JCPSLP Vol 19 No 2 2017

Moreover, the perspectives of SLPs engaged with delivery of stuttering interventions are rarely documented. In their synthesis of qualitative papers pertaining to developmental stuttering, Johnson et al. (2016) found no studies meeting their inclusion criteria between 1990 and 2014 that reported on the perspectives of clinicians delivering stuttering treatments. One such paper has been published subsequently (de Sonneville-Koedoot, Adams, et al., 2015). Arnott et al. (2014) touched on the perceptions of the two treating SLPs in the LP group delivery RCT paper although these were not formally examined as part of the study. As such, while we have considerable empirical support for stuttering intervention efficacy, we have little knowledge on how these interventions translate within community settings or clinicians’ perceptions of their acceptability or practicality. An opportunity to address this gap in the clinical research literature recently arose following a community-based trial of rolling-group LP delivery. This mixed-methods study aimed to evaluate the LP rolling-group effectiveness within community settings, together with clinicians’ perceptions of the viability of this novel model (Rappell, 2015). As reported by Rappell et al. (2017), the study involved a prospective, pre-post measurement design with stuttering severity measured in percentage of syllables stuttered (%SS) at assessment, 6 and 9 months post group commencement and at the completion of Stage 1. Nineteen children aged from 2 years and 9 months to 6 years and their parents participated following a standard intake procedure at four regional community health centres. Each rolling-group was made up of two to four child–parent pairs, led by one of the four participating SLPs and lasted the standard 45–60 minutes regardless of the number of participants. Across all measures the community-based SLPs achieved clinical outcomes similar to those published in the literature for individual and group LP treatment, achieving the completion of Stage 1 with a mean of 7.3 clinical hours, a median number of 15 clinic visits and a mean %SS score of 0.37% with a greater than 50% reduction in clinical hours to achieve Stage 2. Therefore, this study aimed to explore the experiences of participating SLPs when implementing the alternative LP rolling-group model, and their perceptions of the value and sustainability of the model for future service delivery. Method The qualitative component detailed in this paper followed a realist paradigm using an inductive thematic analysis approach, collecting data though semi-structured interviews with six rural SLPs. This dual-design married SLPs’ insights with the quantitative data presented in Rappell et al. (2017), to elicit depth and completeness from complementary findings (Venkatesh, Brown, & Bala, 2013). Ethics approval was obtained from the North Coast NSW Human Research Ethics Committee (No. LNR 073 26). Participants Six SLPs from different towns volunteered to undertake the training and instigate an LP rolling-group together with the coordinating researcher who is a practising SLP in the region. Formal training by Lidcombe Program Trainers Consortium (LPTC) for individual treatment and/or direct training from the program developer Mark Onlsow as part of undergraduate degree studies were the only stipulated requirements. As presented in Table 1, the participating SLPs had from eight years to over 35 years of clinical

experience. In February 2014, all participating SLPs were trained in the management of LP rolling-group model by either the program developer Dr Arnott or the coordinating researcher via teleconference. Three participating SLPs and the coordinating researcher were able to instigate LP rolling-groups at separate community-health centres in four different regional towns. Three of the SLPs who volunteered were unable to commence groups for a variety of reasons including insufficient referrals where two SLPs shared a role (n = 1), SLP absence for medical reasons (n = 1) and leaving the role as SLP (n = 1). Data were collected from those SLPs who were unable to begin groups as they had attended the training and planning phase of the study. As such, their perceptions of the process and aspirations to engage with LP rolling-groups in the future were considered to be valuable insights. The rolling-groups were established at differing times across the four community health sites between March 2014 and April 2015 depending on intake numbers.

Table 1: Demographic data Participant Years in SLP profession

Years since trained in LP Undergraduate* and 2005

Type SLP

#1

28

Generalist**

#2

11

2003

Paediatric

#3

28

Undergraduate*

Generalist**

#4

8

2013

Paediatric

#5

> 35

1991 & 2005

Paediatric

#6 Paediatric * Trained by Lidcombe Program designer Mark Onslow within undergraduate degree as part of core lecture series on stuttering. ** “Generalist” denotes those SLPs whose caseloads include both children and adults. Data collection A semi-structured interview was conducted with each participating SLP at 9 months post commencement of the inaugural group. Enabling debriefing and reflection, the interviews were conducted via telephone by the coordinating researcher, each for a duration of 15–30 minutes. Notes were handwritten concurrently, without the use of a recording device (Sim & Wright, 2000). Key reflections from each SLP were combined into an individualised written summary which was returned to the participant to ascertain if it was a true and full account of her/his perceptions and experiences of the LP rolling-group process. One SLP requested minor alterations to add clarity to several statements contained in the summary. Data analysis The written summaries and handwritten notes from the semi-structured interviews with the SLPs were systematically analysed according to the thematic analysis method (Braun & Clarke, 2006). Specifically, the coordinating researcher immersed herself in the data to ascertain reoccurring topics that could constitute a pattern, leading to codes and themes. Key themes were ultimately broken down into subthemes, expressing the breadth of the SLPs’ perceptions as to whether the novel LP rolling- group model may be seen as a valuable and sustainable alternative for future service delivery. 16 Undergraduate*

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JCPSLP Volume 19, Number 2 2017

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