Do the healthcare interventions we provide for hearing impairment and speech, language and communication difficulties in children born with cleft palate +/- lip impact on educational outcomes?

Background: It has been identified that children born with a cleft palate +/- lip (CP+/-L) are more likely to have poorer educational attainment than their peers. This cannot be explained by the presence of syndromes, genetic factors or increased school absence. Exploring the educational outcomes for individuals with a CP+/-L was raised as a top priority by the James Lind Alliance, a partnership of patients, relatives and clinicians. It is likely that hearing impairment (HI) or speech, language and communication difficulties (SLCD), which are more common among children with a CP+/-L, are responsible. Changes in healthcare interventions for HI/SLCD could enable children with a cleft to fulfil their academic potential and future life opportunities. Aims: To use real world data (RWD) to describe the educational attainment of children born with CP+/-L and a HI or SLCD, and how this varies according to other characteristics. To use RWD to explore if the healthcare interventions we provide for HI or SLCD influence educational outcomes in primary school among children with CP+/-L. Objectives: Using linked health and educational data from the Education and Child Health Insights from Linked Data (ECHILD) database and the Cleft Collective Cohort Study (CC), we estimate the association between educational attainment and (i) HI or SLCD for children born with/without CP+/-L, and; (ii) healthcare intervention use, and timing of intervention implementation, for HI or SLCD for children born with/without CP+/-L. Conduct a target trial emulation to evaluate the effectiveness of our most impactful intervention identified in objective 1, e.g. grommet insertion at the time of palate repair on educational attainment. Methods: Observational data from ECHILD and the CC will be used to describe the cohort of children with HI/SLCD and the associated interventions received for these using ICD-10 and OPCS-4 codes. WP1 (months 1-18) uses ECHILD and WP2 (months 1-34) uses CC to describe the educational outcomes and interventions of children with CL+/-P, with and without HI/SLCD, in terms of whether they sat exams, reached nationally expected levels of attainment and their standardised subject test scores, in primary education. Covariates and confounding factors will be identified from the literature and expert opinion and included within the analysis. The results from WP1/WP2 will feed into WP3 (months 1-42), the target trial emulation. Analysis will be conducted in the Office for National Statistics Secure Research Service using Stata 17 and R. Impact and dissemination: HI and SLCD among children with CP+/-L is an important and understudied area, with enormous practical importance, both in terms of disease burden and economic implications. The research will, for the first time, characterise the association between HI/SLCD, and suggest the relative importance of different healthcare interventions, on educational outcomes in children with CP+/-L. Findings will be disseminated at conferences, published in academic journals and shared with the public and patients, subsequently informing clinical practice within the NHS. It will also allow me the opportunity to acquire a range of skills that will form a crucial element of my training as a clinician-scientist.