Exploring programme theory when integrating ICF categories in a support development programme for children with intellectual disability living in special residences: a realist evaluation

Objectives: The International Classification of Functioning, Disability and Health (ICF) offers a standardised language to inform goal setting, support interventions and follow-up on personal functioning outcomes. There is a lack of knowledge about how ICF can be used in practice in residences providing special services for children with intellectual disabilities. This study explores programme theory when ICF categories were integrated into a support development programme to facilitate systematic follow-up on child-individual support interventions in residences with special services. Methods: The study employs a realist evaluation design, utilising data from individual child case studies, group interviews, and field notes. Results: The findings show that ICF-based follow-up can enable staff to connect personal out-come measures to goals, facilitate infrastructure for measurement and follow-up, create learning and can promote action to improve the children's support. Implementation challenges arose due to an unpredictable and demanding work environment, as well as difficulties in applying ICF categories across various aspects. Conclusions: The findings can inform future research regarding working methods as well as disability care organisations striving to develop evidence-based practices. Program design should respect staff workload and minimize elements that add unnecessary complexity to daily tasks.