Clinical Psychology and Cleft Care Dr Louise Dalton Consultant Clinical Psychologist, Spires Cleft Centre Chair, Cleft Psychology Special Interest Group

Who are we?  Psychologists are not psychiatrists –Do not prescribe medication –Clinical Psychologists undertake a psychology degree, and further doctoral training in clinical psychology  Study of people: how they think, how they act, react and interact.  Consider normal development, how our thoughts, feelings and behaviour are linked.

Who Needs Psychology?  Many people with a cleft do not have significant psychological difficulties  Living with a cleft brings a number of challenges, e.g. –Coping with staring and questions –Surgery; fears and disruptions –Decisions about possible further surgery  Parenting and growing up can be hard work for everybody!  Psychological support can be helpful in coping with these extra-ordinary challenges

What do Psychologists do?  Work in partnership with other members of the team –Support for new parents following diagnosis –Coping with questions and staring –Post natal depression –Tantrums & behavioural problems –School worries, academic progress –Friendships, teasing and bullying –Self confidence –Feeling good about appearance –Coping with clinics & surgery, fears about hospitals –Decision making about more surgery –Support for parents, siblings, children, young people, adults  Individuals, families, groups  Clinics, wards, schools

What do Psychologists do?  Consultation to other members of team  Service evaluation and audit –E.g. What do patients think of our cleft service?  Research –E.g. how can we identify those families who may need most support? –What helps some families cope so well?  Thinking psychologically about the whole service

Psychology Services in UK  Whole time equivalent Cleft Psychologists per 100 births  Newcastle3  Leeds3.9  SW & South Wales3  CleftNetEast3  Spires1.6  Great Ormond Street1.3  Manchester1  Liverpool0.8  Birmingham0.5  Trent0

Using Psychology to improve services  Clinical interview with parents before baby’s lip repair  Experience of diagnosis, coping with parenthood, views of service so far  No difference between parents who had an antenatal diagnosis or a diagnosis at birth  Experience of how diagnosis was given DOES make a difference at 3 months  Development & delivery of training for sonographers around issues relating to diagnosis  Newcastle team DVD project