Implementing participation‐focused services: A study to develop the Method for using Audit and Feedback in Participation Implementation (MAPi)

Abstract

BackgroundIt is widely agreed that children's services should use participation‐focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence‐based knowledge translation strategy, to support implementation of participation‐focused practice in front‐line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers.MethodBest‐practice guidelines for using audit and feedback were followed. For audit, participation‐focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning.ResultsA Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians’ skills in participation‐focused behaviours (median = 3.00–5.00, interquartile range [IQR] = 2.25‐6.00), social processes (median = 4.00, IQR = 3.00–5.00), and behavioural regulation (median = 4.00–5.00, IQR = 3.00–6.00).ConclusionsMAPi provides a practical, off‐the‐shelf method for front‐line services to investigate and support their implementation of participation‐focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across‐services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.

Occupational therapy practice with children with developmental coordination disorder: An online qualitative vignette survey

“…In contrast, previous research has suggested that Allied Health Professionals (AHPs) find it challenging to implement participationfocused services (Kolehmainen et al, 2020;Pentland et al, 2016). Audit of clinical documentation suggests that less than a third of cases treated by AHPs targeted participation outcomes, and the child and parents rarely collaborated on these outcomes (Kolehmainen et al, 2020). However, experienced clinicians can find it difficult to articulate their intervention in clinical documentation, as they have internalised the key ingredients that they use in activities (Zanca et al, 2019).…”

“…However, their reports reflected the principles of participation-based therapy, including use of a goal-oriented, family and child centred, collaborative, strengths-based, ecological, and self-determined process (Palisano et al, 2012). In contrast, previous research has suggested that Allied Health Professionals (AHPs) find it challenging to implement participationfocused services (Kolehmainen et al, 2020;Pentland et al, 2016). Audit of clinical documentation suggests that less than a third of cases treated by AHPs targeted participation outcomes, and the child and parents rarely collaborated on these outcomes (Kolehmainen et al, 2020).…”

“…We developed an online survey involving a qualitative vignette. Clinical practice can be examined directly by observation, or indirectly via proxy measures such as interviewing clinicians (Hrisos et al., 2009), auditing medical records (Kolehmainen et al., 2020), or via clinical self-report of simulated behaviour in a clinical scenario using clinical vignettes (Hrisos et al., 2009). Direct measurement of practice is considered a ‘gold standard’.…”

Implementing an Electronic Patient-Reported Outcome and Decision Support Tool in Early Intervention

“… 27 61 Since EI programs vary considerably in their workflows, available resources, and readiness for change, implementing participation-focused innovations like the YC-PEM e-PRO may benefit from formal assessment of organizational culture and readiness for change, availability of resources for research partnership, and caseload and time constraints within the organization and broader service catchment. 33 34 We therefore can and should anticipate ample scope for further work to design hybrid type-2 and -3 approaches for testing the implementation of a YC-PEM e-PRO option within a broader EI service system, guided by systematic baseline assessment of each participating EI program and according to: (1) its research culture (e.g., Community Impacts of Research Oriented Partnerships [CIROP] 62 ; and (2) its practice behaviors such as adoption of participation-focused practices that are reinforced by tools like the YC-PEM e-PRO option (e.g., Method for using Audit and feedback in Participation implementation 63 64 ; Professional Evaluation and Reflection on Change Tool 65 ). Such programmatic assessment could help with testing how well the YC-PEM e-PRO performs in different conditions, how to leverage available resources to incentivize and prepare an EI site for implementation, and how to monitor service outcomes.…”

Enhancing Fairness in Performance Appraisals: A Conceptual Framework Through a Systematic Literature Review

“…Furthermore, feedback and participation stand as integral components within the design framework. Feedback is instrumental in informing both the ratee and rater about performance, facilitating improvement (Kolehmainen et al, 2020;Wenz et al, 2022). Participation involves individuals in goal setting and system establishment, although studies on its cognitive impact remain limited (Bogard et al, 2020).…”