American Council of Academic Plastic Surgeons
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Barriers to speech language therapy in global cleft care settings: an analysis of Smile Train partner hospitals
Emily Chwa, BA1; Jenna Stoehr, BA1; Arun K. Gosain, MD12
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA 2Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA

Background: Speech language therapy is an integral component of comprehensive cleft care. Smile Train, a nonprofit organization, supports a global partner hospital network where treatment is provided for children with cleft lip and palate. Smile Train periodically surveys its partner hospitals to elucidate strengths and areas for improvement
Methods: The survey was distributed to all Smile Train partner hospitals in 2018 and 2020. Questions regarding speech programs were analyzed with descriptive statistics and compared across the available time frame for all programs and by geographic region
Results: Smile Train has 1,167 partner hospitals, and 110 have formal speech partner programs that provide children with treatments and assessments. 518 sites responded in 2018, and 510 sites responded in 2020 (Table 1). Many sites reported that they face a multitude of barriers to accessing speech therapy. In the most recent survey (2020), the most common challenges to accessing care were an inability to travel (54.1%) and patients being lost to follow-up (40.2%). One-third of sites (32.9%) reported that they did not have access to any speech providers. Partner hospitals in Asia (other than China) reported the least amount of access to speech therapy providers, with 47.7% lacking any providers. For sites with speech providers, speech therapy was provided by speech-language pathologists (SLPs) with a Masterís degree in speech language therapy (37.4%) or SLPs in training (19.7%). 43% of sites relied on speech therapists who presumably did not have formal training as SLPs, most commonly nurses (19.7%), assistants (13.2%), and social workers (9.3%). 7.6% of speech providers were members of the community or family. From 2018 to 2020, there was a 10.2% increase in access to speech therapy, and small increases in access to local language materials (6.9%) and connections with local providers (4.9%)
Conclusion: While significant structural barriers remain regarding access to speech therapy after cleft palate repair, results from the Smile Train partner hospital survey demonstrate that access to care may be improving and identify specific areas for future development. Improvement can be achieved by enhanced training and recruitment of SLPs and addressing travel limitations through telemedicine practices to increase accessibility.

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