JCPSLP Vol 19 No 2 2017

Shaping innovative services: Reflecting on current and future practice

Rolling-group Lidcombe Program delivery A prospective cohort study in community health settings Nicole Rappell, David Schmidt, and Margaret Rolfe

The rolling-group delivery model for Lidcombe Program (LP) treatment for early years stuttering has been shown to be efficacious in a single randomised control trial, yet few speech-language pathologists (SLPs) utilise this option. This paper reports on the quantitative component of a mixed-methods study, conducted in 4 rural NSW towns, in which LP was delivered in a rolling-group model, by community health-based SLPs. Nineteen children under 6 years were recruited. Stuttering severity at commencement, 6 and 9 months post- commencement were compared using a “repeated measures generalised estimating equation approach”. Stuttering severity improved significantly in mean percent syllables stuttered ( p = 0.001), and mean parent–clinician agreed severity rating ( p < 0.001). Mean clinical hours (7.3 hours) and median number of clinic visits (15 visits) per child to reach Stage 2 were equal to literature benchmarks. Our study indicates that the LP specialise in stuttering is an effective, time- saving, and viable alternative to individual treatment. N umerous Australian studies have shown the cumulative incidence of early years stuttering to be almost double the level previously reported (Reilly et al., 2013; Reilly et al., 2009; Yairi & Ambrose, 1999). This rising incidence creates pressure on SLP resources to provide an equitable, quality service for this population. Early intervention is considered best practice as children who stutter have stronger outcomes when treated before 6 years of age (Jones et al., 2005; Onslow, 2016). Judgement concerning treatment timing has been influenced by efficacy studies, together with increasing evidence of the negative sequelae to stuttering for children, adolescents, and adults (Iverach & Rapee, 2014; Langevin, Packman, delivered in a rolling-group model by community-based SLPs who do not

& Onslow, 2009; Mulcahy, Hennessey, Beilby, & Byrnes, 2008). Stuttering is now considered to be less tractable as a child ages, with treatment effect sizes reducing from preschool to adulthood (Onslow, 2016). Several randomised control trials (RCT) support the premise that Lidcombe Program (LP) is efficacious and can lead to a greater reduction in stuttering severity than would be expected by natural recovery (Arnott et al., 2014; de Sonneville-Koedoot, Stolk, Rietveld, & Franken, 2015; Jones et al., 2005). Yet, while efficacious, the LP is known to consume many clinical hours requiring a median of 16 one-hour clinical sessions followed by 10 one-hour clinical maintenance sessions (Packman et al., 2015). Community- based clinicians are faced with numerous pragmatic dilemmas, particularly pertaining to LP program fidelity and “dosage”. One such issue is that of the clinical hours required by the LP, as treatment runs continuously until a child has achieved little or no stuttering, whereas with most other impairments, SLPs tend to deliver treatment in cycles of an active treatment block followed by a no treatment review period. The LP model of continuous treatment may add to caseload congestion by significantly increasing the waiting time of children with other communication issues, and waiting lists have been cited as a barrier to accessing SLP services by consumers (O’Callaghan, McAllister, & Wilson, 2005). Recommendations pertaining to intervention intensity or total duration in the field of speech, language and communication needs vary widely in both timeframe and specificity. For example Law, Garrett, & Nye (2004) suggest longer intervention duration (>8 weeks) for primary developmental speech and language delay/ disorder, while Williams (2012) recommends 30 sessions of 30 minutes for speech sound disorders. However, workplace constraints appear to impact on SLPs’ capacity to implement empirically led recommendations (Baker, 2012). Within private and public clinical practice SLPs are known to reduce both the session length and the number of sessions (To, Law, & Cheung, 2012). In their study of the effectiveness of the LP within Australian community clinics, O’Brian et al. (2013) found that half of the clinicians reduced their session length to 30 minutes from the recommended 45–60 minutes sessions and did not habitually have parents demonstrate treatment within clinic. Alterations to the treatment guidelines such as these likely speak to the difficulties SLPs are facing when attempting to follow evidence-based practice within time-poor clinics.

KEYWORDS CHILDREN COMMUNITY HEALTH

THIS ARTICLE HAS BEEN PEER- REVIEWED LIDCOMBE PROGRAM ROLLING-GROUP DELIVERY STUTTERING

Nicole Rappell (top), David Schmidt (centre) and Margaret Rolfe

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology