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

Background - The 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.

Methods - The 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.

Results - An 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.

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