Assessment and Management of Psychosocial Needs: Social Work Utilization in Comprehensive Cleft Team Care

Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives

OBJECTIVE

Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment.

DESIGN

PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).

RESULTS

Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.

CONCLUSION

Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.

Maternal perception of breastfeeding in children with unilateral cleft lip and palate: A qualitative interpretative analysis

BACKGROUND

Unilateral cleft lip and / or palate (UCL/P) is one of the most common congenital craniofacial differences. The objective of this study was to describe the maternal perception of breastfeeding in children with unilateral cleft lip and palate and to assess the role of breastfeeding counseling.

METHODS

This study was conducted using an interpretive phenomenological approach to explore the experience from the perspectives of mothers breastfeeding her UCL/P child. Twenty-eight mothers of patients with nonsyndromic UCL/P treated with nasoalveolar molding (NAM) therapy between April 2015 and April 2018 were selected during consultations at the Fundación Clínica Noel in Medellín, Colombia. Thematic analysis was conducted for qualitative data.

RESULTS

The findings resulted in six main categories: First contact with the CL/P team, access to early diagnosis and timely treatment, perceptions of parents about health personnel on breastfeeding of CL/P patients, perceptions of mothers toward breastfeeding, perception of advantages and disadvantages of the NAM technique regarding breastfeeding and assessment of the CL/P team. The interviewed mothers, both prenatally and postnatally, stated the benefits of initiating the process prenatally. There are still difficulties in reaching a timely diagnosis. Several mothers noted that health professionals and assistants determined the hospitalization, installation of a nasogastric tube or feeding through a baby bottle or syringe, which prevented the first contact between mother and child. Even though the exclusive breastfeeding process is difficult for these mothers, they acknowledge its immense advantages. Interviewed mothers considered using the NAM therapy advantageous as the obturator allowed a better bottle-feeding process. The interdisciplinary team generates satisfaction, motivation, expectations and happiness in the mothers who initiated this therapy with their children.

CONCLUSION

The participants related difficulties with exclusive breastfeeding. Mothers acknowledged the clinical results when using the NAM therapy and the support provided by the IBCLC. We encourage health providers in Medellín, Colombia, to seek education to enhance their clinical skills and promote and protect breastfeeding. Also, health professionals in other cities or countries could consider search more breastfeeding education as well.

Safeguarding children and young people requiring kidney replacement therapy: challenges and potential opportunities

Kidney replacement therapy (KRT) makes considerable physical and psychological demands on children, young people and their families. The impact can be wide-ranging, affecting education, employment, mental health, finances and relationships for both child and caregiver. It is vitally important for those working with these families to recognise the psychosocial challenges they face and to know the range of interventions available. This article explores the psychosocial impact of KRT, considering opportunities to minimise risk and optimise outcomes for children, young people and their families.

The Impact of Social Determinants of Health in Facial and Craniomaxillofacial Reconstruction: Can We Do Better?

Social determinants of health (SDOH) are integral to consider when delivering craniomaxillofacial and facial reconstructive care for patients. The American Cleft Palate-Craniofacial Association (ACPA) has instituted a formalized multidisciplinary care team model that recognizes such determinants and has aggregated patient-led organizations to strengthen patients' education and support system. This review discusses the need for all surgeons engaged in facial and craniomaxillofacial reconstruction to consider SDOH in their practice. Additionally, we explore how factors such as race, insurance status, education level, cost, and access to follow-up care, impact surgical care for craniosynostosis, facial trauma, orthognathic surgery, head and neck cancer, and facial paralysis. We propose that the ACPA team model be applied to other societies that care for the broader scope of patients in need of facial and craniomaxillofacial reconstruction to strengthen the communication, collaboration, and standardization of care delivery that is personalized to the needs of each patient.

Child Protective Services Referral in a Cleft Lip and/or Palate Population: Assessment of Prevalence, Indications, and Outcomes

OBJECTIVE

To determine the prevalence of, reasons for, and outcomes related to Child Protective Services (CPS) referral in an isolated and syndromic cleft lip/palate population.

DESIGN

Retrospective cohort study.

SETTING

Tertiary Children's Hospital.

PATIENTS

Any patient <18 years of age attending the multidisciplinary cleft team for care at our institution with a history of referral to CPS by the cleft team during the study period 2009 to 2014.

MAIN OUTCOME MEASURES

The number of children with CPS referrals, reasons for CPS referrals, outcomes of CPS referrals, associated psychosocial risk factors potentially predictive of CPS referral; demographics and cleft-related surgical history was also reviewed for each patient.

RESULTS

Of 1392 patients, 25 (1.8%) were identified with a history of referral to CPS. Average age at referral was 11 months; 76.0% of patients were <1 year of age. Most referrals (64.0%) were directly associated with issues related to cleft care. Identified psychosocial risk factors included financial strain, mental illness/cognitive disability, transportation issues, and inadequate social support. Nine families ultimately lost custody of their children temporarily (n = 5) or permanently (n = 4).

CONCLUSIONS

Cleft team family referral to CPS involves long-term patient care challenges requiring maximal medical and social support. Families are most commonly referred for issues related to medical neglect, which can lead to failure to thrive, delays in care, and ultimate removal from the home. Identifying families with known psychosocial risk factors and providing increased support may potentially help avoid referrals to CPS.