Background: People with intellectual disability and chronic and complex support needs often require unique models of care that are intensive and expensive. How these supports can be continued within a rapidly changing policy and funding context in Australia, has not been fully determined. Method: This descriptive study utilised a retrospective electronic case-file audit design. Demographic details, chronic health conditions, medications, behaviours of concern, and overall support needs profile were mapped for 41 participants. Results: The profile is one of an ageing cohort, with high levels of chronicity and polypharmacy that requires a specialised workforce to fully meet their support needs. Conclusion: As the people with ID in this cohort age, the training needs of the current and future workforce will need to adapt as different issues become more prominent. How the national disability health and policy settings can best accommodate these support needs remains unclear.

Young adults with Down syndrome experience increased rates of emotional and behavioural problems compared with the general population. Most adolescents with Down syndrome living in Western Australia participate in sheltered employment as their main day occupation. Relationship between day occupation and changes in behaviour has not been examined. Therefore, the aim of this research was to explore any relationship between post school day occupations and changes in the young person’s behaviour. The Down syndrome Needs Opinion Wishes database was used for case ascertainment of young adults aged 15 to 32 years with Down syndrome. Families of 118 young people in this population-based database completed questionnaires in 2004, 2009 and 2011. The questionnaires addressed both young person characteristics such as age, gender, presence of impairments, behaviour, functioning in activities of daily living, and family characteristics such as income and family functioning. Post-school day occupations in which the young people were participating included open and sheltered employment, training and day recreation programs. Change in behaviour of young adults who remained in the same post-school day occupation from 2009 to 2011 (n = 103) were examined in a linear regression model adjusting for confounding variables including age, gender, prior functioning and behaviour in 2004 and family income. In comparison to those young adults attending open employment from 2009 to 2011, those attending day recreation programs were reported to experience worsening in behaviour both in the unadjusted (effect size −0.14, 95% CI −0.24, −0.05) and adjusted models (effect size −0.15, 95% CI −0.29, −0.01). We found that the behaviour of those participating in open employment improved compared to those attending other day occupations. Further examination of the direction of this association is required.

Most people with intellectual disabilities in Singapore live with family and are supported by family caregivers. Many caregivers lack the awareness, skills and resources needed for their caregiving role. A caregiver support service designed to build the capability of family caregivers serving children and adults with intellectual disabilities was evaluated after 2 years of operation to ascertain the level of caregiver coping and resilience, perceived impact of strategies for emotional support, and satisfaction with a range of support services and gaps in service. Family caregivers were surveyed regarding satisfaction with services received using the Client Satisfaction Questionnaire (CSQ‐8) and feedback from activities and events. Their coping and resilience were measured with the Coping Competence Questionnaire (CCQ). Qualitative data from caregiver interviews and staff focus groups were analysed for key themes that were triangulated and converged with other findings. Satisfaction, better coping and resilience were associated with specific support services. Key themes emerged around several effective supports and areas of unmet needs across the lifespan. Limitations and areas for improvement were identified to meet a broader range of caregivers. Targeted family support services can enhance the well‐being of caregivers supporting people with intellectual disabilities (ID) across the lifespan. The results inform policymakers and support agencies that support of the family, not just the person with ID, is an important factor and needs to be incorporated at the heart of the design and development of any inclusive community living in Singapore.

Working without discrimination is a right of citizenship and a desired outcome among people with intellectual and other disabilities. Greater workforce participation can benefit both society and individual quality of life for economic and non-economic reasons. However, unemployment and under-employment are significant problems affecting people with intellectual disabilities to a greater degree than other groups with disabilities and the general population. This chapter identifies key barriers and new opportunities for people with intellectual disabilities to get and retain jobs of their choice in open or supported employment. Although various vocational training and disability employment support programmes exist that aim to improve outcomes, these programmes vary widely in type, quality, and outcomes achieved. Evidence from national and international experience is presented to describe the most effective employment models and good practices from across different programme types. In particular, those programmes that support working-age youth and adults with intellectual disabilities to gain and retain employment are explored.

Background: Australia's National Disability Insurance Scheme (NDIS) funds individualised supports to increase choice and control. The relationship between NDIS individualised funding, outcomes for wellbeing and exercising choice and control for people with intellectual disability has been unclear.Method: Adult NDIS participants with intellectual disability (N = 62) completed a longitudinal survey with validated instruments exploring personal wellbeing and choice.Findings: Personal wellbeing scores were generally positive, with the mean comparable to that found for a similar population over a decade ago. High choice and control were evident for most individuals over everyday matters, but not key life decisions. Living environment and physical and/or mental and emotional health status were associated with the level of satisfaction with personal wellbeing and everyday choice and control.Conclusions: There is need to better support people with intellectual disability to exercise choice and control over key life decisions and to address disparities in choice and wellbeing associated with living environment, physical and mental and emotional health and future security.