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Do supports and barriers to routine clinical assessment for children with cerebral palsy change over time? A mixed
Claire Kerr1, Iona Novak2, Nora Shields3
1Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.
Insights
Healthcare professionals improved routine clinical assessments for children with cerebral palsy through knowledge translation interventions. Over time, they moved from adopting to embedding and maintaining these assessments, adapting to policy changes and family needs.
Area of Science:
- Rehabilitation Science
- Knowledge Translation
- Health Services Research
Background:
- Routine clinical assessment is crucial for children with cerebral palsy (CP).
- Understanding healthcare professionals' (HCPs) perspectives on implementing these assessments is vital.
- Knowledge translation interventions aim to bridge the gap between evidence and practice.
Purpose of the Study:
- To examine how HCPs' perceptions of supports and barriers to routine clinical assessment for children (3-18 years) with CP evolved.
- To evaluate the impact of a knowledge translation intervention on the implementation of routine clinical assessment.
Main Methods:
- Prospective longitudinal mixed-methods study over 24 months.
- Intervention included knowledge brokers, e-evidence library, education, and practice embedding.
- Data collected via Supports and Barriers Questionnaire and focus groups from HCPs at five disability services.
Main Results:
- HCPs reported increased support for implementing routine assessment over time.
- Qualitative analysis revealed a shift from 'adopting' to 'embedding' and 'maintaining' assessment practices.
- External factors like a new disability funding model influenced integration; sustained communication and skill maintenance were highlighted.
Conclusions:
- Multifaceted knowledge translation interventions effectively support HCPs in embedding routine clinical assessment.
- Embedding and adapting assessments require time, ongoing support, and consideration of policy, organizational context, and family needs.
- Tailoring knowledge translation to policy contexts is essential for successful, evidence-based service improvement, even amidst policy shifts.
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 REHABILITATIONHealthcare 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.
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