(11) North American Cleft and Craniofacial Team Composition: A Survey of the ACPA

Abstract:

Introduction: A collaborative, interdisciplinary approach has been the standard of care for treating patients with orofacial clefts and craniofacial anomalies since the 1900s. Currently, the American Cleft Palate-Craniofacial Association (ACPA) oversees the approval of cleft and craniofacial teams in the United States and Canada, utilizing the Standards for Cleft and Craniofacial Teams produced in 2008. These guidelines provide minimum requirements for cleft teams including mandating each team have access to orthodontic, surgical, and speech-language pathology services.1 However, the guidelines allow teams to tailor their organization to their needs, providing opportunities to outsource other specialized care. Past studies exploring the diversity of ACPA approved teams are outdated, with the most recent survey produced by Strauss in 1998.2 Thus, the objective of this study is to provide information regarding the composition of US and Canadian cleft and craniofacial teams to better understand provider and resource allocation.

Methods: This is a cross-sectional observational study of ACPA approved cleft and craniofacial teams as of February 2, 2023. ACPA teams were identified through indexing on the ACPA official website (acpacare.org). Information was gathered via websites, emails, and phone calls, to determine the breakdown by specialty of the primary team members that were present at every cleft team meeting. The specialty and training of the team director also was recorded. Possible specialists included an oral and maxillofacial surgeon (OMS), plastic surgeon, otolaryngologist (ENT), speech-language pathologist (SLP), orthodontist, pediatric dentist, audiologist, geneticist, social worker, pediatrician, ophthalmologist, general dentist, psychologist, prosthodontist, neurosurgeon, and periodontist. To improve response rates, teams that did not respond to initial inquiry were sent 2 follow-up emails.

Results: Two hundred cleft and craniofacial teams were identified at the time of survey, including 187 teams in the United States and 13 Canadian teams. Information regarding team composition was extracted through sufficient information available online for 50 teams (25%). The remaining 150 teams were contacted via email with 43 teams responding, lending an email response rate of 28.66%. Overall, information for 93 teams in the United States and Canada (46.5%) was collected. Of note, 51 (54.8%) of teams include an OMS, 84 (90.3%) include a plastic surgeon, and 67 (72.0%) include an ENT present at every team meeting. Forty-five teams (48.4%) were noted to include both a plastic surgeon and an OMS. Oral and Maxillofacial surgeons served as the directors of 11 teams surveyed, whereas plastic surgeons served as the directors for 66 teams, and otolaryngologists served as directors on 6 teams.

Conclusion: Cleft and craniofacial team models around North America are highly varied. Almost half of all teams include both a plastic surgeon and OMS, with a majority of teams being directed by plastic surgeons. Future work should focus on the factors influencing the composition of such teams including their relation to patient volume and geographic location. References 1. American Cleft Palate-Craniofacial Association. Standards for Approval of Cleft Palate and Craniofacial Teams. Accessed March, 17 2024. https://acpa-cpf.org/wp-content/uploads/2019/04/Standards-2019-Update.pdf.2. Strauss, R. P. (1998). Cleft palate and craniofacial teams in the United States and Canada: a national survey of team organization and standards of care. The American Cleft Palate-Craniofacial Association (ACPA) Team Standards Committee. Cleft Palate Craniofac J, 35(6), 473-480. https://doi.org/10.1597/1545-1569-35.6.473

Table 1: Composition and Leadership of North American Cleft Teams