Table 2. Thematic Structure of Findings

Main Theme	Subtheme	Analytic Summary
Functional Ambiguity and Information Asymmetry	1) Limits in interpreting behavior due to multifactorial influences	■ Challenging behavior was shaped by mixed sensory, medical, psychological, and environmental factors, making functional interpretation unstable and tentative.
	2) Difficulty regulating triggers amid behavioral unpredictability	■ The unpredictability of behavioral episodes hindered proactive prevention and stimulus control in daily routines.
	3) Asymmetric information flow between home and service settings	■ Gaps in detail, consistency, and accuracy of shared information reduced staff’s ability to develop reliable functional hypotheses.
Ethical Tension and the Burden of Protective Interventions	1) Conflict between safety needs and rights-based restrictions	■ Staff navigated moral tension between minimizing restrictive practices and ensuring immediate safety during high-risk incidents.
	2) Accumulated helplessness during prolonged crisis episodes	■ Extended crisis management generated emotional fatigue, diminished efficacy, and recurring helplessness.
	3) Limits of theory-driven training and need for practical, skills-based coaching	■ Didactic training failed to prepare staff for real-time crises, highlighting the need for hands-on rehearsal, simulation, and coaching.
Value Conflicts Between Happiness and Growth	1) Persistent dilemmas between ensuring daily well-being and promoting developmental progress	■ Staff struggled to balance person-centered quality of life with programmatic expectations for functional improvement.
	2) Restorative effects of small successes	■ Even minor behavioral or functional gains provided emotional reinforcement and restored professional motivation.
	3) Emotional exhaustion driven by repetitive vocalizations and behaviors	■ Continuous exposure to sensory-intensive behaviors contributed to cumulative emotional fatigue.
Practice-Oriented Reconfiguration of Plans and Training	1) Ambivalence about planning: usefulness of structure vs. burden of goal-setting	■ Planning was seen as essential yet difficult due to uncertainty about appropriate goal levels and progression.
	2) Utility of a “one-page profile” as a concise planning tool	■ Staff favored simplified, instantly accessible documents over lengthy administrative plans.
	3) Reorienting training toward practice-based competency development	■ Staff emphasized the need for experiential learning, coaching, and scenario-based training.
	4) Need for tailored parent coaching and collaborative structures	■ Consistency across home and service settings required systematic coaching and coordinated communication with families.