Thesis (M.A.)--University of Wisconsin--Madison, 1972. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

In the UK 27 million working days are lost due to work-related illness or injury; at an estimate of £13.4 billion to the economy. Over the last 30 years researchers have examined safety culture and its relationship to poor safety performance. An organisation in the high hazard construction industry wanted to understand the factors that shaped and influenced safety performance and safety culture. This thesis details a research project which addresses that aim. A multi-method, triangulated approach was adopted combining both qualitative (focus groups and interviews) and quantitative (safety climate questionnaire) methods. The results of the qualitative studies informed the development of the safety climate questionnaire that included a measure of self-reported accidents and near misses. The qualitative studies identified 6 main themes; Communication, Leadership, Employee Engagement & Involvement, Safety Prioritisation, Job Demands and Culture. Quantitative study results show, Upward Communication, Perceived Organisational Support (POS), Employee Engagement. Leader Member Exchange (LMX) and Organisational Commitment demonstrate a significant relationship with Safety Climate. Safety Climate, POS had a Significant, positive, predictive relationship with both accidents and near misses reported. Upward communication had a significant negative, predictive relationship with accidents and near misses. LMX and Organisational Commitment show a Significant, negative, predictive relationship with accidents reported only. Results can be explained in the context of social exchange relationships. Reporting behaviour is being measured, this can be conceptualised as organisational safety citizenship behaviour. The probability of increasing or reducing reporting behaviours is shaped by social exchanges such as; a) the degree that employees feel supported by the organisation, b) and their manager, c) the safety climate, d) their commitment levels e) and opportunities to raise safety concerns. Interventions should aim to develop leaders and organisational practices to be more supportive, to increase reporting behaviour and to create a more accurate picture of safety performance.

This thesis examines associations between positive psychological capital (PsyCap), work engagement, and performance among teachers in Pakistan. A sequential mixed methods design was applied that involved two studies. The first involved a cross-sectional survey of Pakistani teachers (N = 675) that sought to quantitatively establish the nature and strength of relations between PsyCap, work engagement, and job performance. The second was a qualitative study that involved six focus groups with the intention of discursively examining the mechanisms linking PsyCap, work engagement, and job performance. In both studies, teachers were divided into three strata: School, college, and university. A number of significant findings were identified. Overall, the findings from the quantitative study showed that PsyCap and work engagement were additively linked to job performance. PsyCap accounted for relatively large portions of variance in performance compared to work engagement. The results from the qualitative study confirmed and extended the findings of Study 1. Thematic analysis was used to analyse the focus group transcripts. Seven main themes were identified along with a further set of sub-themes. The key themes that emerged were teachers’ role in students’ lives, teachers’ understanding of their job performance. PsyCap and its mechanism, significance of work engagement, PsyCap and work engagement, and demographic and religious factors. The findings shed light on the mechanisms underpinning the positive relationship between PsyCap, work engagement, and performance among teachers, highlighting the role of religious factors within these relationships. The overall results of the current investigation highlight the nature and strength of relationships between PsyCap and performance, and work engagement and performance, and reinforce the value of utilising PsyCap and work engagement in organisational research to enhance performance. Future research should involve other occupational groups to explore the broader application of this framework.

Work ability (WA) concerns a worker’s capacity to manage their job demands in relation to their physical and psychological resources. Over the last decade, the WA construct and its associated measurement instrument, the Work Ability Index (WAI), have become established within occupational health practice in several countries, particularly within Scandinavia. One consequence of this is that occupational health researchers have begun to utilise WA in the prediction of worker health and operational effectiveness outcomes. Anecdotal evidence suggests that occupational health professionals in the United Kingdom (UK) have begun to use, or express interest in using, WA because of its increasingly widespread use in research, the gradual accumulation of information from Scandinavia on its potential for application within occupational health practice, and challenges presented to occupational health by an ageing workforce. In response, the first study in this thesis concerns a survey of UK (n = 436) and Finnish (n = 97) occupational health practitioners centred on their awareness, understanding, and application of WA in occupational health practice. Comparisons are drawn between the two countries to highlight possible areas for development in the use of WA in UK-based occupational health practice. There is a paucity of WA research derived from the UK and manufacturing contexts. As such, the extent to which the WA construct might have utility in these contexts remains unclear. In response, the second study in this thesis concerns a cross-sectional survey of employees drawn from four UK manufacturing organisations (n = 311). The study centres on relations between work ability on the one hand and individual health (psychological distress, job stress, job satisfaction) and organisational effectiveness indices (work engagement, sickness absence) on the other. The predictive influence of personality constructs – core self-evaluation and the Big Five – is also examined. To address some of the limitations of cross-sectional research, the third study offers a longitudinal examination of these relationships involving a 19-month time lag (n = 74). Within the last five years, a number of researchers have sought to examine the relative utility of different versions of the WAI. As with most WA research, this has derived primarily from Scandinavia. The relative utility of different versions of the instrument in the UK and manufacturing contexts remains unclear. In response, the final study in the thesis compares a multi-item and single item version of the WAI in the UK manufacturing sector in terms of the prediction of individual health and operational effectiveness outcomes. This thesis concludes that there is a lack of understanding and use of the WA construct in UK occupational health practice. Work ability, and to a lesser extent the personality constructs, were found to be related to workers’ health, well-being, and organisational effectiveness. Finally, it was found that the two versions of the WAI instrument differed in terms of their predictive validity. The results of this thesis are discussed in light of their application to the development of theory, research, and occupational health practice.

BACKGROUND: Observational studies of drug treatments complement pre-marketing drug trials and provide real-world outcomes of effectiveness and safety. Large UK primary care databases offer cost-effective access to clinical information for long-term studies requiring great statistical power and deliver findings representative of the general population. However, such data are not collected primarily for research, so all share weaknesses that must be offset by sophisticated use of statistical methodologies. This paper clarifies the current strengths and limitations of these data sources and discusses their potential. In the context of routinely collected primary care data sources, studies focusing on drug safety are used to show appropriate application of statistical techniques, and present a contribution to existing methodological practice based on multi-database use. METHODS: Methodological approaches to address potential data-related biases and drug safety study-related issues are discussed. These include coding differences, analyses of exposure, confounding factors to be included in models, missing data, misclassification bias from outcome uncertainty and prescription-only information, and use of sensitivity analyses to estimate the impact of information gaps and verify the validity of findings. A novel application of triangulation between the findings of separate identical analyses of two databases is introduced. RESULTS: The submitted papers are used to exemplify the delivery of more accurate estimates of risks than previous studies, with further comment on how the methodologies were used to address potential issues. The results of triangulation between the findings of two separate identical analyses based on different databases show confidence intervals for the combined results on average 30 per cent narrower than those of the original analyses. CONCLUSIONS: The application of emerging/developing methodologies enables large UK primary care databases with national coverage to deliver robust findings applicable to the general population and derived from long-term studies with great statistical power. The potential for future development is also shown, including use of multi-databases to further increase statistical power.

The thesis attempted to explore the 'lived experience' of young people who have been through the care system, in order to ascertain what changes could be implemented to improve the psychological wellbeing of young people going into the care system in the future. After a brief introduction (chapter one), an evidence synthesis (chapter two) on young people who have been in residential care was conducted, to examine this phenomenon from an international perspective. A comprehensive search strategy produced fifteen studies, which were selected for final review. A process of data extraction and subsequent data synthesis of the fifteen studies yielded twelve themes. The developed themes included topics such as, for example, the quality of relationships: between the young people, the young people and the care staff and the wider community. The thesis then used an empirical research piece (chapter three) to narrow the focus of the topic to Ireland and to explore the views of young people in conjunction with the views of care workers. For this purpose, a convenience sample of twenty participants (ten residential care workers and ten young people who had been through residential care), completed a care questionnaire and an open-ended interview of one-hour duration. A thematic analysis was performed to comprehend the raw data. The thematic analysis of the dataset elicited fourteen themes; 2 young person themes, 3 care worker themes, and 9 joint themes. The developed themes addressed areas such as: 'fitting in,' 'what makes a care worker' and 'wider connected processes.' The findings were considered in light of other research literature in this area. Since many of the themes related to psychological wellbeing of young people in the care system, the Trauma Symptoms Checklist for Children - Alternate (TSCC-A) was chosen as a psychometric to be critiqued (chapter four). The: properties, normative data, reliability, validity and applicability of the measure were considered. In terms of applicability, how appropriate the measure is for use with young people in the care system was a salient issue. The TSCC-A was used to then assess levels of trauma and psychological wellbeing with the young person in the case study (chapter five). In contrast to the earlier chapters, chapter five looked at the care system in terms of secure institutional care (as opposed to residential care in the earlier chapters), which produced insights into the care establishment as a whole and emphasised aspects such as the importance of therapeutic milieu. D4 who was diagnosed with schizophrenia and committed acts of criminal damage and arson had an individualised care approach adopted with him. He was given pre and post psychometrics to chart the success of his time in care (pre and post intervention). The findings suggested that D4 had shown improvement towards his propensity for negative internalising and externalising behaviours and his psychological wellbeing overall had improved. Chapter six then attempted to consider many of the different insights offered by the preceding chapters and it ends by offering suggestions for how the psychological wellbeing for young people in the care system could be improved, through the amelioration of treatment integrity.

Background Awareness of the harmful effects of second-hand smoke (SHS) has led governments in the United Kingdom (UK) and many other countries to introduce smoke-free legislation in almost all enclosed work and public places. Her Majesty’s (HM) Prison Service, which currently holds over 85,000 offenders among whom the prevalence of smoking is high, was granted one of few exemptions from the 2007 smoke-free legislation in England, which allowed prisoners to smoke in their cells. This continued smoking impacts not only on the health of the individual smoker but also, through SHS exposure, on other smokers and non-smokers who live or work in the prison. However there is limited research evidence on levels of SHS in prison; how the current Prison Service Instruction (PSI) 09/2007 relating to smoking restrictions in prisons in England operates in practice and protects staff members and prisoners from SHS; or how feasible, acceptable or successful the extension of smoke-free policies to all areas of the prison are likely to be in preventing further exposure. Methods This thesis employs both quantitative and qualitative methods in a pragmatic mixed-methods design to investigate smoking and smoke-free policy in prisons in England. Initially, the concentrations of airborne particulate matter < 2.5 microns in diameter (PM2.5) were measured, as a proxy measure for SHS, in four English prisons. Samples were taken on wing landings and in smoking and non-smoking cells; and by ambient monitoring as a measure of personal exposure of staff working in these settings. Staff members who participated in this air quality monitoring study were then followed up to complete a one-to-one semi-structured qualitative interview exploring their views on smoking in prison and exposure to SHS, considering how the current PSI worked in practice, and the potential move to a smoke-free prison estate. A proposal to pilot test smoke-free policy in four prisons in England was announced shortly after, and in large part as a result of the findings of these first studies. A mixed methods evaluation of the new smoke-free policy was then conducted at all four sites, involving prisoner and staff questionnaires and focus groups, and air quality monitoring (sampling concentration of PM2.5 on wing landings) three months before and three months after the policy implementation date. Questionnaires and focus groups pre-policy were used to establish current smoking prevalence, investigate smoking practices and identify perceived problems and concerns regarding the move towards a smoke-free policy. Post-policy these methods were used to explore the impact of the smoke-free policy, views on its implementation alongside consideration of how it could be improved in the future. Concentrations of PM2.5 were used to determine whether going smoke-free reduced levels of SHS exposure. Results Initial air quality monitoring measured PM2.5 concentrations from 48 static locations and personal monitoring of 22 staff members. Arithmetic mean PM2.5 concentrations were significantly higher on landings where smoking was permitted in cells compared to completely non-smoking wings. Concentrations of PM2.5 on landings where smoking was permitted in cells often exceeding the World Health Organisation (WHO) upper air quality guidance limit for a 24 hour period. During personal monitoring of staff members, some of the highest concentrations of PM2.5 were recorded during duties such as locking or unlocking cells, handing out mail and cell searching. Qualitative interviews with prison officers who took part in air quality monitoring reinforced these air quality monitoring findings, confirming the times of the day and duties undertaken where they felt most at risk from SHS. Prison officers outlined how the current PSI was often unworkable day-to-day, conceding that prisoners would often ignore the smoking restrictions in place. In the evaluation of the first four pilot sites to go smoke-free in England, findings prior to the implementation reported 65% smoking prevalence amongst prisoners, and highlighted widespread concerns among staff members and prisoners that going smoke-free would lead to an increase in disorder, self-harm, drug use and trading of tobacco. After the introduction of the policy, prisoners reported an increase in disorder and drug use, but staff reports suggested that concerns were predominantly unfounded. Post-policy, 60% of smoking prisoners reported using some form of Nicotine Replacement Therapy (NRT) in an attempt to cut down or quit in advance of policy implementation, but many reported difficulty accessing cessation support, and found the electronic cigarettes purchased as a substitute for smoking unsatisfactory. Support for the future introduction of the smoke-free policy throughout the rest of the English prison estate was much higher among staff members (70%) than prisoners (23%). Only a quarter of former smoking prisoners stated that they would remain smoke-free once released or transferred to a smoking establishment. Prisoners and staff reported positive outcomes from the smoke-free policy, both reporting a cleaner and healthier environment to life and work. There was a 69% median and a 66% mean reduction in PM2.5 concentrations three months after smoke-free policy was introduced, compared to the same samples taken three months pre-policy, and these reductions were highly statistically significant in all four prisons (p < 0.001). Unintended consequences of the smoke-free policy included smoking alternative substances (such as the contents of NRT patches, tea leaves and lawn grass), the creation of a tobacco black market and related bullying and debt, and the smuggling of tobacco. Conclusions Smoking in prisons in England is a source of high SHS exposure for both staff and prisoners, and the current PSI allowing prisoners to smoke in their cells does not protect other prisoners or staff from SHS exposure. Introducing a comprehensive smoke-free policy in four prisons in England proved successful, achieving marked reductions in tobacco use, improved indoor air quality, and healthier living and working conditions. There are however lessons for wider implementation, particularly in relation to setting clear timelines, ensuring that prisoners can access cessation services in advance of policy implementation, consideration of electronic cigarette available, and other unintended factors. Where possible, these factors need to be addressed to safeguard the future successful implementation throughout the rest of the English prison estate.

International bodies and networks within occupational health and occupational health psychology have over the last years highlighted a pressing need to understand how research and best practices can be translated into sustainable business practice. To stimulate and support organisations in strengthening their psychosocial risk management there have been a number of initiatives, guidance and frameworks that focus on best practice principles for managing the psychosocial work environment (BSI, 2011; Leka, Jain, Cox & Kortum, 2011; WHO, 2010). An essential question is how the frameworks launched by international initiatives, frameworks and standards can be re-interpreted and adjusted to fit the language and systems of particular business contexts, such as that of the petroleum industry. To explore this issue, this research has looked at how an oil and gas company has integrated a sustainable and comprehensive system for managing psychosocial risk. This research has two aims. First, it explores how the oil and gas industry can develop and implement a psychosocial risk management system by applying research and best practice in a Norwegian oil and gas company, in order to raise awareness of how psychosocial risk management practices can be integrated into a company’s internal management system. Secondly, it aims at raising awareness and stimulate to the application and use of established knowledge at organisational and national levels in this area. In this sense, the ultimate aim of this research is to inform policy makers about what it takes to actually implement and integrate policy into company context and at the same time to promote a comprehensive approach to worker protection and the promotion of their health. In all, four studies describe aspects of how this integration process has evolved. The first study explored the development and testing of a performance indicator for psychosocial risk in the oil and gas industry (Bergh, Hinna, Leka, & Jain, 2014b). This resulted in the establishment of a proactive exposure psychosocial risk indicator automatically published in the internal organisational performance management system of the organisation. The second study assessed the relationship between the psychosocial risk indicator (PRI) and objective measures, such as installation weight, age and leakage sources, of health and major accident potential, such as hydrocarbon leaks (Bergh, Ringstad, Leka & Zwetsloot, 2014c). Results from the analysis showed that only the psychosocial risk indicator significantly accounted for variation in hydrocarbon leaks. Only partial support was found for the relationship between technical factors and hydrocarbon leaks on the basis of correlation analysis. The third study describes the development of an internal audit tool of the psychosocial work environment in the oil and gas industry, focusing on offshore units (Bergh, Hinna, Leka & Zwetsloot, 2016). Psychosocial risk auditing is a proactive method for monitoring the status of psychosocial factors influencing the risk of stress and ill-health. The last study considered available quantitative and qualitative risk data collected through the PRIMA method over the last 8 years in the organisation to explore specific and common psychosocial risks in the petroleum industry in particular (Bergh, Leka, Zwetsloot, 2017). The results from the analyses confirmed the hypotheses proposed in the study that there was a significant correlation between job resources, job demands and symptoms of work-related stress and that there were differences in psychosocial risk factors and symptoms of work-related stress onshore and offshore. Future research should focus on testing the methods and tools developed in this company. Moreover, research should explore how other companies can incorporate and implement established knowledge on psychosocial risk management.

Background: Unintentional injury in the home setting is the leading cause of mortality and morbidity among pre-school children in the UK. Multi-component, community-based intervention programmes are a recommended means of addressing injury. England operated a national home safety programme based on this approach from 2009 to 2011. The programme was targeted at high risk families and supported through national government funding. Little is currently known about the sustainability of injury prevention programmes, despite its relevance to public health planners and policy makers. Studies of programme sustainability in the global public health literature reveal an over-reliance on self-reported data from a single source and often under represent the target group perspective. Aim and setting of the current study: The current study aims to explore influences on the sustainability of a multi-component injury prevention programme targeted at high risk communities in England. Study design: The multiple case study design used qualitative methods to explore programme and contextual influences on sustainability in five sites. Multiple perspectives were considered including those of families in the target group and professionals involved in scheme delivery. Local, national and global public health policy documents were reviewed to understand the wider context for scheme sustainability and to corroborate research findings. Interviews with stakeholders in injury prevention policy at national and international level were undertaken to explore the conceptualisation of sustainability. Framework analysis was conducted within-case and to identify cross-case over-arching themes. The analytic framework, display matrices and production of case study profiles documented the analysis stages. ‘Thick description’ assists the consideration of transferability of findings to other settings. Principal findings: Little consensus was apparent in the conceptualisation of sustainability among policy makers. Although programme sustainability was seen as relevant to those agencies influential in policy development, this was not reflected in policy documents. Funding availability and a supportive local context for scheme delivery were identified as the two main conditions required for sustainability. Ongoing change within the national political and economic context in England challenged sustainability efforts of local schemes. Three key strategies to actively encourage sustainability were identified: programme adaptation; presence of a co-ordinator or champion and extending collaborative networks. The adoption of these varied in response to contextual changes over time. Ongoing benefits of the scheme were identified in all sites. These included improved safety practices reported by the target group and increased access to harder-to-engage families for scheme professionals. Programme components displayed differential levels of fidelity between and within sites over time. Based on the study findings, a conceptual framework for promoting the sustainability of community-based child injury prevention programmes is presented. Conclusions: This is the first study to comprehensively explore the sustainability of a community-based injury prevention programme in England. It has identified influences on sustainability that contribute to and support findings from other areas of public health. The proposal of a conceptual framework to promote sustainability within community-based child injury prevention programmes makes an original contribution to the field. Potential transferability of study findings suggests that public health gain may be increased by sharing the knowledge base between topics. The study identified considerable challenges to sustaining local public health initiatives amidst ongoing change in the wider political and economic environments. Educating practitioners and policy makers could improve understanding of sustainability and enhance the future prospects for local initiatives. It is therefore recommended that sustainability should form an integral part of the programme planning cycle for public health initiatives.

Background: Injuries are a leading cause of morbidity and mortality in children and young people (CYP) throughout the world and in the UK. Detailed estimates of the risk of specific injuries, namely fractures, thermal injuries and poisonings, are not available for CYP with specific medical conditions, such as epilepsy or attention deficit-hyperactivity disorder (ADHD) in the English primary care population. To date there has been no description of the recording of ADHD by general practitioners (GPs) in English primary care according to people’s area-level social deprivation and strategic health authority (SHA) region. Objectives: 1. To define a cohort of CYP with epilepsy from the UK primary care population. 2. To estimate the risk of specific injuries, namely fractures, thermal injuries and poisonings in CYP with epilepsy compared to CYP without epilepsy. 3. To define and describe the cumulative administrative prevalence of ADHD in CYP in English primary care overall and by age, sex, SHA region, deprivation and calendar time. 4. To estimate the risk of specific injuries, namely fractures, thermal injuries and poisonings in CYP with ADHD compared to CYP without ADHD. Methods: This thesis describes work conducted using a large primary care dataset (the Clinical Practice Research Datalink (CPRD)) containing GP medical records and, for a proportion, linked hospital records from the hospital episodes statistics (HES) database. Firstly, the CPRD was used to define a cohort of CYP with epilepsy and CYP without epilepsy. The GP medical records for this cohort were used to estimate the risk of fractures, thermal injuries and poisonings, in CYP with epilepsy compared to CYP without epilepsy. The rates of injuries were estimated by age and sex. For a proportion of people in this study, the effect on estimates of using linked hospital medical records in addition to the GP medical records was evaluated. Secondly, the administrative prevalence of ADHD recorded by GPs was defined for CYP in England by identifying a cohort of CYP in the CPRD with GP medical records linked to hospital medical records. The cumulative administrative prevalence of ADHD was estimated overall and by age, sex, SHA region, deprivation and calendar time. Thirdly, the GP medical records and linked hospital medical records for the cohort of CYP with ADHD was used to estimate the risk of fractures, thermal injuries and poisonings, in CYP with ADHD compared to CYP without ADHD. The rates of injuries were estimated by age, sex and deprivation. Findings: CYP with epilepsy are at greater risk of fractures, thermal injuries and poisonings compared to CYP without epilepsy. In CYP with epilepsy the incidence of fractures is 18% higher, thermal injuries is 50% higher and poisonings 147% higher than in CYP without epilepsy, with the increased risk being restricted to medicinal poisonings. Among young adults with epilepsy, aged 19 to 24 years, the incidence rate of medicinal poisoning is four-fold that of the general population of the same age. Using GP medical records and linked hospital medical records may improve the ascertainment of injuries. For example, if hospital medical records are used in addition to GP medical records to ascertain femur fractures, a further 33% of fractures may be ascertained compared to using GP medical records alone. In comparison, if hospital medical records were used without GP medical records, 10% of femur fractures may not be ascertained. However, this increased ascertainment of injuries is unlikely to alter the estimates of risk of injuries in people with epilepsy when compared to people without epilepsy (e.g. risk of long bone fractures: using hospital and GP medical records, hazard ratio (HR)=1.25 (95% confidence interval (95%CI) 1.07 to 1.46) vs. using GP medical records alone, HR=1.23 (95%CI 1.10 to 1.38)). The administrative prevalence of ADHD in CYP aged 3 to 17 years old in English GP medical records is 0.88% (95% confidence interval (95%CI) 0.87 to 0.89). The prevalence of ADHD recorded by GPs is around five times greater in males than in females. The administrative prevalence of ADHD appears to increase with age, with the lowest prevalence in 3 to 4 year-olds (0.02 (95%CI 0.02 to 0.03)) and the highest prevalence in 15 to 17 year olds (1.38 (95%CI 1.36 to 1.40)). The administrative prevalence of ADHD is twice as high in CYP from the most deprived areas compared to CYP from the least deprived areas (1.14% (95%CI 1.12 to 1.16) in the most deprived areas to 0.64% (95%CI 0.63 to 0.65) in the least deprived areas)). CYP with ADHD are at greater risk of fractures, thermal injuries and poisonings compared CYP without ADHD. In CYP with ADHD the incidence of fractures is 28% higher, thermal injuries is 104% higher and poisonings is 300% higher than in CYP without ADHD. Conclusions: CYP with epilepsy and ADHD have an increased risk of fracture, thermal injury and poisoning compared to CYP without these conditions. For both conditions the risk of poisoning is higher than the risk of fractures or thermal injuries. The administrative prevalence of ADHD is lower than estimates of community prevalence ascertained from studies not using primary care data. The prevalence of ADHD varied with deprivation, being almost twice as high in CYP from the most deprived areas compared to CYP from the least deprived areas. Future research is required to explore the circumstances surrounding injuries in CYP with and without epilepsy and ADHD. Future research is also required to explore the effect of treating epilepsy and ADHD with medication on injury risk. Research is required to explore the effect of the severity of epilepsy and ADHD on estimated risks of injuries. Future research exploring potential under-diagnosis or under-recording of diagnosis of ADHD in CYP in primary care is needed. CYP with epilepsy and ADHD and their parents should be provided with evidence-based injury prevention interventions because work in this thesis has demonstrated they are at higher risk of injury than the general population of CYP. Health care professionals working with CYP; child and adolescent mental health services; child education or care practitioners; and other agencies and organisations with an injury prevention role, should be made aware of the increased risk of injury in CYP with epilepsy and ADHD. Commissioners of health services for CYP should ensure service specifications include injury prevention training and provision for evidence-based injury prevention interventions.