People with intellectual disability often experience challenges in their lives. These may be due to difficulties in social adaptation, but may also be related to a reality of disempowerment whereby they have little role in the decisions central to their lives or in the provision of health, educational and social services. This book argues for alternative and innovative approaches to leadership in intellectual disability service provision. It does this in the light of service scandals including Winterborne View (UK), Oswald D. Heck (USA), Áras Attracta (Ireland) and many others. This book also explores the failed leadership issues underpinning such debacles and then examines how the context for intellectual disability service provision has changed. The authors propose alternative models for service leadership that are contiguous with the changed landscape, emphasizing participatory models of leadership and ending with exemplary vignettes outlining situations where such innovative change is happening.