Using individual service funds (ISFs) to improve access to self-directed support for adults with intellectual disabilities: a participatory realist review

Background

Individual service funds (ISFs) in England aim to provide self-directed support without the challenge of procuring support and managing a budget. However, few local authorities offer ISFs and some do not offer more choice and control than a council-managed budget.

Methods

This participatory realist review followed RAMESES publication standards. We developed and refined theories using published and grey literature, expert stakeholders and personal narratives (written and video case studies).

Results

We identified eight initial programme theories, forming a programme theory explaining how ISFs generate successful outcomes for adults with intellectual disabilities. These included: involvement in support planning; accessible budget information; flexible use of budgets; outcome-focused support planning; ‘live’ support plans; non-traditional support; positive risk management and trusting relationships.

Conclusion

Our programme theory elucidates causal pathways for successful ISF outcomes, connecting mechanisms to contextual factors. This guides ISF development and implementation and helps adults with intellectual disabilities make informed decisions about ISFs.

Highlights

People with intellectual disabilities want to choose where they get support and who supports them. However, many people cannot or will not do this because buying their own support and managing their own budget is too complicated. This often means they have fewer choices about their support.

ISFs were created to help more people have choice and control over their support. Even though The Care Act (2014) lists ISFs as one of the three main ways to get a personal budget, not many people are offered this option. Sometimes, local authorities say they are offering an ISF, but it is actually a council-managed budget with a limited set of services. They're just calling it by a different name, which can be misleading.

We worked with an advisory network, including adults with intellectual disabilities, and used research papers, reports, video case studies and interviews to develop explanations (called theories) about how ISFs should work for someone with intellectual disabilities.

People who work in social care can use this to make sure their ISFs give someone more choice and control over their life. Adults with intellectual disabilities and their families can use this to check if the ISF they are being offered is likely to work well for them, helping them decide whether to accept the offer.