JCPSLP Vol 20 No 3 November 2018

Nutrition, swallowing, mealtimes: Recipes for success

The ICF as a “way of thinking” An exploratory study of Australian speech-language

pathologists’ perceptions. Kate Ross, Jane Bickford, and Ingrid Scholten

The International Classification of Functioning, Disability and Health (ICF) is a compelling framework and classification system with the potential to enhance person- centred care. This mixed methods study investigates the degree to which the ICF is used by speech-language pathologists (SLPs) in Australia and ascertains their knowledge, endorsement, and perceptions of ICF implementation. Survey data were collected from 117 SLPs and analysed statistically and thematically. Respondents rated their knowledge as “good” and reported using the broader ICF framework more than the detailed classification system. Comparison revealed significantly lower ICF knowledge and use in practitioners working with children and in settings serving children, than those in adult based settings or working with adults. The ICF was discussed as being “a way of thinking” and respondents strongly indicated desire to use it further. Education and promotion strategies should aim to enhance ICF uptake and holistic, person-centred care, leading to improved client outcomes and realisation of the 2030 vision of Speech Pathology Australia. A person-centred approach is central to speech- language pathology (SLP) practice (Speech Pathology Australia [SPA], 2011). The International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) is a comprehensive universal framework and classification system that supports such holistic practice. Its reach extends from clinical practice to use in service management, education, research and policy development, with potential to influence all levels of health care systems (WHO, 2013). The many advantages of the ICF contribute to its widespread acceptance. By shifting focus to holistic practice it can assist with clinical reasoning, problem solving and guide goal-setting (Nguyen et al., 2018). The ICF can help to clarify team roles, enhance communication within and beyond teams, and expand practitioners’ perceptions

of disability, thereby improving health care delivery (Alford, et al., 2015; Pettersson, Pettersson & Frisk, 2012; Vargus- Adams & Majnemer, 2014). Limitations of the ICF include its complex and unwieldy coding systems (Nguyen et al., 2018), unclear terminology (Bornbaum et al., 2015), and absence of classification for the personal factors component (Alford et al, 2015). Associated with these shortcomings is also a lack of provision for capturing subjective experience or quality of life (Pettersson et al., 2012). It can also be challenging to implement and difficult to access expert training in its use (Bornbaum et al, 2015). ICF integration into practice The applicability of the ICF to SLP practice has been discussed in special journal editions, such as Seminars in Speech and Language (2007, 28[4]) and International Journal of Speech Language Pathology (2008, 10[1–2]). Authors have addressed the ICF components theoretically, its general use in clinical practice, and application to specific service populations. The ICF has been used to: investigate the impacts of communication and swallowing impairment on clients’ lives (Baylor, Burns, Eadie, Britton, & Yorkston, 2011); create standardised assessments to capture such impacts (Threats, 2012); and for goal-setting and intervention planning (Bornman & Murphy, 2006). It has also provided a starting point for conceptualising functional intervention, such as the Life-Participation Approach used in aphasia (Chapey et al., 2008). A decade ago the ICF was described as not yet fully integrated into SLP practice (Ma, Threats & Worrall, 2008). This was also an issue in other health professions, such as physiotherapy (Jacob, 2013), occupational therapy (Stewart et al., 2013), and clinical rehabilitation (Wiegand, Belting, Fekete, Gutenbrunner & Reinhardt, 2012). Wiegand and colleagues (2012) found that while the ICF framework and resources had been successfully disseminated in the rehabilitation sector, its implementation was inconsistent. However, the expectation that SLPs will understand and use the ICF is clearly outlined in Speech Pathology Australia’s (SPA) Scope of Practice document (SPA, 2015). University curricula must now demonstrate that student SLPs are learning and using the ICF to meet professional standards prior to graduation (SPA, 2011). Study purpose The ICF clearly relates to a range of SLP practices but despite research into ICF applications, no study has



Kate Ross (top), Jane Bickford (centre), and Ingrid Scholten


JCPSLP Volume 20, Number 3 2018

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