This article examines everyday choices made by 8,892 adults with intellectual and developmental disabilities (IDD) and support-related choices made by 6,179 adults with IDD receiving services from 19 state developmental disabilities program agencies that participated in the 2008-2009 National Core Indicators Project. Controlling for physical and sensory impairment, age, behavioral support, communication, and state, people in residential settings with 16 or more people had less everyday choice than those in other living arrangements. People with mild and moderate IDD had more control over everyday choices when living in their own homes, whereas people with severe and profound IDD had more control when living in agency homes of 3 or fewer residents. For people of all levels of IDD, institutional settings of 16 or more residents offered the lowest levels of everyday choice. Controlling for the same covariates, individuals with all levels of IDD living in their own homes had significantly more support-related choices than those in any other residential arrangement. Controlling for individual and residential setting characteristics, the state in which sample members lived was notably predictive of support-related choice. Overall, the tested variables accounted for 44% of the variability in everyday choice and 31% in support-related choice.

This article presents the findings of a review of evidence related to quality of life in models of supported accommodation for adults with intellectual disabilities identified in English‐speaking nation deinstitutionalization and postdeinstitutionalization studies. An international literature‐based investigation of research published between 1995 and 2005 in English‐language peer‐reviewed academic journals was conducted to: (1) review the outcome of deinstitutionalization and postinstitutionalization studies; (2) examine instruments used to measure outcomes for individuals; and (3) compare costs and benefits associated with different models of supported accommodation. In the deinstitutionalization studies, there was consistent evidence of greater choice and self‐determination, participation in social networks or relationships and community‐based activities, and personal satisfaction in community‐based settings. Postdeinstitutionalization studies provided consistent evidence for greater choice, self‐determination, and participation in community‐based activities in smaller settings, but no evidence for greater physical health or material well‐being, and little evidence for a relationship between type of setting and employment. Future research is needed to meet methodological challenges identified here, to investigate the apparent failure of smaller residences to improve residents’ well‐being and to study systematically factors not directly addressed in the studies under review: poverty and income, organizational culture, and geographical variation.

Qualitative research methods generally depend heav ily on good communication between researcher and informant. When qualitative methodologists study in formants with severe retardation whose use of language may be limited, what do they do?If the researchers plan to study the world of the informant, then traditional participant observation guidelines are useful. But when the researcher wants to interview the informant, some modifications need to be made. The authors suggest several guidelines to follow.

Objective. We identified trends in the receipt of preventive health care by adults with intellectual and developmental disabilities by type of residential setting.Methods. We used data from the 2008-2009 collection round of the National Core Indicators (NCI) program. Participating states drew random samples of adults receiving developmental disabilities services. The study was observational, with both self-report and report by proxy. Once the random samples were drawn in each state, data were collected using the NCI Adult Consumer Survey. Trained interviewers administered the survey in person.Results. The likelihood of a person receiving preventive care procedures was related to age, level of intellectual disability, mobility, health status, and state. Type of living arrangement also affected whether a person received these health services, even after controlling for state, level of disability, and other personal characteristics. In general, people living with parents or relatives were consistently the least likely to receive preventive health exams and procedures.Conclusion. With growing numbers of adults being served in the family home, educational and policy-based efforts to ensure access to preventive care are increasingly critical.

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