JCPSLP Vol 19 No 2 2017

Lidcombe Program [which continues without a treatment break until the child reaches little or no stuttering] means stutterers can start to fill up available therapy slots and impact on caseload [by possibly extending the waiting time of children with other communication issues]. (#5) One participant, who worked very limited hours, reflected that she would not have been able to manage the referral rates for children who stutter without the rolling-group model: “There is no way I could manage them without a group” (#6). Lidcombe Program rolling-groups are a dynamic environment, although the components are standard, following the LP manual. Participants reported feeling this “controlled chaos” (#6) engendered greater cross- fertilisation of ideas and “social support” (#3) between adults (i.e., SLP and parents’ joint problem-solving home practice issues), with additional advantages of being more enjoyable and garnering more real-life communication for the children than individual treatment: “If it’s a bit crazy, it’s okay as they are talking naturally” (#6). Core components of the LP, whether in the traditional individual or new rolling-group delivery model, are that the parents and SLP demonstrate treatment with the child within the session. Several participants commented that this seemed to be a less intense experience for the both child and parent, in the rolling-group format, as they were not the only focus of attention and that the SLP was not felt to be “pointing a finger” (#6) at an individual so much within a group:“[It’s] not just focusing on them” (#1). Participant consensus was that the LP rolling-groups would be part of their service delivery into the future and were optimistic about their expectation to use the LP rolling-group model, even if they had not been able to run groups during the study. Several participants referred to the experience of running the groups as a means of encouraging change across their entire service, not just within their individual practice: “Strongly encourage all clinicians to run LP groups” (#4). Theme 4: Journey Participating SLPs reported experiencing a journey of personal and professional growth, through overcoming confidence issues, and of improving clinical skills. Despite years of clinical experience, participants indicated that new treatment models require practice and can engender concern about the likelihood of positive outcomes. Not all participants were confident when treating children who stutter and several expressed nervousness related to the change in treatment platforms: “[I] needed a bit of self-discipline and a leap to do this, try groups… [it was] not comfortable. [I] made the decision to do it and try hard” (#5). Several participants reported that they had felt more comfortable starting with smaller client numbers and gradually increasing the number of child–parent pairs as their confidence grew: “I felt more comfortable with two and moving up to three” (#4). Participants reported that as they developed expertise in the rolling-group model, they relied less on precise planning of the group structure and sequence, instead opting to utilise the available resources (e.g., toys or worksheets) in a more fluid and flexible way to meet treatment goals within the group: “Not over thinking what your plan is [but using whatever activities or toys are set up to flexibly meet the needs of the children as issues arise within the rolling- group]” (#6).

Capacity building was touched on. One participant directly reflected on the fact that the rolling-groups methodology had been brought to the region via the practitioner-led research study: “[The LP rolling-group model was] brought to us by you [i.e. the coordinating researcher]. Made it an easy thing to be a part of [the establishment of rolling-groups]” (#3). Discussion There is a considerable volume of empirical evidence supporting the LP and yet, as with all stuttering interventions, we have very few insights from the clinicians who deliver these treatments (Johnson et al., 2016) in the communities for which they were designed. This study aimed to highlight the perspectives of community-based SLPs as to whether they perceive the new LP rolling-group model as a valuable or sustainable alternative within their future service delivery. Such insights add depth to the quantitative component of the mixed-methods study reporting on the first community-based study of the LP rolling-group model (Rappell et al., 2017) led by SLPs within regional community-health (i.e., public) centres. Rappell et al. (2017) demonstrated a positive association between the LP rolling-group model and a reduction in stuttering, in line with benchmarks reported in the literature for individual and group LP but with a greater than 50% reduction in clinical hours to achieve Stage 2. Importantly, with regards to ongoing practice change within day-to-day clinical settings, the consensus from the participating SLPs towards the new rolling-group model was comprehensively positive while acknowledging some challenges. The journey from research paper to everyday clinical practice can be a long and arduous one. The results from the original RCT investigating group LP treatment were first presented at the Annual Convention of the American Speech-Language-Hearing Association in 2010. Subsequent presentations and a peer-reviewed journal publication (Arnott et al., 2014) have resulted in limited uptake of this treatment option, posing the self-evident question: why are SLPs not changing their practice with regards to delivery options for the LP? Empirical-based support or recommendations in no way equate to the perception of a treatment protocol being “doable” in a SLPs’ day-to-day clinical setting. Arnott et al. (2014) made reference to the perceptions of the two SLPs involved in the original RCT, recounting that while the rolling-groups were considered more demanding than individual treatment, they were also “clinically gratifying” (p. 11). This overarching sense of optimism towards the rolling- group model featured prominently in the themes derived from the semi-structured interviews held with this study’s SLPs. Challenges perceived by the participants reflected those previously outlined in the literature when embracing clinical change, evidence-based practice (EBP) or research design within the speech-language pathology profession. Limited clinical space (O’Brien, Byrne, Mitchell, & Ferguson, 2013) was one such logistical issue. A sense of time pressure or lack of time has consistently been reported by SLPs as a reason behind poor implementation of EBP (Finch, Cornwell, Nalder, & Ward, 2015; O’Connor & Pettigrew, 2009) and was universally referred to by participants, in one form or another, as an obstacle. The counterbalance to this challenge is a robust perception that the rolling-groups were highly pragmatic in their time-efficiency, due to the reduction in clinical hours per child and the likelihood that

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JCPSLP Volume 19, Number 2 2017

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