{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:19:08Z","timestamp":1787797148443,"version":"build-2784847793"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children and young people with intellectual and developmental disability have long been known to suffer from inequities in accessing safe and quality health care. These challenges are most felt within the emergency department due to its busy, crowded, and overstimulating environments with staff that are not trained to provide reasonably adjusted care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The study is an evaluation using qualitative and quantitative methods of a continuing education and quality improvement programme designed to increase the knowledge, skills, and confidence of healthcare staff in providing reasonable adjustments to children and young people with intellectual disability in hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study evaluated the Motivated for Change programme, which uses Behavioural change, Adult Learning, and Quality Improvement strategies to drive practice change and service improvement. A hundred and thirty\u2010one and 89 staff participated in a pre\u2010 and post\u2010intervention survey. Interviews were conducted with parents of children and young people with intellectual and developmental disability attending the emergency department. Observational studies were also conducted in the pre\u2010 and post\u2010intervention phase. These were transcribed, categorised, and coded with themes derived. Consensus was reached through meetings with the research team.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Motivated for Change programme has demonstrated significant increases in staff knowledge, skills, and experience in providing safe and quality care for these children and young people. Evidence of change is reflected in the parent and staff interview and observational study themes. In addition, staff were further motivated to undertake quality improvement projects, develop an in\u2010house training programme to provide ongoing training for new staff, and make further improvements in the department.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Motivated for Change programme has demonstrated its efficacy in enabling changes in the practice of reasonable adjustments and the emergence of local champions for sustained efforts for ongoing improvements in safety and quality of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and Public Involvement<\/jats:title>\n                    <jats:p>The development of the research question and outcome measures was informed by data from previous research publications involving parents and staff. We sought input from a parent advisory committee in the design of the study. Parents were not involved in the recruitment and conduct of the study. Results were presented to the parent advisory at the end of the study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70776","type":"journal-article","created":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T14:11:19Z","timestamp":1785679879000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving the Safety and Quality of Care for Children and Young People With Intellectual and Developmental Disability. The Motivated for Change Programme in a Paediatric Emergency Department Setting. A Mixed Methods Study"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0962-443X","authenticated-orcid":false,"given":"Natalie","family":"Ong","sequence":"first","affiliation":[{"name":"Sydney Medical School, Faculty of Medicine and Health University of Sydney Camperdown New South Wales Australia"},{"name":"Child Development Unit The Children's Hospital at Westmead Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Ghasem","family":"Zadeh","sequence":"additional","affiliation":[{"name":"Brain and Mind Research Centre University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerzy","family":"Zieba","sequence":"additional","affiliation":[{"name":"Sydney Medical School, Faculty of Medicine and Health University of Sydney Camperdown New South Wales Australia"},{"name":"Collegium Medicum, Faculty of Health Sciences and Psychology University of Rzesz\u00f3w Rzesz\u00f3w Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0988-6591","authenticated-orcid":false,"given":"Karl","family":"Pobre","sequence":"additional","affiliation":[{"name":"Department of Paediatric Emergency The Children's Hospital at Westmead Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1197-1828","authenticated-orcid":false,"given":"Gail","family":"Tomsic","sequence":"additional","affiliation":[{"name":"Child Development Unit The Children's Hospital at Westmead Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Milne","sequence":"additional","affiliation":[{"name":"Child Development Unit The Children's Hospital at Westmead Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8242-9879","authenticated-orcid":false,"given":"Shefali","family":"Jani","sequence":"additional","affiliation":[{"name":"Department of Paediatric Emergency The Children's Hospital at Westmead Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Silove","sequence":"additional","affiliation":[{"name":"Child Development Unit The Children's Hospital at Westmead Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-018-3615-9"},{"issue":"3","key":"e_1_2_11_3_1","first-page":"105","article-title":"BRIEF REPORT: Staff Experience of an Initiative to Improve Emergency Care for Patients With Developmental Disabilities","volume":"23","author":"Koch K.","year":"2018","journal-title":"Journal on Developmental Disabilities"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2021-014608"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-014-0505-5"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-800278-0.00001-4"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2020.08.084"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2010.16.2.46755"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1367493519867234"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/13668250.2016.1236368"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/23297018.2019.1680312"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.2012.01603.x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.2011.01429.x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1352\/1934-9556-48.2.145"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.7748\/nm.22.1.32.e1296"},{"issue":"13","key":"e_1_2_11_16_1","first-page":"1","article-title":"Identifying the Factors Affecting the Implementation of Strategies to Promote a Safer Environment for Patients With Learning Disabilities in NHS Hospitals: A Mixed\u2010Methods Study","volume":"1","author":"Tuffrey\u2010Wijne I.","year":"2013","journal-title":"Health and Social Care Delivery Research"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004606"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-432"},{"key":"e_1_2_11_19_1","volume-title":"IHI Psychology of Change Framework to Advance and Sustain Improvement","author":"Hilton A. 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