\ud challenging behaviour and ⁄ or autism continue to receive\ud very high cost residential support, often in out-of-area\ud residential care. There remains limited evidence of plans\ud to redirect resources to more local service developments
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