Applying the ICF-CY to Specialist Speech-Language Pathologists' Practice With Toddlers With Cleft Palate Speech

Objective: To evaluate how the practice of specialist speech-language pathologists (SLPs) working with young children with cleft palate +/- cleft lip (CP +/- L) maps onto the International Classification of Functioning, Disability, and Health - Children and Youth version (ICF-CY) and consider the functionality of the categories of the ICF-CY for this specialist area of practice. Design: Cross-sectional, qualitative study. Setting: Semistructured face-to-face interviews were conducted with SLPs working in tertiary-level hospitals, universities, and public clinics. Participants: Six specialist SLPs with 17 to 39 years of experience working with young children with CP +/- L as researchers and clinicians in Australia, Brazil, Denmark, Ireland, New Zealand, and the United States. Main Outcome Measure(s): Specialists' practices were captured using in-depth, semistructured interviews. Data collected were analyzed by directed content analysis applying the ICF-CY as a coding schema. Results: In total, 4077 data points were coded. Most mapped onto Body Structures (684, 16.8%), Body Functions (906, 22.2%), and Environmental Factors (1626, 39.9%) with less emphasis on Activities and Participation (560, 13.7%). A "best fit" approach was taken to topics that did not map exactly onto categories of the ICF-CY (eg, velopharyngeal insufficiency [VPI]); however, there was not always an ideally suitable category available. Conclusions: The current study revealed strengths and challenges in categorizing practice within the ICF-CY for children with CP +/- L, including collaboration with parents and significant others, specificity around speech, language, and articulation, and the different types of VPI. Therefore, future discussion around how best to use the framework with children with CP +/- L is needed.