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individuals with psychiatric disabilities in large state -run institutions. In California, institutions for <br />people with intellectual and developmental disabilities are called developmental centers, and <br />institutions for people with psychiatric disabilities are called state hospitals. Within these <br />institutions, people with disabilities have had few opportunities for meaningful interaction with <br />individuals without disabilities, limited access to education and employment, and a lack of <br />individual autonomy. The transition away from housing people with disabilities in institutional <br />settings and toward providing housing and services in home and community -based settings <br />accelerated with the passage of the Americans with Disabilities Act in 1991 and the U.S. Supreme <br />Court's landmark decision in Olmstead v. L.C. in 1999. In Olmstead, the Supreme Court held that, <br />under the regulations of the U.S. Department of Justice (DOJ) implementing Title II of the <br />Americans with Disabilities Act (ADA), if a state or local government provides supportive services <br />to people with disabilities, it must do so in the most integrated setting appropriate to the needs of <br />a person with a disability and consistent with their informed choice. This obligation is not absolute <br />and is subject to the ADA defense that providing services in a more integrated setting would <br />constitute afundamental alteration of the state or local government's programs. <br />The transition from widespread institutionalization to community integration has not always been <br />linear, and concepts of what comprises a home and community -based setting have evolved over <br />time. Although it is clear that developmental centers and state hospitals are segregated settings and <br />that an individual's own house or apartment in a development where the vast majority of residents <br />are individuals without disabilities is an integrated setting, significant ambiguities remain. Nursing <br />homes and intermediate care facilities are clearly segregated though not to the same degree as state <br />institutions. Group homes fall somewhere between truly integrated supported housing and such <br />segregated settings, and the degree of integration present in group homes often corresponds to their <br />size. <br />Below, this assessment includes detailed information about the degree to which people with <br />intellectual and developmental disabilities and individuals with psychiatric disabilities reside in <br />integrated or segregated settings. The selection of these two areas of focus does not mean that <br />people with other types of disabilities are never subject to segregation. Although the State of <br />California did not operate analogous institutions on the same scale for people with ambulatory or <br />sensory disabilities, for example, many people with disabilities of varying types face segregation <br />in nursing homes. Data concerning people with various disabilities residing in nursing homes is <br />not as available as data relating specifically to people with intellectual and developmental <br />disabilities and people with psychiatric disabilities. <br />Table 48: Performance of Regional Center of Orange Countv, December 2018 <br />Dec. 2018 Performance <br />Fewer <br />More <br />More <br />Fewer <br />Fewer <br />Reports <br />consumers live <br />children <br />adults <br />children <br />adults <br />in <br />live with <br />live in <br />live in <br />live in <br />developmental <br />families <br />home <br />large <br />large <br />centers <br />settings <br />facilities <br />facilities <br />(more <br />(more <br />than 6 <br />than 6 <br />people) <br />people) <br />State Average <br />0.12% <br />99.38% <br />80.20% <br />0.04% <br />2.31% <br />261 <br />75A-540 <br />