REORGANIZATION OF CRANIOFACIAL CLEFT CARE DELIVERY - THE MASSACHUSETTS EXPERIENCE

Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s , the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE w as the recommendation that the SHC direct care programs, including all craniofacial and cleft palate clinics, should be dismantled over a nu mber of years. However, due to the economic recession, all, government funding was suddenly withdrawn from cleft palate teams and the state- run SHC clinics were abruptly dissolved. To treat patients left withou t coordinated care, former team members reassembled and began a new cr aniofacial team based at the University of Massachusetts Medical Cente r. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordinat ion of clinical/clerical responsibilities; identifying a physical loca le to hold the clinics; and solicitation of referring health care prov ider referrals and follow-up. All these issues required specific inter ventions that are presented in this paper. Project SERVE, begun under federal auspices, in the Commonwealth of Massachusetts, has recently b een promoted as a model for a new and improved approach to the managem ent of cleft palate and craniofacial care delivery nationwide. Awarene ss of the potential for abrupt, radical change in funding for federall y mandated cleft/craniofacial care is essential, and a successful tran sition to a medical center-based model is possible using the procedure s established at our center.