In 1938, orthodontist Herbert Kurtz Cooper Jr. organized the Lancaster Cleft Palate Clinic in Lancaster, Pa., the first facility of its kind in the United States. Cooper assembled a team of practitioners he described as "motivated to act in the greatest interest of the patient." He avowed, "The only way to make this philosophy work is to follow the three ‘Cs': communication, cooperation and coordination of effort." In other words, Cooper created an interprofessional team.
Today, the benefits of interprofessional education and practice are a topic on the minds of almost all health care professionals. But interprofessional practice does not happen without effort. It requires professionals to learn about other disciplines: their scopes of practice, training and specializations, professional cultures, and treatment practices. Much like learning how to relate to any "foreign" culture, we best acquire such knowledge by immersion—working side-by-side toward common goals. Ideally, when we serve on an interprofessional team, a team identity develops.
Cooper initially brought together an orthodontist, prosthodontist, speech-language pathologist (then called a "speech therapist"), X-ray specialist, psychologist and pediatrician. By 1979, the Lancaster team had grown to 50 members and added disciplines such as otolaryngology, physical anthropology and anatomy, and genetics.
Hundreds of cleft palate-craniofacial teams have since replicated Cooper's model. Nurse practitioners have become key team members across the country. And with the advent of craniofacial surgery, even more disciplines—such as neurology, neurosurgery and neuro-ophthmalology—joined the teams. In 2013, it is not uncommon to see prenatal ultrasonographers communicating with cleft palate teams and, at the University of Pittsburgh, researchers in regenerative medicine.
Cleft palate and craniofacial teams present some of the most impressive examples of interprofessional care. Interprofessional education can be a career-long venture for this "team sport." Team members teach one another, and the most distinguished and mature teams engage in research together.
Central to the world of clefting are interprofessional organizations such as the 65-year-old American Cleft-Palate-Craniofacial Association, which comprises 2,500 member professionals in 30 disciplines from 65 countries. ACPA hosts national educational meetings and publishes the Cleft Palate-Craniofacial Journal. The ACPA and the Cleft Palate Foundation jointly have set forth "team standards," created the Commission on Approval of Teams to manage a team approval process and approved a set of standards to guide interdisciplinary care.
Recognizing that team professions must learn about one another, ACPA published a two-part online core curriculum—written by an interdisciplinary committee—that provides an excellent model for interprofessional education.
The first part presents content that is fundamental across disciplines—team evaluation, classification and anatomy, airway and feeding, non-cleft craniofacial anomalies, and craniofacial development.
Part two details 10 professions' roles in treating patients with clefts and orofacial anomalies.
What could be next for cleft palate and craniofacial teams? They are well positioned to harness telepractice's potential to create expert teams whose members need not practice in the same clinic. A new consultative model is already emerging: The Virtual Center for Velo-Cardio-Facial Syndrome is an innovative, open-access 501(c)3, Internet-based multidisciplinary charitable organization that provides personalized information to people around the world who seek to help manage VCFS, cleft palate and other craniofacial disorders.
Cleft palate-craniofacial teams, interprofessional education and telepractice have much in common. Each paradigm has been developing for decades with relatively little fanfare. But by combining their strengths to support cleft palate teleteams of the future, we can amplify their benefits to society.