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This article discusses the fact that while most people with disabilities spend much of their lives with their natural families, little attention has been given in the past by governments, agencies and researchers to the long term needs of families. It reviews the trends in the provision of support to families, with a specific emphasis on the balance (or imbalance) between services that support and those that supplant the natural family. It concludes with recommendations for research that is needed to inform the policy-making and program design process. Keyword: Families