Background Fifty percent of children with cleft palate have persistent speech problems at 5 years of age requiring speech therapy. Accessing intervention from therapists in many countries is inadequate with inequitable provision.

Aim To evaluate an alternative method of facilitating improvements in speech by enabling parents.

Method 46 children, aged 2.9 to 7.5 years, were included in this two-phase, two-centre, non-inferiority RCT. In the parent-led arm, parents attended a 2-day training course, given a speech programme and conducted home-based therapy for 12 weeks. Parents were supported by a Cleft Speech/Language Therapist (CSLT) using connected health and a one-to-one session. In the control arm, the group received six therapy sessions with a research SLT comparable to typical local service provision. Speech recordings were undertaken pre- and post-intervention. Speech impairment, activity and participation were primary and secondary outcomes. Parent feedback was gathered in telephone interviews/focus groups conducted by independent professionals.

Results Results indicated that parent led articulation therapy achieved comparable outcomes to standard speech therapy for children with cleft palate speech disorders. Both groups showed a statistically significant improvement in PCC scores (mean change = 21%; p<0.001; 95% CI 12.27-19.86), activity (mean change = 2.27 p<0.001; 95% C 1.41-3.13). and participation (mean change= 18.87; p<001; 95% CI 10.87-25.73). There was no statistically significant difference between the groups. The challenges and benefits of the programme according to the parents were analyzed using thematic analysis.,

Conclusion This RCT that showed parent led articulation therapy is effective in changing speech, activity and participation outcomes for children with cleft palate, when supported by a CSLT using connected health, with implications for alternative methods of service delivery. Parents in the parent led arm reported a sense of empowerment, which grew as their children’s speech improved. Progress and challenges in introducing research findings into practice will be highlighted.