Commissioned by the National Disability Insurance Agency, the aim of this review was to understand the interventions and strategies that are being used to help people transition out of institutional care into more individualised home and living options. 

A systematic review and environmental scan of evidence from 2000-2020 across 10 academic databases, 55 organisation websites and 49 grey literature documents was run in October 2020. The academic literature predominantly reported on the process of de-institutionalisation to community group living. The comprehensive search that was conducted included five types of accommodation that people with disabilities transitioned into, which facilitated greater independence as alternatives to institutional or group home models.

In this review, this included:

1. Community or supported;
2. Independent or semi-independent homes, including living alone, co-residency, relationships;
3. Home ownership (shared equity);
4. Home pooling;
5. Housing modifications/redesign/technology including assistive technology and wider living ecology adaptations.

Though housing modifications are not a transition to other housing per se, support to redesign and adapt a home is an intervention which is typically employed to prevent transition to congregate setting and was therefore included as part of this review.

Key findings:

• Interventions that enable transition exist at policy (flexible funding, adequate housing stock), organisational (staff training, provision of specialist services, person centred values), community (technology, outreach supports), interpersonal (staff support and informal networks and supports) and individual levels (involvement and skill development). Barriers to transition also exist at each of these levels
• Improvements in independence, quality of life and wellbeing, social inclusion and participation (including attainment of social valued roles), health and functioning, and adaptive behaviour were found for people with disabilities following transition to housing alternatives other than congregate and group home settings.
• While there was some evidence of benefit from housing transition across a range of outcome measures, indicators and tools used to measure effectiveness were varied across studies with no standardised outcome measure within a category (for example, no single measure of quality of life) and no standard suite of outcome measures being implemented (studies measured a range of factors but not the same range in each study).
• The evidence on cost-effectiveness for living options other than congregate settings was limited (n=5) and inconclusive, requiring further data.
• Evaluation of effectiveness of current practices was not detectible in the environmental scan. Many of these initiatives are new and developing. There is a need to evaluate these practices to establish impact on participant outcomes.