Supporting Our Cleft and Craniofacial Patients Beyond the Clinic: Scholarships to Promote Academic Achievement

Villavisanis, Dillan F.; Folsom, Nancy; McKenna, Rachel A.; Taylor, Jesse A.

doi:10.1177/10556656221089154

Cited by 6 publications

(4 citation statements)

References 6 publications

(6 reference statements)

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“…One such strategy has been the implementation of a nurse navigator to act as a primary point of contact between families and the institutional cleft team, who plays a similar but broader role than the feeding-support described by Pandya et al 15,17 The nurse navigator also provides support in addressing financial concerns, navigating counseling, and obtaining a prenatal evaluation. 17,26 Importantly, this study demonstrates socioeconomic and temporal factors together may most significantly impact weight gain in patients with CL/P, suggesting a window of opportunity for intervention by multidisciplinary teams. Perhaps future investigations may include prospective studies aimed to address the critical 4-to 8-week window described here.…”

Section: Discussionmentioning

confidence: 74%

Socioeconomic Disparities in Failure to Thrive and Weight Gain for Patients With Cleft Lip and Palate

Villavisanis,

Morales,

Wagner

et al. 2023

FACE

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Background: Given the relatively resource-intensive burden of treating orofacial clefting and its functional and aesthetic sequelae, it is perhaps unsurprising that lower socioeconomic status is known to have adverse effects on outcomes in patients with cleft lip and/or palate (CL/P). Although outcomes in patients with CL/P are known to be influenced by socioeconomic status, the relationship between socioeconomic status and age-related weight gain has not been described. This study aimed to determine time-specific socioeconomic disparities in weight-for-age Z-scores and failure to thrive in patients with CL/P. Methods: This retrospective study evaluated patients presenting with CL/P from 2009 to 2019 at a tertiary children’s hospital. Failure to thrive status was determined by weight-for-age Z-scores less than −2.00 (second percentile) or from the EHR. Median income by block group was determined from US 2019 census data. Results: Multivariate linear regression models controlled for syndromic status, sex, and race revealed significant associations between median block group income and weight-for-age Z-scores at 4 weeks (β = .14, P = .009), 6 weeks (β = .15, P = .003), and 8 weeks (β = .14, P = .002). Mann Whitney U tests revealed significantly different weight-for-age Z-scores between low-income and high-income groups at 4 weeks ( P = .002), 6 weeks ( P < .001), 8 weeks ( P < .001), 10 weeks ( P = .005), and 12 weeks ( P = .004). Conclusions: Patients with CL/P and lower socioeconomic status may be most susceptible to disparities in weight gain between 4 and 8 weeks of age. Lower socioeconomic status was an independent predictor of failure to thrive for patients with CL/P in this cohort. This study highlights a welcome opportunity for timed intervention in patients with CL/P and lower socioeconomic status.

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Section: Discussionmentioning

confidence: 74%

Socioeconomic Disparities in Failure to Thrive and Weight Gain for Patients With Cleft Lip and Palate

Villavisanis,

Morales,

Wagner

et al. 2023

FACE

Self Cite

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“…17 The nurse navigator also provides support in navigating counseling, obtaining a prenatal evaluation, and addressing financial concerns. 17,39 Importantly, this study demonstrates geospatial and socioeconomic factors together may most significantly impact presurgical services, suggesting a welcome opportunity for intervention by multidisciplinary teams. Results from this study may further underscore the importance of cultivating a diverse clinician and surgical workforce in optimally treating patients from a variety of socioeconomic and racial/ethnic backgrounds.…”

Section: Discussionmentioning

confidence: 78%

Geospatial and Socioeconomic Factors Interact to Predict Management and Outcomes in Cleft Lip and Palate Surgery: A Single Institution Study of 740 Patients

Villavisanis

Wagner

Morales

et al. 2023

The Cleft Palate Craniofacial Journal

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Objective Determine interactions between geospatial and socioeconomic factors influencing cleft lip and/or cleft palate (CL/P) management and outcomes. Design Retrospective review and outcomes analysis (n = 740). Setting Urban academic tertiary care center. Patients 740 patients undergoing primary (CL/P) surgery from 2009 to 2019. Main Outcomes Measures Prenatal evaluation by plastic surgery, nasoalveolar molding, cleft lip adhesion, and age at CL/P surgery. Results Prenatal evaluation by plastic surgery was predicted by the interaction between higher patient median block group income and shorter patient distance from the care center (OR = 1.07, p = 0.022). Nasoalveolar molding was also predicted by the interaction between higher patient median block group income and shorter distance from the care center (OR = 1.28, p = 0.016), whereas cleft lip adhesion was predicted by higher patient median block group income alone (OR = 0.41, p < 0.001). Lower patient median block group income predicted later age at cleft lip (β = −67.25, p = 0.011) and cleft palate (β = −46.35, p = 0.050) repair surgery. Conclusions Distance from the care center and lower median income by block group interacted to significantly predict prenatal evaluation by plastic surgery and nasoalveolar molding for patients with CL/P at a large, urban, tertiary care center. Patients living farthest from the care center who received prenatal evaluation by plastic surgery or who underwent nasoalveolar molding had higher median block group income. Future work will determine mechanisms perpetuating these barriers to care.

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“…45,46 A patient-centered approach is pivotal as these social phenomena fluctuate widely across patients of different age groups, socioeconomic or cultural background, and clinical trajectory. Educational initiatives, such as Individualized Education Programs 12 and higher education scholarships 47 may be optimally navigated with support from social services. 12 Comprehensive centers may be best equipped with adequate social work linkage for families in most need of this care; social workers can educate families on how to maximize resources available to them, supplement care to allow for overall compliance, and connect families to each other for psychosocial aid.…”

Section: Social Considerationsmentioning

confidence: 99%

Choosing a Multidisciplinary Cleft and Craniofacial Team: Medical, Surgical, and Social Considerations

Villavisanis

Blum

Plana

et al. 2022

The Cleft Palate Craniofacial Journal

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Cleft and craniofacial conditions often present with a variety of functional and esthetic sequelae optimally treated by a multidisciplinary approach. Diagnosis of such conditions pre- or postnatally may evoke parental uncertainty and anxiety, and an important primary consideration is the selection of a cleft and craniofacial team. Identifying an optimal team may be particularly important for developing long-term relationships with clinicians who will ideally work intimately with the family from diagnosis to adulthood. While families, parents, and providers should consider several factors, a dearth of evidence-based suggestions preclude critical appraisal of cleft and craniofacial teams. In this article, the authors summarize medical, surgical, and social considerations for selecting a cleft and craniofacial team to optimize patient outcomes and the family/caregiver experience.

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Supporting Our Cleft and Craniofacial Patients Beyond the Clinic: Scholarships to Promote Academic Achievement

Cited by 6 publications

References 6 publications

Socioeconomic Disparities in Failure to Thrive and Weight Gain for Patients With Cleft Lip and Palate

Socioeconomic Disparities in Failure to Thrive and Weight Gain for Patients With Cleft Lip and Palate

Geospatial and Socioeconomic Factors Interact to Predict Management and Outcomes in Cleft Lip and Palate Surgery: A Single Institution Study of 740 Patients

Choosing a Multidisciplinary Cleft and Craniofacial Team: Medical, Surgical, and Social Considerations

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