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A national postal survey was sent to all speech and language therapy managers/directors in England and Wales (n =206), to identify individuals aged 8-18 years with a cleft palate, who have persisting communication difficul-ties. Twelve of the 303 young people identified in the survey were studied further through a residential intervention programme (July 1999). The findings have far-reaching implications for all involved in the management of these children/adolescents’ psychosocial welfare, especially the Cleft Palate Team and those responsible for their education. [The term ‘cleft palate’ incorporates those with cleft lip and palate and non-cleft velopharyngeal incompetence (VPI).]

Speech and language deficits frequently implicate accompanying psychosocial problems (such as low self-esteem). An alternative management approach is described which adopts a holistic paradigm and provides a unique opportunity for intensive work on communication within a supportive environment. The residential programme for 8-14 year olds with persistent communication difficulties incorporated cognitive, emotional and psychosocial dimensions of communication, co-ordinated with work on speech features. Although the programmes were developed for children with cleft palate, they have potential for benefiting a wide range of communication impairments of different aetiologies. A forthcoming manual with resource material developed by the research team will be used in studies across these groups.

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