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Shaping innovative services: Reflecting on current and future practice
82
JCPSLP
Volume 19, Number 2 2017
Journal of Clinical Practice in Speech-Language Pathology
Nicole Rappell
(top) and David
Schmidt
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
COMMUNITY
BASED
LIDCOMBE
PROGRAM
PRACTICE
CHANGE
ROLLING-GROUP
MODEL
STUTTERING
programs with fidelity. For example, de Sonneville-
Koedoot, Adams, Stolk, and Franken (2015) conducted
focus groups following a randomised control trial (RCT) to
ascertain clinician attitudes and beliefs towards the LP or
DCM approaches. The authors reported that the uptake
and utilisation of treatment models are greatly influenced
by subjective clinician-driven factors, which are rarely
addressed in efficacy studies. Additionally, de Sonneville-
Koedoot, et al. (2015) highlighted that SLPs who volunteer
for research projects may be considered early adopters of
innovation and as such their insights are potentially crucial
to wider practice change.
It is also possible that these detours from the core
guidelines are a direct attempt by SLPs to reduce time
spent in stuttering treatment in order to manage increasing
caseloads. Although not often referred to in efficacy
studies, the fact that the LP runs continuously rather than
in a block-review cycle, as is commonly practised by many
SLPs, adds significantly to caseload management issues.
A single RCT comparing individual to group LP treatment
(Arnott et al., 2014) demonstrated no differences between
the arms with regard to the number of weeks or clinical
visits required and percentage of syllables stuttered at
criteria for Stage 2. Of particular interest for SLPs was that
the group arm, while demonstrating clinical equivalence,
consumed approximately half the clinical hours when
compared to the individual treatment arm. The rolling-group
method utilised in this RCT differs from conventional SLP
groups as the make-up of the group changes over time.
Rolling-groups start with a set number of children and as
one child completes treatment a new child begins in his or
her place (Rappell, Schmidt, & Rolfe, 2017). To this end,
the LP rolling-group model of delivery may offer a clinical
solution for SLPs where stuttering treatment duration is
impacting on overall caseload management.
Furthermore, our understanding of how empirically
based stuttering treatments are translated to clinical
practice is somewhat limited by a paucity of reporting on
broader issues that may be influential to community level
uptake. The majority of LP efficacy studies have been
under the auspices of the program developers (Guitar
et al., 2015) and less than a handful of studies have
investigated transferability to the wider community (O’Brian
et al., 2013), including examination of outcomes when
delivered by inexperienced SLPs (de Sonneville-Koedoot,
Stolk, et al., 2015; McCulloch, Swift, & Wagnitz, 2017) or
conducted by independent researchers (Franken, Kielstra-
Van der Schalk, & Boelens, 2005; Miller & Guitar, 2009).
Rolling-group therapy delivery is seldom used
in speech-language pathology services and
yet this model of admitting new clients
continuously as space permits offers the
real-world possibility of dramatically reduced
clinical hours for the treatment of stuttering
in young children. Rolling-group delivery for
the Lidcombe Program (LP) has proven
clinical equivalence with individual treatment
in a randomised control trial, the findings of
which were recently replicated in a
community-based trial. This paper details the
perceptions of six speech-language
pathologists (SLPs) who participated in that
community-based trial to ascertain the
viability of this alternative model of service
delivery. Participating SLPs universally
supported the rolling-group model. The three
themes drawn from the semi-structured
interviews described logistical challenges,
the need for managers to proactively support
clinicians when moving to a rolling-group
model through the allocation of time for
capacity building, and a desire to embrace
practice change.
A
broad body of empirical evidence has been
published to provide speech-language pathologists
(SLPs) with an understanding of treatment efficacy,
and to a lesser degree “‘real-world”‘ effectiveness, for
young children who stutter. Two prominent such treatment
models are the Lidcombe Program (LP; Jones et al.,
2005; Packman et al., 2015) and RESTART – Demands
and Capacities Model (DCM; de Sonneville-Koedoot,
Stolk, Rietveld, & Franken, 2015). Both programs feature
treatment manuals to support standardised practice
and implementation with fidelity in research and clinical
contexts. However, in the field of early years stuttering
treatment, it is known that SLPs in community clinics often
reduce sessions times or omit aspects from the guidelines
(O’Brian et al., 2013).
A number of factors have been identified that may limit
the capacity of SLPs to implement stuttering treatment
Rolling-group Lidcombe
Program
Perspectives from participant clinicians in a community-
based cohort study
Nicole Rappell and David Schmidt