An exploration of how people, services and communities influence the Five Accomplishments.
Author: Liz Leach
John O’Brien’s Five Accomplishments remain an influential framework within person-centred and community-based support. As with all the contributions John made to the civil and disability rights movement, his intention was the improvement of lived experience for those who may be dependent on support from other people to achieve a good quality of life.
The Five Accomplishments describe what people’s lives would look like if they were supported in a manner that was aligned with the principles of person centred practice, inclusion and self-determination. And, they provide a way of assessing whether support is helping people live meaningful, inclusive lives.
The Five Accomplishments are:
The Five Service Accomplishments have shaped, and continue to shape, contemporary thinking across health, social care and community based support since they were first published in 1987. Nearly 40 years on, and despite a recognition of and an adoption of these principles in some aspects of service and support delivery, many services continue to struggle to consistently realise them in practice.
They are often used as aspirational or vision statements which influence the aims and objectives of the service rather than them being embedded in the culture of how the service, the organisation or the team go about their work. However, the Five Accomplishments are not outcomes that can be delivered through organisational intent alone, they emerge through the belief systems people hold, the relationships that are developed and through this the collective culture that is formed. This is then further influenced by the overall conditions of the society and communities we are living within.
The achievement of the Five Accomplishments is therefore influenced by at least three interconnected domains:
Understanding the relationship between these areas may help explain why some services create conditions for genuine inclusion and flourishing, while others drift toward maintenance, control, and institutional practice despite espousing person-centred values.
Importantly, the Five Accomplishments are not solely individual accomplishments, they are relational accomplishments, for instance:
At the centre of all support systems are people whose beliefs, values, emotions, and motivations profoundly shape practice. While systems and policies matter greatly, the daily experience of support is often determined through ordinary interactions between people.
Beliefs are particularly influential. The extent to which support providers, both the direct support workers and the organisation they work for, believe people are capable, valuable, and able to grow affects the way they relate to the people they support. This also influences how they identify the opportunities available to people, how they find the ways to make the most of these opportunities without being risk averse, and the expectations they hold about what is possible.
Deficit-based thinking can quietly undermine accomplishment even within services that outwardly promote inclusion and empowerment. Where people are primarily viewed through the lens of risk, diagnosis, vulnerability, or dependency, the support provided can become limiting and protective rather than enabling.
This tension is often reflected in the difference between espoused and enacted values. Services may espouse person centred approaches, inclusive practice and the support for self-determination, while everyday provision demonstrates decisions that enact control, restriction, and professional authority. This discrepancy is not always the result of ill-intent. Frequently it emerges from unconscious misalignment between external rhetoric and internal beliefs, as well as other factors including fear, emotional and physical exhaustion, institutional conditioning, and systemic pressure.
Fear occupies a particularly important role within services today, this includes the fear of blame, fear of risk, fear of organisational failure, and fear of serious incidents this produces cultures of protectionism, defensiveness and proceduralism. Under these conditions, services may begin prioritising certainty and containment over relationships, creativity, and human possibility. The language of empowerment may remain present while the lived experience becomes increasingly restrictive.
Similarly, burnout and emotional fatigue affect the relational capacity of practitioners and organisations. To achieve everyday outcomes for most citizens as set out in the Five Accomplishments requires emotional energy, imagination, hope, and persistence for people who face often a multitude of barriers in everyday life. It therefore requires practitioners and support providers who can remain curious, relational, and emotionally present.
In under-resourced, routinised or highly pressured environments, services can drift toward time management, task completion and risk aversion because these are psychologically easier to sustain than relational engagement.
This highlights the importance of understanding and embedding values and beliefs that align with the principles set out in the Five Accomplishments and to bring this to life in the way support is provided. This can be attained through the provision of training, encouraging reflective practice, creating psychologically safe organisational cultures, and inspiring values driven leadership capable of holding complexity without collapsing into either blame or excessive control. The relational quality of service delivery is inseparable from the emotional conditions within which practitioners themselves operate.
While people shape relational practice, they do not operate in isolation. Services exist within wider political, economic, and structural environments that significantly influence what becomes possible.
Political and policy contexts influence and shape the priorities of service. Short political cycles, lead to funding and priority changes, which sits uneasily alongside the long-term relational work required to support meaningful inclusion and participation. As a result, services can often operate within cultures shaped by commissioning funding cycles, performance and quality management, inspection requirements and the current long-term impact of austerity.
While some of these mechanisms, such as performance management, may aim to improve quality of life and to maintain safe working practices, they can also unintentionally encourage short term thinking, external requirements determining how support is provided, defensive practice and procedural compliance.
Finance and resources clearly matter. Understaffed services, fragmented provision, and unstable funding all restrict the possibility of relational work. However, resources alone do not guarantee accomplishment. Institutional cultures can exist within both poorly funded and well-funded environments. Scarcity may restrict possibility, but abundance without human values can still produce depersonalized and segregated forms of support.
The design of systems and processes themselves also shapes practice. Many systems and processes continue to remain planned around organisational convenience and efficiencies, dominated by risk aversion and management rather than around human relationships and community life, producing fragmented experiences for people and families, who may find themselves repeatedly navigating chaotic and disconnected services that each hold only partial responsibility.
Services may espouse inclusion, self-determination and person-centredness while consciously or unconsciously enacting siloed working, gatekeeping, service prioritisation and transactional interactions. It is in such environments where enacted values become increasingly important.
The true values of systems are often revealed not through mission statements, but through the interaction between those providing support and those who are supported.
Community factors are equally significant. The Five Accomplishments are social in nature and cannot be achieved solely through professional intervention. Community presence and participation depend upon communities themselves being accessible, welcoming, and relationally open. Social isolation, stigma, poverty, discrimination, and the erosion of community infrastructure all affect the possibility of inclusion and at times create the very momentum needed for people to reach out and connect with one another, where people find the power to self-organise to address the issues they face and to share their experiences, ideas, solutions and resources.
This suggests that the achievement of the Five Accomplishments is not solely the responsibility of health and social care services or of support providers. It is also connected to the relational health of the local area, the wider communities and society itself.
Alongside individual and structural influences, there is a third dimension that shapes the possibility of achieving the Five Service Accomplishments, this is the community.
Services do not function solely through the system and processes or through the individual practice of the people who work within that service. Services function through a connection with the community and via shared cultures, narratives, expectations, and relational energy.
The achievement of the Five Accomplishments often depends upon whether groups of people can sustain a shared understanding of what matters and work collectively toward it over time. This goes beyond the service itself and includes people supported by services, family members, members of the community, practitioners and leaders.
Where there is limited agreement about concepts such as choice, safety, participation, or independence, members of the community can face confusion, misunderstandings and the collective efforts can become fragmented. As a result, people may pull in opposing directions, resulting in inconsistency and relational breakdown, which then reverses the principles set on in the Five Service Accomplishments.
By contrast, when there is a collective understanding, the energy towards the principles set out in the Five Accomplishments can develop and this shared vision creates the confidence amongst the people involved, in each other and in the purpose.
Over time, these relational experiences help to shape who we are, what we believe, how we are together and the future we are collectively working towards.
Culture too may be understood as the repeated enactment of values through relationships and behaviour. Small relational acts, for instance; listening carefully, sharing power, holding hope, making space for participation, gradually shape the emotional and moral character of community and the services within it. Equally, repeated acts of control, exclusion, or defensiveness can normalise institutional cultures even within services or communities that outwardly identify as person-centred and inclusive. Collective momentum within the community is therefore not abstract. It is produced through interactions, shared narratives, and sustained relational practice.
The Five Accomplishments are relational accomplishments. They arise through interactions between people, systems, and communities. The question for modern services is therefore not simply whether they understand the framework, but whether the conditions exist for these accomplishments to genuinely flourish. And, also the understanding that the accomplishments emerge where internal beliefs, external conditions, and collective relational cultures become sufficiently aligned. It depends not only on what services say they value, but on the values they enact through relationships, behaviours, decisions and future direction.
We are fortunate to be able to learn from John O’Brien's prolific work in the field of inclusion, civil and disability rights and use his gift to help us shape the future of health and social care provision around the world.
The publisher is Citizen Network. The Conditions of Accomplishment © Liz Leach 2026.
community, disability, Inclusion, intellectual disabilities, social care, England, Northern Ireland, Scotland, Wales, Article
