Do supports and barriers to routine clinical assessment for children with cerebral palsy change over time? A mixed methods study

Professor Christine Imms1

Professor of Occupational Therapy, Australian Catholic University

Aim: To investigate changes over time in allied health professional’s (AHP) perceptions of supports and barriers to implementing routine clinical assessment for children with cerebral palsy.

Method: Longitudinal mixed method approach. AHP (occupational therapists, physiotherapists and speech pathologists) employed in five disability service organisations were recruited. Participants completed the Supports and Barriers Questionnaire (SBQ; measuring organisational structures, resources, therapists, assessment tools, children and families) and participated in focus groups at baseline, 6, 12 and 24 months following introduction of routine clinical assessment procedures. Quantitative data were analysed descriptively. Baseline qualitative data were analysed inductively and a thematic framework developed. This framework was applied longitudinally using a constant comparative approach, facilitating identification of framework elements that emerged, or became less dominant, over time.

Results: 447 AHP participated (baseline n=227, 6m n=227; 12m n=224; 24m n=189). Mean SBQ ratings on all domains remained positive over time indicating that overall AHP felt supported in implementing routine clinical assessment. Five themes emerged at baseline: ‘motivated to adopt routine clinical assessment’, ‘ensuring effective ongoing communication’, ‘acquiring and utilising expertise’, ‘availability and distribution of resources’ and ‘therapist perceptions of child and families’ wishes’. Longitudinally, themes demonstrated how routine assessment practices and clinical expertise were embedded and maintained. Critical reflection on the utility and costs of routine assessment were evident over time, attributable in part to national changes in funding of disability services.

Significance of the findings to allied health: Organisational commitment, adequate resourcing and effective communication are required to implement and embed change in AHP services.