Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
School of Health Sciences, The University of Western Sydney, Camperdown, NSW, Australia.
Int J Lang Commun Disord. 2024 Nov-Dec;59(6):2423-2440. doi: 10.1111/1460-6984.13091. Epub 2024 Jul 24.
Children with a cleft palate (with or without a cleft of the lip) often require speech-language therapy (SLT) services to achieve age-appropriate speech. For many children, this involves attending SLT services delivered by both specialised cleft team speech-language therapists (SLTs) and a local, community or school-based SLT. Given that these two different SLTs are typically involved in the child's care, it is important to ensure that effective communication, coordination and collaboration occur between them. This is known as continuity of care. While continuity of care in speech therapy has not generally been evaluated, in medicine it has been shown to improve health outcomes.
To identify what is known from the existing literature about processes for continuity of care in cleft speech therapy services.
METHODS & PROCEDURES: A scoping review was conducted using Arksey and O'Malley's methodological framework. Seven databases were searched including MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, PsychINFO, Scopus, Web of Science and SpeechBITE. Covidence was used to screen 733 initial articles and five studies met the inclusion criteria. Thematic analysis was conducted to identify global and subthemes.
Five papers were included for analysis. These identified two salient characteristics of cleft speech therapy continuity of care: (1) it is a continuous cycle and (2) it is complex. Although parents are integral team members, cleft and community SLTs must be responsible for initiating communication and collaborating. Furthermore, cleft SLTs have a crucial role in disseminating information and resources, as well as offering guidance and support.
CONCLUSIONS & IMPLICATIONS: Given that only five studies were included, there is a need to gather more information from parents, community SLTs, and cleft SLTs to understand their experiences and perspectives. From what is known, there are breakdowns in the processes needed for continuity of care, including confusion regarding roles and responsibilities, and community SLTs lacking confidence, knowledge and support. Recommendations are provided to facilitate improvements in continuity of care.
What is already known on the subject Children with CP±L often require SLT from two different clinicians including a specialised cleft SLT and a community or school-based SLT. As such, it is important that effective communication and collaboration occur between them to ensure continuity of care. What this study adds to the existing knowledge This study identified a breakdown in the processes necessary for continuity of care. According to community SLTs, there is a discrepancy between their expectations and current practices. This scoping review has identified two critical characteristics of effective continuity of care: (1) it operates as an ongoing cycle; and (2) it is a complex, multifaceted endeavour. What are the practical and clinical implications of this work? This study highlights the importance of cleft and community SLTs taking the initiative in communication and collaboration, rather than solely relying on parents as intermediaries. By offering practical recommendations, this research aims to improve continuity of care, potentially fostering greater awareness and advancements in service delivery.
患有唇腭裂（伴有或不伴有唇裂）的儿童通常需要言语语言治疗（SLT）服务，以达到与年龄相适应的言语水平。对于许多儿童来说，这涉及到接受由专门的腭裂言语治疗师（SLT）和当地社区或学校的 SLT 共同提供的 SLT 服务。鉴于这两个不同的 SLT 通常都参与到儿童的护理中，确保他们之间进行有效的沟通、协调和合作非常重要。这被称为连续性护理。虽然连续性护理在言语治疗方面尚未得到普遍评估，但在医学领域，它已被证明可以改善健康结果。
确定现有文献中关于腭裂言语治疗服务连续性护理过程的相关知识。
本研究采用 Arksey 和 O'Malley 的方法论框架进行了范围综述。检索了包括 MEDLINE 通过 OVID、EMBASE 通过 OVID、CINAHL 通过 EBSCO、PsychINFO、Scopus、Web of Science 和 SpeechBITE 在内的七个数据库。使用 Covidence 对 733 篇初始文章进行了筛选，其中 5 篇研究符合纳入标准。采用主题分析方法识别出全局和子主题。
纳入了 5 篇论文进行分析。这些论文确定了腭裂言语治疗连续性护理的两个显著特征：（1）它是一个连续的循环；（2）它是复杂的。尽管父母是不可或缺的团队成员，但腭裂和社区 SLT 必须负责发起沟通和协作。此外，腭裂 SLT 在传播信息和资源、提供指导和支持方面发挥着关键作用。
鉴于仅纳入了 5 项研究，有必要从父母、社区 SLT 和腭裂 SLT 收集更多信息，以了解他们的经验和观点。根据已知信息，连续性护理所需的流程存在缺陷，包括角色和职责混淆，以及社区 SLT 缺乏信心、知识和支持。本研究提出了一些建议，以促进连续性护理的改善。
目前已知患有 CP±L 的儿童通常需要来自两位不同临床医生的 SLT，包括专门的腭裂 SLT 和社区或学校的 SLT。因此，确保他们之间进行有效的沟通和协作对于连续性护理至关重要。本研究在现有知识的基础上有何新增：本研究发现连续性护理过程中存在缺陷。根据社区 SLT 的说法，他们的期望和当前实践之间存在差异。本范围综述确定了有效的连续性护理的两个关键特征：（1）它作为一个持续的循环运作；（2）它是一个复杂的、多方面的努力。这项工作的实际和临床意义是什么？本研究强调了腭裂和社区 SLT 主动沟通和协作的重要性，而不仅仅依赖父母作为中介。通过提出切实可行的建议，本研究旨在改善连续性护理，从而有可能提高服务提供的意识和发展。
