Conclusions

Residential care is very different in different parts of the world. In the United Kingdom it is provided by small community-based homes, who take an extremely difficult clientele, and face problems associated with high costs, scandalous events, and a lack of a clear rationale. Despite these difficulties there are wide variations in the performance of such homes, particularly in terms of their immediate impact. Outcomes after the residents have left are harder to influence. However, an approach combining attention to the residents' education, behavioural problems, and family environment seems likely to be effective. In the longer term, the residential sector is likely to shrink and the part that remains may well need to become more specialized. Research that could guide such developments is lacking and should be undertaken.

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