JCPSLP Vol 19 No 2 2017

the long-term outcomes for the LP rolling-groups within both private and public sector community settings with treatment (rolling-group) and control (individual treatment) group comparisons. Acknowledgements Funding for this research was provided by the NSW Health Education and Training Institute as part of the Rural Research Capacity Building Program. While this funding provided education and support for the researcher, the funding agency had no influence on the conduct or reporting of the study. References Arnott, S., Onslow, M., O’Brian, S., Packman, A., Jones, M., & Block, S. (2014). Group Lidcombe Program treatment for early stuttering: A randomized controlled trial. Journal of Speech, Language, and Hearing Research , 57 (5), 1606– 1618. Baker, E. (2012). Optimal intervention intensity in speech-language pathology:Discoveries, challenges, and unchartered territories. International Journal of Speech- Language Pathology , 14 (5), 478–485. Bauld, L., Ferguson, J., McEwen, A., & Hiscock, R. (2012). Evaluation of drop-in rolling-group model of support to stop smoking. Addiction , 107 , 1687–1695. de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M.-C. (2015). Direct versus indirect treatment for preschool children who stutter: The RESTART randomised trial. PLoS ONE , 10 (7), 1–17. Franken, M.-C. J., Kielstra-Van der Schalk, C. J., & Boelens, H. (2005). Experimental treatment of early stuttering: A preliminary study. Journal of Fluency Disorders , 30 (3), 189–199. Ioannidis, J. (2005). Why most published research findings are false. PloS Medicine , 2( 8 )(e124). Retrieved from http://dx.doi.org/10.1371/journal.pmed.0020124 Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders , 40 , 69–82. Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised controlled trial of the Lidcombe Programme of early stuttering intervention. British Medical Journal , 331 (7518), 659–663. Langevin, M., Packman, A., & Onslow, M. (2009). Peer responses to stuttering in the preschool setting. American Journal of Speech-Language Pathology , 18 (3), 264–276. Law, J., Garrett, Z., & Nye, C. (2004). The efficacy of treatment for children with developmental speech and language delay/disorder: A meta-analysis. Journal of Speech, Language, and Hearing Research , 47 (August), 924–943. May, J., & Erickson, S. (2014). Telehealth: Why not? Journal of Clinical Practice in Speech-Language Pathology , 16 (3), 147–151. McCulloch, J., Swift, M. C., & Wagnitz, B. (2016). Case file audit of Lidcombe Program outcomes in a student-led stuttering clinic. International Journal of Speech-Language Pathology , 19 (2), 165–173. Mulcahy, K., Hennessey, N., Beilby, J., & Byrnes, M. (2008). Social anxiety and the severity and typography of stuttering in adolescents. Journal of Fluency Disorders , 33 (4), 306–319. O’Brian, S., Iverach, L., Jones, M., Onslow, M., Packman, A., & Menzies, R. (2013). Effectiveness of

post-commencement assessment that stabilised over the subsequent three months, as would be expected (de Sonneville-Koedoot et al., 2015). While the lack of a control group in this study means that other possible explanations for reductions in stuttering cannot be ruled out (e.g., spontaneous recovery), the findings should provide encouragement to SLPs working across many paediatric environments who are seeking a solution to expanding caseloads and ongoing service demand. Of particular interest to community-based SLPs is the reduction in required face-to-face clinical hours. One of the known clinician criticisms of the LP is the number of clinical hours required to reach little or no stuttering (Packman et al., 2015). This study has shown that a rolling-group model provided a greater than 50% reduction in face- to-face treatment time, achieving Stage 1 with a mean of 7.3 clinical hours. The ability to treat multiple children simultaneously ensures that children not only receive evidence-based LP, but also the reduction in hours can provide SLPs with more time to dedicate to the remainder of their clinical caseload, including those who decline or are ineligible for group therapy. Participating SLPs had no experience in working with a rolling-group model of intervention and as a result were learning the process while implementing therapy. This, however, further emphasises the findings of clinical equivalence; if community SLPs with generalist caseloads can achieve these clinical results while learning a new way of practising, then the future potential for the rolling- group model once SLPs have embedded the process, is encouraging. The stringent conditions under which most clinical trials are realised may be discouraging for SLPs, being perceived as not reflective of their clinical settings (May & Erickson, 2014). This may in part account for the poor uptake of the LP rolling-group delivery option to date despite the known reduction in clinician time spent in treatment. This study has gone some way to address this issue with the rolling-groups being trialled within community clinics. As noted, the primary limitation of this study is the lack of control group, meaning that the results demonstrate an association between the provision of the LP rolling-group model and reduction in the children’s stuttering, but do not demonstrate causation. Additional limitations include the small number of participants and lack of intra-observer agreement over severity ratings. While these limitations reduce statistical power and impact on the ability to draw conclusions for a wider population, the pragmatic nature of this study provides evidence of what may be achieved within real-world settings. Conclusion This study indicates that the LP rolling-groups led by community-based SLPs can be both effective and efficient in the treatment of stuttering for young children. The rolling-group model was associated with significant clinical improvement and a reduction of clinical hours. These findings provide evidence that LP rolling-group participants consumed 50% fewer clinician hours than children receiving individual treatment, with equivalent client outcomes. The evidence suggests that this service model has the potential to be recommended particularly where SLPs are struggling to manage extensive waiting lists. The rolling-group program appears applicable across a broad range of clinical environments but most particularly in rural and regional community health settings. Future research is needed into

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology