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Good Practices towards Inclusion, Activity and Participation of Children with Complex and Intense Support Needs

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Title: Good Practices towards Inclusion, Activity and Participation of Children with Complex and Intense Support Needs
Language: English
Authors: Jo Lebeer (ORCID 0000-0001-5929-7783), Adelinda Araujo-Candelas (ORCID 0000-0002-9489-8880), António Portelada, Beno Schraepen, Mia Nijland, Christine Plivard, Reka Orban, Eniko Batiz (ORCID 0000-0001-7311-8286), Magdalena Tsoneva, Heleen Neerinckx, Marina Luisa Rodocanachi Roidi, Enablin+ Working Group
Source: International Journal of Disability, Development and Education. 2026 73(3):409-424.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 16
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Best Practices, Inclusion, Foreign Countries, Multiple Disabilities, Children, Quality of Life, Training, Professional Personnel, Parent Child Relationship, Parent Attitudes, Attitudes, Individual Needs
Geographic Terms: European Union, Belgium, Netherlands, France, Italy, Portugal, Romania, Bulgaria
DOI: 10.1080/1034912X.2025.2475108
ISSN: 1034-912X
1465-346X
Abstract: Background: Children with multiple disabilities and complex and intensive support needs are at risk of separated and passive lives in institutional care. Following the call of the UNCRPD, and in view of developing an innovative in-service training, a European group of care providers, parents and training institutions, developed a framework to define good practices towards a more inclusive and active life in education and elsewhere. Methods: Following a Delphi procedure in four international meetings, to which local professionals and parents were invited, criteria of good practices enabling participation and activation of children with severe multiple disabilities were set up. Examples were explored which responded to these criteria. Results: Fifty-nine professionals and parents from eight EU countries participated. They selected 12 criteria about quality of life, a challenging and inclusive learning environment, family-centeredness, high care ethics, teamwork, activity and participation. They nominated 29 projects fulfilling five or more criteria. Conclusion: Examples show that children with multiple and complex disabilities, despite being totally dependent on intense support, can have meaningful inclusive education and other inclusive activities, provided there is enough support and staff and parents understand how to give that support.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1504023
Database: ERIC
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  Value: <anid>AN0192434291;54q01apr.26;2026Mar24.05:09;v2.2.500</anid> <title id="AN0192434291-1">Good Practices Towards Inclusion, Activity and Participation of Children with Complex and Intense Support Needs </title> <p>Background: Children with multiple disabilities and complex and intensive support needs are at risk of separated and passive lives in institutional care. Following the call of the UNCRPD, and in view of developing an innovative in-service training, a European group of care providers, parents and training institutions, developed a framework to define good practices towards a more inclusive and active life in education and elsewhere. Methods: Following a Delphi procedure in four international meetings, to which local professionals and parents were invited, criteria of good practices enabling participation and activation of children with severe multiple disabilities were set up. Examples were explored which responded to these criteria. Results: Fifty-nine professionals and parents from eight EU countries participated. They selected 12 criteria about quality of life, a challenging and inclusive learning environment, family-centeredness, high care ethics, teamwork, activity and participation. They nominated 29 projects fulfilling five or more criteria. Conclusion: Examples show that children with multiple and complex disabilities, despite being totally dependent on intense support, can have meaningful inclusive education and other inclusive activities, provided there is enough support and staff and parents understand how to give that support.</p> <p>Keywords: activity and participation; children with complex and intense support needs; profound intellectual and multiple disability; Good practices; inclusion; quality of life</p> <hd id="AN0192434291-2">Introduction</hd> <p>Children with multiple disabilities, with severe cognitive, social, motor, sensory, communication impairments, feeding difficulties and other medical complications such as epilepsy, are in need of continuous and intensive support. In English literature they are designated by the label 'PIMD – profound intellectual and multiple disabilities' (Nakken & Vlaskamp, [<reflink idref="bib24" id="ref1">24</reflink>]). In French the concept 'polyhandicapés' is used (Zucman, [<reflink idref="bib50" id="ref2">50</reflink>]). These children present a particular challenge, as their complex needs require complex solutions (Hogg, [<reflink idref="bib15" id="ref3">15</reflink>]).</p> <p>The United Nations' Convention on the Rights of People with Disability (UNCRPD [<reflink idref="bib44" id="ref4">44</reflink>]), states that the goal must be 'full inclusion and participation in all aspects of life'. Though in many countries laws were made compatible with the UNCRPD, and complex care is increasingly being delivered, these children hardly participate in mainstream school, let alone receive an appropriate education commensurate with their potential abilities (Ramberg et al., [<reflink idref="bib33" id="ref5">33</reflink>]; Schädler et al., [<reflink idref="bib36" id="ref6">36</reflink>]; Arthur-Kelly et al., [<reflink idref="bib1" id="ref7">1</reflink>]). This happens in high income (de Boer & Munde, [<reflink idref="bib10" id="ref8">10</reflink>]) as well as low- and middle income countries (McKenzie et al., [<reflink idref="bib22" id="ref9">22</reflink>]). They generally lack activities and lead passive lives (Van der Putten et al., [<reflink idref="bib45" id="ref10">45</reflink>]). Especially those children with severe and profound disabilities with behaviour challenges and autistic spectrum conditions often experience a poor quality of life and were unable to benefit from opportunities offered by new service models (Beadle-Brown et al., [<reflink idref="bib4" id="ref11">4</reflink>]).</p> <p>Although many European countries in the past 20 years made significant improvements in the transition from institution-based to community-based care, a large proportion of children are taken care of in segregated institutions. The European Association of Service Providers for People with Disability EASPD (European Association of Service Providers to Persons with Disability) ([<reflink idref="bib11" id="ref12">11</reflink>]) has made de-institutionalisation a key goal, but the process has been termed 'one step forward, two steps back' (Šiška & Beadle-Brown, [<reflink idref="bib38" id="ref13">38</reflink>]).</p> <p>For children with the most severe impairments, with intensive and complex support needs (CISN), it is far from easy to operationalise what is 'reasonable accommodation', due to the high care needs, difficulties in communication and organisation. Not surprisingly, there is very little inclusion (Slee, [<reflink idref="bib39" id="ref14">39</reflink>]). There is a need for a paradigmatic shift of attitudes, finances, training and opportunities.</p> <p>To raise awareness about the possibility and the need for inclusion, we created a European partnership of universities and service-providers: 'Enablin+'. The project's prime objective was to develop an interprofessional in-service training specifically oriented at people supporting children with CISN. Its objectives were as follows: to provoke a shift of mind from an impairment- towards a needs-based approach; to facilitate activities and participation in various life domains; to professionalise staff and to strengthen parent-professional cooperation and empowerment.</p> <p>Following Pless and Pinkerton's ([<reflink idref="bib32" id="ref15">32</reflink>]) proposal to look at disability in a non-categorical way, we prefer to define children based on a 'needs' concept, consistent with a contemporary conceptual shift in thinking, away from a medical impairment model, towards a biopsychosocial model (Buntinx & Schaloc, [<reflink idref="bib7" id="ref16">7</reflink>]). We present the term <emph>'children with complex and intense support needs'</emph> (CISN). 'Complex and intense' means that intense support is needed to function in multiple domains in daily life (including learning, communication, relating, nutrition, hygiene, moving, etc.), involving various professionals or caretakers for most part of the day and/or night.</p> <p>Because learning from examples is powerful, one of the questions of the Enablin+ project was to define what could be considered good practices regarding active inclusion in education and other life domains of children with CISN, and to look for examples. This article describes the process of developing a set of criteria to that purpose.</p> <hd id="AN0192434291-3">Good Practices – How to Define It?</hd> <p>The term 'best practices' has often been used in a number of contexts as a way to improve practice and reflection (Bernsteinn & Van der Ven, [<reflink idref="bib5" id="ref17">5</reflink>]). It originated in the commercial sector. It appeared in disability and other welfare service areas connected with disability advocacy associations (Osburn et al., [<reflink idref="bib29" id="ref18">29</reflink>]). In health services, it needs to be based on evidence-based guidelines and recommendations (Perleth et al., [<reflink idref="bib30" id="ref19">30</reflink>]). However, the concept 'best' is problematic: it involves measurement, competition, ranking and is expert-defined.</p> <p>Knowing that not all practices are equally good and even 'less than ideal' practices can be useful for learning, we prefer the term 'good practices'.</p> <p>Solla Salvador ([<reflink idref="bib40" id="ref20">40</reflink>]) defined 16 criteria for good practices in inclusive education, based on child aspects, community and methodological aspects. Figure 1, based on Flores et al. ([<reflink idref="bib13" id="ref21">13</reflink>]), summarises the characteristics of good practices: they include innovation, creativity, originality, developing democratic and sustainable values; enhance motivation, change, ... and allow adaptation, transferability and replication, not in a sense of repetition. They allow everyone to find a place to learn and they favour understanding, knowledge, know-how and debate. A practical action implies well-defined objectives, well-defined strategies, and a participatory approach, innovative actions associated with projects and developed in a partnership network, creating networks, procedures, transferability and sustainability. Educational innovation is associated with pedagogical renewal, change and improvement and focuses more on the process than on the product. Good practices are models with reliable and comprehensive guidelines, which present good results in the most varied dimensions.</p> <p>Graph: Figure 1. Good practices. Adapted from Flores et al. ([<reflink idref="bib13" id="ref22">13</reflink>]).</p> <p>The aim of the present study was to investigate innovative 'good practices', concerning the realisation of a more inclusive and a more active quality of life for children with CISN, which could serve as a basis for training. As defined by the International Classification of Functioning (World Health Organization, [<reflink idref="bib47" id="ref23">47</reflink>]), 'activity' is whatever people do in the domains of learning, general tasks and demands, communication, mobility, self-care, domestic life, relationships, school or leisure. Participation is defined by 'involvement in a life situation'. Research questions were as follows: (<reflink idref="bib1" id="ref24">1</reflink>) what are criteria to consider 'good practices' which facilitate an inclusive quality of life, activity and participation of children with CISN? (<reflink idref="bib2" id="ref25">2</reflink>) search for and select examples of such good practices according to the defined criteria; (<reflink idref="bib3" id="ref26">3</reflink>) determine which examples are suitable for in-service staff training?</p> <hd id="AN0192434291-4">Participants and Procedure</hd> <p>We adopted a qualitative research multiple case study design (Zelčāne & Pipere, [<reflink idref="bib48" id="ref27">48</reflink>]) Based on the literature, our own field experience, and an inventory of experiences of professionals and parents gathered in a 2014 start-up conference, we developed a list of criteria of 'good practices' regarding active inclusion, according to a modified Delphi procedure (Hasson et al., [<reflink idref="bib14" id="ref28">14</reflink>]) in three rounds (2014–16) until consensus was reached. The procedure is described in Figure 2. Participants were professionals and parents dealing directly (as caretakers, educators, health professionals) or indirectly (as case managers, directors, personnel trainers) with children and youngsters (age range 0–25) with children with CISN from eight EU countries.</p> <p>Graph: Figure 2. Procedure to define and refine criteria of good practices of facilitating activities and participation of children with complex and intensive support needs in an inclusive way.</p> <p>Four international partner meetings were organised, with an interval of 6–8 months, each time in a different country. Each Delphi round consisted of an international core team plus an invited 'local experts' team, consisting of various stakeholders, professionals as well as parents, having experience with children with CISN. The place of the meetings was deliberately chosen to ensure a good variety of conditions: high-inclusion and low-inclusion countries, rich and poor countries. The participants were recruited by convenience sampling, ensuring good representation. The first round ended with a provisional list of 12 criteria. Then, partners sent out a self-made questionnaire to nominate good practice examples in their own country, asking for a description in writing and video recording, plus a motivation and to what degree they correspond to the suggested criteria. In subsequent rounds, examples were presented in a professional/parent seminar and criteria were refined in a shared discussion, until consensus was reached. The process was concluded in a fourth meeting during a train-the-trainers course, where some new examples were shown.</p> <hd id="AN0192434291-5">Data Analysis</hd> <p>Four researchers based in different countries analysed the data consisting of video examples, case notes and meeting reports, according to thematic network analysis (Attride Stirling, [<reflink idref="bib2" id="ref29">2</reflink>]). No special computer programme was utilised. Differences in interpretation were discussed in videoconferences and physical meetings until consensus was reached. A summary of the analysis was presented to the larger research group in a next larger international meeting. No specific reliability measurement was utilised in this phase of qualitative research, as this was not considered necessary. According to Korstjens and Moser ([<reflink idref="bib19" id="ref30">19</reflink>]), quality criteria used in quantitative research, e.g. internal validity, generalisability, reliability, and objectivity, are not suitable to judge the quality of qualitative research. However, the presentation and discussion of the analysis to the larger group of researchers during each international meeting could be considered a form of qualitative inter-rater reliability. The research followed the rules of the Helsinki declaration. All participants gave their consent to participation.</p> <hd id="AN0192434291-6">Results</hd> <p>A total of 59 people from eight countries participated: in the first round, 31, in the second 30 and in the third round 27. The core group of 21 experts participated in more than 1 round, an invited group of local experts from various professions and parents differed in each round (Table 1).</p> <p>Table 1. Participants in qualitative research rounds on determining criteria of good practice in continuous support of children with complex and intense support needs.</p> <p> <ephtml> <table><thead><tr><td><p>Participant experts</p></td><td><p><italic>N</italic> = 59</p></td></tr></thead><tbody><tr><td><p>educational psychologists</p></td><td><p>21</p></td></tr><tr><td><p>medical doctors</p></td><td><p>4</p></td></tr><tr><td><p>special needs teachers</p></td><td><p>10</p></td></tr><tr><td><p>mainstream teachers</p></td><td><p>9</p></td></tr><tr><td><p>physiotherapists</p></td><td><p>4</p></td></tr><tr><td><p>speech therapists</p></td><td><p>2</p></td></tr><tr><td><p>directors of centres</p></td><td><p>3</p></td></tr><tr><td><p>parents</p></td><td><p>2</p></td></tr><tr><td><p>social workers</p></td><td><p>2</p></td></tr><tr><td><p>sociologists</p></td><td><p>2</p></td></tr></tbody></table> </ephtml> </p> <p>Initially, 12 criteria were selected (Table 2).</p> <p>Table 2. Criteria of good practice regarding inclusion, activation and participation of young people with complex and intense support needs. Final results.</p> <p> <ephtml> <table><tbody><tr><td><list list-type="Bullet"><list-item><p>Good practices must create a continuous support system or services which works in all 8 domains of Quality of Life (QoL)</p><list list-type="Bullet"><list-item><p>emotional well-being – contentment, self-concept, lack of stress</p></list-item><list-item><p>interpersonal relations – interactions, relationships, supports</p></list-item><list-item><p>material well-being – financial status, employment, housing</p></list-item><list-item><p>personal development – education, personal competence, performance</p></list-item><list-item><p>physical well-being – health and health care, activities of daily living, leisure</p></list-item><list-item><p>self-determination – autonomy/personal control, personal goals, choices</p></list-item><list-item><p>social inclusion – community integration and participation, roles, supports</p></list-item><list-item><p>rights – legal, human (respect, dignity, equality) as defined in the UN Convention of the Rights of People with a disability</p></list-item></list></list-item><list-item><p>Good practices must offer a challenging learning environment, i.e. an environment that offers new, enriching, slightly more difficult experiences, and rupture a status quo. It starts from the assumption of 'modifiability', i.e. that all children are able to learn, whatever the barriers to learning they experience. Challenging activities must be accompanied with adequate mediation to enable children to take part in these activities. Time, patience and mediating skills of supporting staff are key</p></list-item><list-item><p>Quality of care should not block inclusion. This means that high quality care oriented at physical, emotional and social well-being, must not stand in the way of an active inclusive life.</p></list-item><list-item><p>Good practices should be family-centred; they should organise work not because of staff commodity, but should be focused on the needs of families.</p></list-item><list-item><p>Good practices should favour interprofessional teamwork</p></list-item><list-item><p>Good practices promote age-appropriate inclusion (participation) in school, leisure and society in general. Real inclusion starts from a positive concept of a person's capability despite impairment and the aim to create a sense of belonging and togetherness.</p></list-item><list-item><p>Good practices should be based on an 'ethics-of-care' principle, placing human dignity as a highest priority</p></list-item><list-item><p>Good practices use as 'regular' things as possible (learning materials, assistive technical aids, toys, furniture, etc.), based on the concept of '<italic>universal design</italic>' and "universal design for learning (UDL), to enable activity and participation</p></list-item><list-item><p>Good practices must show that inclusion is enriching for all, that children with CISN have a <italic>positive role in society</italic>, and be not just a burden</p></list-item><list-item><p>Good practices must have a <italic>flexible and innovative rule</italic> system, so as to maximise adaptation to the child's and family's needs and allow participation</p></list-item><list-item><p>Good practices must be evaluable</p></list-item><list-item><p>Good practices must be accessible to people with less resources.</p></list-item></list></td></tr></tbody></table> </ephtml> </p> <p>It was agreed upon that good practices regarding activity and inclusion of children with CISN should in the first place be based on, or at least make a substantial effort in, the eight domains of quality of life (QoL) as defined by Schalock and Verdugo ([<reflink idref="bib37" id="ref31">37</reflink>]).</p> <p>As a second criterion, a 'challenging learning environment' was chosen. This aspect is often lacking in caring for children with CISN (Nijs & Maes, [<reflink idref="bib26" id="ref32">26</reflink>]). Challenge is the opposite of passivity. It means to disrupt an equilibrium and offer new experiences. That all children, including those with CISN, are modifiable and have a learning potential is a postulate proposed by Feuerstein ([<reflink idref="bib12" id="ref33">12</reflink>]), which nowadays has a confirmed neurobiological basis in experience-dependent neuroplasticity and environmental enrichment (Chaudhury et al., [<reflink idref="bib9" id="ref34">9</reflink>]; Kondo et al., [<reflink idref="bib18" id="ref35">18</reflink>]). Putting children in a challenging learning environment, however, is not enough. Prerequisites are joint attention and sufficient time to engage in meaningful interaction, in order to create learning opportunities (Neerinckx, [<reflink idref="bib25" id="ref36">25</reflink>]). Challenging activities must be accompanied by adequate mediation to enable children to take part in these activities. Mediation is defined as a quality of interaction between a 'caregiver' and a child, so that the child will adequately learn from the proposed stimuli (Tzuriel, [<reflink idref="bib43" id="ref37">43</reflink>]).</p> <p>A third criterion stresses the aspect of <emph>inclusion</emph> and formulates it in a negative way: quality of care should not stand in the way of inclusion. In the experience of participants, service providers of children with CISN may have an excellent quality of care in separate environments, with, however, little opportunities for inclusive participation in regular environments, as is still customary in large parts of Europe.</p> <p>A fourth criterion is <emph>family-centeredness</emph>. This is one of the 'F-words' (function, family, fitness, fun, friends and future) considered fundamental in care & rehabilitation (Bamm & Rosenbaum, [<reflink idref="bib3" id="ref38">3</reflink>]; Rosenbaum & Gorter, [<reflink idref="bib35" id="ref39">35</reflink>]). The needs of families with children with CISN have been neglected for a long time (Zucman, [<reflink idref="bib50" id="ref40">50</reflink>]). There is widespread advocacy of 'de-institutionalization' (European, [<reflink idref="bib11" id="ref41">11</reflink>]; O'Brien, [<reflink idref="bib28" id="ref42">28</reflink>]). Families want enough support to enable a decent family life (Lodomez, [<reflink idref="bib21" id="ref43">21</reflink>]). This goal is far from achieved, even in wealthy regions of Europe. Sometimes children with CISN are taken care of far away from home. e.g. in 2015 more than 6000 French individuals with disability were taken care of in neighbouring countries, because there was not adequate support available in their neighbourhood (Campion & Moullier, [<reflink idref="bib8" id="ref44">8</reflink>]); since then there has been a governmental plan to deploy services in the families' proximity. Good quality support should be adequate enough to allow a decent family life, allowing families to function as part of their communities.</p> <p>The fifth criterion is based on the observation that <emph>interprofessional teamwork</emph> is far from implemented well in institutional care. Real interprofessional teamwork consists of working jointly on commonly agreed objectives and strategies; it involves a recognition of everyone's expertise, good communication between team members and good leadership (Tsakitzidis et al., [<reflink idref="bib42" id="ref45">42</reflink>]).</p> <p>A sixth criterion deals with the aspect of a<emph>ge-appropriate inclusion based on an individual's capabilities</emph>. Inclusion should not be dependent on the degree of impairments nor should it remain childish. Inclusive activities can be organised provided one takes into account a child's capabilities, regardless of the severity of his/her impairments. The concept of 'capability' has been defined in Nussbaum's 'capability approach' (Nussbaum, [<reflink idref="bib27" id="ref46">27</reflink>]). It contains 10 aspects: to live to the end of a human life, to have bodily health and integrity, senses, imagination and thought; emotions and attachment to people; a conception of what is 'good'; to experience belonging, to live with concern for nature; to play, laugh and enjoy, and to have control over one's environment. Nussbaum states that even people with very severe impairments possess most of these capabilities.</p> <p>The seventh criterion is an <emph>'ethics of care' approach also rooted in</emph> human capabilities constituting the essence of human dignity (Zucman, [<reflink idref="bib49" id="ref47">49</reflink>]).</p> <p>An eighth criterion is formed by the concept of '<emph>Universal design</emph>'. This stems from architecture, referring to making the environment maximally accessible by taking away barriers, and by creating an aesthetic design useful for everyone. Examples are a talking elevator, or a low-floor train accessible for wheelchair users as well as baby prams, without having to use special entrances for the disabled. Recently, it has been extended to creating services and education, accessible for all, with the least special adaptations. Children with CISN often need adaptive equipment for communication, mobility and care, but these can be designed in a more aesthetic and inclusive way, attractive to everyone. Many activities can be done in an inclusive way, e.g. musical activity, nature walks, scouting, listening to relaxing music in a quiet room, and do not require very special adaptations. 'Snoezelen' rooms can be made by using a universal design, instead of having the disabled children placed in a segregated setting. An example is multisensory books and storytelling: this way of reading books and telling stories appeals to all the senses (ten Brug et al., [<reflink idref="bib41" id="ref48">41</reflink>]); this is exciting not only for children with severe intellectual disabilities but appeals to all children.</p> <p>As a ninth criterion, participants chose to highlight the idea that '<emph>inclusion is an enrichment for all</emph>'. Good practices should show that having children with CISN at school is not just a burden, but can be an enrichment for the school by becoming creative in finding out which adaptations work and which activities can be done together.</p> <p>A tenth criterion is '<emph>flexible adaptations</emph>', which stems from the UNCRPD concept of 'reasonable adaptation'. It is based on the participants' shared experience that successful inclusion is marked by readiness to step down from a rigid application of rules, standards, habits, benchmarks, curricula, etc.</p> <p>The eleventh criterion of <emph>evaluability</emph> requires that it should be verifiable and in what way 'good practices' are actually good.</p> <p>Finally, the twelfth criterion is based on Nussbaum's ([<reflink idref="bib27" id="ref49">27</reflink>]) concept of justice and is a consequence of the right to inclusion, explicitly mentioned in the UNCRPD: good practices should be accessible even to people with less resources.</p> <p>The final result of defining the criteria is given in Table 2.</p> <hd id="AN0192434291-7">Examples of Nominated Projects of 'Good Practice'</hd> <p>In order to be nominated as 'an example of good practices', projects should not fulfil all criteria to 100%. In each partner country, we selected practices in which we thought that they would fit several criteria. In the end, 29 projects were identified that fulfilled five or more criteria (Table 3). The number five was chosen to make sure that efforts were being made to change from a segregating setting towards inclusive practices. Thirteen of them are described in more detail in a book and DVD for training purposes (Lebeer et al., [<reflink idref="bib20" id="ref50">20</reflink>]).</p> <p>Table 3. Examples of good practice of activity & participation in children with CISN and partial or complete correspondence with 12 criteria.</p> <p> <ephtml> <table><thead><tr><td /><td><p>1</p></td><td><p>2</p></td><td><p>3</p></td><td><p>4</p></td><td><p>5</p></td><td><p>6</p></td><td><p>7</p></td><td><p>8</p></td><td><p>9</p></td><td><p>10</p></td><td><p>11</p></td><td><p>12</p></td></tr><tr><td /><td><p>QoL</p></td><td><p>CE</p></td><td><p>QoCI</p></td><td><p>FC</p></td><td><p>IPT</p></td><td><p>AAIC</p></td><td><p>EC</p></td><td><p>UD</p></td><td><p>PR</p></td><td><p>FR</p></td><td><p>Ev</p></td><td><p>AD</p></td></tr></thead><tbody><tr><td><p><bold>Inclusive education projects</bold></p></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><p> Day-care inclusive nursery for young children</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> inclusive education teamwork between primary school, mobile team, university college, and parents (4 projects)</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> 'To School Together' inclusive classrooms</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> Special Needs Service School</p></td><td><p>+</p></td><td><p>+</p></td><td><p>-</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p><bold>Family-oriented inclusive counselling services</bold></p></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><p> Quality of Life support Centre</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> Circles of support for community-based inclusive approach</p></td><td><p>+</p></td><td><p>-</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td></tr><tr><td><p> Service Network 'Rare Disability'</p></td><td><p>+</p></td><td><p>-</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>-</p></td><td><p>±</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p><bold>Inclusive leisure time initiatives</bold></p></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><p> Integrated Summer camp</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td></tr><tr><td><p> Inclusive theatre company</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td></tr><tr><td><p><bold>Comprehensive child/family oriented intervention</bold></p></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><p> Early intervention service</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> Integrated rehabilitative approach</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> Home support service teams (several centres)</p></td><td><p>+</p></td><td><p>±</p></td><td><p>-</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>-</p></td><td><p>±</p></td><td><p>±</p></td><td><p>±</p></td><td><p>+</p></td></tr><tr><td><p> Consultation centre for augmentative and alternative communication</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> 'Preparing for life' transition adolescents project</p></td><td><p>+</p></td><td><p>-</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p><bold>Activity/participation promotion</bold></p></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><p> Songbox (children's songs to support communication &learning).</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> Musical workshops (several projects)</p></td><td><p>+</p></td><td><p>±</p></td><td><p>±</p></td><td><p>±</p></td><td><p>-</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td></tr><tr><td><p> Activity-promoting workshops (several projects)</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>±</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p><bold>Networks/web-based platforms</bold></p></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><p> Parents/professionals networks (4 projects)</p></td><td><p>+</p></td><td><p>±</p></td><td><p>-</p></td><td><p>+</p></td><td><p>+</p></td><td><p>-</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td></tr><tr><td><p> Learning Centre</p></td><td><p>±</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>+</p></td><td><p>±</p></td><td><p>+</p></td><td><p>+</p></td></tr><tr><td><p> Expert Knowledge Centers & web-based platform (4 projects)</p></td><td><p>+</p></td><td><p>-</p></td><td><p>-</p></td><td><p>-</p></td><td><p>+</p></td><td><p>-</p></td><td><p>+</p></td><td><p>-</p></td><td><p>-</p></td><td><p>-</p></td><td><p>+</p></td><td><p>+</p></td></tr></tbody></table> </ephtml> </p> <p>1 QoL: quality of life; CE = challenging learning environments; QoCI = quality of care oriented to inclusion; FC = family-centeredness; IPT = interprofessional teamwork; AAIC = age-appropriate inclusion based on capabilities; EC = ethics-of-care; UD = universal design; PR = stress-positive role; FR = flexible rules; ev = evaluability; AF = affordable. <emph>significance of signs: + = explicitly present; ± sometimes present, sometimes not; - = not present.</emph></p> <p>An example is an inclusive day-care nursery for young children with and without special needs, which fulfils all criteria. It employs volunteers from the community, including volunteers with intellectual disability. It takes care of placing children part- or full-time in mainstream schools, and as such can be considered a project of continuing inclusive support.</p> <p>Four projects were nominated, in four different countries, of inclusive education at kindergarten, primary and medium school age. They are characterised by intensive teamwork between school staff, special needs teachers, a mobile therapists' team, university college monitoring and apprentices, as well as parent involvement. A particular case is the 'Classroom on wheels' or 'To School Together classrooms' in the Netherlands. These are organised in a mainstream school, with full time assistance by a multi-professional care and support team. Children join regular activities with other children as much as possible (e.g. recreation, music lessons and mealtimes). Children with and without disabilities learn reciprocally. One partner country nominated schools in a segregated setting as examples of inclusion, because they also provide support in mainstream schools.</p> <p>Four expert centres in three countries have been nominated which provide support to professionals working with children with complex and intense support needs. Their activities include training workshops, conferences, web-based platforms, practical research working groups and institutional counselling for particularly complex problems.</p> <p>One centre organises circles of support for a community-based inclusive approach. A circle of support is a reflection and dialoguing group consisting of parents and volunteers who have a special relationship and are in close contact with the disabled child. The group meets a few times a year, led by a trained coach, and uses an explicitly inclusive and QoL approach (O'Brien, [<reflink idref="bib28" id="ref51">28</reflink>]).</p> <p>A consultation centre for children and adults with aphasia and dysphasia has been nominated, because it searches for possibilities of communication via assistive technologies, with a strong emphasis on parent/professional/volunteer networking and inclusion.</p> <p>Several projects have been nominated that use music as a tool for stimulating communication and activities. One project was explicitly oriented to inclusion, in working with mixed (disabled or not) peers using children's songs and a multimodal songbook. Other projects focused on stimulating physical activities through music.</p> <p>A Quality of Life Centre is a start-up to coach institutions, schools, families and service centres to develop inclusive projects for children and adults with complex and intensive support needs and explicitly train quality of life enhancement. In one of the partner countries (France) the 'Rare Disability Network' was nominated, which provides advice and support to professionals in order to develop comprehensive intervention strategies adapted to the needs of the person and it orients families to the right places and resources. Several home-based service centres have been nominated, where professionals work with children, at home or in schools, assisting in the implementation of adapted projects or care. The French government-financed 'SESSAD' (Service d'Education Spécialisée et de Soins à Domicile – Special Needs Education and Home Care Service) is an example of an institutional reform. Four parent/professional networks have been presented, taking care of an interactive website and publications, oriented towards parents and daily caregivers, regarding themes such as sleep, nutrition, toileting, prevention of burnout.</p> <p>One example of good practice is an inclusive theatre company, which performs presentations in front of a large public, festivals or other public events. Theatre has been effectively used by a service provider as a tool for learning, activation, inclusion, quality of life, which allows involving children with severe impairments as well.</p> <p>One country mentioned an early intervention service with a parent-toddler playgroup, home visits, collaborative goal setting, demonstrations to parents (e.g. dressing), parent empowerment in family support networks.</p> <p>An integrated rehabilitation service was also nominated, which is characterised by a comprehensive approach, based on all ICF components: medical aspects, functional, participation, environmental and personal factors. It integrates music as a tool for activation, and organises inclusive summer camps. It also has a transition project to adulthood, which focuses on adolescent age, preparing young adults with multiple disabilities to build a life project. This is an example of a life-long continuing inclusion support system.</p> <hd id="AN0192434291-8">Discussion</hd> <p>The process to arrive at a consensus took two years, a relatively long time for a Delphi procedure. Participants came from eight EU countries, with different languages, cultures, attitudes, economic resources and views. In some countries (Italy and Portugal) inclusive education is nationally organised, considered almost 'natural', whereas in others, children with CISN are taken care of in separate institutions. Although Schalock & Verdugo's Quality of Life criteria were shared starting points, only two (social inclusion and rights) out of eight domains are related to inclusion. The emphasis on inclusion (as for example stated in the UNRPD) remained a point of discussion during the whole criteria-searching process. Some participants were convinced that high support and care needs of children with CISN – who are unable to talk, to move, to eat, or any self-care – are incompatible with inclusive education or inclusive leisure activities. Showing examples of good practice, by video or in real visits, generated a dialogue to generalise and refine criteria and challenge prejudices.</p> <p>This might be a sign of a cultural transition: from 'caring' - with its emphasis on impairment and health – to 'support', with an emphasis on functioning and participation. The concept of complex care has been researched extensively (Brenner et al., [<reflink idref="bib6" id="ref52">6</reflink>]). 'Participation', as a priority goal for intervention, has increasingly received attention not only in literature concerning special education but also in medical literature (Imms, Adair, et al., [<reflink idref="bib16" id="ref53">16</reflink>]).</p> <p>Participation seems more complex than it appears at first sight. It is both an entry point for learning and personal development, as well as an outcome: it involves many key concepts, bound in the term 'family of participation-related constructs', such as attendance, involvement, engagement, preferences, activity competence, capability, capacity, sense of self, self-regulation, context and environment (Imms, Granlund, et al., [<reflink idref="bib17" id="ref54">17</reflink>]). For children having severe difficulties in acquiring competences in most areas, participation hardly seems possible. However, they have a set of capabilities (Morris, [<reflink idref="bib23" id="ref55">23</reflink>]) which nevertheless make participation possible and meaningful. The examples we found show that prioritising on participation in regular life situations also allows the range of activities to become extended. e.g. a tetraparetic bedridden child, unable to sit, who had never left his house, was able to enjoy a walk in the park, once he became able to sit in a wheelchair, thanks to the work of the interdisciplinary team of the home-support centre. They had a hard time convincing his mother that it was feasible. That is still far from full inclusion, but the project was nominated because this apparently small step signified a huge life change for this child.</p> <p>Other projects showed that it is possible to organise inclusive education in a meaningful way (i.e. in the sense of the above described participation constructs), even with children with severe cognitive, motor, language and social impairments. This requires an orientation of the staff and parents towards all the mentioned criteria and to have strong views on and commitment to inclusion. Full inclusion is not always feasible, but if people are creative and flexible, they always find ways to make children participate and to have real interprofessional teamwork. e.g. a 'Together to school' class in the Netherlands, which has 6 children with multiple severe impairments, is embedded in a regular primary school with organised frequent living-and-learning-together moments between 'typical children' and children with disability, not only at mealtimes and leisure, but also during maths lessons, story reading, theatre and art. In this project, the health care team fully participates in a regular environment, in contrast to care and education that usually takes place in the same separate campus. However, more than just 'being there', the focus of the health staff has shifted from being merely oriented towards individual rehabilitation and reducing impairments, towards allowing participation.</p> <p>This complexity has been highlighted in our study by a qualitative methodology. Instruments to measure 'participation' (Resch et al., [<reflink idref="bib34" id="ref56">34</reflink>]) and quality of life (Petry et al., [<reflink idref="bib31" id="ref57">31</reflink>]) exist specifically for children with PIMD. A weakness in our study is that we could not actually measure participation with one of these instruments. We felt the need to clarify the quality of participation, inclusion and activity.</p> <p>Another weakness might be a selection bias. Surely, there might be other suitable candidates as examples of good practice. The list presented in Table 2 remains open.</p> <p>Another possible criticism is that 'Assistive technology' is missing from the criteria list. It is evident that nowadays full access to assistive technology in communication, mobility or other domains is crucial to activity and participation. An important question, however, remains, how technology can be used as a facilitator of activity and participation, e.g. in the playground, rather than having the child be pushed in her wheelchair, a four-wheel go-cart can be used with an extra seat; a battery-powered wheelchair can also be attractive to non-disabled peers.</p> <hd id="AN0192434291-9">Conclusions and Recommendations</hd> <p>The list of criteria of good practices regarding activity and participation of children with CISN was useful in finding a number of practical examples which are an excellent source of learning, even though some of them only partially fulfilled these criteria. Despite the seemingly 'utopian' character of the 12 criteria, we found several projects explicitly working towards, or having realised good practice in all twelve. All nominated projects are working towards more activity, participation, and 'ethics- of-care', in high-income as well as low-income countries.</p> <p>We recommend that service providers dealing with children with multiple severe disabilities and continuous complex needs adopt these criteria (as stated in Table 2) to enhance the quality of support in a more inclusive way; that staff is trained to 'think and act inclusion', i.e. to facilitate participation-oriented activities; to set up a challenging and inclusive learning environment and take everyone's capabilities as a starting point regardless of the impairment severity in more inclusive environments. As for further research, the criteria of good practices could be operationalised and tested. The United Nations Convention on the Rights of People with Disability, and the World Health Organisation ([<reflink idref="bib46" id="ref58">46</reflink>]) advocated these issues in a general way. The challenge remains how to get current policy makers and field workers to invest a sufficient amount of time and finances in order to get more services for children with CISN to move in this direction.</p> <hd id="AN0192434291-10">Key messages</hd> <p></p> <ulist> <item> Children with complex and intensive support needs (CISN) should have more meaningful activities and participate in inclusive education or other life domains.</item> <p></p> <item> As a basis for training professionals and parents with children with CISN, and to create a shift of mind, examples of good practices in working towards activation and inclusion can be useful.</item> <p></p> <item> We defined 12 criteria to which good practices promoting activity and participation should respond.</item> <p></p> <item> Good practices should take quality of life criteria as a framework; offer a challenging and inclusive learning environment and take everyone's capabilities as a starting point regardless of the impairment severity.</item> <p></p> <item> 29 projects across 8 European countries have been nominated of which 13 were included in a training manual and DVD.</item> </ulist> <hd id="AN0192434291-11">Acknowledgments</hd> <p>The Enablin+ project acknowledges financial support from the European Commission, Life Long Learning Programme. Contract 541981-LLP-1-2013-1-BE-LEONARDO-LMP from 1/1/2014 to 30/6/2017. This document reflects the views of the authors only, and the Commission cannot be held responsible for any use, which may be made of the information contained therein.</p> <p>The authors are grateful to their colleagues of the Enablin+ Working Group: Belgium: Bea Maes (Catholic University of Leuven, Department of Special Needs Education), Anneleen Penne (Multiplus Expert Centre for people with PIMD, University of Leuven), Claudia Claes (University of Ghent), Luk Dewulf (De Seizoenen Productions), Inge Wagemakers (Ministry of Education), Katleen Ballon, Katia Verhaeren & Mieke De Strooper (Villa Clementina); The Netherlands: Inge Kroes & Rianne Kleine Koerkamp (Quality of Life Centre, Wijhe), Roeland Vollaard (Class on Wheels, Alkmaar); Alies Kap (Stichting Gewoon Bijzonder (Foundation "Ordinarily Special"), Petra Poppes ('s Heerenloo Care Group & University Groningen), Joke Visser (NSGK National Foundation Children with Disability); France: Eric Zolla, Annemarie Boutin & Elisabeth Zucman (CESAP, Paris); Romania: Eniko Batiz, Istvan Szamoskozi & research group (Babes-Bolyai University, Dept. of Applied Psychology, Cluj-Napoca); Isle de la Réunion: Elisabeth Houot, Marlène Grégoire, Laurence Richard, Nacer Njoudi & Marika Rieth-Socha (Association St François d'Assise); Bulgaria: Apostol Apostolov, Andreas Andreou, Zvezdelina Atanasova, Stanimira Atanasova, Aneta Morfova, Nikoleta Yoncheva (Karin Dom Centre, Varna); Italy: Anna Maria Dal Brun (IRCCS Fondazione Don Carlo Gnocchi, Milano Italy), Gabriele Baldo (University of Trento); Portugal: Ana Paula Antunes (Agrupamento de Escolas de Portel, Alentejo), Carmen Nunes (Association of Parents of Children with Autism), Hugo Rebelo, Catia Coelho, Maria Luisa Gracio, Maria José Saragoça & Nuno Costa (University of Évora).</p> <p>The authors also would like to thank Juliet Goldbart & Claire Pierson of Manchester Metropolitan University (U.K.) for acting as external evaluators to the Enablin+ project.</p> <hd id="AN0192434291-12">Disclosure Statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <ref id="AN0192434291-13"> <title> References </title> <blist> <bibl id="bib1" idref="ref7" type="bt">1</bibl> <bibtext> Arthur-Kelly, M., Foreman, P., Bennett, D., & Pascoe, S. 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  Data: Good Practices towards Inclusion, Activity and Participation of Children with Complex and Intense Support Needs
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  Data: <searchLink fieldCode="AR" term="%22Jo+Lebeer%22">Jo Lebeer</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5929-7783">0000-0001-5929-7783</externalLink>)<br /><searchLink fieldCode="AR" term="%22Adelinda+Araujo-Candelas%22">Adelinda Araujo-Candelas</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9489-8880">0000-0002-9489-8880</externalLink>)<br /><searchLink fieldCode="AR" term="%22António+Portelada%22">António Portelada</searchLink><br /><searchLink fieldCode="AR" term="%22Beno+Schraepen%22">Beno Schraepen</searchLink><br /><searchLink fieldCode="AR" term="%22Mia+Nijland%22">Mia Nijland</searchLink><br /><searchLink fieldCode="AR" term="%22Christine+Plivard%22">Christine Plivard</searchLink><br /><searchLink fieldCode="AR" term="%22Reka+Orban%22">Reka Orban</searchLink><br /><searchLink fieldCode="AR" term="%22Eniko+Batiz%22">Eniko Batiz</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7311-8286">0000-0001-7311-8286</externalLink>)<br /><searchLink fieldCode="AR" term="%22Magdalena+Tsoneva%22">Magdalena Tsoneva</searchLink><br /><searchLink fieldCode="AR" term="%22Heleen+Neerinckx%22">Heleen Neerinckx</searchLink><br /><searchLink fieldCode="AR" term="%22Marina+Luisa+Rodocanachi+Roidi%22">Marina Luisa Rodocanachi Roidi</searchLink><br /><searchLink fieldCode="AR" term="%22Enablin%2B+Working+Group%22">Enablin+ Working Group</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Disability%2C+Development+and+Education%22"><i>International Journal of Disability, Development and Education</i></searchLink>. 2026 73(3):409-424.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 16
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  Data: 2026
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Best+Practices%22">Best Practices</searchLink><br /><searchLink fieldCode="DE" term="%22Inclusion%22">Inclusion</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Multiple+Disabilities%22">Multiple Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+Life%22">Quality of Life</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Professional+Personnel%22">Professional Personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Attitudes%22">Parent Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Attitudes%22">Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Needs%22">Individual Needs</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22European+Union%22">European Union</searchLink><br /><searchLink fieldCode="DE" term="%22Belgium%22">Belgium</searchLink><br /><searchLink fieldCode="DE" term="%22Netherlands%22">Netherlands</searchLink><br /><searchLink fieldCode="DE" term="%22France%22">France</searchLink><br /><searchLink fieldCode="DE" term="%22Italy%22">Italy</searchLink><br /><searchLink fieldCode="DE" term="%22Portugal%22">Portugal</searchLink><br /><searchLink fieldCode="DE" term="%22Romania%22">Romania</searchLink><br /><searchLink fieldCode="DE" term="%22Bulgaria%22">Bulgaria</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/1034912X.2025.2475108
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1034-912X<br />1465-346X
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Children with multiple disabilities and complex and intensive support needs are at risk of separated and passive lives in institutional care. Following the call of the UNCRPD, and in view of developing an innovative in-service training, a European group of care providers, parents and training institutions, developed a framework to define good practices towards a more inclusive and active life in education and elsewhere. Methods: Following a Delphi procedure in four international meetings, to which local professionals and parents were invited, criteria of good practices enabling participation and activation of children with severe multiple disabilities were set up. Examples were explored which responded to these criteria. Results: Fifty-nine professionals and parents from eight EU countries participated. They selected 12 criteria about quality of life, a challenging and inclusive learning environment, family-centeredness, high care ethics, teamwork, activity and participation. They nominated 29 projects fulfilling five or more criteria. Conclusion: Examples show that children with multiple and complex disabilities, despite being totally dependent on intense support, can have meaningful inclusive education and other inclusive activities, provided there is enough support and staff and parents understand how to give that support.
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  Label: Entry Date
  Group: Date
  Data: 2026
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  Label: Accession Number
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  Data: EJ1504023
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        Value: 10.1080/1034912X.2025.2475108
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      – Text: English
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      – SubjectFull: Best Practices
        Type: general
      – SubjectFull: Inclusion
        Type: general
      – SubjectFull: Foreign Countries
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      – SubjectFull: Multiple Disabilities
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      – SubjectFull: European Union
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      – TitleFull: Good Practices towards Inclusion, Activity and Participation of Children with Complex and Intense Support Needs
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      – PersonEntity:
          Name:
            NameFull: Reka Orban
      – PersonEntity:
          Name:
            NameFull: Eniko Batiz
      – PersonEntity:
          Name:
            NameFull: Magdalena Tsoneva
      – PersonEntity:
          Name:
            NameFull: Heleen Neerinckx
      – PersonEntity:
          Name:
            NameFull: Marina Luisa Rodocanachi Roidi
      – PersonEntity:
          Name:
            NameFull: Enablin+ Working Group
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 04
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1034-912X
            – Type: issn-electronic
              Value: 1465-346X
          Numbering:
            – Type: volume
              Value: 73
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: International Journal of Disability, Development and Education
              Type: main
ResultId 1