1. A richer picture of people and relationships
Attachment is a growing field of endeavour, despite struggling for air in a policy environment dominated by individualism. Mullen summarises research and the development of measures. Rather than treating care staff as lacking free will and in need of “training,” Quilliam et al. examine staff perspectives on paperwork. They reveal gaps and ways that it hinders them from supporting residents well, concluding that organisations should consult staff to design paperwork with goodness of fit to practice. Sango and Forrester-Jones explore religious and spiritual communities, which have maintained a presence in intellectual disability despite their lack of congruence with contemporary secular policies. People supported in faith-based residential services had significantly larger networks than those living in non-faith-based services: faith communities can be a conduit to companionship. Finally, Manor-Binyamini explores intra-cultural diversity: educated Bedouin women who marry men with intellectual disability.
2. Where current policies fall short
Bigby et al. compared supported living with group homes: despite claims about the greater potential of supported living, quality of life was “mediocre” for people residing in both. There were particular shortcomings in physical health, personal development, and interpersonal relationships. Awan et al. examined services for adults with rare genetic syndromes who engage in challenging behaviour. There was no association between the degree of challenging behaviour and service receipt. This echoes previous research, while highlighting the added sophistication demanded by complex conditions that require the integration of behavioural and physiological interventions. The remaining two papers question whether employment should remain the only answer to what makes a meaningful adult life? Cheng et al.’s scoping review found it impossible to identify effective support strategies, suggesting a focus on organisational interventions that achieve a better fit between employees and the organisation. Moore et al. did this by investigating a large retail organisation that had tailored jobs previously. Yet centralised recruitment processes, technological changes, and productivity and efficiency demands meant they had ceased to employ people with intellectual disability.
3. New thinking about wellbeing
Even though the social model appears to be in the ascendancy, the vast majority of people with intellectual disabilities experience physical or mental health problems, or both. Cocks et al.’s cross-sectional survey of adults with intellectual disability found 22% in poor health: being old, poor, and living alone increased the risk. Erickson et al. explain the implications of people with intellectual disability having significantly more complex medication regimens: not only more medications, but also more frequent and constrained administration (time of day, avoiding food or other drugs, through routes other than the mouth). Wark urged attention to location since researchers rarely specify place, despite reduced access to health services in rural settings. Finally, Martínez-Tur et al. analyse services that do not manage to overcome differences in perspective between service staff and parents. While 30% of organisations achieved high mutual communication between workers and family members, severe disability made differences about self-determination more likely.
4. Conclusions
These papers raise new topics for consideration, and highlight complexity and diversity. They should provoke new conceptualisations that move beyond twentieth-century dichotomies (social–medical, urban–rural), and neoliberal focus on employment, to develop twenty-first-century concepts that allow for multiplicity and diverse modes of existence, across people and the lifespan.