Methods

Beyond Binaries takes an in-depth case study approach to neurodevelopmental service redesign, using observations, interviews, and document analysis to track changes as they unfold. Two case studies—one in Wales and one in England—will allow for comparison across different national healthcare contexts.

1. Observations: Key strategic meetings on neurodevelopmental service restructuring will be observed to capture real-time decision-making, negotiations, and challenges. This will provide insights into how diagnoses shape services and identify barriers and facilitators to change. Observations will include public consultations, specialist working groups, and advisory panels.

2. Semi-Structured Interviews: Interviews with 70 key stakeholders across both case study sites will explore diverse perspectives on ADHD, autism, and service redesign. Participants will include: local and national transformation leaders (e.g. commissioners, policy-makers, lived experience advocates etc), diagnostic professionals and individuals undergoing or awaiting assessment. These interviews will uncover personal and professional views on the role of diagnosis in service provision.

3. Document Analysis: Policy papers, clinical guidelines, consultation reports, and other key publications will be analyzed to understand how service planning is influenced by existing frameworks and emerging research.Together, these methods will provide a comprehensive understanding of how neurodevelopmental services are evolving and the implications of these changes for individuals and society.

The study has received ethical approval from the FHASS Social Sciences and International Studies Ethics Committee at the University of Exeter.