JCPSLP Vol 19 No 2 2017 low res

26 / 64

80 JCPSLP Volume 19, Number 2 2017 Journal of Clinical Practice in Speech-Language Pathology
the long-term outcomes for the LP rolling-groups within
both private and public sector community settings with
treatment (rolling-group) and control (individual treatment)
group comparisons.
Acknowledgements
Funding for this research was provided by the NSW Health
Education and Training Institute as part of the Rural
Research Capacity Building Program. While this funding
provided education and support for the researcher, the
funding agency had no influence on the conduct or
reporting of the study.
References
Arnott, S., Onslow, M., O’Brian, S., Packman, A., Jones,
M., & Block, S. (2014). Group Lidcombe Program treatment
for early stuttering: A randomized controlled trial. Journal of
Speech, Language, and Hearing Research, 57(5), 1606–
1618.
Baker, E. (2012). Optimal intervention intensity in
speech-language pathology:Discoveries, challenges, and
unchartered territories. International Journal of Speech-
Language Pathology, 14(5), 478–485.
Bauld, L., Ferguson, J., McEwen, A., & Hiscock, R.
(2012). Evaluation of drop-in rolling-group model of support
to stop smoking. Addiction, 107 , 1687–1695.
de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., &
Franken, M.-C. (2015). Direct versus indirect treatment for
preschool children who stutter: The RESTART randomised
trial. PLoS ONE, 10(7), 1–17.
Franken, M.-C. J., Kielstra-Van der Schalk, C. J.,
& Boelens, H. (2005). Experimental treatment of early
stuttering: A preliminary study. Journal of Fluency Disorders ,
30(3), 189–199.
Ioannidis, J. (2005). Why most published research
findings are false. PloS Medicine, 2(8)(e124). Retrieved from
Iverach, L., & Rapee, R. M. (2014). Social anxiety
disorder and stuttering: Current status and future directions.
Journal of Fluency Disorders, 40, 69–82.
Jones, M., Onslow, M., Packman, A., Williams, S.,
Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised
controlled trial of the Lidcombe Programme of early
stuttering intervention. British Medical Journal, 331 (7518),
659–663.
Langevin, M., Packman, A., & Onslow, M. (2009). Peer
responses to stuttering in the preschool setting. American
Journal of Speech-Language Pathology, 18(3), 264–276.
Law, J., Garrett, Z., & Nye, C. (2004). The efficacy of
treatment for children with developmental speech and
language delay/disorder: A meta-analysis. Journal of
Speech, Language, and Hearing Research, 47(August),
924–943.
May, J., & Erickson, S. (2014). Telehealth: Why not?
Journal of Clinical Practice in Speech-Language Pathology,
16(3), 147–151.
McCulloch, J., Swift, M. C., & Wagnitz, B. (2016). Case
file audit of Lidcombe Program outcomes in a student-led
stuttering clinic. International Journal of Speech-Language
Pathology, 19(2), 165–173.
Mulcahy, K., Hennessey, N., Beilby, J., & Byrnes, M.
(2008). Social anxiety and the severity and typography of
stuttering in adolescents. Journal of Fluency Disorders ,
33(4), 306–319.
O’Brian, S., Iverach, L., Jones, M., Onslow, M.,
Packman, A., & Menzies, R. (2013). Effectiveness of
post-commencement assessment that stabilised over the
subsequent three months, as would be expected (de
Sonneville-Koedoot et al., 2015). While the lack of a control
group in this study means that other possible explanations
for reductions in stuttering cannot be ruled out (e.g.,
spontaneous recovery), the findings should provide
encouragement to SLPs working across many paediatric
environments who are seeking a solution to expanding
caseloads and ongoing service demand.
Of particular interest to community-based SLPs is the
reduction in required face-to-face clinical hours. One of the
known clinician criticisms of the LP is the number of clinical
hours required to reach little or no stuttering (Packman
et al., 2015). This study has shown that a rolling-group
model provided a greater than 50% reduction in face-
to-face treatment time, achieving Stage 1 with a mean
of 7.3 clinical hours. The ability to treat multiple children
simultaneously ensures that children not only receive
evidence-based LP, but also the reduction in hours can
provide SLPs with more time to dedicate to the remainder
of their clinical caseload, including those who decline or are
ineligible for group therapy.
Participating SLPs had no experience in working with
a rolling-group model of intervention and as a result
were learning the process while implementing therapy.
This, however, further emphasises the findings of clinical
equivalence; if community SLPs with generalist caseloads
can achieve these clinical results while learning a new
way of practising, then the future potential for the rolling-
group model once SLPs have embedded the process, is
encouraging. The stringent conditions under which most
clinical trials are realised may be discouraging for SLPs,
being perceived as not reflective of their clinical settings
(May & Erickson, 2014). This may in part account for the
poor uptake of the LP rolling-group delivery option to
date despite the known reduction in clinician time spent in
treatment.
This study has gone some way to address this issue with
the rolling-groups being trialled within community clinics.
As noted, the primary limitation of this study is the lack of
control group, meaning that the results demonstrate an
association between the provision of the LP rolling-group
model and reduction in the children’s stuttering, but do
not demonstrate causation. Additional limitations include
the small number of participants and lack of intra-observer
agreement over severity ratings. While these limitations
reduce statistical power and impact on the ability to draw
conclusions for a wider population, the pragmatic nature
of this study provides evidence of what may be achieved
within real-world settings.
Conclusion
This study indicates that the LP rolling-groups led by
community-based SLPs can be both effective and efficient
in the treatment of stuttering for young children. The
rolling-group model was associated with significant clinical
improvement and a reduction of clinical hours. These
findings provide evidence that LP rolling-group participants
consumed 50% fewer clinician hours than children receiving
individual treatment, with equivalent client outcomes. The
evidence suggests that this service model has the potential
to be recommended particularly where SLPs are struggling
to manage extensive waiting lists. The rolling-group
program appears applicable across a broad range of clinical
environments but most particularly in rural and regional
community health settings. Future research is needed into