title: Supports and barriers to implementation of routine clinical assessment for children with cerebral palsy: A mixed-methods study.
abstract: OBJECTIVE
  The purpose of this study is to investigate supports and barriers to evidence-based routine clinical assessment of children with cerebral palsy.
  
  
  METHODS
  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.
authors.affiliation: a Centre for Disability and Development Research , Australian Catholic University , Fitzroy , Victoria , Australia.|b School of Nursing and Midwifery , Queen's University Belfast, Medical Biology Centre , Belfast , United Kingdom.
authors.forename: Claire
authors.identifier: http://orcid.org/0000-0003-2067-5091
authors.initials: C
authors.lastname: Kerr
authors.affiliation: c Department of Physiotherapy, School of Allied Health , La Trobe University , Bundoora , VIC , Australia.|d Northern Health , Melbourne , Australia.
authors.forename: Nora
authors.initials: N
authors.lastname: Shields
authors.affiliation: e St Giles , Launceston , Tasmania , Australia.|f Centre for Rural Health , University of Tasmania , Launceston , Tasmania , Australia.
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Quarmby
authors.affiliation: g Alfred Health , Victoria , Melbourne , Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Roberts
authors.affiliation: a Centre for Disability and Development Research , Australian Catholic University , Fitzroy , Victoria , Australia.
authors.forename: Christine
authors.identifier: http://orcid.org/0000-0001-9055-3554
authors.initials: C
authors.lastname: Imms
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D004185:Disability Evaluation; D055317:Evidence-Based Practice; D017144:Focus Groups; D006801:Humans; D008297:Male; D000072087:Occupational Therapists; D059825:Physical Therapists; D013070:Speech Therapy; D011795:Surveys and Questionnaires
keywords: Cerebral palsy; implementation; routine assessment