The document discusses research on supporting people with intellectual disabilities to live in the community. It finds that deinstitutionalization has generally led to better outcomes for people with intellectual disabilities compared to living in institutions. However, there is variability in outcomes depending on factors like the severity of disability and the design of community-based living arrangements. Specifically, smaller group homes with 1-6 residents tend to have better outcomes than larger clustered housing arrangements or institutions. The quality of staff support and opportunities for meaningful engagement are also important factors influencing life quality. Overall, well-designed and implemented community living options can support good outcomes for everyone, including those with more significant needs, but support must be carefully planned and monitored.
1. Supporting People with Intellectual Disability to
Live Good Lives in the Community – the Role
of Group Homes Past- Present and Future.
Professor Christine Bigby
Living with Disability Research Group
La Trobe University
Supp
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Grou
Profe
Living
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3. Outline
Background – group homes as part of deinstitutionalisation
Evidence outcomes and staff practice -group homes vis institutions
Evidence group homes and other models
Evidence current situation in Australia – outcomes, staff practices- culture
Understanding reasons for variability and poor performance
What makes a difference - improving outcomes
5. Early forms of accommodation - Institutions
Design
• large congregations of people
• physically and socially segregated from the wider society.
Staff Working practices
• depersonalisation (removal signs and symbols of individuality and
humanity)
• rigidity of routine (fixed timetables irrespective of preferences or needs)
• block treatment (processing people in groups without privacy or
individuality)
• social distance (symbolising the different status of staff and residents) (King,
Raynes and Tizard, 1971).
Outcomes
• social exclusion – abuse – loss of individuality/humanity - lack choice,
personal development (Blatt, 1966)
Condemnation of institutions from 1970s driven by scandal and ideology of
normalisation
7. Deinstitutionlisation
“….one common factor is the embrace of the concept of normalisation and the rejection of
segregation of people with intellectual disabilities from the rest of society. (Bradley, 1994)
Deinstitutionlisation more than closure of institutions
Requires both significant individualised support as well as societal change
(Bigby & Fyffe, 2006)
… The success or failure of deinstitutionalization will rest with our ability, collectively, to
prepare our communities to accept persons with intellectual disabilities as valued and
contributing members of our society. (Gallant, 1994, cited Bigby & Fyffe, 2006)
Main strategy - accommodation support - little initial attention to community change
̶ still more than half of all disability expenditure on supported accommodation (AIHW, 2012)
Australia
– 1-6 bed supported accommodation (group homes)
– larger hostel facilities many now closed
UK
– small supported accommodation
– campus cluster style accommodation small units on same site many now closed
– some intentional villages
– growth of supported living options
9. Research Findings: Deinstitutionalisation
Better outcomes
‘There can be no doubt, in general, that people with an intellectual disability
benefited from deinstitutionalisation’ (Mansell & Ericsson, 1996).
– More choice making opportunities
– Larger social networks and more friends
– Access to mainstream community facilities
– Participation in community life
– Chances to develop and maintain skills
– More contact from staff and more engagement in ongoing activities
– A better material standard of living
– Increased acceptance from the community.
Less clear advantages -challenging behavior, psychotropic medication, health
(Emerson & Hatton, 1996 & Kozma, Mansell & Beadle Brown, 2009)
Victorian studies similar findings (Bigby, 2006; Bigby, Cooper & Reid; 2012, Clement & Bigby, 2010)
Better Outcomes Possible for Everyone
̶ Early UK demonstration programs - community living is possible for everyone
– even people with severe challenging behavior and high complex support
needs (Mansell et al., 1987)
11. Research Findings: Variability
Variation
Best institutions better than the worse supported accommodation (staffed
individual or small group)
Best supported accommodation exceeds best institutions
Variability most apparent on QoL domains of community participation, social
networks and self determination
People with more severe intellectual disability fare worse
Closing institutions does not guarantee against the re-emergence of “institutional”
practices or ensure improved client outcomes (Felce, 1996; Mansell & Ericsson, 1996).
Low engagement of clients in meaningful
activities has persisted in community houses
(Mansell, 1996)
Is the model flawed or the implementation?
Community living requires careful and
sustained implementation and monitoring strategies. clip
13. Variability in performance in residential settings in England and
Wales for engagement in meaningful activity
Mansell (2006)
Mean = 13.7% Range = 2 - 23%
Mean = 24.7% Range = 6 - 54%
Mean = 47.7% Range = 8 - 74%
Victorian study 6 organisations – 33 houses (Mansell, Beadle-Brown, Bigby, in press)
Mean engagement 51% Range 0-100
15. Post Deinstitutionlisation Research
Why variability – why best institutions cannot match
Degree of impairment major predictor
Necessary but Not Sufficient Conditions –
Resources - below a critical threshold will affect outcomes – there are no cheap
good quality services (Emerson & Hatton, 1994, Mansell et al., 2007)
-once adequate marginal or decreasing returns(Mansell, Felce, Knock, 1982)
Design
• Size 1-6 and then stepped rather than gradual (Tossebro, 1995)
• Type ordinary and dispersed (Emerson et al.; Janssen et al., 1999; Mansell & Beadle Brown, 2009)
• small body of literature - Some definitions
•Dispersed – small group homes 1-6 ( housing + support) or supported living 1-3 (separate
housing and support)
•Cluster – ‘number of living units forming a separate community from the surrounding
population’
• residential campus’s often institutional sites
•cluster housing – separate housing same site, or cul de sac
•intentional villages – separate site, shared facilities – unpaid life sharing – strong ideology (Camphill)
some failed attempts with staff in OZ Redlands
17. Design Type: Research Findings
Mansell & Beadle Brown (2009) reviewed 19 papers - 10 studies, UK, Oz,
Netherlands, Ireland – most large robust studies
‘Dispersed housing is superior to cluster housing on the majority of quality
indicators’
Cluster housing has poorer outcomes on domains of Social Inclusion, Material
Well-Being, Self-Determination, Personal Development, and Rights
On most sub domains dispersed housing has better or no different outcomes
(see table)
Only exception Physical Well-Being villages or clustered settings primarily
villages not cluster
o No studies reporting benefits of clustered settings.
o No evidence cheaper
̶No evidence more connected to community of people with intellectual disability
̶No evidence that residents are safer in cluster settings
19. Quality of life domains Dispersed
Better
No
difference
Cluster
/village
better
Social inclusion x - -
Access to local neighbourhood x - -
Use of community facilities - xx -
Number of community amenities
visited
x - -
Community activities and
opportunities
xxx x -
Residential well-being x - -
Interpersonal Relations xx xx -
Sexual activity - x -
Relationships with family, carers,
others
x x -
Number of people in network xxx x -
Composition of network - x -
Contact with family/family members
in network
- xxxx x
People with ID in network x xx -
Local people in network x x -
Contact with friends x x x
Contact with neighbours - x -
Observed contact from others - x -
Stayed away/guest to stay - x -
Vistors to home x - x
Material Well-Being x xx -
Emotional Well-Being - x -
Challenging behaviour/stereotypy x xx -
Satisfaction in all areas except
friendships/relationships
- x -
Satisfaction friendships/relationships - - x
Chaos and confusion x - -
Quality of life domains Dispersed
Better
No
difference
Cluster
/village
better
Self Determination xxxxxx xxxx -
Personal Development - x -
Scheduled activity x xx -
Constructive activity - x -
Opportunities to learn new
skills
x - -
Change in adaptive
behaviour over time
- x -
Change in domestic activity
and in responsibility
x - -
Life achievements and
changes
x - -
Education/employment x - -
Work experience/adult
education/day centre
activities
- x -
Rights - - -
Privacy x - -
Access/adapted environment - x -
Freedom x - -
Exclusion/restraint, sedation
used for challenging
behaviour
x - -
20. 生活品質領域 分散
式較
佳
無差
別
聚集
/ 公
設較
佳
社會融合 x
有管道與當地鄰里接觸 x
使用社區設施 xx
拜訪社區文化福利設施的數量 x
社區活動與機會 xxx x
住宿福祉 x
人際關係 x
性活動 x
與家人、照顧者以及其他人的關
係
x x
網絡的人數 xxx x
網絡的構成 x
與家人 / 家庭成員的接觸 xxx x
網絡中有智能障礙同儕 x xx
網絡中有當地居民 x x
與朋友的接觸 x x x
與鄰居的接觸 x
生活品質領域 分散
式較
佳
無差
別
聚集
/ 公
設較
佳
他人觀察到的接觸 x
外宿 / 訪客來住 x
訪客來家拜訪 x x
物質福祉 x xx
情緒福祉 x
挑戰性行為 / 刻板化 x xx
除了友誼 / 人際關係其他領域皆滿意 x
滿意人際關係 x
衝突與混亂 x
個人發展 x
預定的活動 x xx
結構化的活動 x
學習新技能的機會 x
適應行為的改變 x
居家活動以及負責任的改變 x
生活成就與改變 x
教育 / 就業 x
21. 生活品質領域 分散式
較佳
無差別 聚集 /
公設
較佳
工作經驗 / 成人教育 / 日間中心活動 x
權利
隱私 x
有管道 / 環境調整 x
自由 x
隔離 / 為了挑戰性行為使用的限制、鎮靜藥物 x
22. 22
Design Type: Research Findings
Supported Living
• Semi independent living US
• ‘Personalised residential supports’ Australia (Cocks & Boaden, 2011)
• 1-3 people, separation housing & support , drop in support or 24 hour (Kinsella,
1993).
• Likely to grow with new funding arrangements
• Little evidence re outcomes, support arrangements or communities
• Better outcomes
• choice, frequency and range of community activities,
• more cost effective (Stancliffe, 1997, Stancliiffe & Keene, 2000; Howe et al., 1998, Emerson et al, 2001, Perry et al., 2012)
• Poor outcomes
• exploitation, scheduled activities, health, money management (Felce et al., 2008; Perry et al.,
2012; Emerson et al., 2001)
• Few differences – except choice and control (Stainton et al., 2011)
• Implementation issues - absence of appropriate support – formal and informal
23. 23
設計型態: 研究發現
支持性居住
• 美國半獨立居住
• 澳洲‘個人化居住支持’ (Cocks & Boaden, 2011)
• 1-3 人,住宅與支持分開, 探訪式支持 (drop in support) 或 24 小時 (Kinsella, 1993).
• 很可能跟新的經費安排方式一起成長
• 在成果上少有實證,支持安排或是社區
• 較好的成果
• 選擇,參與社區活動的頻率與範圍,
• 更具成本效益 (Stancliffe, 1997, Stancliiffe & Keene, 2000; Howe et al., 1998, Emerson et al, 2001, Perry et al., 2012)
• 較差的成果
• 剝削、預定的活動、健康、金錢管理 (Felce et al., 2008; Perry et al., 2012; Emerson et al., 2001)
• 少有不同之處 – 除了選擇與掌控 (Stainton et al., 2011)
• 與執行有關的議題 – 缺乏適當的支持 – 正式與非正式
24. 24
Situation in Australia in Dispersed Supported Accommodation
Study of 6 organisations in Victoria – 33 group homes 151 residents (Mansell, Beadle Brown & Bigby,
2013 )
Level of Ability
̶ residents less disabled than comparable UK services (Netten et al., 2010)
̶ people with lower support needs more engaged – with little staff support
Low or Variable engagement - mean 51%
̶ people with more severe intellectual disability 39% vis 61% mild
Staff Practices
Staff Assistance - mean 3% of the time
Staff Contact - mean 10% of the time - 4-6 mins every hour
̶ 25% -50% of residents no contact during an hour
Only consistently high levels of Active Support in one organisation, especially for
people with more severe disabilities
Substantial variation within and between homes – less than 1/3 people were
receiving consistently good support
26. 26
Staff Culture in Group Homes
̶ Resemblance to aspects of institutional culture – qualitatively different ,
more individualised, more taking care of
̶ Most resemblance – social distance – manifested as ‘otherness’ ‘not like
us’ (Bigby et al., 2012)
Dimension Polar End (s) Descriptor
Alignment of power-
holders with the
organisation’s values
Misalignment of power holder
values with organisations
espoused values (alignment)
‘We’re not going to do
it that way’.
Regard for service
users
Otherness (the same as other
citizens)
‘Not like us’
Perceived purpose Doing for (doing with) ‘We look after them’
Working practices Staff centred (client centred) ‘Get it done so we can
sit down’
Orientation to change
and ideas
Resistance (openness) ‘Yes but’
28. 28
Group Home Culture
When we get to the shopping centre
we are taken to a café/juice bar. The
four men are seated around a table
and Jeff [house supervisor] and Kirsten
go to the counter. They come back
with four identical orange-based drinks
and doughnuts. [No effort to offer a
choice or involve people in paying for
the drinks.] I go and order my drink.
The seating area is quite tight, so
Kirsten sits at a different table. Valerie,
who is working later that afternoon,
passes the table where we are sitting
and talks to Kirsten. (F/MS/021105)
Misalignment of power-holders
with the organisation’s values
•Disregard for a comprehensive
understanding of the goal of
building inclusive communities
• Focus on community presence
but not community participation
•Power held by cliques
Regard service users as
‘other’
•Fundamentally different
• Too disabled
• No skills
• Can watch, but not get
involved
Purpose - doing ‘for’ not ‘with’
• Looking after people – looking after the house
•Getting people out
•Sequential – hierarchy – tasks then engagement
Resistance to change and new
ideas
•Resistance to ideas of community
participation, active support, and
more individualised activities
Staff centred
working practices
•Staff needs prioritised
•Block treatment
30. 30
What is a good group home?
What should you expect to see?
Do these findings reasonate with your services?
What is a good group home ?
What should you expect to see?
o resident outcomes
o staff practices
o organisational processes
Raising your sights [clip Alex and Simonn] Mansell, 2010
32. 32
Good outcomes - Indicators
Quality of Life
Domain
Indicators which can be observed for people with severe and profound intellectual disabilities receiving support
Social Inclusion • People live in an ordinary house in an ordinary street in which other people without disabilities live
• People are supported to access the local community and its facilities
• People are supported to take part in activities in the community not just with other people with disabilities. Support can be
paid support, families, volunteers, the members of community groups which the person attends.
• People are supported to have a valued role in the community.
• People are known by their name and are missed if they are not present.
Physical well-being • People are supported to move around safely in their home and in the community (without staff being risk averse).
• Personal care is provided well and promptly, and pain/illness recognised and responded to
• People are supported to live healthy lifestyles with a healthy diet and adequate exercise
• People are supported to relax and take part in leisure and hobbies of their choosing
• People are supported to access healthcare promptly when ill as well as regular health checks appropriate to age and
disability.
Interpersonal
relations
• Where people have family, they are supported to have positive contact with them on a mutually agreed or satisfying basis.
• People have members in their social network other than immediate family, and paid staff and their associates.
• People are supported to develop and sustain contact with new people with similar interests both with and without
disabilities.
• People experience positive, respectful, helpful interactions with staff and others in their social network.
• From at least some, ideally most, of these contacts, people experience affection and warmth.
Material well-being • People have a home to live in that is suited to their needs in terms of location, design, size and décor, within the
constraints of cultural and economic appropriateness.
• People have their own possessions which are displayed appropriately around their home.
• People have enough money (through employment or benefits) to afford the essentials in life and at least some non-
essentials (e.g. holiday, participation in preferred activities in the community etc).
• People have reliable transport to access community facilities that they would like to or need to access
33. 33
Emotional well-
being
• People appear content with their environment, their activities and their support
• People take part happily in a range of activities and interactions when given the right support to do so
• People do not show challenging behaviour or spend long periods in self-stimulatory behaviour
• People appear at ease with staff presence and support
Self-determination • People are supported to make choices and their choices respected (at least about day to day aspects and preferably about
larger life decisions)
• People’s own preferences and agendas guide what staff do rather than staff’s agendas and preferences
• People are supported to understand and predict what their day will be like
• People are supported to be part of their person-centred planning process and/or have someone who knows them well and
who can help others to understand their desires and wishes.
Personal
development
• People are supported to engage in meaningful activities across a range of life areas (employment, household/gardening,
leisure, education, social)
• People are supported to try new activities and experiences where they experience success and develop skills.
• People are supported to demonstrate what they can do (their competence) and experience self-esteem.
Rights • People’s dignity and privacy are respected
• People are supported to follow their religious and cultural beliefs if they wish to
• People are supported to access to all communal areas in their own home and garden as and when they wish to
• People are supported to have meaningful input into their household direction, and ideally into service and organisational
direction and into broader lobbying efforts
37. 37
Glimpses of a different culture -
Positive regard for residents ‘Like Us’ - assumption of
essential humanness
When we just call them people, like I would call you a person, that just seems way more
respectful, and I think it gives everyone the attitude, around how you’re thinking too. If
you’re treating people with the respect they deserve, then people will respect them
(I/KF/083011).
39. 39
Attending to Difference
Attached little importance to severity of impairment
Discomfort with articulating difference – only when pushed
He relies on my judgement a lot I suppose, what we do and where we go, which is okay,
because the basic fact is that Hank can’t tell me exactly what he wants to do, but we try
and find stuff that he likes to do. (I/LL/091611)
Acknowledged Limitations
Minimally they might put away their washing....if someone’s home Daisy or Pearl or
someone [staff] will put their washing on their chair tables and take them into their room,
but that’s as far as it goes. They can’t put the clothes into their wardrobes themselves, so
the staff take over. (I/AM/083011).
‘The arms and legs’ of residents, doing things that people could not do for themselves.
Developmental age reflected in interactions – playful interactions – having
fun.
Pearl takes the pills and some chocolate mousse down to Kirstin’s bedroom, where
Kirstin is lying in her bed. She knocks on the door, goes in, nudges Kirstin and speaks to
her. Kirstin opens her eyes and wants to hold Pearl’s hands. They hold hands and clap
them together. (F/ED/072811)
41. 41
Guides to Thinking- Heuristics
The Golden Rule
‘Do unto others as you would have them do unto you (Honderich, 1995, p.321).
Staff avoided de-personalising language, treated residents respectfully, got them out of the
house on weekends as this is how staff themselves would like to be treated.
‘I think of how would I like to be treated myself. I mean anything can happen. Next week I
could be in a wheelchair myself, so I like to treat people how I feel that I would like to be
treated’. (I/BH/102811)
Referent is staff members own preferences and values
The Platinum Rule [empathy]
‘Doing unto others, wherever possible, as they want to be done by’ (Popper
(1945/1962)
• Understanding the perspective or standing in the shoes of another
•Interpreting facial expressions, behaviours, and body language and state with
confidence that someone is feeling cold, distressed, happy, in pain, etc.
Juggling two rules
‘If I was in Hank’s position, what would I expect? And I would expect someone to help me
do this stuff, so it’s not really a big deal, and for Hank it’s been his whole life, so he
probably just sees it as being helped to do all of this stuff. It’s normal for him’.
(I/AC/091611)
43. Person Centred Approaches
‘There is now no serious alternative to the principle that services should be tailored to
individual needs, circumstances and wants’ (Mansell & Beadle Brown, 2005)
Striving to be Person centred is a core feature of health and social service systems
Represents fundamental shift in thinking – evolved over past 40 years
• Individualization - finely tailored to the needs and wishes of the individual;
• Responsiveness - adapt to the changing needs and continually shape support to the
needs of the individual
• Control - individuals exercise control over the type of services and support they receive
(Mansell, 2005)
• Understood and operationalised at different levels of system e.g. control
• System level - control of a funding package = choice of service provider or place of
residence
• Organisational level - control over the type of service = choice when support is provided,
by whom, staff selection and who a person might live with.
• Micro individual level - control of what and how support is provided on daily basis = control
of how long have a shower, bath or shower or whether support provided to interact with a
local shopkeeper
- reliant on skills of staff
- providing the opportunity so a person can experience the possibility they like or dislike
-capacity to elicit and respond to service user feedback about it.
45. Person centred action
Different person-centred approaches tackle different levels of the system
People with more severe intellectual disability need more than funds, system
design, person centred thinking or planning
Action at the micro level to improve outcomes and achieve values such as
inclusion, independence and choice and control.
Skilled staff support to facilitate:
Engagement in meaningful activity and relationships are the primary vehicles by
which many aspects of quality of life are realised (Schalock & Alonso, 2002).
̶ personal development is only possible if people participate in
activities that broaden their experiences;
̶ interpersonal relations and social inclusion depend on interacting
with other people; and
̶ physical health depends on lifestyle and activity (Robertson et al. 2000;
Beadle-Brown, 2006; Mansell & Beadle-Brown, 2012).
•Engagement - An indicator of quality of life
•Engagement - A means to achieving quality of life
47. What makes a difference – not just values
Good quality of life outcomes when......
Complex interactions 6 main elements
Necessary but not
sufficient conditions
• Adequate resources
•Size & Type
Coherence of organisational values
and policies & a mission that puts quality of life
of service-users at the core of all its actions
Organisational leadership policies and procedures
Service characteristics
Staff training
Staff characteristics
An informal culture that is
congruent with and supports
the formal mission of the
organisation
Service user characteristics
Organisational and staff
practices that compensate
as far as possible for
inherently disadvantageous
characteristics of residents
Staff and managerial
working practices that
reflect organisational
values and policies and
the principles of active support
An external environment that is
congruent and reinforces the
mission and values of the
organisation
49. Challenges for the Future
Reduce variability in group homes models – adopt strong clear practice frameworks
Attention on micro level practice
Development of core practice frameworks – the Way we Work combining person centred
approaches rather than disaggregating
Value and recognition of skilled practice – empathy is not enough
• Individualism and growth of dedifferentiation – loss of specialist knowledge
Whole of organisational approach diverse programs and service users
Use of Active Support across settings and service types – as indivdualised support more
common (revisiting Saxby et al., 1986 - convivial encounters)
Organisation of practice leadership – dispersed individual settings – unbundle from
administrative tasks
Political and Community commitment
Social solidarity to provide funding
Social connections to be involved
‘there are risks to be managed which cannot not be addressed by person centred
planning or this way or that way which require strategic direction of public authorities in
other domains.
51. 51
Contact c.bigby@latrobe.edu.au
Resources
Raising our sights services for adults with profound intellectual and multiple
disabilities : a report / by Jim Mansell. Vidoes
http://webarchive.nationalarchives.gov.uk/
+/www.dh.gov.uk/en/MediaCentre/Media/DH_117967
http://www.kent.ac.uk/tizard/news/Raising_our_sights_video.html
52. 52
連絡信箱 : c.bigby@latrobe.edu.au
參考資源
Raising our sights services for adults with profound intellectual and multiple
disabilities : a report / by Jim Mansell. Vidoes
http://webarchive.nationalarchives.gov.uk/
+/www.dh.gov.uk/en/MediaCentre/Media/DH_117967
http://www.kent.ac.uk/tizard/news/Raising_our_sights_video.html
53. References 1( 參考文獻 )
Bigby, C (2006). Shifting models of welfare: Issues in the relocation from an institution and the organisation of community
living. Journal of Policy and Practice in Intellectual Disability, 3, 147-154.
Bigby, C., & Fyffe, C. (2006) Tensions between institutional closure and deinstitutionalization: What can be learned from
Victoria’s institutional redevelopment. Disability and Society, 21, 6, 567 - 581
Bigby, C., & Fyffe, C. (2006) Tensions between institutional closure and deinstitutionalization:
Bigby, C., & Fyffe, C. (2009). A position statement on housing and support for people with intellectual disability and high,
complex or changing needs. Journal of Intellectual and Developmental Disability, 34, 96-100
Bigby, C., T. Clement, J. Mansell and J. Beadle-Brown. 2009. ‘it’s pretty hard with our ones, they can’t talk, the more able
bodied can participate’: Staff attitudes about the applicability of disability policies to people with severe and profound
intellectual disabilities. Journal of Intellectual Disability Research 53: 363-76.
Bigby, C. and T. Clement. 2010. Social inclusion of people with more severe intellectual disability relocated to the
community between 1999-2009: Problems of dedifferentiated policy? In More than community presence: Social
inclusion for people with intellectual disability. Proceedings of the fourth annual roundtable on intellectual disability
policy., 30-40. Bundoora: La Trobe University.
Bigby, C., & Fyffe, C. (2010). More than Community Presence: Social Inclusion for People with Intellectual Disability.
Proceedings of the Fourth Annual Roundtable On Intellectual Disability Policy. Bundoora: La Trobe University.
Mansell., J., Beadle-Brown, J., & Bigby, C. (in press) Implementation of active support in Victoria, Australia: an exploratory
study. Journal of Intellectual and Developmental Disabilities
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Bigby, C., Knox, M., Beadle-Brown, J., Clement, T., Mansell., J (2012) Uncovering Dimensions of Informal Culture in
Underperforming Group Homes for People with Severe Intellectual Disabilities. Intellectual and Developmental
Disabilities
54. References 2 ( 參考文獻 )
Bigby, C., (2012). Social Inclusion and People with Challenging Behavior: A Systematic Review. Journal of Intellectual and
Developmental Disability. 37, 4, 360–374.
Clement, T., & Bigby, C. (2012). Competencies of frontline managers of supported accommodation services: Issues for
practice and future research. Journal of Intellectual and Developmental Disability, 37,131-140
Johnson, H., Douglas, J., Bigby, C., Iacono, T (2012) Social interaction with adults with severe intellectual disability: Having
fun and hanging out. Journal of Applied Research in Intellectual Disability 25, 329-341
Blatt, B. and F. Kaplan. 1966. Christmas in purgatory: A photographic essay on mental retardation. Boston, Mass: Allyn and
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