Transition of Care for Young Adults With Cleft Lip and Palate: We’ve Got Some Growing up to Do !

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Background and purpose: For many young adults with cleft lip and palate (CLP), traditional team services come to an abrupt end at age 18, necessitating a transition from child-centered to adult-centered care. There is a shift in focus from the cleft itself and clinician reported outcomes to patient self-report about the perceived impact of the cleft. Transition also befalls the parents and team providers. We propose an evidence-based person-centered delivery model of care using the concepts of the International Classification of Functioning, Disability, and Health (ICF) (WHO, 2001, 2004). The ICF represents a shift from health condition and body impairment-centered descriptions of disability to a more comprehensive documentation, including a wider range of functionality indicators. This model of Transition of Care is proposed to facilitate a positive shift from pediatric to adult-centered care. It is timely for teams to embrace the concept of transition of care, and to provide services that recognize the importance of personal and environmental factors in facilitating holistic transition planning and service delivery (ICF, WHO, 2001), which are developmentally appropriate to young adults with CLP (Farre & McDonagh, 2017; Farre et al., 2016).The purpose of this proposed evidence based model is to provide a framework for redesigning the way services are delivered to a young adult with CLP. The concepts of this model are relevant to all specialists on the cleft palate team. The aim of this presentation is to create an awareness of young adults with CL/P who are generally a neglected population in terms of team care and to suggest a new and fresh approach to service delivery to these individuals with the emphasis on clinical resources.Content: A brief overview of adolescents and young adults with CLP and their multidisciplinary needs will be presented. A framework for a holistic service delivery model developed by Vallino and Louw (2017) will be presented. We will suggest strategies for teams to improve the care for young adults with CLP and share a clinical toolbox comprised of a compendium of resources.Conclusion: The proposed Service Delivery Model for young adults with CLP necessitates a change in perspective that embraces constructs such as person-centered care in order to ensure the best outcomes for these individuals. These concepts can be applied by all cleft palate team members. Adopting a life span perspective reinforces the understanding that living with and managing CLP is dynamic and that transition is a process rather than a point in a person's life.

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