# The Impact of Support Intensity Needs on Person-Centred Case Management

## TL;DR

This study examines how support needs affect resource allocation for people with intellectual and developmental disabilities in Italy, finding that those with the highest needs often receive fewer supports.

## Contribution

The study introduces multivariate count models to analyze interdependent support types and reveals inequities in resource allocation for high-need individuals.

## Key findings

- Individuals with the highest support intensity needs received fewer supports in adaptive skills and community participation.
- Residential settings were associated with higher support provision compared to family or independent living.
- Assistive technologies and prosthetics were linked with more comprehensive support packages.

## Abstract

Background: International and national policies increasingly call for person-centred approaches in disability services, yet little is known about how support intensity needs influence the allocation of resources for individuals with intellectual and developmental disabilities (IDDs). In Italy, where integrated socio-health systems operate within a human rights framework, this quantitative study investigates how individual and contextual factors shape resource use in individualized support planning. Methods: We analyzed data from 1152 adults with IDDs enrolled in 23 service centres across 13 Italian regions. Case managers developed Individualized Support Plans (ISPs) informed by the Supports Intensity Scale and socio-ecological variables. Resource use was measured as weekly counts of adaptive skills training, community participation supports, habilitation services, prosthetics, and assistive technologies. We applied multivariate count models (Sarmanov–Lee) to capture the interdependence across support types. Results: Findings show that gender and level of intellectual functioning did not significantly affect resource allocation. However, individuals with the highest support intensity needs often received fewer supports, particularly in adaptive skills and community participation. Residential settings were associated with higher levels of support provision compared to family or independent living. Assistive technologies and prosthetics were linked with more comprehensive support packages. Conclusions: While person-centred planning frameworks are being implemented, systemic inequities remain, with those at the highest levels of need at risk of receiving fewer enabling supports. Multivariate modelling provides a robust tool for understanding resource use and highlights the importance of equity-focused planning. These findings support policy and practice reforms that operationalize human rights principles and align with the UNCRPD, ensuring more inclusive and responsive systems of support.