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Background We hypothesised that a key factor determining the quality of active support was ‘practice leadership’ – provided by the first-line manager to focus staff attention and develop staff skills in providing direct support to enable people with intellectual disabilities to have a good quality of life. This exploratory study focused on what levels of practice leadership were found and its role in explaining variation in active support. Method Relevant aspects of management, including practice leadership, were assessed by questionnaires administered to staff in residential settings alongside observational measures of active support and resident engagement in meaningful activity. Relationships between these variables were explored using regression and post hoc group comparisons. Results There was wide variation, with average levels of practice leadership being low, though improving over the period studied. Practice leadership had a significant impact on active support, but was fully mediated by the effect of quality of management. When the quality of management was higher better practice leadership did produce a significant difference in active support. However, higher quality of management on its own did not produce better active support. Conclusions A number of limitations are acknowledged and further research is required. Practice leadership appears to be an important factor in enabling staff to provide active support but as part of generally good management. Given the rather low levels found, attention needs to be given to the training, career development and support of practice leaders and also to how to protect their time from their many other responsibilities.

Despite older people representing a significant majority of victims of abuse in the UK and Europe, evidence about its characteristics and management is limited. This article reports on an analysis of adult protection referrals for older people over an eight year period in two English local authorities. It extends understanding of the characteristics of elder abuse and identifies lessons for its effective management. Findings suggest that older people are at particular risk of multiple and physical abuse. Those living alone are especially vulnerable to financial abuse and those living in a care home to multiple abuse. The most common sites of abuse were the person's own home or a care home. Just two fifths of abuse referrals were confirmed, with the vast majority involving multi-agency consultation and most resulting in ongoing monitoring. Findings also suggest that risk is a product of the intersection of dependency and setting and that information about user and carer need—especially the nature of disabi...

PurposeThe purpose of this paper is to report the key findings from a study of adult protection referrals collected by two English local authorities during 1998‐2005.Design/methodology/approachReferrals were analysed for patterns relating to risk with client level data supplemented by information from the local authority databases and from the Care Quality Commission. The analysis also examined associations between adult protection processes and outcomes and looked at how adult protection monitoring data could be improved to better inform safeguarding management and practice at local and national level.FindingsSexual abuse was most frequently reported for people with intellectual disabilities, who were also at higher risk of abuse when living out of area. Older people were most at risk of financial abuse in community settings and of neglect in residential care.Originality/valueThe study identifies patterns of risk in the abuse of older people and those with intellectual disabilities and informs preventive interventions. It also indicates priorities for improving the quality and comparability of adult protection monitoring data.

Background: Studies of engagement in meaningful activity often focus on a short period during the afternoon. The question arises whether this produces different results from studies covering the whole day. Methods: Data collected for 18 individuals using a 20-s momentary time-sample from 08:00 to 19:00 over a number of days for each person were analysed. Duration of behaviours was compared when estimated from a 2-h period between 16:00 and 18:00 and the period 08:00-16:00 and 18:00-19:00. Results: No significant differences at P < 0.01 were found for engagement in meaningful activity, two-way interaction or 24 of the 26 behaviour codes used. Longer duration during the period 16:00-18:00 was found for personal care, which includes eating, and for neutral staff contact in institutions only. No differences were found for any code in housing. Conclusion Observation of activity during the period before and during the evening meal by momentary time-sampling can be used to estimate overall levels of engagement in meaningful activity, two-way interaction and total staff contact, together with other behaviours, with the exception of personal care and neutral contact from staff in institutional settings. Further research is needed to confirm this result.

Background Adult protection monitoring data held by local authorities in England provide opportunities to examine referrals for alleged sexual abuse for people with intellectual disability to identify patterns of risk. Methods Adult protection monitoring data collected by two local authorities was analysed, with referrals for alleged sexual abuse compared to referrals for other types of abuse for people with intellectual disability and the wider research evidence. Results Over a fifth of referrals related to alleged sexual abuse, with two-thirds of these for women. Sexual abuse was confirmed in just over a quarter. Similarities were found with the findings of Brown et al. (Mental Handicap Research, 8, 1995:3) across a range of key characteristics. Conclusions Adult protection monitoring data can be used to provide risk management information on the sexual abuse of people with intellectual disability. To maximize its potential, detailed case characteristics need to be included and attention given to improving comparability between databases.

• Summary: This article examines the processes and outcomes of adult protection referrals in two local authorities in England using adult protection monitoring data collected between 1998 and 2005, identifying learning for the use and development of adult protection monitoring. • Findings: Associations were found between aspects of process and outcome in adult protection case management; police and regulatory agency involvement increased over time, over four-fifths of referrals resulted in investigations which were associated with higher levels of inter-agency involvement, abuse was confirmed for over two-fifths of referrals, there was significant territorial variation across a range of process and outcome measures and specialist adult protection coordinators were associated with higher levels of monitoring and post-abuse work. The study concluded that more work is needed to improve and standardize adult protection monitoring data if it is to more effectively inform case management and inter-authority comparisons. • Applications: The evidence from the study suggests that adult protection monitoring data can be used to help review and organize adult protection work at agency, team and case levels and is consequently of potential value to team managers, social workers and specialist co-ordinators working in adult protection.

Structured diaries describing the activity of three people with mental handicaps were kept by direct-care staff and compared with results of simultaneous direct observation using five-second momentary time-sampling. Item-by-item agreement on main activity in five-minute time blocks ranged from 41 to 72 per cent. Even averaged across three-hour sessions substantial inaccuracy remained. These results suggest great caution is needed in using diaries as a source of evaluative data.

A training course was provided to disseminate good practice in the provision of staffed housing for people with mental handicaps in South East Thames Regional Health Authority. A follow-up questionnaire of people who attended two years after the course showed that respondents rated the course as a major contributor to their practice. A survey of four London health regions showed much greater development of staffed housing in South East Thames Regional Health Authority, including development in districts which were not committed to this model before the course, than in the other three regions.

Verbal interactions involving direct care staff in a group home for people with moderate and severe mental handicaps were observed. The total amount of interaction staff had with residents and with each other was compared. The existence of interaction under different configurations of staff and residents was also examined. Overall, the care staff were involved in interactions across 71.1 per cent of observed intervals. They were almost twice as likely to be involved in interactions to or from residents (47.3 per cent) than to or from other staff (25.9 per cent). However, when compared across different configurations, interactions with residents were less frequent when other staff were present, suggesting that interactions with staff were preferred. Examination of staff-staff interactions suggested that these were largely work-related, so to dismiss them as detrimental to people's work is premature. Ways in which staff-staff interaction may be important are discussed.

Observational measures of client engagement and staff-client contact were taken of 33 people attending a day centre for adults with mental handicap. A low ability group were engaged in constructive activity for 22%, a middle ability group for 46% and a high ability group for 66% of the observations. Assuming a notional 5-hour ‘working’ day in the centre, people in the low ability group were engaged for, on average, 66 minutes; people in the middle group for 2 hours 18 minutes; and people in the high ability group for 3 hours 18 minutes. The most common disengagement code for the highest ability group (53% of disengaged observations) was ‘inactivity’ - people were either spectating or doing nothing although they had materials available. For the middle and low ability groups the most common codes were ‘waiting’ (e.g. for staff, client, materials to work with) and ‘not allowed or enabled to participate in activity by member(s) of staff (e.g. not included in a team game, not given necessary materials with which to participate, not given anything to do). Together these accounted for over half of the ‘disengaged‘ time of the middle and low ability groups: i.e. the low ability group spent, on average, 2 hours and 18 minutes waiting or not enabled to participate out of a notional 5 hour ‘working’ day. The implications of these results are discussed.

As the policy of community care is translated into reality a number of challenges are beginning to appear on the horizon, including the identification of client groups whose members are proving difficult to serve. People with severe mental handicaps who exhibit severe problem behaviours are one such group (DHSS, 1984; King's Fund, 1987). This paper introduces a series of articles to be published in Mental Handicap that will explore the provision of community based services for this client group. The series will focus on issues arising from the work of the South East Thames Regional Health Authority's Special Development Team.

• Summary: This study focused on the incidence of adult protection referrals, the people involved as victims, perpetrators and referrers and the type of abuse in two local authorities in the south-east of England. • Findings: The number of referrals increased over time; those for older people stabilized but those for younger adults were still rising. There was a clear association between location or setting, perpetrator and type of abuse. A referral about someone living in a care home was more likely to identify abuse by multiple staff and institutional abuse or neglect, especially if the individual was an older person with mental health problems. People with learning disabilities were more likely to experience sexual abuse, mainly from other service users or members of their family. Those living in a private home with others, primarily relatives, tended to be at risk of financial, physical or psychological abuse. Older people living alone were particularly vulnerable to financial abuse by family members or, less frequently, home care workers. • Applications : This study suggests that well-developed adult protection procedures identify many more cases than previously estimated. Further research is needed to explain the low level of referrals from mental health services and variation between territories.

Background: An important question in community living is what factors influence the extent to which staff provide ‘active support’. Methods: Engagement, care practices and a range of staff and organizational characteristics were studied in 72 residential homes serving 359 adults with intellectual disabilities. Managers in 36 settings were trained in person-centred active support (PCAS). A group comparison design and multivariate analysis was used to investigate the relationship between variables. Results: The PCAS group showed more active support, assistance, other contact from staff and engagement in meaningful activity but no difference in choice-making or assessment of participation in activities of daily living. The PCAS group had more staff with a professional qualification, were more likely to think that challenging behaviour was caused by lack of stimulation, had attitudes more in line with a policy of community care, rated most care tasks as less difficult, and were more organized to deliver active support. The comparison group were more likely to think that challenging behaviour was learned negative behaviour, showed more teamwork and were more satisfied. Multivariate analysis identified a range of staff and organizational variables associated with engagement and active support. Conclusions: The results suggest that some variables which have not hitherto been studied in relation with active support are associated with it. Professional qualification, knowledge and experience appear to be important as do some staff attitudes, clear management guidance, more frequent supervision and team meetings, training and support for staff to help residents engage in meaningful activity.

Aim: To explore the views of families, managers and specialists about ‘out-of-area’ placement of people with learning disabilities. Method: Information was collected for 30 people through interviews with their families, home managers and care managers. Focus-groups were conducted with community learning disability teams. Interviews and discussion concerned views about suitability of placements and their operation. Results: The results confirmed that the predicted problems of out-of-area placements occur. Placements, especially those placements which can support people with more complex needs, were difficult to find and secure. The distance involved in some placements caused problems for families, care managers, home managers and community team staff of coordinating and liaising to ensure that appropriate care is provided. Problems of poor quality care were identified by families and particularly by members of community teams. However, the findings were mixed, with care managers, home managers and those family members who agreed to be interviewed generally satisfied. Conclusions: It is clear that out-of-area placements cause some problems, particularly for community teams, but that they also satisfy some professionals and family members.

Background Evaluative studies have shown that special units for people with intellectual disabilities (ID) who have challenging behaviour have advantages and disadvantages. There has been no survey of their number or characteristics for nearly 20 years. Methods A questionnaire was sent to all National Health Service trusts that had ID inpatient beds, and all private or voluntary healthcare establishments providing services for people with mental health problems or ID. This asked for information about the unit, its residents and the views of the unit manager. Results Forty-four agencies confirmed that they provided assessment and treatment units, of which 38 returned questionnaires. These units served 333 people, of whom 75% had mild or moderate ID. A quarter had been there for more than 2 years. Forty per cent of residents had a discharge plan, and 20% had this and the type of placement considered ideal for them in their home area. The main strengths of the units were identified as the knowledge and experience of the staff and having sufficient staff; the main problems as inappropriate admissions, bed-blocking and the relationship with other services; difficulties with recruiting and retaining staff; the location and environment of the unit; and the mix of residents. Conclusions There has been an increasing rate of provision of special units, which now predominantly serve people with moderate or mild ID. This model of service provision is becoming more widespread, but the potential problems identified 20 years ago are still present. Areas are identified for further research.

This mainly exploratory study was a one‐point‐in‐time survey of the situation in one English county. This study involved a survey of all social care homes in the county, followed by measures of quality of life/service for a random sample of 30 people identified by the survey, interviews with home managers, service users, family carers and care managers, and focus groups with members of four community learning disability teams. The total number of people placed from out‐of‐area was estimated to be close to 2,000 (1,500 were placed by the local authority within the county). The main reason for such placements was lack of good local services, but cost also seemed important. For many of those who had been in long‐stay hospital, locality appeared not to be important. Effects varied, but at least a third of people were experiencing very poor service quality and quality of life. Family carers generally felt their relative was happy, but fear of losing the placement was a strong theme. Distance was a major difficulty for both family and care manager involvement. For local community learning disability teams, the main problems included increased workload, reduced provision for local residents, difficulty in dealing with placing authority and the poor quality of the homes. Challenges for public agencies include provision of better local services, management of the cost incentives, especially for London Boroughs, and a system where funding follows the person wherever they chose to live.

This paper reviews progress in deinstitutionalisation and community living for people with learning disabilities. The effects of replacing institutional care on residents are summarised and some emerging problems identified.

Grouping people with learning disabilities and challenging behaviour in residential care has been the focus of several recent research studies. This paper describes these studies and what they found. In general, they show negative effects of grouping people with challenging behaviour together in terms of the quality of staff interaction with them and the outcomes they experience.

Background This critical review considers the nature and importance of person-centred planning in the context of current British policy and service development in intellectual disability. The difference between person-centred planning and other kinds of individual planning is discussed. Materials and method The scale of the task of implementing person-centred planning as a national policy initiative is considered. The limited evidence base for person-centred planning is reviewed and the reasons for the failure of previous attempts at individual planning are analysed. The assumption that person-centred services will be produced by a new kind of individual planning is questioned. Conclusions Consideration is given to what would be necessary to make services more person-centred, including changes in power relations, funding arrangements and staff training and supervision.

This paper responds to four commentaries on our original paper in this issue. We respond to issues raised under three headings addressing the scale of the task envisaged in the 2001 White Paper Valuing People, the feasibility and effectiveness of individual planning and how to achieve person-centred action. We conclude that there is substantial agreement about the goals of intellectual disability services and the processes that need to take place around individuals to help them get what they need and want. We disagree about whether person-centred planning will deliver this, and about whether it will provide a robust basis for claiming and defending the resources people with intellectual disabilities will need in the future.

This article focuses on the development and current situation of services for people with learning disabilities in England. Deinstitutionalisation started in the 1960s, when a series of scandals in hospitals were brought to public attention. In response, the 1971 government White Paper Better Services for the Mentally Handicapped was published, and the first community‐based services were introduced. Further policy papers attempted to modernise social services in the following period. The 2001 White paper Valuing People is the most recent policy framework specific to people with intellectual disabilities. It identifies rights, independence, choice and inclusion as the four leading principles for services and support, and will be of primary importance for future development. However, at present implementation is in the very early stages. Not least, the intense implementation of market mechanisms by the Thatcher Government in the 1980s and 1990s has led to a situation that is hard to grasp, the organisation of care and support varying from authority to authority.

Following earlier findings that people with intellectual disability and challenging behaviour received poorer care when they lived in a grouped setting (75% or more residents also having challenging behaviour), this study aimed to investigate whether people without challenging behaviour also experienced different care or lower engagement in meaningful activity when living with people with severe or potentially severe challenging behaviour. Kruskal-Wallis analysis revealed no effect of living in homes where residents had challenging behaviour, either on care practices or on engagement in meaningful activity. This was also true for sub-groups selected because they might be more vulnerable. Further Mann-Whitney analyses revealed no differences between those living in homes where no-one had severe or potentially severe challenging behaviour compared to those living in homes where anyone had challenging behaviour, and no differences between those people living in homes where less than 75% of the residents had challenging behaviour compared to those where 75% or more had challenging behaviour. Using a narrower definition of challenging behaviour, as severe and frequent aggression, also produced no significant effects. Possible explanations for these somewhat surprising results are discussed and suggestions for future research are presented.

Forty-nine adults with learning disabilities living in 13 small staffed homes in England were studied as part of larger projects in 1997 and again in 2000. A pre-test/post-test comparison group design was used to assess differences in staff implementation of "active support," service user engagement in meaningful activities and adaptive behaviour. Homes which adopted active support showed significantly increased engagement in meaningful activity and adaptive behaviour between 1997 and 2000. A comparison group showed no significant change.

Active support is an effective intervention to support engagement of residents with intellectual disability in group homes. This survey explored resident characteristics of the people supported by organisations implementing active support, the provision of active support, its procedures and systems, and resident engagement in meaningful activity and relationships.Information was collected through questionnaires and direct observation of 33 group homes from 6 organisations in Victoria, Australia, with a 5-10-year history of implementing active support.Residents with lower support needs were engaged with little staff contact or assistance. Use of active support systems and structures was mixed. Only one organisation consistently provided good active support.Administrative systems and structures are not sufficient to change staff interaction and thus resident experience. Shared supported accommodation services may represent an inefficient use of resources for more able residents, as staff resources are not maximised to support for resident engagement.

Three individual cases of adults with severe or profound learning disabilities who moved from institutional care to individually-designed placements in small group homes are used in order to illustrate implications for good practice, management and policy-making. One case was of a successful placement which showed improved results over time; the second was a placement closed down to save money and the third was a placement which broke down in crisis with readmission to institutional care, but which was eventually recreated successfully. The cases show the need to work at three levels: the relationship between the individual and their immediate environment, the relationship between how this environment is delivered and how the placement is organised; and the relationship between the placement and the service system of which it is part.

Culture recurs as an important but under-investigated variable associated with resident outcomes in supported accommodation for people with intellectual disability. This study aimed to conceptualize the potential dimensions of culture in all group homes and describe the culture in underperforming group homes. A secondary analysis, using an inductive interpretative approach, was undertaken of a large qualitative data set from a study that had used ethnographic and action research methods to explore the quality of life outcomes for residents in 5 small group homes. Five categories were developed: misalignment of power-holder values with organizations espoused values, otherness, doing for not with, staff centered, and resistance. Differences from institutional culture are discussed, and the potential of the findings as a starting point to consider culture in high performing group homes and develop a quantitative measure of culture.

In a foreword to 'Shaping the Future of Care Together', Prime Minister Gordon Brown says that a care and support system reflecting the needs of our times and meeting our rising aspirations is achievable, but 'only if we are prepared to rise to the challenge of radical reform'. A number of initiatives will be needed to meet the challenge of improving social care for the growing older population. Before the unveiling of the green paper, The National Institute for Health Research (NIHR) announced that it has provided 15m pounds over a five-year period to establish the NIHR School for Social Care Research. The School's primary aim is to conduct or commission research that will help to improve adult social care practice in England. The School is seeking ideas for research topics, outline proposals for new studies and expert advice in developing research methods.

Los servicios sociales comunitarios para personas con discapacidad garantizan una mayor calidad de vida que los centros residenciales, y no son más costosos. Éstas son las principales conclusiones de un análisis que ha recibido el respaldo de la Asociación Internacional para el Estudio Científico de las Discapacidades Intelectuales (IASSID), que examina –a partir de artículos de síntesis– la literatura científica que compara la eficacia de los servicios comunitarios frente a los grandes centros residenciales en lo que al bienestar de las personas con discapacidad se refiere. Y el resultado no deja lugar a dudas: “una y otra vez, los estudios han mostrado que los servicios comunitarios son superiores a las instituciones”. Cuando lo que se compara son distintas modalidades de servicios comunitarios (hogares de grupo de gran tamaño, hogares de grupo de pequeño tamaño, fórmulas de vida independiente o semiindependiente), se encuentran pocas diferencias entre la vida independiente y los hogares de grupo más pequeños. Dada la relativa amplitud del corpus de investigaciones manejado, es lógico que se observen ciertas variaciones en las conclusiones de los estudios. Los autores del documento consideran que tres factores podrían explicar tales disparidades: las propias características de los residentes, el diseño de los servicios y la competencia del personal que los atiende.

This review focuses on structured observational research, primarily in services for people with learning disabilities. Observational research is particularly useful where people using services are unable to answer interviews or questionnaires about their experiences, and where proxy respondents may not be sufficiently accurate sources of data. The review illustrates the use of observational data in assessing and improving the quality of services. Using examples from the research literature, the review deals with the question of what to observe and how to define it so that the information gathered is valid and reliable. It deals with sampling (how often to observe and for how long) in order to obtain representative information, considers the practical steps that have to be taken in order to make observations in services, and shows how to analyse and present observational data.

Background As institutions for people with intellectual disabilities have been replaced with community services, health care provision has developed to provide assessment and treatment, low and medium secure units for people with challenging behaviour or mental health problems. These include both public and private sector provision. Little is known about these services. The aim of this study was to describe the characteristics of the services studied and to compare the different types of service. Methods A survey was carried out of National Health Service (NHS) and independent sector (IH) health settings providing specialist inpatient services for people with intellectual disabilities. Data were collected on setting and patient characteristics, staffing and management and care processes and outcomes. Results Services were very unevenly distributed across England. There were differences between NHS and IH settings. IH assessment and treatment units were bigger, had higher occupancy and lower staff ratio. In all three types of unit, IH units had fewer visits to patients, used more seclusion, physical restraint and had more locked areas. They had more complaints in more services from users and (for assessment and treatment units and low secure units only) from relatives. In low secure units, they had more adult protection referrals. On the other hand, IH units used fewer agency staff in assessment and treatment units (though more in medium secure units) and provided more appraisals, more visits from commissioners, more consultations with GPs and dentists and more use of whistleblowing procedures by staff. A quarter of people in NHS assessment and treatment units had finished treatment but had no plan for discharge. Conclusions Further research is required to determine the reasons for differences observed between IH and NHS units. The large number of people who have finished treatment emphasizes the importance of developing housing in the community with sufficiently skilled support. The large number of patients in low secure services raises the question whether this type of service is recreating the intellectual disability institutions which government policy intends to close.

The gradual abandonment of large residential institutions1 and their replacement by small‐scale services to enable people to live well in the community has probably been the most significant policy development in intellectual disability in the post‐war period (Mansell and Ericsson, 1996). This process of ‘deinstitutionalisation’ is well advanced in Scandinavia, the United States of America, Canada, the United Kingdom, and Australasia. In these countries, the policy debate about whether to provide institutions or community services is largely resolved. The questions that remain are those of implementation and particularly of whether the kinds of supported accommodation that have been provided replicate institutional features and should themselves be reformed. For many other countries, the debate between institutional and community services has never been particularly important because most people with intellectual disabilities live with their families and services to support them are relatively undeveloped. In these countries, it should be possible to develop community‐based services directly, without going through a phase of institutional care. In a third group of countries, the dominant form of service provision remains institutional care and the question of whether and how to replace this remains a matter of debate. For example, many central and eastern European countries provide institutions of very poor quality and currently have proposals to renovate, upgrade and extend them using international funds instead of replacing them with services to support people in the community. The international legal framework sets out the right of disabled people to live in the community. The United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006), which came into force in May 2008, recognises this right through Article 19, which entails the provision of “a range of in‐home, residential and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community.” The Convention obliges states to develop community living that will replace institutional care through a process of ‘progressive realisation’. This requires states to take measures to the maximum of their available resources with a view to achieving progressively the full realisation of the rights involved. They must, therefore, move in the direction of realising the rights of disabled people but they are allowed to do so at a rate determined partly by the resources available to them. Good information is central to this process of reform and service development. People making decisions about the pace and scope of change, the kind of services needed and the organisation and management of those services are often faced with strongly‐held opinions from proponents of different service models. The purpose of this position statement by the Comparative Policy and Practice Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disability is to set out concisely the evidence comparing institutional to community‐based services and to draw out the main implications for policy‐makers.

Background and aims: This study aimed to collate and summarise statistical information on the number of people with disabilities living in all types of residential care but with a particular focus on those living in institutional care within 28 countries in Europe to analyse the costs and outcomes of the transition to community-based services in order to provide recommendations for agents in these countries to help bring about the change. The rationale for the study was to inform the political debate, to provide evidence and recommendations to support the move to community-based living for people with disabilities. The study aimed to collect data across client groups (intellectual disability, physical and sensory disability and mental illness) and across different age groups (children, adults and older adults). Description of project: There were two phases to this study—the first provided a description of service types in each country and collated existing official statistics on the number of people with disabilities in the different types of residential services; the second phase analysed the existing body of knowledge on costs and outcomes of institutional and community-based services to provide conclusions and recommendations. Conclusions: More than 1.45 million people with disabilities in Europe still live in residential care with 70% of these living in services with over 30 places. Data was better on people with intellectual disabilities than for other user groups but figures collated are none-the-less an underestimation. Drawing together such a mass of information served to highlight the extent of the work still needed to achieve the UN Convention on the Rights of People with Disabilities in almost all the countries included in terms of community-based services for all. It also highlighted the gaps in the available data. Challenges in the task of collating information included the lack of information collated at national level, the issue of varying definitions in use and inconsistency in how and where data was available. Discussion: Most countries in Europe still have some way to go to be able to meet Article 31 of the UN Convention on the Rights of Persons with Disabilities. Recommendations focuses are offered to help bridge the gaps in data available on the situation of people with disabilities.

Background The level of resident's adaptive behaviour and staff facilitative practices are key sources of variation in outcomes for residents in community-based residential services. The higher the resident support needs the poorer their outcome. Although substantial investment has been made in values-based training for staff, their attitudes and the impact of these on practice is largely unexplored. Method and findings The first study used ethnographic and action research methods to examine the daily lives of 25 residents with severe and profound intellectual disabilities (ID), who lived in five small group homes, and the attitudes of the staff supporting them. Thematic analysis of the data led to a proposition that although staff accept principles of inclusion, choice and participation for people with ID in general, they do not consider it feasible to apply these to the people with severe and profound ID to whom they provide support. The findings from a second study that used a group comparison design and administered a short questionnaire about staff attitudes to 144 direct-care staff and first-line managers working in disability services confirmed this hypothesis. Conclusions The study suggests more focused attention is needed to staff understanding the values embedded in current policies and their application to people with more severe disabilities.

Active Support (AS) is an approach for promoting increased engagement in activities by people with intellectual disability (ID).We critically reviewed the available research on AS, and added a commentary to help guide future research and practice.Despite weaknesses in the research design of some studies, there is consistent evidence that AS results in increased engagement in activities. There is also some limited evidence of other beneficial outcomes. All published research to date has involved people with ID in community group homes with 24-hour staffing.The established efficacy of AS for increasing engagement means that research attention can now be given to: (a) developing AS to enhance its positive impact on outcomes such as choice and relationships; (b) exploring the wider implementation of AS beyond community group homes and people with ID; and (c) examining the effectiveness of wide-scale implementation of AS, with careful attention to issues such as management, organisational and staffing factors, and cost.