Organising care for complexity: a pathways model for adult community intellectual disability services

Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. <i>Care</i> pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and dementia within a community-based service architecture. It considers recent focus on digitalsation, prevention, workforce and practice innovation. The model aligns with contemporary policy priorities. We argue that pathway-based care delivery provides a pragmatic and ethically grounded framework for organising services. It supports consistency, integration, and preventative care while reducing reliance on reactive risk-based responses. By synthesising service design principles, core pathway functions, and system interfaces, this paper offers a coherent model for contemporary community intellectual disability services. Further empirical evaluation is required to assess the impact of care pathways on outcomes, patient experience, and cost-effectiveness.

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Publication Details

Journal
International Review of Psychiatry
Published
2026-02-02
DOI
https://doi.org/10.1080/09540261.2026.2624620
Primary Topic
Down syndrome and intellectual disability research
Type
article
Field-Weighted Citation Impact
0.00
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article

Organising care for complexity: a pathways model for adult community intellectual disability services

Regi Alexander, Kiran Purandare, Rory Sheehan, Bhathika Perera et al.
International Review of Psychiatry
Down syndrome and intellectual disability research
article

Organising care for complexity: a pathways model for adult community intellectual disability services

Regi Alexander, Kiran Purandare, Rory Sheehan, Bhathika Perera, Indermeet Sawhney, Laura Korb, Lance Watkins, Richard Laugharne, Angela Hassiotis, Heather Hanna, Satheesh Gangadharan, Rohit Shankar, Niall O’Kane, Ashok Roy, Samuel Joseph Tromans, Asif Zia, Ganesan Rajagopal, Jane McCarthy, Jana DeVilliers
article en

Abstract

Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. <i>Care</i> pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and dementia within a community-based service architecture. It considers recent focus on digitalsation, prevention, workforce and practice innovation. The model aligns with contemporary policy priorities. We argue that pathway-based care delivery provides a pragmatic and ethically grounded framework for organising services. It supports consistency, integration, and preventative care while reducing reliance on reactive risk-based responses. By synthesising service design principles, core pathway functions, and system interfaces, this paper offers a coherent model for contemporary community intellectual disability services. Further empirical evaluation is required to assess the impact of care pathways on outcomes, patient experience, and cost-effectiveness.

International Review of Psychiatry
Swansea Bay University Health Board (GB), NHS Lothian (GB), King's College - North Carolina (US), Barnet Enfield and Haringey Mental Health Trust (GB), King's College London (GB), Central and North West London NHS Foundation Trust (GB), Sussex Partnership NHS Foundation Trust (GB), Hertfordshire Partnership University NHS Foundation Trust (GB), State Hospital (GB), Coventry and Warwickshire Partnership NHS Trust (GB), Southern Health and Social Care Trust (GB), Cornwall Partnership NHS Foundation Trust (GB), Leicestershire Partnership NHS Trust (GB), University College London (GB), De Montfort University (GB), Peninsula College of Medicine and Dentistry (GB), Camden and Islington NHS Foundation Trust (GB)
Quality Education
Openalex Percentile: Top 69%
Down syndrome and intellectual disability research
DOIOpen Access PDFOpenAlex
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