The 2014 U.S. Centers for Medicare and Medicaid Services "Settings Rule," which took effect in 2023, restricts Home and Community Based Services funding for adults with intellectual disabilities to small integrated settings and person-centered supports. The Settings Rule responds to the fact that community services, mandated by the…

Background: As practice leaders, frontline managers observe staff working, provide feedback and use organisational structures to improve staff skills and focus on service-user quality of life. This qualitative study explored the experiences and barriers for frontline managers providing practice leadership to staff in community services for adults…

Background: In the United States, 16 states have adopted Technology First initiatives to improve people with intellectual and developmental disabilities' access to technology. Method: Our aim was to examine if Technology First initiatives impact the allocation of technology in Home and Community-Based Services (HCBS) for people with intellectual…

Background: Research on training direct support professionals to address challenging behaviour exhibited by adults with intellectual disabilities is essential in generating effective training approaches for this sector. This systematic review's objective was to evaluate the effects of training types and whether specific training delivery…

Background: Leadership is crucial for frontline managers leading direct support staff in intellectual and developmental disability (IDD) services because it impacts both the staff and service users. Method: A systematic review using CADIMA software, guided by the 2020 PRISMA statement, analysed 32 articles from Scopus, WOS, PsycINFO and EBSCO…

Individuals with intellectual and developmental disabilities face barriers to accessing sex education, including a lack of professional ownership over providing sex education. Limited information exists regarding educator training background, funding structure, and who they serve. We interviewed 58 sex educators of individuals with intellectual…

Background: Unpredictability, the risk of harm and possibility of rewards, are integral elements of encounter. Risk literature offers insight on the complex ways in which risk perceptions and attunements shape behaviours and interactions in encounter between people with and without intellectual disability. Method: The paper draws on risk…

In 2014, the U.S. Centers for Medicare & Medicaid Services (CMS) launched the Home and Community-Based Services (HCBS) Final Rule intended to improve the quality of HCBS for people with disabilities. The Rule focuses on improving outcomes through person-centered services and supports. These outcomes include privacy and dignity. This study…

Recognizing the crisis the COVID-19 pandemic represents to the Home- and Community-Based Services (HCBS) service system and the health, safety, and quality of life of people with intellectual and developmental disabilities (IDD), states temporarily amended their HCBS programs to strengthen service delivery. States are able to temporarily amend…

This study's aim was to examine the impact of pandemic emergency Home- and Community-Based Services (HCBS) payments on the continuity and security of people with intellectual and developmental disabilities (IDD). Using a multilevel logistic regression, we analyzed secondary Personal Outcome Measures interviews from 738 people with IDD (March 2020…

Using the 2008-2013 Medicaid Analytic eXtract files, this retrospective cohort study was to evaluate the effect of Medicaid home and community-based services (HCBS) waiver programs on emergency department (ED) utilizations among youth with autism spectrum disorder (ASD). Our study showed that the annual ED utilization rates were 13.5% and 18.8%…

Despite physically relocating "into" the community, many people with intellectual and developmental disabilities (IDD) fail to be meaningfully included "in" the community. The Home and Community Based Services (HCBS) Settings Rule was introduced to expand community integration, person-centered services, and choice. The aim of…

Background: Adults with intellectual and developmental disabilities (IDD) have high rates of homelessness. This observational study evaluates Bridges to Housing, a cross-sector intervention offering immediate access to housing and supports to this population in Toronto, Canada. Methods: Twenty-six participants, enrolled between April 2016 and…

Self-directed home and community based services (HCBS) waiver services and supports for people with intellectual and developmental disabilities (IDD) have become a viable and widely used method of service provision in the United States. Grounded in theories of self-determination, previous literature on self-direction has suggested high…

Emerging research tests the impact of United States Medicaid home and community-based (HCBS) waiver policy on outcomes for people with intellectual and developmental disabilities; however, this body of work has yet to be synthesized. We conducted a scoping review to establish what is known about the impact of Medicaid HCBS policy on the lives of…