Caroline Reid and colleagues have previously shown that the PBS service in Ealing reduced emotional and behavioural difficulties and improved carers’ ability to cope. We collected further data on education, health and social care service use for ten children supported by PBS in Ealing. In Bristol we collected data for twelve children on behaviours that challenge, positive developmental skills before and after the intervention, and use of education, health and social care service by individuals with behaviours that challenge and carers. In Halton we collected service use data for five adults and information on behaviours that challenge, engagement in meaningful activities and community participation.
PBS service costs varied across the three sites from less than £200 per participant per week to around £700. Outcomes improved in all three samples. The total cost of health and social care services (and education for children) during the intervention averaged between £1500 and £2300 per week. Most children and adults supported with PBS were able to avoid residential placements or to be transferred to more service-intensive residential care.
In the absence of a comparator we conducted a Delphi exercise using six ‘case vignettes’. The aim was to estimate the cost of current packages of care that support people with learning disabilities and behaviours that challenge in England. Detail findings from this Delphi study will be published soon. They provided a benchmark for comparisons in the three local studies of PBS (and will be of interest more broadly). We concluded that although there is an initial increase in cost during the period when PBS is provided, avoiding residential placements or transfer to more expensive residential care has the potential to substantially reduce care costs over the longer term. Findings from this multi-faceted study are now being published , but have already informed analyses underpinning recent NICE guidelines.