Supports and barriers to implementation of routine clinical assessment for children with cerebral palsy: A mixed-methods study

Abstract

Purpose: The purpose of this study is to investigate supports and barriers to evidence-based routine clinical assessment of children with cerebral palsy.

Method: This mixed methods study included physiotherapists, occupational therapists and speech pathologists providing services to children with cerebral palsy (3–18 years) within five organizations across Australia. Four organizations initiated standardized routine clinical data collection (Commencing organizations), and one had previously mandated routine assessment (Comparison organization). Participants completed the Supports and Barriers Questionnaire (n = 227) and participated in focus groups (n = 8 groups, 37 participants). Quantitative data were summarized descriptively, qualitative data were analyzed thematically and comparisons between organizations assessed.

Results: Organizational structures, resources, therapists within organizations, assessment tools, and children and families were, on average, viewed as supportive of routine clinical assessment. There were no differences between the Comparison and Commencing organizations except ‘therapists within the organization’ were viewed as more supportive by the Commencing organizations (p = 0.037). Five themes were derived from qualitative analyzes: motivation to adopt routine clinical assessment; acquiring and utilizing expertise; ensuring effective ongoing communication; availability and distribution of resources; and therapist perceptions of child and family wishes.

Conclusions: Organizations experience challenges to effective and sustained implementation of routine clinical assessment. Adequate resourcing and positive, clear communication were perceived as critical for success.

Implications for Rehabilitation

• The value of routine clinical assessment of children with cerebral palsy is undisputed.

• Tailored solutions to organization-specific challenges are required when implementing routine clinical assessment for children with cerebral palsy.

• Positive, clear communication of organizational priorities by management may assist AHPs to prioritize workload activities when changing practice.

Keywords:

• Cerebral palsy
• routine assessment
• implementation

Acknowledgements

The authors acknowledge and thank all of the partner organizations (Cerebral Palsy Alliance, St Giles, Novita Children’s Services, Yooralla and Kids Plus) and participating AHPs as well as the children and families who took part, the Steering Committee, including Michael Debinski (Chair) and Sharon Cutrale (consumer representative) and the members of our Local Advisory Committees.

The “Cerebral Palsy Check Up: Providing the best service at the best time” group is:

Chief investigators.

Prof. Christine Imms, Center for Disability and Development Research, Australian Catholic University.

Prof. Iona Novak, Cerebral Palsy Alliance; University of Notre Dame.

Prof. Dinah Reddihough, Murdoch Childrens Research Institute; University of Melbourne; Royal Children’s Hospital, Melbourne.

Prof. Nora Shields, La Trobe University; Northern Health.

Prof. H. Kerr Graham, Orthopedic Department, Royal Children’s Hospital, Melbourne

Dr. Steven Bowe, Deakin University

Associate/partner investigators

Ms. Kerry Evans and Dr. Angela Crettenden, Novita Children’s Services.

Ms. Sarah Foley, Kids Plus Foundation.

Dr. Elspeth Froude, Australian Catholic University, St Giles.

Dr. Adrienne Harvey, Royal Children’s Hospital, Melbourne.

Dr. Petra Karlsson and Ms Hayley Smithers-Sheedy, Cerebral Palsy Alliance.

Ms. Marisa McCague, Ms. Meredith Fordyce and Mr. Ashley Creighton, Yooralla.

Dr. Lyndsay Quarmby, St Giles.

Dr. Melinda Randall, Australian Catholic University; Murdoch Childrens Research Institute

Project manager and research assistants.

Dr. Claire Kerr, Center for Disability and Development Research, Australian Catholic University.

Richard Barclay, Cerebral Palsy Alliance; University of Sydney.

Mahek Dudhwala, Australian Catholic University.

Kanchana Pathirana, Elsa Reuter, Dr. Annemarie Wright, Novita Children’s Services.

Madeline Rowell, St Giles.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

This partnership project was funded by the Australian National Health and Medical Research Council (APP1055278) and received financial and substantial in-kind support from each partner organization: Cerebral Palsy Alliance, St Giles, Novita Children’s Services, Yooralla. and Kids Plus.