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

Purpose
To understand how healthcare professionals’ perceptions of supports and barriers to routine clinical assessment, for children aged 3–18 years with cerebral palsy, evolved in the presence of a knowledge translation intervention.

Methods
A prospective longitudinal mixed-methods study was completed. The intervention comprised knowledge brokers, an e-evidence library, locally provided education and embedding routine clinical assessment in practice. Healthcare professionals from five disability services completed the Supports and Barriers Questionnaire and focus groups at baseline, 6, 12 and 24 months. Quantitative data were analysed descriptively and qualitative data using longitudinal framework analysis.

Results
Questionnaire ratings indicated participants felt supported in implementing routine assessment over time. Subtle differences emerged from the longitudinal framework analysis. Participants shifted from ‘adopting’ to ‘embedding’ and ‘maintaining’ routine assessment. Integration of assessment was impacted by a new national disability funding model. Participants highlighted the need to maintain skills and for unambiguous, sustained communication between the organisation, clients, and stakeholders. If, how and why families engaged with routine assessment developed over time.

Conclusions
After an initial focus on pragmatic implementation issues, over time healthcare professionals began to reflect more on the complexities of children and families’ engagement with assessment and the impact on the therapist-child-family relationship. Trial registration: This trial was not a controlled healthcare intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015.

IMPLICATIONS FOR REHABILITATION
• Healthcare professionals can be supported over time to embed routine clinical assessment using multifaceted knowledge translation interventions.

• It takes time and ongoing support for healthcare professionals to embed, maintain and begin to adapt the routine clinical assessment to fit with policy, organisational context and the needs and wishes of children and families.

• Understanding and tailoring knowledge translation approaches to the policy context are essential.

• Even in the context of major policy shifts, it is possible to harness the commitment of organisations and professionals to improve their services in line with evidence-based approaches.

*The Best Service Best Time Author Group: Petra Karlsson, Sarah Foley, Lyndsay Quarmby, Kerry Evans, Marisa McCague, Dinah Reddihough.