Care (Education) and Treatment Reviews are meant to keep people with learning disabilities and autistic people out of psychiatric hospitals, but no one knows whether they actually work. This study will find out. These reviews were introduced in 2014 to prevent unnecessary hospital admissions and speed up discharges, yet there is almost no evidence on how they function or whether they achieve their goals. The research team will track what happens during reviews, analyse who speaks and who gets heard in decision-making, and examine hospital admission and discharge data over time. They will also capture the experiences of people with learning disabilities and autistic people themselves, including those with moderate to severe intellectual disabilities. If the reviews prove effective, the findings will produce practical guidance that could reshape how these assessments are run across the NHS. That could mean fewer people being admitted to psychiatric hospitals, shorter stays for those who are admitted, and better care overall. If the reviews are not working, the study will reveal what needs to change. The team is working with Learning Disability England, the National Autistic Society, and the Challenging Behaviour Foundation to ensure the results reach the people who need them.
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Background: In 2014, Care (Education) and Treatment Reviews (C(E)TRs) were implemented to reduce the number of people with learning disabilities and autistic people being admitted to psychiatric hospitals and to encourage discharge of those already within hospital. However, we know very little about the mechanisms by which C(E)TRs may work and whether they can be effective. Aim: To undertake an evaluation of C(E)TRs with children and adults with learning disabilities and autistic children and adults across a range of inpatient settings, including those in the community who receive a C(E)TR because they are at risk of admission. Method: This project has four stages and uses mixed methods. Within Stage 1, online national surveys with 100 people with learning disabilities and autistic people, 100 families and carers, and 250 C(E)TR panel members, and health and social care professionals will be completed. A further 25 people with moderate to severe intellectual disabilities will be recruited and adapted methods to capture their voice within structured interviews will be used. Within Stage 2, we will attend C(E)TRs, CPA, and other patient meetings for 20 people to track progress over time and undertake up to 180 semi-structured interviews with attendees over 15 months. We will complete a documentary review of C(E)TR paperwork, capture communicative exchanges during meetings, and using applied linguistic analysis, determine the relative contributions of individuals to the decision-making process. We will also will develop a descriptive temporal pathway model of the C(E)TR process over time and how they affect care pathways. In Stage 3, we will model relationships between C(E)TRs and variables such as the numbers of admissions, discharges, inpatients over time using anonymised data available from NHS Digital. We will explore the potential cost implications of C(E)TRs. We anticipate having data for 132 months (11 years). In Stage 4, we will combine our quantitative and qualitative data to generate conclusions and develop and publish good practice guidance for C(E)TRs inclusive of practical resources and tools. Timeline for Delivery: The project will be delivered over 36-months. Stage 1 is scheduled to last 9 months, while Stage 2 will last 15 months. Stage 3 is scheduled to last 7 months, and Stage 4 is 4 months. Anticipated Impact and Dissemination: The findings from this study will be used to produce good practice guidance for conducting C(E)TRs inclusive of practical resources and tools. It is anticipated that this will lead to improvements in how reviews are conducted leading to improved care for people with learning disabilities and/or autistic people, reducing the need for hospital admission or decreasing the length of hospital stay. We have partnered with Learning Disability England (LDE), the National Autistic Society (NAS), and the Challenging Behaviour Foundation (CBF) who will each lead one of our three Lived Experience Advisory Panels (LEAPs) who will participate in co-production, co-design and dissemination. Together with our PPI partners, we will place information about our study and our good practice guidance on their websites and within their newsletters. We will develop accessible videos about our study and our findings together with our PPI partners and place them in the public domain. We will hold joint dissemination events to ensure maximum reach including specific events to showcase our good practice guidance.
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