Using the 'F-words' to adopt a holistic and child rights promoting approach in developmental assessment clinics in Sydney: a quality improvement study.

backgroundThe way childhood disability is understood and represented in various domains is evolving. The 'F-words for Child Development', derived from The International Classification of Functioning, Disability and Health, is a framework that is gaining increasing prominence. This paper reports on a quality improvement project in South Western Sydney, designed to encourage a more holistic, strengths-based approach to assessment, formulation and documentation in a child developmental assessment service. We implemented the 'F-words' framework (Function, Family, Fitness, Fun and Friends) into routine clinical practice.

methodsThe framework was incorporated into standardised clinic proformas, and regular team education and awareness building activities were conducted. We audited clinical reports pre-intervention and post-intervention to assess how well the 'F-words' framework was incorporated. We also assessed clinician and family perspectives and experiences with this tool using electronic surveys. Thematic analysis was performed on the open text responses.

resultsAn audit was conducted on 88 reports completed pre-intervention and 112 reports post-intervention. There was an improvement in the reporting of strengths post-intervention. 95% (n=106) of reports clearly documented the child's strengths at the start of the report compared with 74% (n=65) pre-intervention and 85% (n=95) documented at least 4 of the 5 F-words domains, compared with 8% (n=7) pre-intervention. Multidisciplinary clinicians (n=21) and families (n=18) responded to the electronic surveys. The 'F-words' framework was very well received, with most clinicians and families finding it an effective, easy and helpful tool for enhancing clinical assessment, presenting a balanced, non-deficit focused reflection of the child, broadening understanding of the child's strengths and empowering families by fostering a more collaborative approach. None of the respondents rated the tool as unhelpful, although a minority were undecided.

conclusionThe 'F-words' framework can be easily incorporated into clinical practice. Clinicians and families engaged with the service were positive about this approach.