JCPSLP Vol 20 No 3 November 2018

Challenges with policy and funding Time and resource restrictions Constraints to service provision Adverse workplace culture Working in specific settings e.g., acute hospital or education Poor management support Insufficient promotion and education

Presence of ICF in research Endorsed by professional body Working in specific groups e.g., rehabilitation or disability Supportive workplace culture Access to time and resources

Social facilitators

Social barriers

Facilitators and barriers

Institutional facilitators

Institutional barriers

Access to learning opportunities

Personal knowledge and strategies

Limited personal knowledge

Knowledge and uptake by colleagues Working in a transdisciplinary or multidisciplinary team

Unsuitable for client control

Individual facilitators

Individual barriers

Limited knowledge, uptake and utility in colleagues Team culture

Strong therapeutic relationship

Note: Social, institutional, individual levels classified according to WHO (2002)

Lighter colour = fewer references Darker colour = more references Key

Figure 2. Facilitators and barriers to use of the ICF

Spectrum of uptake Respondents reported a continuum of ICF integration into their practice, from little or no use through to a more assimilated uptake. The theme of “wanting to use the ICF further” was also present in the data, with practitioners seeking strong models of skilful practice in which the ICF is used for a range of purposes, including assessment and intervention and creating supportive workplaces. This notion is represented by the quote, “I would be interested to see examples of how it can be integrated into SP (SLP) assessment report templates” (ID162_paed_9yrs). A few respondents’ notions about the ICF conflict with the WHO ICF manual (WHO, 2013), principally describing the ICF terminology as not being client or family friendly without appreciating that it is acceptable to modify language where appropriate. Other respondents assumed the ICF applied only to client-based practice or student education. Despite the overall trend of limited uptake, a theme of using the ICF as a “way of thinking” was present for those who do use it. Respondents reported using the ICF as an implicit mindset or guideline, rather than explicitly applying it to practice. For example, one respondent said, “I do not overtly talk about ‘the ICF model’ but am always thinking about the patient in terms of the impact their impairment may be having on their activities and participation” (ID44_adult_2yrs). Transitioning from theory to practice was reported as difficult by some and easy by others, depending on their context. Responses indicated some participants did not know how to apply the framework in practice, e.g., “I have no idea how I would apply it directly to practice”

(ID239_paed_1yr). At the other end of the spectrum were those who viewed the framework as a standard part of their practice, evidenced as follows, “It is widely used in the literature, which means that research is easily transferrable to my work, because it uses a framework that my colleagues and I are familiar with” (ID44_adult_2yrs). Although many respondents are not explicitly using or talking about the ICF, a number reported always having it in their thinking, with varying opinions on the ease of theory- to-practice transition. Summary of key findings Survey respondents were typically at the lower end of experience, with a bias towards South Australian and rural practitioners. Respondents rated their ICF knowledge as “good”, valued the tool, and reported using the general framework aspects of the ICF more than the coding components. Comparison revealed significantly lower self-reported knowledge and use of the ICF in practitioners working with, and in settings predominantly servicing, children than those working with adults in combined acute and rehabilitation settings. There were no significant interactions related to ICF use or appreciation for practitioners from different locations, working in multidisciplinary teams or depending on years of practice. Respondents reported more advantages than disadvantages to using the ICF, but recounted experiencing more barriers than facilitators when endeavouring to implement it. Many described limited to no use of the ICF, with some rudimentary understanding evident. However, themes of using the ICF as a “way of thinking” and “wanting

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JCPSLP Volume 20, Number 3 2018

Journal of Clinical Practice in Speech-Language Pathology