Remote support for individuals with intellectual disabilities living independently: a scoping review

Abstract

Objectives

The purpose of this project was to conduct a scoping review to understand factors related to remote support provision among individuals with intellectual disabilities in independent living.

Methods

A systematic search was employed among eight large databases, yielding 207 articles. Following a two-phase screening process, 22 articles were included in this review. Data were charted and summarized according to types of remote support, outcomes, best practices, barriers and facilitators, and ethical considerations.

Results

Overall, remote support provision was associated with positive outcomes (e.g. academic skills). Most studies used mobile apps or video self-modeling/prompting. Training for support workers facilitates use, and privacy concerns should be addressed among organizations.

Discussion

Given the shift to online technology over the Covid-19 pandemic, remote support can complement in-person support when used skillfully and appropriately. Importantly, remote support should be individualized for each person. Greater research is needed using diverse study designs, assessing perceptions of support providers, and on remote support that enables live communication between users and providers.

Introduction

Independent living in Canada and research approach

Individuals with intellectual disabilities have long endured ableism and have been subjected to isolation and institutionalization in attempts to ‘remove’ and ‘hide’ individuals with disabilities from society (Goodley 2017). Shifts in conceptualizing disability spurred political and policy changes for community integration for individuals with disabilities. A new support model exists to enable social integration by providing personalized and functional support to individuals with intellectual disabilities while living independently (Brisenden 1986). In Canada and many other places in the world, people can access ‘independent’ or ‘supported’ living services, in which individuals live in their own home (alone, with a partner/spouse, or a roommate) and have organized support that enables the individual to choose how to live, work, learn, and participate actively in the community (Batavia et al. 1991, Community Living British Columbia [CLBC] 2015). Independent living aligns with the philosophy that individuals with disabilities have the right to autonomy and decision-making (Brisenden 1986). Support can include training in life and professional skills, supervised care, environmental adaptations, and physical assistance to achieve better independence, community participation, and personal satisfaction (Accardo and Whitman 2011).

CLBC is the Crown Agency in British Columbia that funds community living supports and services in our province, including residential supports. In response to differing housing needs and wants, CLBC developed the Inclusive Housing Framework to inform practice on housing solutions (CLBC 2016). Based in Schalock’s Quality of Life Framework (Schalock 2004)), the five elements of include: 1) choice and control (over living space), 2) basic inclusion requirements (e.g. promoting community participation, affordability), 3) ratio of people with and without disabilities, 4) diversity (accessibility and specialization of housing), and 5) sustainability (sense of permanency in housing). During the Covid-19 pandemic, CLBC began supporting a transition to using more remote services to provide support, and questions emerged about how remote support can be best delivered while covering the five elements of the Inclusive Housing Framework. As such, a partnership was formed between four community living non-profits funded by the Crown Agency and the UBC Centre for Inclusion and Citizenship, the “Remote Support Working Group,” to help address these questions and understand the literature on remote support. This review was guided by a community based participatory research approach as it was conducted in equitable partnership between researchers and community organizations (Israel et al. 2010). Community members were engaged throughout the research process through collaborative processes with meaningful input of stakeholders including service users (self-advocates).

Independent living support

Traditionally, support has been provided in-person. In-person support for those accessing independent living can offer several benefits, such as increased participation in the labour market, improved quality of life, enhanced community integration (Hurstfield et al. 2007, McCarron et al. 2019). However, in-person support can be costly to individuals receiving support, organizations, and governments (Hurstfield et al. 2007, May et al. 2019). In efforts to reduce costs and provide measures for physical distancing during the Covid-19 pandemic, remote support is increasingly offered by service organizations (Doody and Keenan 2021, Wos et al. 2021). Remote support varies across regions and may consist of monitoring systems in homes (e.g. cameras, sensors), virtual smart technology (e.g. voice assistant, smart appliances), or the use of devices (e.g. computers, tablets) to enable live two-way communication with support professionals (Taber-Doughty et al. 2010, Tassé et al. 2020).

While remote support is also delivered through the Internet and other technologies, remote support is different from eHealth, telehealth, or telecare in that it does not focus on health services and information, nor does it aim to improve healthcare (cf. Eysenbach 2001). Research into the effectiveness of ‘eHealth’ for seniors and people living with a disability in Canada and elsewhere has been burgeoning over the last 40 years (e.g. Oudshoorn et al. 2020). However, research on remote support for Canadians with intellectual disabilities to live in community independently has only begun to emerge. Most of these researchers explored individuals with intellectual disabilities’ virtual interactions with the health care system during COVID (e.g. Lake et al. 2021, Selick et al. 2021). For example, in a Canadian study, Lunsky et al. (2021) looked at the role of direct support workers in facilitating access to virtual health care. Relatedly, in the United States, Nygren and Lulinski (2020) looked at the impact of the service disruption and the role of remote support; these researchers found that while 74% of individuals with intellectual disabilities had lost at least one or more of their services entirely, only a small percentage of services were being delivered virtually. The lack of uptake and research on remote supports for individuals with intellectual disabilities is surprising given that researchers) are advocating for increased access to technology to optimize individualized supports in community and to enhance individuals with intellectual disabilities’ quality of life (e.g. Bigby et al. 2017, Tassé et al. 2020).

Benefits of remote support

While in-person support will always be necessary for some in independent living, remote support offers the opportunity for better distribution of resources (Tassé et al. 2020). Staff members can provide hands-on support to those individuals who need it while reducing the overall need of available staff presence (Tassé et al. 2020). Other benefits of remote support include allowing organizations to serve more individuals without increasing personnel or overtime hours (Tassé et al. 2020). In addition, research suggests that remote support can meet a wide range of support needs without negatively impacting quality of life for individuals with intellectual disabilities (Perry et al. 2012). There are also benefits of remote support for support users. For example, a study found that a remote support training program helped individuals with intellectual disabilities to gain three self-selected recreational and independent living skills (e.g. cooking; Pellegrino and DiGennaro Reed 2020). Research also shows that people with disabilities experience a greater sense of autonomy, independence, and privacy due to the reduced need for staff in their homes (Niemeijer et al. 2010, Tassé et al. 2020, Wennberg and Kjellberg 2010).

There have been few individual studies examining how remote support services are delivered to enhance independent living for persons with disabilities. A recent study examined how workers provide support to individuals with intellectual disabilities using DigiContact, a 24/7 available, on-demand remote support service using video and audio calls with trained support workers (Zaagsma et al. 2023). Through qualitative interviews, the authors found that support activities focus on enhancing capabilities of individuals living independently by focusing on problem solving and coping skills (Zaagsma et al. 2023). Providing a welcoming and safe digital environment with close collaboration among support staff was important for facilitating the support process (Zaagsma et al. 2023). Another study in the Netherlands evaluated the impact of an online program that allows video calling between ‘coaches’ (i.e. support workers) and clients) (de Wit et al. 2015). Clients reported greater accessibility to support workers due to video calling and maintained their quality relationships with each other (de Wit et al. 2015).

Challenges with remote support

This same study suggested that the usability of remote support is lower due to support users’ concerns about privacy (de Wit et al. 2015). They also reported that clients faced difficulty using technology due to low quality Internet connection (de Wit et al. 2015). There are barriers to using and experiencing benefits from remote support with respect to program design, delivery, and implementation. However, little research exists on the impact of remote support services, privacy concerns, and best practices, and this research has not been reviewed in a consistent manner. Reviews exist that examine specific types of technology (e.g. mobile apps) for specific disability groups (e.g. autism spectrum disorder) (e.g. Francis et al. 2018, Hrabal et al. 2023). Other reviews examine independent living broadly for individuals with intellectual disabilities and report a small section on technology, but digital support is not the focus of the review (e.g. Lennard et al. 2020, Marcotte et al. 2020). Remote support can encompass many types of digital technology and formats and it is valuable to understand the breadth of support among support users in independent living.

Purpose of the review

Given the recent uptake of remote support services among community organizations, there is a need to collate the literature and provide a better understanding of remote support services offered to individuals with intellectual disabilities. Substantial attention has been paid to understanding digital and remote support for health services (e.g. eHealth, mHealth, telehealth; (Oudshoorn et al. 2020) but those services do not cover support for independent living issues (e.g. transportation, cooking). Remote support is an understudied model of practice for support users living independently in community settings. Guided by our community partners, the purpose of this study was to map the literature on remote support provided to individuals with intellectual disabilities in independent living. Specifically, a scoping review was conducted to understand the types of remote support provided, best practices for remote supports, barriers, and facilitators to implementation, ethical considerations, and implementation outcomes.

Methods

A scoping review was conducted as it allows for evidence to be mapped according to existing literature and can help to identify evidence gaps and recommendations for best practices in policy, a key focus for this review (Khalil et al. 2016). Because there is little research on remote support in independent living, it is not feasible or appropriate to conduct quality appraisal of studies through a systematic review (Munn et al. 2018). The scoping review is meant to showcase a body of literature as a whole and provide general recommendations for future researchers, practitioners, and policymakers rather than make concrete conclusions (Munn et al. 2018). The five-stage framework for scoping reviews developed by Arksey and O’Malley (2005) was used: (1) identify the research question, (2) identify relevant studies, (3) select studies, (4) chart the data, and (5) summarize the results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (Tricco et al. 2018) was also used for reporting purposes. While a protocol was developed for internal use by the research team, it was not registered.

Stage 1: identify the research question

In collaboration with stakeholders from the four community living partner organizations, the primary research question was: what is known from the literature about the provision of remote support (services) for individuals with intellectual disabilities in independent living contexts? For this review, we were interested in all types of remote support (e.g. mobile apps, two-way communication). The community organizations were specifically interested in understanding: 1) the type of remote support provided, 2) best practices for providing remote support, 3) barriers and facilitators to implementing remote support, 4) ethical considerations for the provision of remote support services, and 5) implementation outcomes.

Stage 2: identify relevant studies

The literature search strategy was developed by RH and ZM in collaboration with a librarian (AL). The search terms were informed by previous work completed by one of the authors (RH) as well as through preliminary searches completed by the librarian (AL) to validate the use of terminology. Search terms related to identifiers in the following three categories: (a) intellectual disabilities; (b) remote supports and telehealth; and (c) independent or supportive living. Additionally, the search was limited to title and abstract only to ensure the intended focus of the article aligned with the research scope. It is worth noting that ‘telehealth’ was included to capture a larger field, with the understanding that articles relating to healthcare would be excluded. As explained in the Introduction, remote support does not include the provision of healthcare. Thesaurus terms were not used in the search because in the field of social work and allied health, terminology is flexible, evolving, and unstandardized as different preferences are emphasized in different jurisdictions. Many inconsistencies exist in terminology and databases have lagged in capturing interventions and/or populations under one blanket term, and if they do, they can represent biased or problematic language. A recommendation to not use thesaurus or subject heading terms does not come lightly, and searches should always still be validated using a comparison with and without them. For this review, this method was employed.

The searches were conducted by ZM and AL on May 26, 2022 of articles published from 2015 to 2022 (including early access articles beyond May) using the following databases: Web of Science, APA PsycINFO, Medline, ERIC, Education Source, Scopus, and Embase. These databases were selected because they specialize in the fields of disability, allied health, and humanities research. The decision to time limit the search from 2015 was made in partnership with the four community organizations. While the researchers were advocating for a ten-year time span, the partners were committed to looking at how remote supports have evolved in supporting independent living since the pandemic. We came to a consensus of a start date of 2015 to capture some earlier developments. All articles were uploaded to the database software platform Covidence where the deduplication process occurred and was reviewed for any articles de-duplicated in error. The search was run again on May 24, 2023 to locate any additional studies published since the original search was conducted. These results were de-de-deduplicated against the earlier search results in Covidence. See Appendix A for the full search strategies for each database.

Stage 3: select studies

This review included a two-phase screening process: (1) title and abstract, and (2) full text. ZM and RH each conducted a title and abstract screening independently before further refining eligibility criteria and resolving conflicts in the title/abstract screening phase. Then, the full texts of the articles were retrieved and SVCL screened them against the inclusion criteria, with the support of RH when uncertainty arose. Authors were not blinded to the study’s title, author, or institution.

Articles considered for inclusion were peer-reviewed original research studies and other evidence syntheses (e.g. literature reviews, scoping reviews, systematic reviews, meta analyses) published in English. Articles were excluded if they were study protocols or editorials (i.e. wrong study design). Given that this topic is not yet robust, it is appropriate to include secondary research to provide readers with an accurate representation of the literature. This synthesis crosses multiple fields, and a search would not uncover the original studies presented in the syntheses that did come back in a search. Grey literature, such as theses, dissertations, websites, and organizational reports, were excluded. To be included, participants of the studies needed to be adults (18+) with intellectual disabilities (as defined in the description of the article’s sample) living independently in supported living, home shares, or shared living communities. In alignment with the crown agency responsible for adults supports and services in our province, we used the official definition of intellectual disabilities employed by the crown agency that is based on the Diagnostic Statistical Manual-5 definition of intellectual disabilities: characterized by significant limitations both in intellectual functioning and in adaptive behaviour which covers many every day social and practical skills and which originates during the developmental period (CLBC 2016).

Articles pertaining to individuals living in group homes, or transitioning to residential childcare (i.e. wrong intervention) were excluded. Articles were excluded if they did not focus on individuals with intellectual disabilities (wrong patient population, e.g. older adults with chronic conditions, physical disabilities, mental health, no disability). For the purpose of this review, remote support services included technologies such as smart home, home-based support like window/door sensors, motion detectors, medication dispensers, in addition to personal assistance devices, two-way communication systems, and other services that allow a remotely located support staff to monitor the status and safety of individuals requiring support to live independently (Tassé et al. 2020). Articles focusing on the use of remote technologies in the facilitation amongst support staff, or literature where telehealth itself was the entire focus, were excluded. A PRISMA flow chart (Liberati et al. 2009) outlining the search strategy process can be seen in Figure 1.

Figure 1.

PRISMA-P flow diagram of article selection process (Liberati et al. 2009).

Stage 4: chart the data

SVCL completed the data extraction process with support from RH. RH and SVCL discussed the data extraction tool and items before collecting data to ensure clarity and consistency. SVCL piloted the tool and reviewed the initial data extraction with RH. RH provided feedback and the tool was refined to add in ‘description of methods’ and ‘measures’ to understand how studies were conducted and data was collected. SVCL extracted the following information from each article using Covidence: author(s), title, country, study aim, study design, description of methods, measures, population description, inclusion criteria, exclusion criteria, total number of participants, intervention description (if applicable), key findings, type of remote support, and recommendations. Only data related to remote support and independent living for individuals with intellectual disabilities was extracted. The authors were not blinded during the data extraction and charting process.

Stage 5: collating, summarizing, and reporting the data

The results were summarized according to types of remote support, implementation outcomes, best practices, barriers and facilitators, and ethical considerations. The results were also separated based on primary and secondary research. Conclusions of the syntheses, and of the primary research, are not to be conflated into a single original analysis, but the discussion creates the bridge between the conclusions found through both streams of information. Risk of bias and quality assessments of articles were not completed as these assessments do not align with the objectives of a scoping review (Higgins and Green 2008).

Results

Articles retrieved

The original search strategy identified a total of 207 potentially relevant articles. After deduplication, title/abstract screening, and full text screening, 20 studies met the inclusion criteria. An updated search ran on May 24, 2023 resulted in an additional 28 articles retrieved, of which 2 articles were included after screening, for a total of 22 studies. The included articles consist of 16 primary studies and six secondary studies (i.e. reviews). Of the primary studies, designs included qualitative research (n = 7), multiple baseline/probe study design (n = 4), case report (n = 1), randomized controlled trial (n = 1), pilot field studies (n = 1), cross-sectional study (n = 1), and retrospective study (n = 1). Studies were conducted in the United States (n = 11), Europe (n = 10), and Canada (n = 1). Detailed information on articles and participants can be found in Table 1.

Table 1.

Characteristics of articles retrieved for review.

Primary Research
Reference	Study design	Location	Participants	Type of Remote Support	Intervention (If Applicable)		Main Findings
(Bridges et al. 2020)	Multiple baseline/ probe design	United States	3 adults with moderate to severe intellectual and/or developmental disabilities attending 9-week postsecondary education program	Mobile app called HP Reveal: Augmented reality app that allows users to upload videos that can be accessed by a marker or target	Task analyses to assess participants’ ability to use HP Reveal and number of steps performed independently after HP Reveal video model		Participants improved independence of targeted daily living skill after using HP Reveal
(Cullen et al. 2017)	Multiple baseline/ probe design	United States	2 adults (ages 20 and 22 years old) with intellectual and/ or developmental disabilities attending postsecondary education	Self-directed video prompting	Participants asked to use iPad with video to clean table with debris		Video prompting was effective in improving accurate completion of cleaning tasks
(Dalprà et al. 2015)	Case report	Italy	1 30-year-old woman with Down Syndrome	“Casa Satellite” is a smart home, pilot training (safety, indoor environmental control, communication, entertainment)	Video touch screen that reminds participants of all tasks that users must perform inside home		Smart home helps people live independently by completing activities of daily living
(Janson et al. 2021)	Qualitative research	Norway	4 dyad interviews with caregivers and residents and 1 focus group interview with 7 care staff and managers	Mobile app “APPetitus” allows users to track meals and offer nutrition recommendations	N/A		APPetitus mediates nutritional conversations between support users and caregiver. Helps users to make positive nutritional behaviour change
(Morse et al. 2021)	Multiple baseline study	United States	7 total participants from ages 18 to 22 years from an agency providing supported employment and community living programs for adults with developmental disabilities	Mobile app “Picture Scheduler" allows users to create visual tasks and organize into categories that are supplemented with pictures and instructions	Participants listened to scripted instructions and then had to make a smoothie by viewing a video in an app		Picture Scheduler supported improvements in task performance with reductions in time and steps to completion
(Moyà-Köhler and Domènech, 2022)	Qualitative research	Spain	40 individuals with intellectual disabilities	Smart home with QR codes distributed around house that provide instructions	N/A		Support users did not use QR codes for any purpose
(Nierling and Maia, 2020)	Qualitative research	Germany	Experts from European disability organizations as well as pan-European user groups	Assistive technology	N/A		Virtual integration is necessary for all technology to be accessible to individuals with disabilities for independent living purposes
Owuor and Larkan, 2017	Qualitative research	Ireland	Individuals with intellectual disabilities who have diverse communication abilities (number of participants not stated)	Assistive technology	N/A		Assistive technology can enhance self-determination and independence among individuals with disabilities; increase social network; need well-resourced staff
(Price et al. 2018)	Multiple probe design	United States	4 individuals with intellectual or developmental disabilities between the ages of 17 and 25 years of age attending a school-to-work transition program on a large public university campus	Google Maps	Students taught to use the bus through Google Maps using a fading procedure		75% of students learned how to use the bus independently using Google Maps
(Smith et al. 2023)	Randomized controlled trial	United Kingdom	90 individuals recruited with intellectual disabilities and 117 support staff	Intelligent personal assistants (e.g. Google Home smart speakers)	N/A		Participants had positive experiences with technology; increased sense of agency (qualitative but not quantitative)
(Stock et al. 2019)	Pilot field studies	United States	Study 1: 23 individuals with intellectual disabilities and Study 2: 12 individuals with intellectual disabilities	Smart travel system that enables pre-trip planning, assessment, and training to use public transportation	N/A		Study 1: Participants significantly improved vehicle identification abilities post-training Study 2: Significant difference between paper training and smart travel system for completion and timeliness of pre-trip tasks
(Subach and Sullivan, 2022)	Qualitative research	United States	8 adults with intellectual and/or developmental disabilities, 9 parents/ caregivers	Virtual culinary program “Ram Chef” that provides individualized adapted cooking instruction	N/A		Ram Chefs helps to achieve independence in meal preparation and a sense of relatedness with other participants
(Tassé et al. 2020)	Qualitative research	United States	56 adults with intellectual and developmental disabilities who use remote supports	Provision of supports by staff at a remote location who are engaged with an individual through equipment with the capability for live two-way communication	N/A		Safety, increased independence, better health (e.g. medication reminders) are benefits; privacy and malfunctioning technology are concerns with remote support
(Wagner et al. 2022)	Cross-sectional study	United States	49 directors of state departments of developmental disabilities	A service that uses technology to support an individual with developmental disabilities from a location outside of the home	N/A		Less than half of states provide remote support but adoption is increasing; states report difficulties in implementation due barriers including fear of danger, privacy concerns, user buy-in, cost prohibitive perceptions, and technology failures
(Zaagsma et al. 2020a)	Qualitative research	Netherlands	Individuals with intellectual and developmental disabilities who receive professional support and case workers (18 participants total)	“DigiContact”: 24/7 available online support service that uses video conferencing techniques to enable communication between support users and specially trained support staff	N/A		Online support used in addition to on-site support; online support provides additional flexibility; support addresses mental health, interpersonal relations, cognitive strategies social contacts, and practical issues
(Zaagsma et al. 2020b)	Retrospective study	Netherlands	648 individuals with intellectual and developmental disabilities using services to live independently	See above	N/A		Use of online support increased during Covid-19 pandemic; service providers can increase responsiveness towards changes in support demand by service users

Secondary Research
Reference	Study design	Location	Participants	Type of Remote Support	Intervention (If Applicable)		Main Findings
Baxter and Reeves, 2023	Literature review	United States	Students with intellectual disabilities	Assistive technology (text to speech, electronic calendars, task analysis apps, safety apps)	N/A		Assistive technology can support independent living skills (e.g. meals, cleaning, job search); allows individuals to feel safer in community
(Francis et al. 2018)	Review	United States	7 college students with autism disorder reviewed apps	Mobile apps	N/A		10 apps found total, 2 apps related to independent living: (1) Shopping List Ease (users create shopping lists) and (2) Left for Spending (users create budgets, set spending amounts, and track)
(Hrabal et al. 2023)	Systematic review	Switzerland	Studies for this review included adults with autism disorder	Assistive technology	N/A		27 included studies; mostly taught meal preparation and housekeeping skills in school settings or vocational centers;
(Lennard et al. 2020)	Systematic review	United Kingdom	Studies were included if they involved adults with learning disabilities or pervasive development disorder	General smart technology	N/A		14 included studies; smart technology can support independent living by improving safety and reducing cost of care
(Marcotte et al. 2020)	Systematic review	Canada	Studies were included if they involved individuals with autism disorder	Video self-modeling and prompting	N/A		19 included studies; video self-modeling supports development of communication and activities of daily living skills; video prompting supports transitioning between daily activities
Wang and Jeon, 2023	Systematic review	United States	Adults with autism disorder	Assistive technology	N/A		Assistive technology improves community living skills like navigation, step-by-step activities to be involved in community, and provides social networks

Types of remote support

Primary research

The types of remote support provided to individuals with IDD varied across studies. The most common form of remote support in primary research studies included the provision of general remote support (i.e. provision of supports by staff of an agency provider at a remote location who are engaged with an individual through equipment with the capability for live two-way communication, n = 4) (Tassé et al. 2020, Wagner et al. 2022, Zaagsma et al. 2020a, Zaagsma et al. 2020b), video self-modeling (i.e. the learner is first asked to observe a video of himself/herself performing a task, and to then replicate the behaviours) or video prompting (i.e. video segments presenting a task step by step, and they are used while the person is performing the task in question (n = 3) (Bridges et al. 2020, Cullen et al. 2017, Morse et al. 2021), and mobile applications (apps; an interface on a handheld device that connects users with contents for knowing and tools for doing; Scolari et al. 2012) (n = 2) (Janson et al. 2021, Price et al. 2018). Other types of remote support included smart home technology, which includes smart devices that are integrated into an intelligent system, offering management, monitoring, support and responsive services (Marikyan et al. 2019), e.g. smart speakers, QR codes, automated apartments (n = 3) (Dalprà et al. 2015, Moyà-Köhler and Domènech 2022, Smith et al. 2023); general assistive technologies (defined by the World Health Organization as products, systems, and services which “maintain or improve an individual’s functioning and independence and thereby promote their well-being” [World Health Organization 2016]) (n = 2) (Nierling and Maia 2020, Owuor and Larkan 2017), virtual culinary program (n = 1) (Subach and Sullivan 2022), and a smart travel system (web- and mobile-based support pre-trip assessment, training, and planning activities to support travel using fixed route public transportation) (n = 1) (Stock et al. 2019).

Secondary research

Reviews focused on different types of remote support, including mobile apps (Francis et al. 2018), video self-modeling/prompting (Marcotte et al. 2020), general smart technology (review did not provide definition; (Lennard et al. 2020), and general assistive technology (Baxter and Reeves 2023, Hrabal et al. 2023, Wang and Jeon 2023).

Implementation outcomes

Primary research

Studies reported many positive outcomes associated with remote support. Five studies reported on the overall use of remote support (Moyà-Köhler and Domènech 2022, Nierling and Maia 2020, Wagner et al. 2022, Zaagsma et al. 2020a, Zaagsma et al. 2020b) noting that general assistive technologies are needed (Nierling and Maia 2020, Owuor and Larkan 2017). Some studies reported that remote support was used complementary to in-person support (Zaagsma et al. 2020a) but that the use of online support increased during Covid-19 (Zaagsma et al. 2020b). Similarly, Wagner et al. (2022) found that the rate of adoption of remote support services has increased markedly in the last decade in the USA due to specific funding sources. Contrastingly, one study found that assistive technology can be viewed as an additional laborious task for support staff to carry out, which slow the adoption of assistive technology across services (Owuor and Larkan 2017). Further, another study noted that smart technology was not always used even if it was available (Moyà-Köhler and Domènech 2022). Another two studies reported on the usability and acceptability of remote support, finding that apps and other types of remote support are viewed as beneficial and easy to use (Bridges et al. 2020, Smith et al. 2023).

Five studies reported that remote support technology generally helps individuals with intellectual disabilities to live independently and improve activities of daily living or daily living skills (Dalprà et al. 2015, Owuor and Larkan 2017, Price et al. 2018, Subach and Sullivan 2022; Tassé et al. 2020). Other common outcomes included improvements in task performance or completion (n = 5) (Bridges et al. 2020, Cullen et al. 2017, Morse et al. 2021, Owuor and Larkan 2017, Stock et al. 2019). Additional psychosocial and health benefits reported included increased sense of agency and wellbeing (qualitatively but not quantitatively; Smith et al. 2023), better sense of relatedness with others (Owuor and Larkan 2017, Subach and Sullivan 2022, Tassé et al. 2020), positive health behaviour change and better communication between individuals with intellectual disabilities and caregivers (Janson et al. 2021), and sense of safety (Tassé et al. 2020).

Secondary research

Four reviews found that remote support technology supported the development and performance of daily living skills (e.g. cooking) (Baxter and Reeves 2023, Hrabal et al. 2023, Lennard et al. 2020, Marcotte et al. 2020). Using electronic calendars to schedule social and independent living activities can support student’s self-determination skills by facilitating event prioritization (Baxter and Reeves 2023). Further, using task-analysis apps can support the development of employment-related skills by mastering instructions (Baxter and Reeves 2023). Another review suggested that assistive technology can improve community living skills such as travel, communication, and shopping (Wang and Jeon 2023). Another review found that mobile apps that support independent living (e.g. budgeting, shopping) score high on usability and satisfaction (Francis et al. 2018).

Best practices

Primary research

In general, studies promoted the use of remote support due to its many benefits as stated above. However, authors noted that remote support should be used in complement to in-person support as onsite support is irreplicable (Morse et al. 2021, Moyà-Köhler and Domènech 2022, Zaagsma et al. 2020a, Zaagsma et al. 2020b). Indeed, the primary goal of remote support services is not to replace support workers; rather, they are intended as an element within the continuum of services and support options (Tassé et al. 2020). Another best practice provided by several authors was to tailor and individualize remote support services to support-users as they each have their own set of preferences and support needs (Bridges et al. 2020, Cullen et al. 2017, Nierling and Maia 2020, Smith et al. 2023, Subach and Sullivan 2022, Wagner et al. 2022, Zaagsma et al. 2020a). Specifically, the duration and frequency of remote support should result from inclusive processes of deliberation and tryout (Zaagsma et al. 2020a). Another best practice included that technology should be offered not only as remote support, but also as an instructional tool to deliver educational programming (Morse et al. 2021). When technology is used as an instructional tool, the features, and programs (e.g. recipes on culinary apps) should be time efficient (Subach and Sullivan 2022). Furthermore, technology needs to be widely accessible, inclusive, and integrated, especially for individuals with visual impairments (Nierling and Maia 2020). Importantly, for remote support to allow for successful outcomes, structural components of the program need to be in place long-term (Zaagsma et al. 2020b).

Secondary research

One review reported on best practices for adults with autism spectrum disorder, 94% of whom had comorbid diagnoses of intellectual disabilities (Hrabal et al. 2023). This review suggested to use non-stigmatizing remote support with larger screens (e.g. iPads) due to the usability when administering video prompting. Technology should also be used to teach skills in their natural environment increase the likelihood of generalization (Hrabal et al. 2023).

Barriers and facilitators

Primary research

Facilitators of remote support include systematically teaching individuals with disabilities how to use technology, with ongoing support and assessment/monitoring (Francis et al. 2018, Smith et al. 2023, Stock et al. 2019, Subach and Sullivan 2022, Wagner et al. 2022). Training and encouragement are also needed for support staff, with additional dedicated staff time to do so (Owuor and Larkan 2017, Wagner et al. 2022). Additionally, remote support services need to be tailored to everyone with the ability to serve multiple purposes, as this is often associated with greater benefits for support users (Smith et al. 2023).

Barriers to remote support include concerns for personal safety (Subach and Sullivan 2022, Wagner et al. 2022); for example, needing safe equipment for preparing food (Subach and Sullivan 2022). Privacy concerns are also barriers to remote support (Wagner et al. 2022), in addition to societal barriers to digital tech use for individuals with intellectual disabilities (Nierling and Maia 2020). Others report that individuals who do not complete instructions or skip steps often lead to poorer outcomes (Cullen et al. 2017). Difficulty obtaining user buy-in, and cost-prohibitive services also act as barriers to remote support (Wagner et al. 2022). Individuals are also concerned with malfunctioning technology (Tassé et al. 2020, Wagner et al. 2022). Specifically, among individuals with visual impairments, individuals are concerned about the lack of access to mainstream technology integration (Nierling and Maia 2020).

Secondary research

One review offers facilitators to implementing remote support in independent living contexts. Lennard and colleagues (2020) suggested that technology needs to provide simple, single-step verbal and pictorial instructions. This review also reinforced that additional training is needed for support staff and this means offering more paid time for staff to complete training. Another review offered barriers and facilitators to using assistive technology. Baxter and Reeves (2023) suggested that technology malfunctioning is a barrier to uptake (e.g. devices breaking losing power) and to prevent malfunctions, training on backup technology and protective device cases are needed.

Ethical considerations

Primary research

Few studies reported on the ethical considerations for remote support. Although articles reported that support users did not have any privacy concerns with technology, authors note that general privacy concerns exist and should be accounted for when offering remote support (Smith et al. 2023, Tassé et al. 2020). Providing education on privacy and data sharing should always be included (Smith et al. 2023). Although some are concerned about personal safety, others felt that remote support was beneficial because users believed break-ins to be less likely and felt safe if emergencies were to occur (Tassé et al. 2020). One study reported that support users had no concerns with social isolation (Tassé et al. 2020). Despite lack of robust information, articles reported that remote support should not be used as a cost-saving measure (Zaagsma et al. 2020a, Zaagsma et al. 2020b).

Secondary research

A review reinforced that there may be stigma and stereotypes associated with remote support in the home, and its acceptability needs to be explored further (Lennard et al. 2020). Another review suggested that all devices should have antivirus software to prevent, detect, and remove computer viruses against any malware to protect support users (Baxter and Reeves 2023).

Discussion

The purpose of this review was to gain a better understanding of remote support services for individuals with intellectual disabilities in independent living. The search revealed 22 relevant articles, most using a qualitative research design or task-analysis intervention. The task analysis interventions involved support users trying apps or video self-modeling or prompting. Many articles discussed the overall need for remote support services in independent living, with increased adoption rates over time. This may be due to several benefits reported, such as satisfaction and task completion. Importantly, providing in-person support in addition to remote support is still necessary, and remote support should be tailored and individualized to the needs and preferences of each support user. Using remote support can be facilitated by offering education and ongoing support and monitoring for both support users and providers and reducing barriers such as attending to privacy concerns and avoiding malfunctioning technology. Ethical considerations should be addressed when researching and providing remote supports in the future.

Types of remote support and outcomes

Remote support was mostly delivered in the forms of live two-way communication, mobile apps, and video self-modeling and video prompting. There are several benefits of using these mobile apps and video self-modeling/prompting, such as improved academic skills (Burton et al. 2013) and leisure skills (Cannella-Malone et al. 2016). Despite these benefits, the use and uptake of video self-modeling and video prompting in real-world contexts is limited. The review by Hrabal et al. (2023) found that most studies involving video modelling and prompting were not conducted in natural environments (i.e. conducted at day schools or rehabilitation centers), and there is limited evidence of generalization and maintenance of functional living skills. Other limitations are that video modelling and prompting requires more complex cognitive, audio, and fine motor skills and thus, incorporation of the technology is not necessarily feasible for all support users (Hrabal et al. 2023).

There are challenges with smartphone apps, too. For instance, many smartphone apps are not accessible to individuals with intellectual disabilities, with too much focus on the ‘technology’ rather than providing support (McNaughton and Light 2013). However, four studies (Tassé et al. 2020, Wagner et al. 2022, Zaagsma et al. 2020a, Zaagsma et al. 2020b) reported the provision of support by staff of an agency provider at a remote location who are engaged with an individual through equipment with the capability for live two-way communication. Live, two-way communication can offer benefits such as increased independence and a sense of safety and security (Tassé et al. 2020). These outcomes align with the Inclusive Housing Framework elements of choice and control and basic inclusion requirements (CLBC 2016). Furthermore, remote two-way communication allows for interpersonal connections between support providers and users, reducing the potential for social isolation (Tassé et al. 2020). Additionally, remote two-way live communication is currently being implemented in policy contexts, such as in British Columbia, Canada and Ohio, USA. As a result, there are several practical implications associated with studying the impacts of remote two-way live communication and should be prioritized in future research.

Barriers, facilitators, and best practices

Despite the reported benefits associated with remote support use (e.g. improved activities of daily living, task performance) (Bridges et al. 2020, Subach and Sullivan 2022), these benefits are not automatically accrued by incorporating remote support into service models. Importantly, this review highlights key best practices for practitioners and organizations when organizing remote support services. In particular, remote support needs to be tailored and individualized to each person’s needs (Subach and Sullivan 2022). This finding is reflective of the larger disability community call for “nothing about us without us” (Charlton 1998) – that is, community activities are meaningless if individual’s preferences are not considered when making decisions around individuals’ care (Bigby 2012). This also aligns with the CLBC element of choice and control as individuals need to be able to help to inform decisions about their support (CLBC 2016). Another best practice identified from this review is that both support staff and users need to be appropriately trained and develop skills to use the remote support technology. As Hrabal et al. (2023) describes, support users need to realize the potential benefits of technology to better adopt its use, such as turning off and on devices and navigating through devices to locate features. Indeed, lack of training for technology particularly among individuals with intellectual disabilities has been identified as a barrier to support during the pandemic (Navas et al. 2021). As such, providing technology training for individuals engaging in remote support is necessary to fulfill the element of diversity (specialized housing) for CLBC (2016). These best practices can help to inform the delivery of remote support services in the future.

The results from this review also suggest that across organizations and regions, remote support uptake and adoption has increased as a service model. This is encouraging given the associated benefits, including potential cost savings for service providers (Tassé et al. 2020). Data from Ohio suggests that remote support services can improve independence for individuals with intellectual disabilities as remote services reduce reliance on support workers in the home (CERRIIDD 2018). Despite these benefits, the primary goal of remote support should not be to remove in-person support from individuals requiring support services. Rather, remote support services should be included as part of the continuum of care provided in partnership with individuals with disabilities, empowering disability voices and choices in care models. Only providing remote services due to ‘cost savings’ is unethical and should be provided in addition to other types of support services (Zaagsma et al. 2020a, Zaagsma et al. 2020b).

Ethical considerations

Privacy concerns are another ethical consideration according to articles in this review. Although there were mixed findings, privacy concerns exist when offering remote support in terms of data storage, client dignity, and physical privacy, and that education is needed to ensure adequate privacy (e.g. Smith et al. 2023). Existing literature outlining privacy concerns for individuals with disabilities using digital technology is also mixed. A recent survey of stakeholders providing long-term digital services to individuals with disabilities suggests that privacy is an important issue, and that data storage needs to protect client privacy (Brand et al. 2020). One way to address privacy concerns is to have support users meet remote support providers to reduce the invasiveness of technology (Brand et al. 2020). Ensuring appropriate antivirus software is uploaded onto all remote support devices is a basic, necessary step to protect the support users (Baxter and Reeves 2023). Furthermore, using videoconferencing software where you can see faces helps to build rapport and reduce privacy concerns among support users (Brand et al. 2020). Overall, greater research is needed on ethical considerations for remote support services given that there were very few studies that addressed any concerns (e.g. social isolation).

Implications for policy and practice

This review offers many implications for policy and practice. The first is that independent living service models in Canada and beyond should consider integrating remote support through live, two-way communication in addition to in-person support. This model allows for similar connections to in-person support and support workers can build a variety of independent living skills rather than just one (e.g. cooking). Organizations that offer remote support need to account for additional funding and time needed to train support workers and users on remote support technology. Training should also cover developing positive interpersonal relationships with individualizing support and help with problem solving and coping skills. Organizations need to carefully consider the ethical considerations and privacy concerns of support users by ensuring appropriate data storage, meeting users before providing remote support, and maintaining physical privacy of users during sessions with video.

Research gaps

From this review, several research gaps can be identified. First, authors often did not report the type of disability for participants, limiting the specificity of our results to particular types of disabilities. Indeed, using remote support services may not be uniformly experienced, and readers should be cautious in generalizing these results to individual people. Researchers are encouraged to engage in detailed reporting practices (including types of disability) when publishing research. Second, due to the nature of existing literature and inclusion criteria of articles being published in English, these studies were conducted primarily in Western high-income jurisdictions. This limits the perspective on the applicability and usefulness of remote support services in other areas. Third, there was a lack of randomized controlled trials and quantitative research conducted in “real-world” settings (as opposed to lab-based), and thus the outcomes associated with remote support services need to be further examined. Fourth, studies lack involvement from other relevant stakeholders such as parents/caregivers and support workers, and greater research is needed to supplement these perspectives. Additionally, although there were studies that examined skill and performance-related outcomes, very few studies examined the perspectives and experiences of individuals with intellectual disabilities using remote support. Fifth, studies included were likely only published if they had positive outcomes, leading to publication bias, and thus positive outcomes may not be representative of all real-life experiences of remote support services. Researchers are encouraged to publish null results or negative findings from remote support use to better understand how to implement remote support in practice.

Limitations

This review has limitations that warrant further discussion. Because of the title and abstract search parameters, articles may have been missed if they discussed any of the three elements to the search (intellectual disabilities, independent living, or remote support) only in the full-text, or if an abstract was not included in the database at the time of the search. However, we conducted an updated search in May 2023 to ensure that all relevant and new articles were captured. The search did not include MeSH or other specific thesaurus terms, as specific terminology were of interest that did not have direct thesaurus equivalents, and this would have resulted in a significant volume of unrelated articles. Nonetheless, some research may have been missed because MeSH and other subject headings were not used. Further, the term ‘learning disabilities’ was not included in the search, but after re-running the search with ‘learning disabilities’, no additional articles were found. Articles may also have been missed because the reference lists of the 22 included articles were not searched as part of this review. Furthermore, we did not complete full text review and data extraction with two independent coders. The authors were also not blinded to the study author or title when conducting data screening and extraction. Furthermore, broadening the review to include studies about telehealth may have changed the conclusions from this review.

Conclusion

This review was guided by a community based participatory research approach in partnership with CLBC and thus has valuable implications for research and practice. Greater research using diverse methods and with all relevant stakeholders is needed to further understand the impact of remote support services from individual, interpersonal, and policy perspectives. Additional research is needed on the influence of different types of remote support services (e.g. video conferencing software) in addition to existing apps. Overall, remote support services are well supported by the research and continue to be used across North America and Europe due to several benefits (e.g. satisfaction, cost savings). However, training is required to implement remote support, with privacy considerations. This review highlights the benefits of tailoring support to the needs of each user, and the potential of remote support when incorporated appropriately along with a spectrum of other support services for individuals with IDD in independent living settings. When these best practices are adopted for remote support, they can fulfill the five elements of the Inclusive Housing Framework as proposed by CLBC (2016).

Appendix A.

APA PsycInfo

Provider: EBSCO

Search conducted on May 26, 2022

S1	TI ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*) OR AB ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*)	Limiters - Scholarly (Peer Reviewed) Journals; Published Date: 20150101-20221231; Document Type: Editorial, Journal Article; English Search modes - Boolean/Phrase	24,404
S2	TI (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*") OR AB (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*")	Limiters - Scholarly (Peer Reviewed) Journals; Published Date: 20150101-20221231; Document Type: Editorial, Journal Article; English Search modes - Boolean/Phrase	48,098
S3	TI ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living") OR AB ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living")	Limiters - Scholarly (Peer Reviewed) Journals; Published Date: 20150101-20221231; Document Type: Editorial, Journal Article; English Search modes - Boolean/Phrase	1,428
S4	S1 AND S2 AND S3		12

Search conducted on May 24, 2023

An update was completed of the above searches for 2015-2023, and limited only to peer-reviewed journals. A total of 21 articles were exported and de-duplicated.

Web of Science

Provider: Clarivate

Search conducted on May 26, 2022

S1

"intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity* (Topic) and (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*") (Topic) and "independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living" (Topic) and English (Languages) and Arts and Humanities Citation Index (AandHCI) or Emerging Sources Citation Index (ESCI) or Science Citation Index Expanded (SCI-EXPANDED) or Social Sciences Citation Index (SSCI) (Web of Science Index)

Web of Science Core Collection Timespan: 2015-01-01 to 2022-12-31 (Publication Date)

64

Search conducted on May 24, 2023

An update was completed of the above search for 2015-2023. A total of 80 articles were exported and de-duplicated.

Scopus

Provider: Elsevier

Search conducted on May 26, 2022

S1

(TITLE-ABS-KEY ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR idd OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*) AND TITLE-ABS-KEY ((telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*")) AND TITLE-ABS-KEY ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living")) AND PUBYEAR > 2014 AND PUBYEAR < 2023 AND (LIMIT-TO (LANGUAGE , "English")) AND (LIMIT-TO (DOCTYPE , "ar") OR LIMIT-TO (DOCTYPE , "re") OR LIMIT-TO (DOCTYPE , "ed") OR LIMIT-TO (DOCTYPE , "Undefined"))

74

Search conducted on May 24, 2023

An update was completed of the above search for 2015-2023. A total of 92 articles were exported and de-duplicated.

Embase

Provider: Ovid

Search conducted on May 26, 2022

1	("intellectual disab*" or "developmental disab*" or "intellectual and developmental disab*" or IDD or "complex needs" or "complex support needs" or "complex health needs" or "special needs" or "extra support needs" or "mentally handicap*" or "mental handicap*" or autis* or neurodiversity*).ab. or ("intellectual disab*" or "developmental disab*" or "intellectual and developmental disab*" or IDD or "complex needs" or "complex support needs" or "complex health needs" or "special needs" or "extra support needs" or "mentally handicap*" or "mental handicap*" or autis* or neurodiversity*).ti.	119,064
2	limit 1 to (english language and embase and yr="2015 - 2022" and (article or article in press or editorial or "review"))	36,724
3	(telemedicine or tele-medicine or telehealth or tele-health or telecare or tele-care or ehealth or ((distance or interactive or online or virtual or remote or phone or telephone or video* or chat or digital or electronic or technolog*) and (support* or help or assist* or service*)) or teletherapy or tele-therapy or telecounselling or telecounseling or tele-counselling or tele-counseling or "personalized support*" or "personal support*").ab. or (telemedicine or tele-medicine or telehealth or tele-health or telecare or tele-care or ehealth or ((distance or interactive or online or virtual or remote or phone or telephone or video* or chat or digital or electronic or technolog*) and (support* or help or assist* or service*)) or teletherapy or tele-therapy or telecounselling or telecounseling or tele-counselling or tele-counseling or "personalized support*" or "personal support*").ti.	538,462
4	limit 3 to (english language and embase and yr="2015 - 2022" and (article or article in press or editorial or "review"))	126,551
5	("independent living" or "supported living" or "living independently" or "individual living" or "living individually" or "assisted living" or "home shar*" or homeshare or "community living" or "shared living").ab. or ("independent living" or "supported living" or "living independently" or "individual living" or "living individually" or "assisted living" or "home shar*" or homeshare or "community living" or "shared living").ti.	13.040
6	limit 5 to (english language and embase and yr="2015 - 2022" and (article or article in press or editorial or "review"))	2,242
7	2 and 4 and 6	9

Search conducted on May 24, 2023

An update was completed of the above searches for 2015-2023. A total of 12 articles were exported and de-duplicated.

Medline

Provider: EBSCO

Search conducted on May 26, 2022

S1	AB ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*) OR TI ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*)	Limiters - Date of Publication: 20150101-20221231; English Language; Publication Type: Editorial, Journal Article Search Modes - Bolean/phrase	45,297
S2	AB (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*") OR TI (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*")	Limiters - Date of Publication: 20150101-20221231; English Language; Publication Type: Editorial, Journal Article Search Modes - Bolean/phrase	223,400
S3	AB ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living") OR TI ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living")	Limiters - Date of Publication: 20150101-20221231; English Language; Publication Type: Editorial, Journal Article Search Modes - Bolean/phrase	3,895
S4	S1 AND S2 AND S3		20

Search conducted on May 24, 2023

An update was completed of the above searches for 2015-2023, and limited to peer-reviewed journals. A total of 27 articles were exported and de-duplicated.

ERIC

Provider: EBSCO

Search conducted on May 26, 2022

S1	TI ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*) OR AB ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*)	Scholarly (Peer Reviewed) Journals; Published Date: 20150101-20221231; Journal or Document: Journal Article (EJ); Publication Type: Journal Articles; Language: English Search modes - Boolean/Phrase	8,846
S2	TI (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*") OR AB (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*")	Scholarly (Peer Reviewed) Journals; Published Date: 20150101-20221231; Journal or Document: Journal Article (EJ); Publication Type: Journal Articles; Language: English Search modes - Boolean/Phrase	20,096
S3	TI ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living") OR AB ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living")	Scholarly (Peer Reviewed) Journals; Published Date: 20150101-20221231; Journal or Document: Journal Article (EJ); Publication Type: Journal Articles; Language: English Search modes - Boolean/Phrase	200
S4	S1 AND S2 AND S3		12

Search conducted on May 24, 2023

An update was completed of the above searches for 2015-2023, and limited only to peer-reviewed journals. There were no new additions to the results in this database.

Education Source

Provider: EBSCO

Search conducted on May 26, 2022

S1	AB ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*) OR TI ("intellectual disab*" OR "developmental disab*" OR "intellectual and developmental disab*" OR IDD OR "complex needs" OR "complex support needs" OR "complex health needs" OR "special needs" OR "extra support needs" OR "mentally handicap*" OR "mental handicap*" OR autis* OR neurodiversity*)	Peer Reviewed; Published Date: 20150101-20221231; Publication Type: Academic Journal; Document Type: Article, Editorial; Language: English Search modes - Boolean/Phrase	13,032
S2	AB (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*") OR TI (telemedicine OR tele-medicine OR telehealth OR tele-health OR telecare OR tele-care OR ehealth OR ((distance OR interactive OR online OR virtual OR remote OR phone OR telephone OR video* OR chat OR digital OR electronic OR technolog*) AND (support* OR help OR assist* OR service*)) OR teletherapy OR tele-therapy OR telecounselling OR telecounseling OR tele-counselling OR tele-counseling OR "personalized support*" OR "personal support*")	Peer Reviewed; Published Date: 20150101-20221231; Publication Type: Academic Journal; Document Type: Article, Editorial; Language: English Search modes - Boolean/Phrase	36,371
S3	AB ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living") OR TI ("independent living" OR "supported living" OR "living independently" OR "individual living" OR "living individually" OR "assisted living" OR "home shar*" OR homeshare OR "community living" OR "shared living")	Peer Reviewed; Published Date: 20150101-20221231; Publication Type: Academic Journal; Document Type: Article, Editorial; Language: English Search modes - Boolean/Phrase	480
S4	S1 AND S2 AND S3		16

Search conducted on May 24, 2023

An update was completed of the above searches for 2015-2023, and limited only to peer-reviewed journals. A total of 20 articles were exported and de-duplicated.

Funding Statement

This study was funded by Mitacs IT28427 and the Community Living Society, Aspire, Spectrum and Inclusion Langley. The Remote Support Working Group includes Community Living Society, Aspire, Spectrum and Inclusion Langley.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Data is available upon request.