Camphill Village Kimberton Hills: Innovations in Intentional Supportive Community Living

Human Services
Typography

Summary

Depending on why you come to Camphill Village Kimberton Hills, you might think of it first and foremost as a biodynamic farming and gardening training center, or as an example of intentional community living, or as a place where people with so-called mental disabilities live alongside their non-labeled counterparts, a model for compassionate home-integrated elder care, a local organic food producer and source of organic-biodynamic vegetables, whole-grain sourdough bread, or lunch, or a workshop and conference site. Perhaps you would see it as an ideal place to help students of varying ages integrate ideas about sustainability, social renewal, local sustainable agriculture, healthy lifestyles, watershed management, sustainable architecture and entrepreneurial partnerships. You might see it as an ideal place to volunteer for a day, a year or a lifetime.

In fact, all of these and more are elements of this community, a part of the international Camphill Movement, serving vulnerable people through intentional community living.

Vulnerable people

While many people are vulnerable in these times, those with mental disabilities can easily fall into unemployment and poverty, experience poor health and need significant support.

At present, two widely accepted residential models for adults with disabilities are institutionalization and group homes, though small-scale dispersed housing opportunities are growing in popularity. Preliminary results from a recent evaluation conducted by the Camphill Association of North America, in partnership with researchers at the University of Toronto and Immaculata University, indicates that the Camphill communities, including Camphill Village Kimberton Hills, provide a high quality of life for adults with disabilities that compares favorably to other living options. Among the small-scale dispersed housing opportunities, Camphill is a particularly successful and viable alternative, with a meaningful and engaging life for adults with disabilities.

Local and enterprising

Camphill Village Kimberton Hills (Kimberton Hills) is situated outside of Philadelphia in Chester County and is home to 42 adults with disabilities and 68 other adults and children. Neighbors, volunteers, employees, partners, donors and customers likely comprise well over 3,000 people who are involved in its community life. The community, based on 432 acres, is also home to a public café, a licensed organic grass-fed raw milk dairy with local sales, the Sweetwater Bakery, which produces organic sourdough bread products and cookies for sale regionally, Birchrunville Farm artisan cheesemaker, its own organic/biodynamic Sankanac CSA with 180 shareholding families, and fibers, clay, and wood craft workshops with products sold on-site and at local farmers' markets and craft fairs.

Pro-social organization

Kimberton Hills is an intentional community in which adults with and without so-called disabilities can experience meaningful social and cultural interactions and vocational opportunities. This model results is an organizational structure that is participatory, horizontal and processual, to help maximize everyone’s possibility to express individual capacities. The people who live in the community choose this life—and the benefits of the community are not financial rewards, as neither those with or without disabilities are salaried. The organization maintains a strong focus on environmentally sustainable practices including biodynamic farming and environmentally-sound building practices. It encourages volunteerism by hosting one and two-year placements for individuals from across America (some via AmeriCorps) and around the world. Camphill Village Kimberton Hills combines an innovative work, organizational and living model, which especially benefits adults with disabilities, and encourages environmental sustainability, volunteerism and social entrepreneurship.

Summary

Depending on why you come to Camphill Village Kimberton Hills, you might think of it first and foremost as a biodynamic farming and gardening training center, or as an example of intentional community living, or as a place where people with so-called mental disabilities live alongside their non-labeled counterparts, a model for compassionate home-integrated elder care, a local organic food producer and source of organic-biodynamic vegetables, whole-grain sourdough bread, or lunch, or a workshop and conference site. Perhaps you would see it as an ideal place to help students of varying ages integrate ideas about sustainability, social renewal, local sustainable agriculture, healthy lifestyles, watershed management, sustainable architecture and entrepreneurial partnerships. You might see it as an ideal place to volunteer for a day, a year or a lifetime.

In fact, all of these and more are elements of this community, a part of the international Camphill Movement, serving vulnerable people through intentional community living.

Vulnerable people

While many people are vulnerable in these times, those with mental disabilities can easily fall into unemployment and poverty, experience poor health and need significant support.

At present, two widely accepted residential models for adults with disabilities are institutionalization and group homes, though small-scale dispersed housing opportunities are growing in popularity. Preliminary results from a recent evaluation conducted by the Camphill Association of North America, in partnership with researchers at the University of Toronto and Immaculata University, indicates that the Camphill communities, including Camphill Village Kimberton Hills, provide a high quality of life for adults with disabilities that compares favorably to other living options. Among the small-scale dispersed housing opportunities, Camphill is a particularly successful and viable alternative, with a meaningful and engaging life for adults with disabilities.

Local and enterprising

Camphill Village Kimberton Hills (Kimberton Hills) is situated outside of Philadelphia in Chester County and is home to 42 adults with disabilities and 68 other adults and children. Neighbors, volunteers, employees, partners, donors and customers likely comprise well over 3,000 people who are involved in its community life. The community, based on 432 acres, is also home to a public café, a licensed organic grass-fed raw milk dairy with local sales, the Sweetwater Bakery, which produces organic sourdough bread products and cookies for sale regionally, Birchrunville Farm artisan cheesemaker, its own organic/biodynamic Sankanac CSA with 180 shareholding families, and fibers, clay, and wood craft workshops with products sold on-site and at local farmers' markets and craft fairs.

Pro-social organization

Kimberton Hills is an intentional community in which adults with and without so-called disabilities can experience meaningful social and cultural interactions and vocational opportunities. This model results is an organizational structure that is participatory, horizontal and processual, to help maximize everyone’s possibility to express individual capacities. The people who live in the community choose this life—and the benefits of the community are not financial rewards, as neither those with or without disabilities are salaried. The organization maintains a strong focus on environmentally sustainable practices including biodynamic farming and environmentally-sound building practices. It encourages volunteerism by hosting one and two-year placements for individuals from across America (some via AmeriCorps) and around the world. Camphill Village Kimberton Hills combines an innovative work, organizational and living model, which especially benefits adults with disabilities, and encourages environmental sustainability, volunteerism and social entrepreneurship.

Issue to address

Issue to address

Community life, like family life, has become increasingly challenging to sustain in a healthy way. As our perceptions become global, and economics takes a forefront in many areas, genuine relatedness to our local areas and people can become less personal and important. We are stretched between what makes sense on a macro level, and relationships on our micro-levels. What really matters? How can our society shape itself to address both macro and micro levels, both the global and the personal, in ways that encourage dignity and health? Can we attend to our own needs without compromising someone else's? Can we not only include people who have different mental and emotional challenges, but learn from them, and apply those lessons—often lessons of the heart—to our lives and communities? If we take seriously any of the sustaining elements of life, can we begin to experience interweaving and discover ideas and ways to make life better?

The latest trend in care for adults with disabilities shows a shift away from large institutions and towards inclusion within small-scale dispersed housing opportunities. Though the goal of this shift is to improve the quality of life for adults with disabilities, physical ‘inclusion’ in a community does not necessarily lead to increased social connectedness and the experience of real community participation (Bigby 2004), access to stable, permanent and valued work (Fresher-Samways, Raush, Choi et al. 2003), or good physical health (Robertson, Emerson, Gregory et al. 2000). Thus, people with developmental disabilities continue to experience higher rates of unemployment, discrimination, poor health and low social status compared with the general population (Cummins 2001), even in the best of economic circumstances. Among ordinary challenges to productive adult life, one in particular, aging, can challenge successful integration for those with developmental disabilities, who are expected to age earlier and experience increasing medical and behavioral difficulties at an earlier age than those without handicaps, at around 50 years of age (Factor 1997; Griswold 1999).

In many situations, adults with disabilities are either the recipients or consumers of service, with each model clearly differentiating between those who serve and those who receive service, or those who contract service and those who provide them. Either model can fail to give credit to the abilities that people with so-called disabilities have or, by design, set up a hierarchy that may decrease the dignity of either the so-called person with disabilities or the caregiver. While past negligence and abuse have prompted current best practice models to encourage independent decision-making by consumers of service, the interdependent model of community may be able to address the needs for independence while also acknowledging that, as human beings, we all, at times, need effective help of others (interdependence) and to learn from and care for each other.

One solution

One solution

Camphill Village Kimberton Hills was established near Philadelphia in 1972 following the donation of 350 acres from the Alaric and Mable Pew Myrin family. Its mission is to “create and maintain a community that promotes well-being and dignity, especially including adults with developmental disabilities; and to administer land and natural resources according to the principles of biodynamic agriculture, other ecologically sound practices, and conservation.” Kimberton Hills is designed so that residents of the village live together in mixed households, and work together in various enterprises throughout the village, although the village does have the option for day villagers to participate on a part-time or full-time basis and commute from home.

The Camphill model developed initially as an autonomous village that included children with disabilities in Scotland in the 1940s as a response to social disintegration in Europe at that time. It has developed many variations in the over 20 countries in which it exists, sometimes because of local and governmental issues, but also because each Camphill is independent and has flexibility to innovate. In Kimberton Hills there is a strong desire to recognize individual dignity and capacity regardless of whether the person joins with a diagnosis or not.

Community members commit to following the best ideas regardless of with whom they originate. Another value espoused by the community is to recognize that each person’s work is valuable to the whole, regardless of how the general society might choose to value it. For instance, in order to minimize the effects of labeling internally, the community does not pay salaries to anyone who lives in the community, but rather budgets and allocates funds to households and workshops based on need. People with disabilities contribute entitlement funds; people without diagnoses contribute by abjuring salaries and equity. Although some community members without diagnostic labels (coworkers) are in managing roles, people with so-called disabilities have responsibilities and are acknowledged as partners in the community’s well-being.

Innovations in multiple areas

Innovations in multiple areas

Kimberton Hills promotes a high quality of life for adults with disabilities through employment opportunities, social and cultural life, educational opportunities, health and therapeutic support, and strong community engagement. It has the capacity to enable its seniors to remain a part of the community, valuing their contributions. It maintains a strong emphasis on environmental sustainability, which translates to various sustainable practices, biodynamic farming and “green” building. It has developed a horizontal structure that serves the dual aspects of a nonprofit corporation and an intentional community and encourages genuine participation in decision-making and governance. The cost for adults with disabilities is substantially less than that of traditional models. This is achieved through the intelligent communitarian use of resources, partnerships with local businesses, rentals, dedicated donors, and social enterprises that provide income and vocational opportunities. It works to create congruence between its ideals and all areas of involvement. A strong educational component includes cultural events open to the public, internal and open courses, tours and multiple forms of volunteer opportunities in the community.

High quality of life

High quality of life

The intentional community living model enables Kimberton Hills to address vocational, residential, social, emotional and physical needs of adults with disabilities. One keystone is an emphasis on opportunities for independence and interdependence, achieved by work and living situations in which all residents make an active and significant contribution to the village. The village’s emphasis on simple living and environmental sustainability creates a variety of job responsibilities that can be broken down into simple steps, such as creating woven rugs from recycled materials, helping to care for farm animals, helping to prepare meals, bagging bread and cookies for sale, or helping with garden harvests. Indeed, everyone is needed to help out.

Many thrive on the accountability and relevance of their work, citing their responsibilities in the café or in the garden as one of their favorite parts of life in Kimberton Hills. Each person works morning and afternoon each week day, returning to the households for shared meals. Work opportunities include agricultural work in the garden or in the dairy farm, maintenance of the estate, work in the café or bakery, arts and crafts areas like music, knitting, spinning, weaving, or pottery, or in the households, where homemaking is considered a significant vocation. As people age, their abilities and interests may change, and their changing needs are accommodated within the village structure.

Villagers live in mixed households, with resident volunteers, some with families. Through expanded family life, work throughout the village, social events and numerous activities, there are ample opportunities for social life. Enrichment activities include educational workshops, music workshop and village orchestra, movement activities, art and plays or musicals that feature casts from both inside and outside the community, as well as active participatory festival times. An on-site team that includes a part-time nurse and massage therapist provides medical and alternative therapies, and also facilitates group sessions around life skills like safety, relationships and weight maintenance.

These programs, resources and opportunities for engagement enable Kimberton Hills to provide adults with disabilities with real, meaningful lives and ample opportunities for individual growth, social connectedness and authentic community participation. Furthermore, because there are long-term resident coworkers in the village and short-term (one, two or three year) resident volunteers, this structure provides the opportunity to develop genuine and long-term friendships, as well as to experience new and enriching friendships. Compared to high turnover rates in small group homes where 50 percent of staff changes in the course of one year (Larson & Lakin 1992 & 1999), some in the Kimberton Hills community can count relationships that extend well over 25 years and continue to this day.

Village residents eat mainly organically grown food, and get regular exercise and plenty of fresh air. There are currently no residents with diabetes or even a pre-diabetic condition.  Lifestyle seems to contribute to health and well-being in many ways, and the local family physician who advises the village has acknowledged that people with disabilities in Kimberton Hills seem to be healthier than what is expected for their population.

Joining Kimberton Hills is arranged through a series of steps. The village has an office for admissions; it hosts monthly informational tours for those interested, and can offer alternative arrangements. An initial inquiry is followed by a written application and interview process, then try-out visits. For adults with disabilities, the village can best welcome those who are capable of some level of independence, such as the ability to find their way around the village after some orientation, with openness to learning and trying new things. For those who may consider the village, it is important that there is a genuine choice to join or not. Because it is  important for all members of the community to contribute, during the try-out visit, adults with disabilities will join different workshops or job activities to explore how they might best fit. If the visit proves a good fit, then arrangements can be made to integrate the new members into the community when openings occur.

The Camphill Association of North America recently conducted an evaluation of its ability to provide high-quality of life for adults with disabilities. Using the Quality of Life Profile developed by researchers at the University of Toronto, the study used a combination of interviews and focus groups to assess quality of life for residents of Camphill communities throughout North America along nine dimensions related to both individual development and community inclusion and living. Also rated were the opportunities for meaningful life choices. Results indicate that Camphill compares favorably to other living options, outperforming large congregate care, small congregate care, independent living and family living (Goeschel & Heitzman 2010).

Environmental sustainability

Environmental sustainability

Sound ecological living is a fundamental tenet of Kimberton Hills, and the village won the 2008 Pennsylvania Environment Council’s People’s Choice Sustainability Award, among other accolades, for its ongoing commitment to environmental sustainability. The village built several new buildings in 2003-4 and renovated a space to serve as a new café in 2008. These buildings feature sustainable and recycled or recyclable materials, such as cellulose insulation from recycled newspapers, roof water catchment systems from the metal roofs to direct rainwater for low-flush toilet use, laundry and landscape watering, a constructed wetlands garden that filters wastewater with native wetlands plants, Solatubes for sunlight, and an innovative attic fan system that replaces air conditioning. In addition, solar panels mounted on a nearby garage partially meet the electricity needs of the new buildings. The café is heated and cooled utilizing a geothermal installation. The village purchases all sustainably produced electricity through a Philadelphia-based company, the Energy Coop. Residents know and use many ecologically sound daily practices and usually opt to walk or bike to and from work, further decreasing the village’s carbon footprint. Cars and errands are shared, minimizing need.

In addition, Kimberton Hills received a perfect score, a 5-star rating, from the Cornucopia Institute for its organic dairy. The Institute assessed approximately 110 farms and distributers for best practices in organic dairy farming. Criteria include whether antibiotics and hormones are used, farm size, pasture size and rotation, certification, milk quality and production numbers. The Camphill dairy farm is maintained on 250 acres of mixed pasture, hay and arable land, and cows are an integral component of the village’s biodynamic farming practices. The dairy provides milk to households in the village, to the locally-owned Kimberton Whole Foods, and the local organic yogurt company, Seven Stars. The households also use this milk for cheese and yogurt production.

The biodynamic garden is run by a head gardener and a crew of 10 other gardeners from the village, including apprentices. The Sankanac Community Supported Agriculture (CSA) Garden provides food for 180 family shares and, along with the dairy, produces a seasonal mix of vegetables, meat, eggs, herbs, fruit and flowers to village households, the village café and members of the surrounding community. It currently has a waiting list for new members. Mixed livestock that includes cows, goats, sheep and donkeys, plus compost bins in each household, allow gardeners to use organic fertilizing methods. In addition, there is strong emphasis on creating a balanced ecosystem by careful nourishing of insect and wildlife on the premises. This year and in previous years the community has hosted lectures on ecological beekeeping, as well as cultivating its own hives. A recently-developed 2-year Garden Apprenticeship Program trains young people in biodynamic farming practices.

The village has produced the Kimberton Hills Agricultural Calendar, Stella Natura, for more than 35 years, available to home and professional gardeners worldwide (www.stellanatura.com).
The community’s 100 acres of woodlands border the French Creek, a small river with an Exceptional Value designation. The healthiest part of the creek was found to border Kimberton Hills’ property by a study commissioned by the French and Pickering Creeks Conservation Trust. The community is currently involved in a forestry plan being designed to minimize invasive species and optimize the health of the woods.

At its core, a unique duality found at Kimberton Hills is an intimate connection to the land, via intentional community life where children and adults of many abilities live, work and grow together. With its emphasis on self-reliance and range of work that villagers and coworkers alike can take on, Kimberton Hills is able to meet many of its needs. This duality ensures that the activities and competencies of the village are complementary and aligned with the overall mission. Joining this is a third element: dedicated and inspirational work with arts, education and culture. All three aspects are supported by the community’s commitment to study and integrate ideas developed from the work of Rudolf Steiner (1861-1925), and pediatrician and social innovator, Karl Koenig (1902-1966), the originator of the Camphill village concept.

Low-cost model for adults with disabilities

Low-cost model for adults with disabilities

The cost to support one adult with disabilities at Kimberton Hills is currently $42,000 annually, between one-half and one-sixth the cost in state-funded options. Kimberton Hills is able to achieve this low cost through several means. The village enterprises fund one-quarter of the costs of the village operating budget. Because the village contains over 100 people, they are able to leverage bulk buying and cooperative purchasing to keep costs down. The village is also moderately self-sufficient; households get a large amount of fruits, vegetables, dairy products and bread from various enterprises within the village, and in turn the garden benefits from compost produce scraps saved by the individual households.

Long- and short-term resident volunteers play an important role towards this end, and are integral to ensuring that households and the workshops run smoothly. It is estimated that the resident volunteers’ contributions offset at least approximately $1.5 million of potential cost. Coworkers without salaries hold positions throughout the village in areas such as financial administration, coordination, admissions, marketing and outreach. As a result, Kimberton Hills employs only 8 people (including 5 who are part-time) who do not live within the village, helping to keep overhead costs down. Finally, the village maintains a strong ethos of recycling, upcycling, sharing, and “making do” and “using what’s available” to encourage creative solutions to keep down costs, as well as welcoming part-time volunteers.

Villagers and their families help cover costs through fees and contributions, though the village for a long time admitted people “who clearly belonged” with only what they could offer. Kimberton Hills’ fundraising efforts cover about 25 percent of the annual operating budget. All capital expenses are fundraised. It has received grants from the Pew Charitable Trust, The Philadelphia Foundation, Phoenixville Community Health Foundation, The McLean Foundation, The Arthur J. Miller Foundation, The Pottstown Health and Wellness Foundation, BNY Mellon and others. Individual and corporate donors contribute. The village’s various enterprises are, for the most part, self-sustaining, and though the community is willing to subsidize ventures through the start-up phase, the goal is for new ventures to break even within two or three years.

Kimberton Hills maintains several rental properties on the premises that are leased on a year-to-year basis, providing both income and the flexibility to expand or contract village household capacity as needed. In fact, the village maintains a few facilities that fall in and out of use based on the interests and skills of individual coworkers, such as woodworking facilities, pottery facilities and cheese-making facilities. Here, the community approach shows itself to be differentiated from an institutional or business model. The use of spaces and the development of workshops often rely on who is available with what capabilities—individual’s strengths and needs—rather than continuity based on hiring. It rents some of the available spaces to local businesses to provide additional income while strengthening the local economy.

For example, several years ago a local dairy farming family was struggling to survive financially, and Kimberton Hills had unused cheese-making facilities that were doubling as storage. These farmers now pay a low rent, utilities, and a percentage of gross profits to the village to use the space and equipment, and today their artisan cheese label has allowed their farm to continue to operate. The village maintains a similar relationship with the family-owned bakery that operates in the heart of its premises, with village residents participating. It also sells the dairy’s raw milk to the Seven Stars Yogurt label.

Ideals into practice

Ideals into practice

The community’s philosophy includes the belief that money management should align with the philosophical and spiritual guidelines of Camphill communities. This includes sensitivity to the social impact of its investments. Although the village does not have an endowment, its cash reserves are placed with organizations that meet the following guidelines:

  • Socially responsible and renewing;
  • Environmentally sound and corrective;
  • Beneficial to their communities and employees; and/or
  • Working out of, or supportive of, Anthroposophy (developed by Rudolf Steiner and others), including the notion that people have the capacity to solve personal and social problems using inherent and available wisdom.

The cash reserves are invested in local banks, the Rudolph Steiner Foundation, and the Triskeles Foundation, where money is pooled for investment by professional socially-responsible investment managers. In addition, Kimberton Hills has loaned money to the locally-owned Kimberton Whole Foods to help develop additional stores. Thus, the village utilizes a socially-responsible investment strategy to reflect its values outside its premises, as well as within its own community.

Educating others

Educating others

Kimberton Hills encourages tours for interested groups. Its varied landscape of innovations makes it especially interesting for school groups of all ages, for architecture and land use classes, for those studying sustainable lifestyles, and those interested in alternatives to usual care situations. There are training courses in the village for biodynamic gardening and farming, social therapy with adults with disabilities, and the art of caring for elders. The village hosts other trainings such as nursing, nutrition and therapy workshops, and provides a venue for other initiatives to hold workshops and meetings. It has recently joined with Camphill Special Schools to open a first-year Seminar in Social Therapy, which can grant accredited college credits. Its Myrin Library houses a strong collection of the works of Rudolf Steiner, as well as related books and various other works of interest. The library is open to the public with a small yearly fee, and the volunteer librarians are available on Thursday mornings.

Rose Hall, besides being the venue for village and other workshops, hosts lectures, plays, dances and concerts. Rose Hall was voted the "best live music venue" in Chester County by the Philadelphia Inquirer in 2008. Its excellent acoustics and interested and knowledgeable audiences charm musicians, and its yearly "hootenanny" outdoor event is becoming a local favorite.

Conclusion

Conclusion

Camphill is a successful and viable alternative to provide a meaningful and engaging life for adults with and without disabilities. It is pursuing its twin goals to create a living, working, celebrating and caring community environment within which adults with and without developmental disabilities can thrive, and to promote sound ecological living practices. The result is an environment that promotes high quality of life for all of its residents, and especially adults with developmental disabilities, and does so at a fraction of the cost of other residential and day options for adults with disabilities. It achieves this through a series of complementary mission-oriented activities, including partnerships and enterprises that further the organization’s social and ecological mission while strengthening the local economy and social life.

Diedra Heitzman, MSW is Executive Director/ Village Coordinator of Camphill Village Kimberton Hills. She and her husband share life with others in the community, where they have raised their family and lived for 28 years. She has been active in Camphill internationally for most of those years. She received her MSW from the University of Michigan.

Jessica Yen served Camphill Village Kimberton Hills in 2010 as an intern during her Masters Program, now completed, at the Harvard School of Public Health. She has been an Evaluation Consultant for the Food Project, Youth Force Task Coordinator at the Harvard Prevention Research Center, and a volunteer at Urban Sprouts. Following graduation she now resides and works in San Francisco.

References

References

Bigby, C. (2004). But why are these questions being asked?: A commentary on Emerson. Intellectual and Developmental Disability. 29, 202-205.

Cummins, R.A. (2001). Living with supports in the community: Predictors of Satisfaction with life. Mental Retardation and Developmental Disabilities Research Reviews. 7, 99-104.

Factor, A. R. (1997). Growing Older with a Developmental Disability: Physical and Cognitive Changes and Their Implications. Chicago: Rehabilitation Research and Training Center on Aging with Mental Retardation, University of Illinois at Chicago.

Fresher-Samways, K.,  S. Raush, K. Choi, Y. Desrosiers & G. Steel. (2003). Perceived quality of life of adults with developmental and other significant disabilities. Disabilities and Rehabilitation. 25, 1097-1105.

Goeschel, J.  & D. Heitzman. (2010). Providing Quality of Life Through Intentional Community Living: Outcomes Evaluation for the Camphill AmeriCorps Education Award Program of the Camphill Association of North America (inc. University of Toronto).

Griswold, K. & M. Goldstein. (1999). Issues Affecting the Lives of Older Persons With Developmental Disabilities, Psychiatric Services: Practical Geriatrics, Vol. 50 No. 3.

Larson, S.A. & K.C. Lakin. (1992). Direct-care staff stability in a national sample of small group homes. Mental Retardation. 30, 13-22.
Larson, S.A. & K.C. Lakin. (1999). Longitudinal study of recruitment and retention in small community homes supporting persons with developmental disabilities. Mental Retardation. 37, 267-280.

Robertson, J., E. Emerson, N. Gregory, C. Hatton, S. Turner, S. Kessissoglou & A. Hallam. (2000). Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities. Research in Developmental Disabilities. 21, 469-486.