JCPSLP Vol 20 No 3 November 2018

Perceived utility Respondents reported valuing the ICF framework in specific settings and for certain tasks, such as in relation to core components of practice: decision-making, holistic thinking and clinical reasoning. Almost two thirds of the respondents also commented that the ICF promotes a holistic, person- centred care, an approach endorsed by SPA (2011). Furthermore, the ICF was seen to benefit clients and their families by involving them in treatment, improving treatment outcomes and quality of life. These findings bode well for continuing uptake. ICF uptake Unsurprisingly, respondents indicated that they used the ICF for clinical rather than management purposes, consistent with their employment as practitioners. The fact that 76% of respondents acknowledge use of the ICF for goal-setting is encouraging; this is arguably the fulcrum of therapeutic intervention and likely to have a significant influence on clinical interactions. Several comments by practitioners reflected rudimentary understanding, with a belief expressed by some that the ICF only applies in certain settings. The lower uptake of, and knowledge about, the ICF for practitioners in paediatric settings may in part reflect that the ICF was initially presented in adult health contexts, with integration of the paediatric perspective occurring only in 2012 (WHO-FIC Resolution 2012). Also, different practice models and priorities are applied within education settings, where a health-related framework may be considered irrelevant. Resources highlighting the relevance of applying the ICF when working with children outside the health care system include Westby and Washington’s (2017) comprehensive, practical tutorial. It reviews the ICF framework, describes its implications for SLPs, distinguishes between the frequently confused concepts of activity and participation, and demonstrates its use for assessment and intervention purposes using a case study. A lower uptake of the ICF by practitioners working in acute settings may be due to the dominance of the medical model, challenging application of a biopsychosocial approach (McCooey-O’Halloran, Worrall, & Hickson, 2004). In contrast, SLPs working in outpatient rehabilitation, private practice, university or other settings reported higher use of the ICF. The ICF complements the functional and holistic focus of the outpatient rehabilitation setting, where medical issues are less pressing, and compensation and adjustments to the client’s new life gain focus (Vargus- Adams & Majnemer, 2014). However, the ICF pertains to all people and settings (WHO, 2001). Employment of the ICF by practitioners across different settings would assist in the creation of a common ground, enhancing transitions – for example, client transfer from hospital to outpatient rehabilitation (Nguyen et al., 2018), and provide a shared promoting superior, holistic, person-centred care (Vargus- Adams & Majnemer, 2014), it is concerning that health professionals, including SLPs, report limited use. This could lead to restricted consideration beyond impairment of clients’ contextual factors and meaningful social participation, potentially contributing to poorly tailored therapy (Cunningham & Rosenbaum, 2015). Australian SLPs, consumers and stakeholders have collaborated to create a vision for the profession in 2030 (SPA, 2016) language for inter-professional practice. Implications of limited uptake Considering the ICF’s established effectiveness in

wherein concepts of the wider community, of clients beyond impairment, and of a common language between professions are considered. The ICF can assist the profession to achieve these goals. Transition from theory to practice Researchers recognise the potential of the ICF to facilitate a shift in culture towards a biopsychosocial approach to practice (Vargus-Adams & Majnemer, 2014). Many practitioners in the current study reported “wanting to use the ICF further” and sought specific examples of ICF use, including for assessment, intervention and creating like-minded workplaces. Although further research is warranted in order to develop practical evidence-based examples for ICF application in practice (Nguyen et al., 2018), action to improve ICF-related knowledge translation can begin by targeting reported facilitators and barriers to its implementation. Respondents described more barriers than facilitators. They included challenges with policy and funding, time and other resource constraints, unsupportive workplace cultures, and limited personal and colleagues’ knowledge and application, all of which are critical to integration of new knowledge into practice (Stewart et al., 2013). A shift towards workplace cultures that support and encourage the ICF is necessary in order to stimulate increased use. Several comprehensive approaches that support ICF integration have been implemented: Portugal was the first to adopt the ICF across its education sector (Sanches-Ferreira, Lopes-dos-Santos, Alves, & Silveira-Maia, 2018); Italy has employed a regional approach (Francescutti et al 2009), and Ontario, Canada is implementing a population level early intervention service for children that involves evaluation of children’s communicative participation outcomes following therapy (the Preschool Speech and Language Program; Cunningham & Rosenbaum, 2015). In Australia the National Disability Insurance Scheme (NDIS), which is conceptually underpinned by the ICF (NDIS, 2013), will expose a higher proportion of Australian SLPs, especially those working with children, to ICF principles. Following an international study into application of the ICF in occupational therapy, Stewart and colleagues (2013) suggested ways to improve ICF uptake that can be implemented at the local level, including experiential learning, either independently or in multidisciplinary teams, and learning from and with each other about the ICF through discussions and debates. Creation of a SLP special interest group might provide a forum for such activities. Small projects could be undertaken, including developing forms that promote the use of the ICF for assessment or reporting purposes or negotiating simplification of ICF terminology to increase accessibility; particular attention to differences between activity and participation is warranted. More case studies conveying different aspects of the ICF could be developed. Guided expert facilitation in individual workplaces has been successful in facilitating ICF implementation where training can be personalised, depending on the group’s knowledge level. For example, a change-management process enabled the ICF to be adopted within a stroke unit (Tempest & Jefferson, 2015). Accredited university programs can guarantee that students are learning and using the ICF (SPA, 2011) and students may know more about the ICF than their placement educators (Di Tondo et al., 2018). In a mutually

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JCPSLP Volume 20, Number 3 2018

Journal of Clinical Practice in Speech-Language Pathology