JCPSLP Vol 19 No 2 2017

Results Four major themes were identified from the analysis of the interview data that reflect a high level of consistency between participants regarding their perceptions of the LP rolling-group intervention. Themes of challenges, scaffolds, betterment, and journey were interwoven, creating a rich fabric of change-process understanding. Theme 1: Challenges The theme of challenges encapsulates the broad nature of obstacles that the participants either anticipated or encountered as they engaged with the new model. While these were not insurmountable, the participants expressed concerns over the logistics of establishing rolling-groups, managing the perceived complexity of a new way of working, and the ever-present lack of time for planning and organisation. In two cases, logistical obstacles such as limited referrals prevented the rolling-groups from being established, whereas in the main these were overcome. The greatest barriers related to allocation of a suitable space and insufficient diversity of resources for play activities, with groups requiring up to four “stations” where each child–parent pair had an activity to engage with independently: “Issue was room size. [It was] crowded to get three parents and three kids in the room” (#4). Of particular concern to many participants was having sufficient activities to engage all of the children across a diverse range of ages and stuttering severity levels over the treatment period: “[Having a] variety of activities is a challenge, as the groups are ongoing, not just a six to eight week block” (#5). Having activities designed for differing levels of stuttering severity occurring concurrently meant that the LP rolling- groups were both less structured and at a higher level of clinical complexity than standard SLP groups, requiring a flexible approach: “Lidcombe Program groups are less structured than other groups and therefore more challenging. Other groups are generally an activity being done by the entire group” (#5). The rolling-group format requires new child–parent pairs to start their treatment with others who are already in the group and may have well-established skills. Consequently, the SLP is required to juggle a broad variety of needs in rapid succession, such as demonstrating aspects of early treatment in structured conversations followed quickly by discussion with parents regarding their child entering maintenance having met the criteria for Stage 2: “Competing skills and stimuli. Managing multiple stimuli and still staying on track and staying on time and collecting data….[it’s] quite a complex skill” (#3). Often parents were at differing stages in their engagement with the LP methods and therapy journey, requiring extra care and skill in order to avoid parental fears generated by comparison with those more experienced at treatment: “More thought on new people in the group [to support their integration into an established group]” (#5). Participants expressed a universal feeling that newly graduated SLPs may require extra support in the form of ongoing coaching and may need to be familiar with individual LP prior to engaging with the rolling-group model: “ [A] new graduate may need to shadow or watch groups prior to running them. Could be a bit overwhelming. How to keep things going” (#4). Limited time was a standout obstacle expressed by all the participants, who reflected their concerns prior to commencement that additional time would be required to embed a new process, organise clients and plan the new

model: “Biggest concern initially was that it was going to take more time, particularly around coordinating families” (#6). Time factors were of particular concern for part-time SLPs, with the challenge of coordinating client attendance

when working limited hours. Theme 2: Scaffolds

“Scaffolding” refers to a temporary supporting framework that can be applied while a process or new skill is being learnt. The theme of scaffolds reflects the participants’ sense of skills or supports that would enable them to transfer to a new way of working with the LP rolling-group delivery. The participants believed their general clinical skills and knowledge would be applicable to the rolling-group model and were pragmatic regarding their ability to develop new systems or materials. Participants felt that a strong level of confidence with the standard individual LP treatment protocol was a core foundation skill, as was prior expertise with the principles of group therapy in a broader sense: “Probably the confidence that you have the knowledge and skills to run the Lidcombe Program first” (#6). Several comments endorsed the idea that the participants’ customary clinical methods had been supplemented via by the formal teleconference training and informal ongoing mentoring during the study: “[It was] good to watch videos of others running groups” (#4). Participants felt they enabled themselves to embrace the new model by being prepared. Well-prepared resources went some way to mitigate concerns over the “controlled chaos” [#6] nature of the rolling-groups: “Having a list of activities from structured to unstructured was initially useful” (#6). Theme 3: Betterment aspirations derived from engaging in the rolling-groups. Participants were universally optimistic following their involvement in the study, sharing their aspirations to continue running the LP rolling-groups, regardless of whether they had been able to establish one during the time of the project or not. The major benefits reported were time-efficiency and more real-life communication interactions between the children, such as negotiating over a preferred toy or waiting for a turn during a dynamic group conversation. For busy clinicians the rolling-group offered a solution to the day-to-day stress of managing a large caseload: “Grouping stutterers is much more time-efficient way to go as long as outcomes are comparable” (#5). Time savings were clearly articulated by the two SLPs who ran their groups throughout the entire study. One reflected that the rolling-groups were very pragmatic, as it meant that a clinician’s time was never under-utilised should a client fail to attend an appointment without notice, reflecting that for this reason alone, even if the time frame was longer, it would likely be more efficient: “[The rolling-group model represented a] …useful use of time... misses [i.e., clients absent] for all sorts of good reasons... [but there was] always one there [when using the rolling- group model]” (#5). This compares to the impact traditional stuttering treatment may have on the waiting times for children with other communication issues, particularly as stuttering treatment is usually continuous and not delivered in “blocks”: Betterment as a theme broadly encompasses the participants’ sense of both the benefits and future

84

JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology