TABLE 2.

Joint display of the five highest ranked challenges of each global region with exemplary qualitative responses

	Mean score/rank
	USA/Canada	UK/Ireland	Australia/New Zealand
Ensuring appropriate day programming or educational services	3.9 (1)	3.65 (2)	3.76 (1)
Supporting people who cannot be out and about in the community, perhaps must quarantine, and who have had their usual day program disrupted is the biggest challenge (USA) Keeping people occupied when they are unable to attend day activities (Australia)
Supporting, enabling socialization with family/friends	3.89 (2)	4.04 (1)	3.33 (3)
The main challenges are the lack of family interactment due to stay at home, social distancing, and older population families staying quarantined. Electronic communications work with some individuals; however, some do not seem to understand (USA) Issues relating to isolation from friends, family, and paid carers for people with ID (Australia) They were isolated from family… Sometimes we try to make phone or facetime arrangements, but it is harder for people with DD to see family they cannot hug or go visit (Canada) The main challenges were the social restrictions during lock down in NZ—not being able to see friends and family face to face, electronic platforms are a substitute but not the same (New Zealand) Using public health guidance, risk reduction strategies impact heavily on the social and activity opportunities for those with DD (Ireland)
Ensuring adequate staffing of familiar support workers and caregivers	3.67 (3)	3.42 (3)	‐
Challenges relate to availability of staff—particularly consistent staffing (Australia) Reduced staff due to inability of no cross over into another home (multiple group homes) . . . Can no longer have “relief list” (Canada) Staffing due to COVID guidelines (Ireland) Considerable need for additional staffing as everyone remained home for many months during the pandemic. Staffing levels so critically low that even meeting basic needs (showering, positioning, etc.) difficult to achieve some days (USA)
Identifying/planning alternate entertainment activities (not including television)	3.52 (4)	3.38 (4)	‐
The challenge is to try and make life nice for the service users in our care. We cannot go out on day trips or visit nice places and have dinner out. We try and come up with ideas for activities within the house due to level 5 restrictions. We can go out on the bus for a drive but cannot get off the bus. (Ireland) Individuals are not able to participate in community activities they enjoyed in the past and I think that a lot of facilities are struggling to keep individuals entertained and engaged while also quarantining (USA) Keeping people engaged in activities (New Zealand)
Managing challenging behaviors	3.41 (5)	3.38 (4)	3.48 (2)
Struggling to meet the needs of those with behaviors of concern missing day services and their routine (Ireland) Challenging behaviors due to absence of regular programs/unable to facilitate regular outings (NZ) We have seen a great increase in the number of challenging behaviors, but I suspect that far more individuals are also struggling and not displaying challenging or dangerous behaviors. My concern is that folks are being traumatized by this, and we are not recognizing it (USA)
Ensuring access to regular allied health specialists	‐	‐	3.33 (3)
The loss of face‐to‐face therapies and loss of stimulation and opportunities for sensory stimulation is unhealthy (USA) Appropriate and timely support from health and mental health professionals (New Zealand)
Meeting mental health care needs and providing emotional support	‐	‐	3.33 (3)
It has been hard on people who like to hug/value personal touch and some of us decided that this was an acceptable risk under the circumstances given the risk minimization strategies we had in place (hand washing, etc) (New Zealand) Supports provided for recognizing mental health needs in ID population are limited (Australia)