This SIG 5 activity includes two articles from a forum on sharing research conducted in clinical settings around the world. The first article is a literature review about the psychosocial impacts of craniofacial care on patients and their caregivers. It highlights pediatric medical traumatic stress (PMTS) as a common difficulty impacting this population. The article begins with a review of the literature around how prenatal and early childhood medical diagnoses can impact caregivers. Authors discuss how burden of care for early surgery and frequent and ongoing medical appointments contributes to feelings of stress, anxiety, and development of medical trauma. Next, the article reviews literature on PMTS in the pediatric population and highlights some of the medical experiences the craniofacial population and their families may experience that put them at risk for developing PMTS. There are limited studies thus far examining PMTS in the craniofacial population, but preliminary findings do indicate that this population is at risk of both short term as well as lifelong psychosocial impacts. The article provides recommendations for screening measures that can be implemented in clinics and also highlights the importance of identifying and referring patients and families who may be experiencing PMTS. The author introduces trauma-informed care as a way to provide patients and caregivers with a sense of control by giving choices in the context of their medical care. Ways to incorporate trauma-informed care into craniofacial practice and to advocate and educate other multidisciplinary team members about trauma-informed care are also discussed. In conclusion, the article acknowledges how understanding PMTS can be helpful for speech-language pathologists (SLPs) in all contexts of craniofacial care, from multi-disciplinary team visits, to nasopharyngoscopy, and even in ongoing speech therapy visits. SLPs play an important role in screening, providing support, and encouraging resilience in their craniofacial patients. This leads to the second article, which is based on a survey conducted at a single healthcare institution aimed at examining how psychosocial barriers impact patient and family compliance with home exercise programs (HEPs). The authors begin by reviewing the literature around speech sound disorder treatment in the craniofacial population, interventions focusing on parent implementation and participation, and the influence of environmental factors in the participation and success of speech therapy. They draw attention to motor learning principles which emphasize a high frequency of practice and transfer of skills to affect change, as part of the motivation to improve parent involvement in speech therapy. The authors designed a 17-item survey based on prior research about psychosocial barriers and their own clinical experiences. The survey was sent to caregivers whose child received speech therapy at the study institution and was completed by 17 respondents (63% response rate). Discussion of the results revealed that the majority of participants completed HEP less than 75% of the time, and more than half of the caregivers reported two or more psychosocial barriers to completion. The authors offer insights into the nuanced factors that prevent consistent completion of speech HEPs. In conclusion, they discuss how understanding of psychosocial barriers can help SLPs to adjust their implementation of HEPs to better meet the needs of their parents and improve treatment outcomes.

Learning Outcomes
You will be able to:

• describe two strategies to reduce child stress and improve coping in the context of craniofacial care
• identify potential psychosocial barriers that commonly serve as inhibitors for patient completion of home exercise programs

Assessment Type
Self-assessment—Think about what you learned and report on the Completion Form how you will use your new knowledge.

Articles in This Course

1. Pediatric Medical Traumatic Stress in Individuals With Craniofacial Conditions by Canice E. Crerand, Kristin Billaud Feragen, Alexis L. Johns, Hailey Umbaugh, Madeline McClinchie, Amelia F. Drake, Carrie L. Heike, Joyce P. Yi-Frazier, and Nicola M. Stock, published in SIG 5, Volume 9, Issue 3, June 2024
2. Psychosocial Barriers to Completion of Speech Home Exercise Programs by Jennifer Torres, Sydney Gayner, Jessica Aceste, and Margaret Lico, published in SIG 5, Volume 9, Issue 3, June 2024