Integrating Mental Health Assessment and Intervention into Cleft Care:A Single-Arm Prospective Interventional Study from a Tertiary Cleft Treatment Centre in Northwest Nigeria

ABSTRACTBackground: Children with orofacial clefts (OFCs) experience significant psychosocial morbidity, yet the integration of mental health services into cleft care remains limited in low-resource settings. This study evaluated the impact of integrating structured mental health assessment and intervention into routine cleft care. Methods: This single-arm prospective interventional study enrolled 484 children with OFCs (aged 6–17 years) attending a tertiary cleft clinic in Kano, Northwest Nigeria (January 2024–March 2025). Participants underwent a standardised mental health assessment using validated tools. A stepped-care intervention model was implemented, comprising universal psychoeducation (delivered to all participants), group art therapy (added for those with mild-to-moderate difficulties), and targeted psychiatric referral (added for those with severe difficulties). Outcomes were assessed at baseline, 3 months, and 6 months, and analysed using mixed-effects regression models with Bonferroni correction for multiple comparisons. All hypothesis tests were two-sided. Results: Of 484 enrolled participants, 456 (94.2%) completed 6-month follow-up. Mean Pediatric Quality of Life Inventory (PedsQL) total scores improved from 54.3±11.2 to 79.8±9.4 (mean difference 25.5, 95% CI 23.8–27.2, p<0.001; Cohen's d=2.28). Rosenberg Self-Esteem Scale (RSES) scores increased from 16.9±4.3 to 25.7±3.1 (d=2.05). Revised Children's Anxiety and Depression Scale-25 (RCADS-25) scores decreased from 38.6±8.9 to 21.4±6.2 (d=1.93). Strengths and Difficulties Questionnaire (SDQ) scores reduced from 19.4±4.7 to 12.3±3.8 (d=1.51). Integrated services were associated with higher surgical adherence than the historical control period (92.3% vs 78.6%), although this comparison is subject to secular trend and unmeasured confounding. Speech therapy uptake within the study period was 189/484 (39.0%), compared with 42/484 (8.7%) who had ever received speech therapy at baseline. Conclusions: Integration of mental health assessment and stepped-care intervention into routine cleft care was associated with sustained improvements in quality of life, self-esteem, anxiety/depression, behavioural difficulties, surgical adherence, and speech therapy uptake. This model warrants evaluation in a randomised controlled trial to determine whether the observed improvements are attributable to the intervention. It offers a potentially scalable, culturally adaptable approach for low-resource settings.