JCPSLP Vol 20 No 3 November 2018

particularly those with a functional focus, while others found it didn’t apply to acute, public sector, or lone discipline settings, for example “The overall concept/model/ framework fits well with mental health clients where service focus is on functionality and recovery” (ID164_paed_35yrs). The disadvantages reported included that the ICF is not user friendly. A number of respondents identified the coding system as tedious, time consuming and irrelevant e.g., “The coding system is fiddly and I don’t believe it would enhance my practice” (ID250_unspecified_13yrs). Overall, respondents reported more advantages than disadvantages. Facilitators and barriers Facilitators and barriers were present at social, institutional, and individual levels (Figure 2). Prominent institutional level facilitators included working in settings with a functional focus, such as rehabilitation and disability, and a workplace culture supportive of the ICF. On an individual level respondents emphasised the need for personal knowledge and strategies, such as having a printed copy of the model nearby and reading related articles. Colleagues’ knowledge and uptake of the ICF was also an important facilitator for encouraging respondents’ use and supporting collaboration. One respondent reflected, “When I hear other clinicians talking about the management of their clients using this framework, it encourages me as a new graduate to apply the framework to my work” (ID44_adult_2yrs). Challenges with policy and funding permeated the data, on both social and institutional levels. Resource restrictions were particularly highlighted as follows, “Funding does not support participation based goals” (ID152_both_13yrs). Other prominent institutional barriers included time constraints and a negative workplace culture towards the ICF. Individual barriers included having limited personal knowledge, finding the ICF inappropriate to use within certain contexts, and experiencing limited knowledge, uptake, and utility in colleagues. In summary, barriers were most prominent in the data, with equal representation across all social, institutional and individual levels of influence. Respondents referenced individual level facilitators more than social or institutional level facilitators.

Awareness ( p = .023); Decision-making ( p = .046); knowledge ( p = .002); Coding ( p = .008) and General Framework ( p = .014). Post-hoc testing indicated that in each case differences were between settings predominantly servicing children and any of the other settings. There were no significant differences or correlations regarding the relationship between years of practice and the level of use/utility of the ICF (derived factors Clinical Focus [ p = .147, rs = –.163]; Service and Management Focus [ p = .614, rs = –.057]; Education, Appraisal and Support [ p = .560, rs = .003]; Service Quality [ p = .506, rs = .067]; and Decision-making [ p = .326, rs = –.113]). Key Themes Written qualitative responses, typically in bullet points, were provided by 75 respondents. Each response ranged from 1 to 132 words (mean = 24.5). Advantages and disadvantages Respondents reported a range of advantages and disadvantages, corresponding to the perceived utility of the ICF tool itself, its value in specific settings and usefulness in work tasks (Figure 1). Over half the respondents emphasised that the ICF promotes a holistic, person- centred way of thinking and practising. Furthermore, some indicated that the ICF improves client outcomes and quality of life, and benefits the client and their families throughout the clinical process as evidenced by this quote: “approaching therapy from this angle means clients are more motivated, involved and therapy becomes more client-centred and salient, resulting in better outcomes” (ID 1 218_adult_13yrs). Many respondents described the framework as clear and realistic, and emphasised its value in clinical tasks, particularly goal-setting. For example, one respondent said the framework assisted with “Helping families consider broader areas in goal-setting, to make goals more specific” (ID3_paed_3yrs). Only three respondents described the codes and checklists as useful. Some respondents mentioned the benefit of the ICF in service management, student education and broader social tasks. A few respondents valued the ICF in specific settings and areas of practice,

Promotes a holistic person- centred approach Framework is clear and realistic Benefiting clients and families Improved client outcomes and quality of life

Not user friendly Coding system is tedious and time consuming

Utility of the tool

Perceived utility of the ICF

Utility in specific settings

Utility in work tasks

Assists clinical tasks Assists service management tasks Assists policy development and census collection

Complements settings with functional focus

Seen as irrelevant in some settings

Key

Advantages

Disadvantages Lighter colour = fewer references Darker colour = more references

Figure 1. Perceived utility of the ICF

115

JCPSLP Volume 20, Number 3 2018

www.speechpathologyaustralia.org.au