Contextual factors influencing neuro-affirming practice: Identifying what helps or hinders implementation in health and social care.

There has been limited research to date into contextual factors hindering or supporting the successful implementation of neuro-affirming practice in support for Autistic and otherwise neurodivergent adults. We used a Realist Evaluation approach to explore key contexts affecting neuro-affirming practice. A preliminary programme theory of key aspects of support was developed. Views on current practice were sought through structured interviews with 32 senior professionals in leadership roles within Health and Social Care services in Scotland. This study identified important contexts shaping the implementation of neuro-affirming practice for adults. Results indicate widespread professional support for modifying practice to better accommodate neuro-affirming ideas, and scope to achieve this. However, some contexts, including limited resources, restrictive eligibility criteria and rigid service structures, hinder progress. Growing demand for services was often viewed as a restrictive context, but it also offered a chance to rethink conventional, one-size-fits-all models and adopt neuro-affirming approaches. The study is important in addressing a current gap in research into professional perspectives of the contexts required to develop transdiagnostic, neuro-affirming approaches and pathways for Autistic and neurodivergent adults. The insights from this study may offer transferable practice approaches, applicable across different countries with similar healthcare contexts.Lay abstractDelivery of neuro-affirming adult support pathways for Autistic and other neurodivergent adults by Health and Social Care institutions can be affected by different contexts. However, there is limited research to date into the most supportive contexts for effective neuro-affirming practice. This study aimed to explore the most beneficial contexts for neuro-affirming approaches, and barriers to this. We did this by using existing research to develop a theory about the most helpful approaches to support for Autistic adults, then gathering the views of 32 senior professionals in leadership roles within Health and Social Care services to explore supports and challenges they experience in implementing these approaches. The study identified important contexts for delivery of neuro-affirming practice and how these might be achieved. Some contexts, such as limited resources, restrictive eligibility criteria and inflexible service structures, could limit progress. However, although these were often seen as barriers, they also offered a chance to rethink one-size-fits-all models and adopt neuro-affirming approaches. This study is important in addressing a current gap in research into professional perspectives of the ways neuro-affirming approaches can be developed in practice, to support Autistic and neurodivergent adults. The insights from this study may offer transferable lessons, applicable across different regions and countries.