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JCPSLP
Volume 19, Number 2 2017
Journal of Clinical Practice in Speech-Language Pathology
model: “Biggest concern initially was that it was going to
take more time, particularly around coordinating families”
(#6). Time factors were of particular concern for part-time
SLPs, with the challenge of coordinating client attendance
when working limited hours.
Theme 2: Scaffolds
“Scaffolding” refers to a temporary supporting framework
that can be applied while a process or new skill is being
learnt. The theme of scaffolds reflects the participants’
sense of skills or supports that would enable them to
transfer to a new way of working with the LP rolling-group
delivery. The participants believed their general clinical skills
and knowledge would be applicable to the rolling-group
model and were pragmatic regarding their ability to develop
new systems or materials.
Participants felt that a strong level of confidence with
the standard individual LP treatment protocol was a core
foundation skill, as was prior expertise with the principles of
group therapy in a broader sense: “Probably the confidence
that you have the knowledge and skills to run the Lidcombe
Program first” (#6).
Several comments endorsed the idea that the
participants’ customary clinical methods had been
supplemented via by the formal teleconference training and
informal ongoing mentoring during the study: “[It was] good
to watch videos of others running groups” (#4).
Participants felt they enabled themselves to embrace the
new model by being prepared. Well-prepared resources
went some way to mitigate concerns over the “controlled
chaos” [#6] nature of the rolling-groups: “Having a list of
activities from structured to unstructured was initially useful”
(#6).
Theme 3: Betterment
Betterment as a theme broadly encompasses the
participants’ sense of both the benefits and future
aspirations derived from engaging in the rolling-groups.
Participants were universally optimistic following their
involvement in the study, sharing their aspirations to
continue running the LP rolling-groups, regardless of
whether they had been able to establish one during the
time of the project or not. The major benefits reported were
time-efficiency and more real-life communication
interactions between the children, such as negotiating over
a preferred toy or waiting for a turn during a dynamic group
conversation.
For busy clinicians the rolling-group offered a solution
to the day-to-day stress of managing a large caseload:
“Grouping stutterers is much more time-efficient way to go
as long as outcomes are comparable” (#5).
Time savings were clearly articulated by the two SLPs
who ran their groups throughout the entire study. One
reflected that the rolling-groups were very pragmatic, as
it meant that a clinician’s time was never under-utilised
should a client fail to attend an appointment without
notice, reflecting that for this reason alone, even if the time
frame was longer, it would likely be more efficient: “[The
rolling-group model represented a] …useful use of time...
misses [i.e., clients absent] for all sorts of good reasons...
[but there was] always one there [when using the rolling-
group model]” (#5). This compares to the impact traditional
stuttering treatment may have on the waiting times for
children with other communication issues, particularly as
stuttering treatment is usually continuous and not delivered
in “blocks”:
Results
Four major themes were identified from the analysis of the
interview data that reflect a high level of consistency
between participants regarding their perceptions of the LP
rolling-group intervention. Themes of challenges, scaffolds,
betterment, and journey were interwoven, creating a rich
fabric of change-process understanding.
Theme 1: Challenges
The theme of challenges encapsulates the broad nature of
obstacles that the participants either anticipated or
encountered as they engaged with the new model. While
these were not insurmountable, the participants expressed
concerns over the logistics of establishing rolling-groups,
managing the perceived complexity of a new way of
working, and the ever-present lack of time for planning and
organisation. In two cases, logistical obstacles such as
limited referrals prevented the rolling-groups from being
established, whereas in the main these were overcome.
The greatest barriers related to allocation of a suitable
space and insufficient diversity of resources for play
activities, with groups requiring up to four “stations” where
each child–parent pair had an activity to engage with
independently: “Issue was room size. [It was] crowded
to get three parents and three kids in the room” (#4).
Of particular concern to many participants was having
sufficient activities to engage all of the children across a
diverse range of ages and stuttering severity levels over
the treatment period: “[Having a] variety of activities is a
challenge, as the groups are ongoing, not just a six to eight
week block” (#5).
Having activities designed for differing levels of stuttering
severity occurring concurrently meant that the LP rolling-
groups were both less structured and at a higher level of
clinical complexity than standard SLP groups, requiring
a flexible approach: “Lidcombe Program groups are
less structured than other groups and therefore more
challenging. Other groups are generally an activity being
done by the entire group” (#5). The rolling-group format
requires new child–parent pairs to start their treatment
with others who are already in the group and may have
well-established skills. Consequently, the SLP is required to
juggle a broad variety of needs in rapid succession, such
as demonstrating aspects of early treatment in structured
conversations followed quickly by discussion with parents
regarding their child entering maintenance having met the
criteria for Stage 2: “Competing skills and stimuli. Managing
multiple stimuli and still staying on track and staying on time
and collecting data….[it’s] quite a complex skill” (#3).
Often parents were at differing stages in their
engagement with the LP methods and therapy journey,
requiring extra care and skill in order to avoid parental fears
generated by comparison with those more experienced at
treatment: “More thought on new people in the group [to
support their integration into an established group]” (#5).
Participants expressed a universal feeling that newly
graduated SLPs may require extra support in the form
of ongoing coaching and may need to be familiar with
individual LP prior to engaging with the rolling-group model:
“ [A] new graduate may need to shadow or watch groups
prior to running them. Could be a bit overwhelming. How to
keep things going” (#4).
Limited time was a standout obstacle expressed by
all the participants, who reflected their concerns prior to
commencement that additional time would be required to
embed a new process, organise clients and plan the new