JCPSLP Vol 19 No 2 2017

Shaping innovative services: Reflecting on current and future practice

Rolling-group Lidcombe Program Perspectives from participant clinicians in a community-

based cohort study Nicole Rappell and David Schmidt

Rolling-group therapy delivery is seldom used in speech-language pathology services and yet this model of admitting new clients continuously as space permits offers the real-world possibility of dramatically reduced clinical hours for the treatment of stuttering in young children. Rolling-group delivery for the Lidcombe Program (LP) has proven clinical equivalence with individual treatment in a randomised control trial, the findings of which were recently replicated in a community-based trial. This paper details the perceptions of six speech-language pathologists (SLPs) who participated in that community-based trial to ascertain the viability of this alternative model of service delivery. Participating SLPs universally supported the rolling-group model. The three themes drawn from the semi-structured interviews described logistical challenges, the need for managers to proactively support clinicians when moving to a rolling-group model through the allocation of time for capacity building, and a desire to embrace practice change. A broad body of empirical evidence has been published to provide speech-language pathologists (SLPs) with an understanding of treatment efficacy, and to a lesser degree “‘real-world”‘ effectiveness, for young children who stutter. Two prominent such treatment models are the Lidcombe Program (LP; Jones et al., 2005; Packman et al., 2015) and RESTART – Demands and Capacities Model (DCM; de Sonneville-Koedoot, Stolk, Rietveld, & Franken, 2015). Both programs feature treatment manuals to support standardised practice and implementation with fidelity in research and clinical contexts. However, in the field of early years stuttering treatment, it is known that SLPs in community clinics often reduce sessions times or omit aspects from the guidelines (O’Brian et al., 2013). A number of factors have been identified that may limit the capacity of SLPs to implement stuttering treatment

programs with fidelity. For example, de Sonneville- Koedoot, Adams, Stolk, and Franken (2015) conducted focus groups following a randomised control trial (RCT) to ascertain clinician attitudes and beliefs towards the LP or DCM approaches. The authors reported that the uptake and utilisation of treatment models are greatly influenced by subjective clinician-driven factors, which are rarely addressed in efficacy studies. Additionally, de Sonneville- Koedoot, et al. (2015) highlighted that SLPs who volunteer for research projects may be considered early adopters of innovation and as such their insights are potentially crucial to wider practice change. It is also possible that these detours from the core guidelines are a direct attempt by SLPs to reduce time spent in stuttering treatment in order to manage increasing caseloads. Although not often referred to in efficacy studies, the fact that the LP runs continuously rather than in a block-review cycle, as is commonly practised by many SLPs, adds significantly to caseload management issues. A single RCT comparing individual to group LP treatment (Arnott et al., 2014) demonstrated no differences between the arms with regard to the number of weeks or clinical visits required and percentage of syllables stuttered at criteria for Stage 2. Of particular interest for SLPs was that the group arm, while demonstrating clinical equivalence, consumed approximately half the clinical hours when compared to the individual treatment arm. The rolling-group method utilised in this RCT differs from conventional SLP groups as the make-up of the group changes over time. Rolling-groups start with a set number of children and as one child completes treatment a new child begins in his or her place (Rappell, Schmidt, & Rolfe, 2017). To this end, the LP rolling-group model of delivery may offer a clinical solution for SLPs where stuttering treatment duration is impacting on overall caseload management. Furthermore, our understanding of how empirically based stuttering treatments are translated to clinical practice is somewhat limited by a paucity of reporting on broader issues that may be influential to community level uptake. The majority of LP efficacy studies have been under the auspices of the program developers (Guitar et al., 2015) and less than a handful of studies have investigated transferability to the wider community (O’Brian et al., 2013), including examination of outcomes when delivered by inexperienced SLPs (de Sonneville-Koedoot, Stolk, et al., 2015; McCulloch, Swift, & Wagnitz, 2017) or conducted by independent researchers (Franken, Kielstra- Van der Schalk, & Boelens, 2005; Miller & Guitar, 2009).

KEYWORDS COMMUNITY BASED

THIS ARTICLE HAS BEEN PEER- REVIEWED LIDCOMBE PROGRAM PRACTICE CHANGE ROLLING-GROUP MODEL STUTTERING

Nicole Rappell (top) and David Schmidt

82

JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology