Continuity of Care in Cleft Palate Speech-Language Pathology Services

Abstract

Children born with cleft palate often require long-term speech-language pathology (SLP) intervention to support communication development. In Australia and New Zealand, care is typically delivered through a dual service model in which children attend periodic reviews with a hospital-based cleft team SLP while receiving therapy from a community-based SLP closer to home. This model requires coordination between cleft team SLPs, community SLPs, and parents. Achieving continuity of care across these stakeholders is essential to optimise speech, language and feeding outcomes, yet challenges in communication and information sharing may affect care delivery. Despite its recognised importance in healthcare, continuity of care has been underexplored within cleft speech services.

Drawing on Haggerty et al.'s (2003) framework, this thesis examines three dimensions of continuity of care in cleft speech services: informational continuity (knowledge transfer between providers and families), management continuity (coordinated care across settings), and relational continuity (ongoing relationships between families and clinicians).

The thesis comprises five publications: a scoping review, three qualitative studies exploring the perspectives of cleft team SLPs, community SLPs, and parents, and a synthesis paper. The scoping review identified fragmented processes for achieving continuity of care internationally, including unclear roles, inconsistent communication practices, and limited access to specialist support.

Three qualitative studies using reflexive thematic analysis explored stakeholder perspectives in Australia and New Zealand, highlighting the importance of relationships in supporting collaboration across services.

The final synthesis paper introduces the Tri-Care Cleft Speech Pathology Model, positioning cleft team SLPs, community SLPs, and parents as collaborative partners and providing recommendations to strengthen continuity of care in cleft speech services.