Evaluating the Impact of a Global Cleft Speech Mentorship Program on Expanding Practitioner Competency in Low- and Middle-Income Countries.

A primary challenge in global cleft care lies in the limited opportunities for cleft-specific training and mentorship available to speech practitioners worldwide, particularly in low-income and middle-income countries (LMICs). In addition, the limited number of speech therapists with cleft experience in LMICs creates a significant barrier to access to care for individuals with cleft lip and palate globally. The inaccessibility of cleft-specific clinical instruction and cleft-trained speech therapists impacts the effectiveness of intervention and, subsequently, the speech-language development of cleft-affected individuals worldwide. A structured virtual clinical mentorship program targeting speech practitioners of all skill levels in LMICs was established to address this gap in comprehensive cleft care provision. This article will examine the effectiveness of a structured cleft speech mentorship program in expanding practitioner competency in LMIC communities and, as a result, building capacity for cleft speech care globally. The authors will outline various aspects of the development and implementation of this cleft speech mentorship program, including rationale, participant recruitment, program requirements, and impact assessment tools utilized. An analysis of pre-program and post-program data will be conducted to evaluate the degree to which clinical skills were improved, identify persistent areas of weakness, and examine the effectiveness of the program in expanding speech practitioner competency.

Impact of an International Training on Interventionists' Expertise in Cleft Palate Speech: Results From Oaxaca, Mexico.

PURPOSE: International cleft lip and palate surgical charities recognize that speech therapy is essential for successful care of individuals after palate repair. The challenge is how to ensure that cleft speech interventionists (i.e., speech-language pathologists and other speech therapy providers) provide quality care. This exploratory study investigated effects of a two-stage cleft training in Oaxaca, Mexico, aimed at preparing speech interventionists to provide research-based services to individuals born with cleft palate. Changes in the interventionists' content knowledge and clinical skills were examined. METHOD: Twenty-three cleft speech interventionists from Mexico, Guatemala, and Nicaragua participated in a hybrid two-stage training, completing an online Spanish cleft speech course and a 5-day in-person training in Oaxaca. In-person training included a didactic component and supervised clinical practice with 14 individuals with repaired cleft palates. Testing of interventionists' content knowledge and clinical skills via questionnaires occurred before the online course (Test 1), immediately before in-person training (Test 2), and immediately after in-person training (Test 3). Qualitative data on experience/practice were also collected. RESULTS: Significant increases in interventionists' overall content knowledge and clinical skills were found posttraining. Knowledge and clinical skills increased significantly between Tests 1 and 2. Clinical skills, but not knowledge, showed further significant increases between Tests 2 and 3. Posttraining, interventionists demonstrated greater expertise in research-based treatment, and fewer reported they would use nonspeech oral motor exercises (NSOME). CONCLUSIONS: Findings provide preliminary support for such two-stage international trainings in preparing local speech interventionists to deliver high-quality speech services to individuals born with cleft palate. While content knowledge appears to be acquired primarily from the online course, the two-stage training incorporating in-person supervised practice working with individuals born with cleft palate may best enhance continued clinical skill development, including replacement of NSOME with evidence-based speech treatment. Such trainings contribute to building capacity for sustainable quality services for this population in underresourced regions.

Global partnerships to create communication resources addressing Sustainable Development Goals 3, 4, 8, 10, and 17.

PURPOSE: This commentary describes the development of global partnerships, capacity-building, and the basis for the creation of a website (Leadersproject.org) used throughout the world that contains free educational resources for the assessment and treatment of people with communication disabilities (PWCD). This website contains speech-language assessment and treatment materials, online skill-building courses, over 200 instructional videos, train-the-trainer course materials, and syntheses of important research and trainings in over 30 languages. This commentary relates the work from leadersproject.org to the United Nations Sustainable Development Goals (SDGs). RESULT: Through this website, the authors have established ongoing global partnerships with other health and education professionals. Moreover, PWCD and their families have used the website for information and support throughout the world. Speech-language pathologists (SLPs) and other health and education professionals use these materials to host capacity-building trainings and to support the development of knowledge and skills to local professionals for the benefit of PWCD. The Leadersproject.org resources have been influential and impactful as measured by approximately 24 000 visits from over 130 countries throughout the world. CONCLUSION: The authors of this paper continue to establish partnerships worldwide to spread education and increase the quality of care provided to PWCD. This commentary paper focuses on the United Nations Sustainable Development Goals (SDGs): good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8), reduced inequalities (SDG 10), partnerships for the goals (SDG 17).

Barriers and Resources to Cleft Lip and Palate Speech Services Globally: A Descriptive Study.

BACKGROUND: Although a number of international cleft organizations and cleft professionals in low- and middle-income countries (LMICs) have built and supported comprehensive cleft care and speech therapy models to address the shortage of speech services in LMICs, the specific speech needs of individuals with cleft lip and palate (CLP) in such countries remain unknown. The objective of this study was to evaluate the barriers to accessing speech services for patients with CLP as well as the resources and models of speech services that are currently available for individuals with CLP in LMICs, with the goal of better understanding the needs of this population. METHODS: Qualitative and quantitative methods consisted of Smile Train partner surveys that were distributed June 25th to July 31st, 2018 worldwide. Surveys were distributed through Smile Train's online medical database, Smile Train Express, which every Smile Train partner uses to report their Smile Train sponsored treatment outcomes. A total of 658 Smile Train partners responded to the surveys. Respondents included surgeons, speech therapists, orthodontists, administrators and nurses who represented non-governmental organizations, hospitals (private or public), hospital groups, and private clinics. RESULTS: Results indicated that lack of resources, including access to local speech providers and language materials, as well as financial constraints such as patient travel and speech treatment costs, are the most commonly reported barriers to accessing speech services across all geographic regions surveyed. CONCLUSIONS: Improving access to CLP speech services in LMICs may require strategies that address lack of speech providers, language materials, and financial constraints.