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. 2026 Aug;29(4):e70776.
doi: 10.1111/hex.70776.

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

Natalie Ong  1   2 , Sarah Ghasem Zadeh  3 , Jerzy Zieba  1   4 , Karl Pobre  5 , Gail Tomsic  2 , Jacqueline Milne  2 , Shefali Jani  5 , Natalie Silove  2
Affiliations

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

Natalie Ong et al. Health Expect. 2026 Aug.

Abstract

Background: 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.

Aims: 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.

Methods: 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-one and 89 staff participated in a pre- and post-intervention 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- and post-intervention phase. These were transcribed, categorised, and coded with themes derived. Consensus was reached through meetings with the research team.

Results: 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-house training programme to provide ongoing training for new staff, and make further improvements in the department.

Conclusions: 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.

Patient and public involvement: 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.

Keywords: children and young people; continuing professional development; developmental disability; intellectual disability; quality improvement.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study timeline.
Figure 2
Figure 2
Staff lanyard on reasonable adjustments.
Figure 3
Figure 3
Hybrid adult learning – CPD model. Incorporating inclusion and leadership for greater change.
See this image and copyright information in PMC

References

    1. Durbin A., Balogh R., Lin E., Wilton A. S., and Lunsky Y., “Emergency Department Use: Common Presenting Issues and Continuity of Care for Individuals With and Without Intellectual and Developmental Disabilities,” Journal of Autism and Developmental Disorders 48 (2018): 3542–3550. - PubMed
    1. Koch K., Lake J. K., Sandrakumar J., Lee J. S., and Lunsky Y., “BRIEF REPORT: Staff Experience of an Initiative to Improve Emergency Care for Patients With Developmental Disabilities,” Journal on Developmental Disabilities 23, no. 3 (2018): 105–108.
    1. Plint A. C., Newton A. S., Stang A., et al., “How Safe Are Paediatric Emergency Departments? A National Prospective Cohort Study,” BMJ Quality & Safety 31, no. 11 (2022): 806–817. - PMC - PubMed
    1. Iacono T., Bigby C., Unsworth C., Douglas J., and Fitzpatrick P., “A Systematic Review of Hospital Experiences of People With Intellectual Disability,” BMC Health Services Research 14, no. 1 (2014): 505. - PMC - PubMed
    1. Lunsky Y., Lake J. K., Durbin J., et al., “Understanding and Improving Care for Individuals With Intellectual and Developmental Disabilities in the Emergency Department,” International Review of Research in Developmental Disabilities 47 (2014): 1–37.

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