JCPSLP Vol 19 No 2 2017 low res

29 / 64

JCPSLP Volume 19, Number 2 2017 83
experience. In February 2014, all participating SLPs were
trained in the management of LP rolling-group model by
either the program developer Dr Arnott or the coordinating
researcher via teleconference. Three participating SLPs and
the coordinating researcher were able to instigate LP
rolling-groups at separate community-health centres in four
different regional towns. Three of the SLPs who volunteered
were unable to commence groups for a variety of reasons
including insufficient referrals where two SLPs shared a role
(n = 1), SLP absence for medical reasons (n = 1) and
leaving the role as SLP (n = 1). Data were collected from
those SLPs who were unable to begin groups as they had
attended the training and planning phase of the study. As
such, their perceptions of the process and aspirations to
engage with LP rolling-groups in the future were considered
to be valuable insights. The rolling-groups were established
at differing times across the four community health sites
between March 2014 and April 2015 depending on intake
numbers.
Moreover, the perspectives of SLPs engaged with delivery
of stuttering interventions are rarely documented. In their
synthesis of qualitative papers pertaining to developmental
stuttering, Johnson et al. (2016) found no studies
meeting their inclusion criteria between 1990 and 2014
that reported on the perspectives of clinicians delivering
stuttering treatments. One such paper has been published
subsequently (de Sonneville-Koedoot, Adams, et al., 2015).
Arnott et al. (2014) touched on the perceptions of the two
treating SLPs in the LP group delivery RCT paper although
these were not formally examined as part of the study. As
such, while we have considerable empirical support for
stuttering intervention efficacy, we have little knowledge on
how these interventions translate within community settings
or clinicians’ perceptions of their acceptability or practicality.
An opportunity to address this gap in the clinical research
literature recently arose following a community-based trial
of rolling-group LP delivery. This mixed-methods study
aimed to evaluate the LP rolling-group effectiveness within
community settings, together with clinicians’ perceptions of
the viability of this novel model (Rappell, 2015). As reported
by Rappell et al. (2017), the study involved a prospective,
pre-post measurement design with stuttering severity
measured in percentage of syllables stuttered (%SS) at
assessment, 6 and 9 months post group commencement
and at the completion of Stage 1. Nineteen children aged
from 2 years and 9 months to 6 years and their parents
participated following a standard intake procedure at four
regional community health centres. Each rolling-group
was made up of two to four child–parent pairs, led by one
of the four participating SLPs and lasted the standard
45–60 minutes regardless of the number of participants.
Across all measures the community-based SLPs achieved
clinical outcomes similar to those published in the literature
for individual and group LP treatment, achieving the
completion of Stage 1 with a mean of 7.3 clinical hours, a
median number of 15 clinic visits and a mean %SS score of
0.37% with a greater than 50% reduction in clinical hours to
achieve Stage 2. Therefore, this study aimed to explore the
experiences of participating SLPs when implementing the
alternative LP rolling-group model, and their perceptions of
the value and sustainability of the model for future service
delivery.
Method
The qualitative component detailed in this paper followed a
realist paradigm using an inductive thematic analysis
approach, collecting data though semi-structured
interviews with six rural SLPs. This dual-design married
SLPs’ insights with the quantitative data presented in
Rappell et al. (2017), to elicit depth and completeness from
complementary findings (Venkatesh, Brown, & Bala, 2013).
Ethics approval was obtained from the North Coast NSW
Human Research Ethics Committee (No. LNR 073 26).
Participants
Six SLPs from different towns volunteered to undertake the
training and instigate an LP rolling-group together with the
coordinating researcher who is a practising SLP in the
region. 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 were the only stipulated
requirements. As presented in Table 1, the participating
SLPs had from eight years to over 35 years of clinical
Table 1: Demographic data
Participant Years in SLP
profession
Years since
trained in LP
Type SLP
#1 28 Undergraduate*
and 2005
Generalist**
#2 11 2003 Paediatric
#3 28 Undergraduate* Generalist**
#4 8 2013 Paediatric
#5 > 35 1991 & 2005 Paediatric
#6 16 Undergraduate* Paediatric
* Trained by Lidcombe Program designer Mark Onslow within
undergraduate degree as part of core lecture series on stuttering.
** “Generalist” denotes those SLPs whose caseloads include both
children and adults.
Data collection
A semi-structured interview was conducted with each
participating SLP at 9 months post commencement of the
inaugural group. Enabling debriefing and reflection, the
interviews were conducted via telephone by the
coordinating researcher, each for a duration of 15–30
minutes. Notes were handwritten concurrently, without the
use of a recording device (Sim & Wright, 2000). Key
reflections from each SLP were combined into an
individualised written summary which was returned to the
participant to ascertain if it was a true and full account of
her/his perceptions and experiences of the LP rolling-group
process. One SLP requested minor alterations to add clarity
to several statements contained in the summary.
Data analysis
The written summaries and handwritten notes from the
semi-structured interviews with the SLPs were
systematically analysed according to the thematic analysis
method (Braun & Clarke, 2006). Specifically, the
coordinating researcher immersed herself in the data to
ascertain reoccurring topics that could constitute a pattern,
leading to codes and themes. Key themes were ultimately
broken down into subthemes, expressing the breadth of
the SLPs’ perceptions as to whether the novel LP rolling-
group model may be seen as a valuable and sustainable
alternative for future service delivery.