Care and service trajectories are identifiable routes through service systems that consist of all steps that people with intellectual disabilities (ID) and their families have to take to realize the care and services they need. Trajectories are especially prominent during the transitions from children's services to adult services. Within a service system in Noord-Brabant (in the Netherlands), the authors examined the course of such trajectories and their main bottlenecks and sought to identify their quality determinants. The first research question was addressed by an exercise in document analysis and the holding of semistructured interviews with key informants within the healthcare sector specialized for serving people with ID. A second research question was addressed by means of a literature review on integrated care. The authors observe that trajectories generally follow a "model route" consisting of five phases but may vary according to age category, degree of disability, and life domain. With respect to "bottlenecks," the authors noted that a lack of suitable supply and long waiting lists are good examples. They found that the literature on integrated care revealed that continuity, accessibility, availability, and flexibility of care and services, together with the seamlessness of transitions, are all important quality determinants for people with ID when judging their service trajectories. Bottlenecks and quality determinants of trajectories are strongly interrelated. The authors concluded that the literature and the key informants agree as to which factors are most important in realizing high-quality trajectories for individual clients. They recommend asking which criteria people with ID and their families value most when judging the quality of trajectories.

General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policyIf you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim. Quality of care and service trajectories for people with intellectual disabilities: defining the aspects of quality from the client's perspective Background: Care and service trajectories for people with intellectual disabilities (i.e. people with mental retardations) are routes within the healthcare delivery system that consist of all the steps that people with intellectual disabilities and their families have to take in order to realise the needed care and services. Aim: This article aims to identify the quality aspects of trajectories that are considered important by people with intellectual disabilities and their parents/relatives. In addition, it examines how these aspects are related to quality determinants mentioned in the literature on integrated care and to authoritative models for quality assessment of care and service delivery. Methods: Quality aspects were collected during eight focus group discussions with people with intellectual disabilities or their parents/relatives. In addition, quality determinants of integrated care and authoritative models for quality assessment were selected by means of a thorough review of the literature. Finally, the quality aspects identified using focus groups were compared to the determinants and models found in the literature.Results: The quality aspects presented by people with intellectual disabilities referred particularly to the immediate situation in receiving care and services, such as 'keeping appointments' and 'time and attention', whereas parents/relatives also referred to broader 'organisational issues', such as 'access to support' and 'problems with placement'. The quality aspects, however, are minimally related to the quality determinants of integrated care, probably because clients and their parents/relatives find it difficult to have an overview of the coherence between the various actions that have to be performed, when going through the trajectories. In contrast, the quality aspects seem to fit into the domains of the authoritative models for quality assessment, probably because of the minimal focus of the models on long-term aspects in care and service delivery.

Background Care and service trajectories for people with intellectual disabilities are routes within the health care delivery system that consist of all the steps that people with intellectual disability and their families have to take in order to realize needed care and services. In contrast to the growing body of system-orientated knowledge concerning quality of care delivered through collaborative relationships between care providers, specific userorientated knowledge is still largely lacking. Aim This article aims to describe the development and the preliminary validation of a user-orientated questionnaire for parents and ⁄ or relatives of people with intellectual disability (QUALITRA-ID-P) to assess the quality of care and service trajectories of their children ⁄ relatives with intellectual disability. Methods First, the phenomenon 'care and service trajectories' was conceptualized on the basis of document analysis and semi-structured interviews with key informants. Second, quality of care and service trajectories were operationalized using focus group discussions with parents and relatives as well as an extensive literature review. Third, the QUALITRA-ID-P was constructed using the results of the conceptualization and operationalization. Fourth, the QUALITRA-ID-P was refined in two stages: examination of (i) feasibility, understandability and completeness and (ii) preliminary validation.Results The final QUALITRA-ID-P is a 49-item scale with good reliability and validity. An exploratory factor analysis resulted in a 3-factor solution with Cronbach's alpha coefficients of 0.98, 0.83 and 0.91. Organizations in the disability sector can use the QUALITRA-ID-P to understand better the experiences of quality of their clients' relatives and as a result improve the quality of trajectories.

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The final result is a 24-item QUALITRA-ID consisting of a personal conversation and a closed-ended part.