**3. The move to community care**

and integration [2]. Debenham [3] identified a barrier to social inclusion as the slow or complete lack of change in attitude from people in society towards people with learning disabilities. This paradigm of care, which focuses on community living and social integration, is however influenced by the attitudes of the general public [3]. In attitude research, expressed opinions may not be the views in fact held by respondents, but views in principle only [4]. Presence without participation can be more isolating than no presence at all [5]. Over the last number of years, there have been significant advances in the growth and development of services in the community for people with learning disabilities worldwide. Contemporary evidence-based practice has focused on the philosophy of social inclusion for people with learning disabilities living in the community [6, 7]. This philosophy is based on the proposition that the quality of life of a person with a disability increases as access to

The chapter will firstly provide a brief discussion on the move from institutional to community care for people with learning disabilities. It then explores attitudes and the possible influences of these attitudes towards people with learning disabilities. This will then be followed by an exploration of researching attitudes. An exemplar of a completed study in Ireland, which utilized a randomized survey combined with a micro-neighbourhood design, will then

Over the years, perceptions towards disability have varied significantly from one community to another and traditional approaches to the care of people with learning disabilities have a rather tarnished history [6]. In this chapter, learning disability is categorized according to the international classification of diseases (ICD) [10] where it is classified as a condition of arrested or incomplete development of the mind, which is characterized by impairment of skills, and manifested during the developmental period, which contributes to the overall level

When children who were labelled 'feeble minded' grew into adults, those who could no longer be taken care of in their own homes were put into asylums or workhouses [9]. Goffman [10] spoke of such institutional care as the tendency towards the absolute control of every aspect of a person's life and which led him to coin the term 'total institution'. This was a situation where people were totally cut off from the wider society for an appreciable period and all aspects of life were conducted in the same place in the immediate company of others and all within the same hierarchic and bureaucratic framework [10]. Similarly, King et al. [11] wrote on institutional care and described how it included block treatment, rigidity of routine, social distance and depersonalization. Goffman referred to living in such institutions as being

For people with a learning disability, the situation was even worse because their experiences may only have been of institutional life and their '*identify kit'* may solely have consisted of

**2. Attitudes towards the care of people with learning disabilities**

of intelligence, i.e. cognitive, language, motor and social abilities [8].

culturally typical activities and settings increases.

186 Learning Disabilities - An International Perspective

be discussed.

stripped of one's identify kit [10].

In many countries, the 1970s brought about major changes in where those with a learning disability were housed and cared for. Normalization as a philosophy of care originated in Scandinavia at the end of the 1950s as a reaction to the shortcomings of institutional care for those with a learning disability. It was based on the premise that the quality of life of a person increases as access to culturally typical activities and settings increased in the person's life. The principle of normalization rested on the premise that people with learning disabilities should enjoy, as far possible, the services available to ordinary people. This philosophy offered a powerful stimulus to the replacement of institutional care [12].

Bank–Mikkelsen [13] defined normalization in terms of enabling people with learning disabilities to live similar lives to people without disabilities. Wolfensberger [14] defined normalization as the utilization of means that are as culturally normative as possible with the avoidance of special segregated services. He later suggested [15] that the term normalization should be changed to social role valorization as he felt that this emphasized the true goal of normalization—that is the development of valued social roles for all people who are at risk of social devaluation.
