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JCPSLP
Volume 19, Number 2 2017
85
Capacity building was touched on. One participant
directly reflected on the fact that the rolling-groups
methodology had been brought to the region via the
practitioner-led research study: “[The LP rolling-group
model was] brought to us by you [i.e. the coordinating
researcher]. Made it an easy thing to be a part of [the
establishment of rolling-groups]” (#3).
Discussion
There is a considerable volume of empirical evidence
supporting the LP and yet, as with all stuttering
interventions, we have very few insights from the clinicians
who deliver these treatments (Johnson et al., 2016) in the
communities for which they were designed. This study
aimed to highlight the perspectives of community-based
SLPs as to whether they perceive the new LP rolling-group
model as a valuable or sustainable alternative within their
future service delivery. Such insights add depth to the
quantitative component of the mixed-methods study
reporting on the first community-based study of the LP
rolling-group model (Rappell et al., 2017) led by SLPs within
regional community-health (i.e., public) centres. Rappell et
al. (2017) demonstrated a positive association between the
LP rolling-group model and a reduction in stuttering, in line
with benchmarks reported in the literature for individual and
group LP but with a greater than 50% reduction in clinical
hours to achieve Stage 2. Importantly, with regards to
ongoing practice change within day-to-day clinical settings,
the consensus from the participating SLPs towards the new
rolling-group model was comprehensively positive while
acknowledging some challenges.
The journey from research paper to everyday clinical
practice can be a long and arduous one. The results
from the original RCT investigating group LP treatment
were first presented at the Annual Convention of the
American Speech-Language-Hearing Association in 2010.
Subsequent presentations and a peer-reviewed journal
publication (Arnott et al., 2014) have resulted in limited
uptake of this treatment option, posing the self-evident
question: why are SLPs not changing their practice with
regards to delivery options for the LP?
Empirical-based support or recommendations in no way
equate to the perception of a treatment protocol being
“doable” in a SLPs’ day-to-day clinical setting. Arnott et
al. (2014) made reference to the perceptions of the two
SLPs involved in the original RCT, recounting that while
the rolling-groups were considered more demanding than
individual treatment, they were also “clinically gratifying” (p.
11). This overarching sense of optimism towards the rolling-
group model featured prominently in the themes derived
from the semi-structured interviews held with this study’s
SLPs.
Challenges perceived by the participants reflected those
previously outlined in the literature when embracing clinical
change, evidence-based practice (EBP) or research design
within the speech-language pathology profession. Limited
clinical space (O’Brien, Byrne, Mitchell, & Ferguson, 2013)
was one such logistical issue. A sense of time pressure
or lack of time has consistently been reported by SLPs
as a reason behind poor implementation of EBP (Finch,
Cornwell, Nalder, & Ward, 2015; O’Connor & Pettigrew,
2009) and was universally referred to by participants, in
one form or another, as an obstacle. The counterbalance to
this challenge is a robust perception that the rolling-groups
were highly pragmatic in their time-efficiency, due to the
reduction in clinical hours per child and the likelihood that
Lidcombe Program [which continues without a
treatment break until the child reaches little or no
stuttering] means stutterers can start to fill up available
therapy slots and impact on caseload [by possibly
extending the waiting time of children with other
communication issues]. (#5)
One participant, who worked very limited hours, reflected
that she would not have been able to manage the referral
rates for children who stutter without the rolling-group model:
“There is no way I could manage them without a group” (#6).
Lidcombe Program rolling-groups are a dynamic
environment, although the components are standard,
following the LP manual. Participants reported feeling
this “controlled chaos” (#6) engendered greater cross-
fertilisation of ideas and “social support” (#3) between
adults (i.e., SLP and parents’ joint problem-solving home
practice issues), with additional advantages of being more
enjoyable and garnering more real-life communication for
the children than individual treatment: “If it’s a bit crazy, it’s
okay as they are talking naturally” (#6).
Core components of the LP, whether in the traditional
individual or new rolling-group delivery model, are that the
parents and SLP demonstrate treatment with the child
within the session. Several participants commented that
this seemed to be a less intense experience for the both
child and parent, in the rolling-group format, as they were
not the only focus of attention and that the SLP was not felt
to be “pointing a finger” (#6) at an individual so much within
a group:“[It’s] not just focusing on them” (#1).
Participant consensus was that the LP rolling-groups
would be part of their service delivery into the future and
were optimistic about their expectation to use the LP
rolling-group model, even if they had not been able to
run groups during the study. Several participants referred
to the experience of running the groups as a means of
encouraging change across their entire service, not just
within their individual practice: “Strongly encourage all
clinicians to run LP groups” (#4).
Theme 4: Journey
Participating SLPs reported experiencing a journey of
personal and professional growth, through overcoming
confidence issues, and of improving clinical skills. Despite
years of clinical experience, participants indicated that new
treatment models require practice and can engender
concern about the likelihood of positive outcomes.
Not all participants were confident when treating children
who stutter and several expressed nervousness related
to the change in treatment platforms: “[I] needed a bit of
self-discipline and a leap to do this, try groups… [it was]
not comfortable. [I] made the decision to do it and try hard”
(#5).
Several participants reported that they had felt more
comfortable starting with smaller client numbers and
gradually increasing the number of child–parent pairs as
their confidence grew: “I felt more comfortable with two and
moving up to three” (#4).
Participants reported that as they developed expertise in
the rolling-group model, they relied less on precise planning
of the group structure and sequence, instead opting to
utilise the available resources (e.g., toys or worksheets) in a
more fluid and flexible way to meet treatment goals within
the group: “Not over thinking what your plan is [but using
whatever activities or toys are set up to flexibly meet the
needs of the children as issues arise within the rolling-
group]” (#6).