Table 5.

Realist matrix for the NAIT programme (programme theory).

Contexta	Mechanismsb	Outcomesc
Policy & directives Attitudes & mind-set Early career professional development needs Knowledge gaps & outdated perspectives Information overload Unsure which sources to ‘trust’ Current levels of multi-disciplinary working (particularly health & education) Professional silos For children & young people: diagnostic services already in place, some pathways For adults: minimal diagnostic services in place, minimal pathways Different funding models nationally Staff recruitment & retention Perception that change is difficult Lack of time & ‘too busy’ Fear of the unknown COVID 19 pandemic recovery	Macro Mechanisms - Engage routinely with a range of national strategic groups, leadership groups, & cross sector groups - Engage the apparatus of government, work with senior government officials, & respond to their requests	Macro Outcomes - Improved responsivity to current issues & needs - Programme team perceived as leaders - Influence on policy & national practice - Improved links & engagement with policy & government - Allocation of funding
	Practitioner Mechanisms - Be action orientated - Be a persuasive & trustworthy source of information across practice & research - Provide accessible, concise, engaging, evidence-informed information, with consistent key messages - Be an accessible team - Challenge & support - Develop debate & consensus on community acceptable cross sector language & terminology - Model expected behaviours	Practitioner Outcomes - Increased responsibility, motivation, empowerment & performance of staff - Improved likelihood of strong & sustainable engagement with key NAIT ideas across staff & practice communities - Agreed language that is acceptable to stakeholders - Inclusive mindset, inclusive staff - Informed & educated staff - Development of leaders
	Institutional Mechanisms - Have a national focus - Promote universal inclusive practice - Provide a systematic framework to embed sustainable practices through high quality professional learning materials - Facilitate & lead multi-professional networks with locally owned change programmes	Institutional Outcomes - Consistent use of recognized evidence based strategies & approaches - Changes in relationships within & across organisations - Increase in multi-agency/multi-disciplinary approach in planning, development & implementation - Robust local & national neurodevelopment networks - Introduction of policies, changes in social norms, &/or normalisation of NAIT recommended practices - Improved quality & consistency of support delivered for children & adults

^a Context: factors which favour or disfavour the activation of mechanisms.

^b Mechanisms: processes underpinning changes in outcomes – ‘active ingredients’ which when activated cause changes in the thinking, behaviours and reasoning of actors, in this case professional staff working in the health and education sector.

^c The direct role of NAIT is to provide support to enable practitioners across sectors to develop practice in this field. Outcomes are focused on practice changes associated with NAIT, and to understand the impacts of NAIT in this ‘audience’ which is the professional staff working in this field. Evaluation of direct interventions provided by clinicians or teachers, or outcomes for service users or families, were not the focus of this phase of the research.