Cerebral palsy check up: Supporting allied health professionals to provide the best service at the best time

Tailored multi-faceted knowledge translation intervention provided to allied health professionals (AHP: physiotherapists, occupational therapists, speech pathologists) who provide services to children with cerebral palsy in four Australian non-government organisations (collectively defined as the Commencing Knowledge Translation group) with the aim on increasing the implementation of routine clinical assessment and provision of evidence-based interventions provided to children aged 3-18 years. The intervention is implemented at each organisation for 2 years and includes four strands: (1) Identification of “Knowledge Brokers” (expert research translators) based at each organisation who will aim to re-dress workplace barriers unique to each site. Each organisation will nominate one or more knowledge brokers for their site. The knowledge brokers will work with the project team, the organisation’s management and the AHPs to act as agents in the process of translating and contextualising evidence for users within the organisation. Materials and procedures used to support knowledge brokers include 1 day training sessions, about the knowledge broker role, delivered by researchers at the beginning and mid-way through the project; peer support through periodic (approximately twice yearly) telephone conferences involving knowledge brokers across organisations; provision of an on-line discussion forum monitored by researchers. Knowledge brokers are intended to provide support to AHP within their own organisation throughout the trial period. Experience and ongoing fidelity of the broker role will be evaluated through focus groups conducted at baseline, 6, 12, and 24 months. (2) Provision of a customised e-evidence library - “CP Decision” - to enable AHPs rapid access to synthesised and critiqued cerebral palsy research evidence. This library employs a traffic light system corresponding to evidence levels and will be updated on an ongoing basis to accommodate new evidence as it emerges. Materials are an on-line database of cerebral palsy specific evidence. Procedures include providing all participating organisations with a password that can be used by employees to log in and review the information as frequently as each individual AHP wishes. CP Decision will be available to all organisations throughout the study period. Intervention fidelity will be assessed for each organisation monthly, by evaluating the frequency of 'visits' to the site as well as by determining the most frequently viewed pages. (3) Negotiated education and professional development days for AHP at partner organisations (implemented by the project investigators, organisation-based knowledge brokers and other experts) about ‘how to’ implement or administer the current and most effective treatment and measurement options for cerebral palsy. This intervention strand will include two elements: a) a study specific element provided to all organisations and b) an organisation-specific element, tailored to meet the needs of individual organisations. The study-specific element is provided at baseline, 6, 12 and 24 months by researchers in a face to face professional development workshop format for half a day. Attendance of participating AHP is recorded, and fidelity assessed via feedback on learning sought through an evaluation form. Organisation-specific elements are negotiated annually with the researchers and can include purchase of educational events (e.g. experts to deliver training sessions on site at the organisation; or payment of registration fees for individual AHP to attend courses) or resources to support implementation of evidence based practices for children with cerebral palsy (e.g. purchase of evidence-based assessment tool). Procedures involve knowledge brokers collaborating with local AHP and managers to develop an annual professional development plan, presenting (in writing) the plan to researchers for consideration and approval against an agreed budget. Fidelity/processes will be assessed by recording of all education events and professional development purchases made for each organisation throughout the project and monthly reporting to the project steering committee. (4) Provision of an electronic cerebral palsy clinical outcomes database (CP Check-UpTM, provided by Cerebral Palsy Alliance). This electronic tool will be used by AHPs to record routine valid and reliable clinical measurements of participating children and to summarise the therapeutic interventions provided to these children. Through generation of an electronic report, the tool will provide feedback about changes in outcomes of individual children over time, guiding evidence-based clinical decision making to support direct therapeutic intervention and timely referral to ancillary services. Materials provided are a study manual and paper-based forms to enable AHP to learn what is included and how to access the database and enter details for children. In addition, personalised log-in details are provided for all participating AHP so that they can access the electronic database and enter data for included children. The Database is made available to each organisation for the period of the study. Support is provided by researchers and the manager of the database. Fidelity is assessed as one key outcome of the study - by extracting data related to number of children for whom an assessment is recorded, frequency of assessment of each included child and proportion of the minimum data set recorded for each assessment.