Children with intellectual disabilities living in residential services are a vulnerable group. They have significant needs for individually tailored support to function in daily life. At the same time, cognitive and communicative limitations pose challenges to their involvement in decisions about how they want to receive support and assistance. There is limited research, but the findings show that residential services consistently struggle to meet the support needs of children and young people with disabilities. It is unclear how staff support children's participation. Building staff capacity to meet the requirements for supporting children with intellectual disabilities requires organisational changes through person-centred approaches, implementing measures to assess human functioning, and ongoing quality improvement (QI) focused on personal outcomes. Process evaluations that emphasise inputs, activities, and outcomes, along with their interrelations, can enhance the understanding of how and why a programme or support initiative succeeds or fails in implementation.
The overall aim of this thesis is to explore and develop programme theory to support the development of staff working methods in residential services for children with intellectual disabilities. The empirical material was primarily collected during the implementation of a support development programme, in which residential staff tested new working methods to improve individual support for children between 2020 and 2023.
Four subsidiary studies have been carried out to gather knowledge that contributes to the overall aim. Study 1 explored staff experiences and conditions for co-producing with children in residential services, using focus groups. Data were analysed through qualitative content analysis. Realist evaluation was employed to identify barriers and enablers (Study II) and to explore programme theory (Study III) during the staging of the support development programme. Study IV examined aspects of child involvement in the support development programme, using deductive content analysis and coding of child case studies, using data from Studies II and III.
Critical realism served as the philosophical framework to synthesise and develop findings from the sub-studies in response to the overall aim. Specifically, by exploring and developing programme theory through the identification and description of the mechanisms, contextual variables, outputs, and outcomes related to the introduction of working methods that help staff plan, implement, follow-up, and involve children with intellectual disability in support interventions within residential services. The findings can assist programme managers and leaders in residences with special services to adapt implementation strategies and support mechanisms to achieve desirable outcomes in their specific operational contexts. Additionally, the findings can serve as a foundation for further knowledge development on working methods for supporting development in residential services and related practices.