Dimensions of support: can we get the best of both worlds?

Background: This research aimed to explore engagement, empow-erment, warmth and rapport in services for people with severe and profound intellectual and developmental disabilities.Method: Participant observations were carried out over 12 months, in two services which provided support for nine service users.Results: The quality of support varied between and within ser-vices. Each service showed different elements of good support but in one setting people were more likely to be engaged and tak-ing part in activities around the house and the garden as well as some community activities and relationships were a focus but in-teractions between staff and the people they support were less warm and respectful. In the other service the communication was more warm and respectful. The focus was on getting people out into the community but within the home people were less likely to be engaged in meaningful activities and relationships. Factors which might explain the difference between the two services and implications for implementation of person- centred approaches will be explored.Conclusions: This research contributes to our understanding of the relationship between service culture, staff practices and user outcomes