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JCPSLP
Volume 19, Number 2 2017
77
spectrum disorder, or Tourette syndrome, that may make
the assessment of unambiguous stuttering difficult were
excluded. Participating children did not undergo a full
developmental assessment, as such minor developmental,
emotional, communication or neurological impairments may
have been concomitant with their stuttering. Six SLPs from
six community health centres volunteered to undertake the
training and instigate a LP rolling-group. 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 was the only stipulated requirement. Participating
SLPs had from 8 years to over 35 years clinical experience.
Rolling-groups were established at differing times across
four community health centres, between March 2014 and
April 2015, led by a single SLP located at each of the sites.
Parent training session
Before the commencement of the LP rolling-group, each
child–parent pair was offered a single individual session.
This 60-minute session provided information on early skills
and knowledge that would be required in treatment.
Parents were introduced to the 10-point LP Severity rating
(SR) scale and the child’s stuttering severity was recorded
by the SLP.
Rolling-group format
This study followed the guidelines in
The Lidcombe
Program of Early Stuttering Intervention Treatment Manual
(Packman et al., 2011). Each group consisted of between
two to four child–parent pairs. While Arnott et al. (2014)
aimed to maintain group composition of three child–parent
pairs, these ultimately ranged from one through to four. In
response, the present study was designed to
accommodate a range from two to four child–parent pairs
at group commencement, with consideration to the
variability of client intake numbers across the study sites.
Initially, the groups comprised solely of children starting their
treatment. However, as one child–parent pair reached
criteria to Stage 2, it was replaced by another pair. Weekly
groups were between 45 and 60 minutes and were led by a
single SLP.
The rolling-group used an area which allowed for “activity
stations” and a main area where the SLP could engage
in a whole-group activity. While each group consisted of
the core LP elements as used within standard individual
treatment, variation did occur within the treatment
sequence. Children often had an active role in determining
the treatment sequence through how they interacted
with the “activity stations” upon entry into the room. For
instance, it was determined that should children wish to
engage in free-play, the session may begin with rating
and adult problem-solving, whereas children choosing to
sit for a table-top activity might lead to a SLP or parent
demonstration of treatment.
Data collection and analysis
The children’s stuttering severity was assessed at four
points: (a) Pre–treatment assessment; (b) the completion of
Stage 1; (c) 6 months post-commencement; and (d) 9
months post-commencement. At each point a stuttering
severity rating (SR) and percentage syllable stuttered (%SS)
were calculated within clinic, during the group closest to
that date. Both SR and %SS were assessed by the treating
clinician and while no formal analysis of inter-observer
reliability was undertaken, all six participating SLPs and two
stuttering specialist SLPs were sent a video containing a
Rolling-group delivery model
supports sustainable intervention
Rolling-group intervention delivery is a model of care
unfamiliar to paediatric SLPs, though often used in the field
of psychology (Bauld, Ferguson, McEwen, & Hiscock,
2012; Tasca et al., 2010). Arnott et al. (2014) explained that
such groups begin with a set number of child–parent pairs
and participants change over time. As a child–parent pair
completes active treatment (little or no stuttering), they are
replaced by a new child–parent pair. This rolling process
creates a group where novice and expert child–parent pairs
are simultaneously being treated according to the LP
guidelines but at differing levels. A single RCT has recently
reported on the rolling-group delivery of the LP (Arnott et
al., 2014) with successful results. Fifty-four child–parent
pairs were randomised into either a control arm (individual)
or treatment arm (rolling-group). There were no statistical or
clinical differences noted between the arms with regards to
number of clinical visits or weeks in treatment. Of great
significance to SLPs was the fact that the rolling-group arm
consumed 46% fewer clinical hours per child to the
completion of Stage 1 (little or no stuttering). Where
community-based SLPs are struggling to provide equitable
treatment for this population, particularly in rural
communities (Verdon, Wilson, Smith-Tamaray, & McAllister,
2011; Wilson, Lincoln, & Onslow, 2002), this unfamiliar
model may provide a sustainable alternative to traditional
individual treatment.
While considered “gold standard” research, a single
RCT may represent only a partial picture of treatment
effectiveness (de Sonneville-Koedoot et al., 2015; Ioannidis,
2005), whereas a Phase IV community-based trial,
independent from program designers, offers a “real-world”
assessment (Onslow, 2016). In their community-based
study, O’Brian et al. (2013) highlighted that “efficacy”
studies, with their stringent criteria and protocols operate
differently from “effectiveness” translational studies
which investigate how a treatment stands up within the
community for which it was designed. Clients drawn from
a single site, with only two treating SLPs and strict criteria
for inclusion were limitations cited by Arnott et al. (2014) of
their RCT for group LP treatment. Therefore, the aim of this
translational study was to determine if SLPs could produce
clinically equivalent reductions in stuttering severity for
young children when delivering the LP in a novel rolling-
group model within their community-based settings. The
qualitative portion of the study examining the perceptions
of the participating SLPs regarding the viability of the
rolling-group model for future service delivery is presented
in Rappell and Schmidt (2017) and a report incorporating
both portions of the study has previously been completed
(Rappell, 2015).
Methods
Approval to conduct the study was obtained from the North
Coast NSW Human Research Ethics Committee (Ref. LNR
073).
Participants and setting
Participants were 19 children aged 2 years 9 months to 6
years and their parents who approached speech pathology
services at a designated centre for advice regarding, and/or
treatment of, stuttering.
Children diagnosed with a major neurological disorder,
such as attention deficit hyperactivity disorder, autistic