ACQ Vol 12 No 3 2010

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ACQ Volume 12, Number 3 2010 141
everything else seemed to have failed. In comparison,
secondary school-aged students who undertook the
Intensive Fluency Programs tended to be recommended for
these as a next logical step in fluency support after initial
assessment.
Qualitative data regarding the factors that appeared to
influence outcomes for the primary school-aged population
was collected from the clinicians involved in the Intensive
Fluency Program. These factors included: internal locus of
control (the desire in the individual to achieve change), strong
parental support and the presence of ongoing social or
emotional factors such as trauma experienced as a refugee
or family break up.
The Lidcombe Program
Implementation
In more recent years, given the growing body of evidence of
the effectiveness of the Lidcombe Program of Early
Stuttering Intervention with school-aged children (Lincoln,
Onslow, Lewis, &Wilson, 1996), it was felt that this program
needed to be incorporated into the CEOM service delivery
model. During the Lidcombe Program, at stage 1, weekly
sessions with the parent and child occur where the focus is
on training the parent to implement verbal contingencies and
accurately provide severity ratings. These verbal
contingencies and severity ratings are implemented daily
within the home environment. Once consistent low levels of
stuttering are achieved, students move onto stage 2 which
no longer requires weekly sessions and the focus is the
maintenance of fluency. The modelling of activities for
parents and the monitoring of implementation of activities in
the sessions were seen to be effective forms of agent
training that integrated well with the agent training
philosophy of the CEOM speech pathology service.
As part of the implementation, the Lidcombe Program
Training Consortium was contacted. Dr Elisabeth Harrison
and Ms Stacey Sheedy came to Melbourne and worked
with the 20 speech pathologists at the CEOM over
three days. This resulted in 2 full days of training in the
Lidcombe Program of Early Intervention, half a day training
in Management of Stuttering in School-age Children and
half a day to discuss ways of incorporating this model into
existing CEOM service delivery with the challenges of high
caseloads.
Of the 80 students who were offered the Lidcombe
Program only 22 (27.5%) commenced the program. There
were a number of reasons for this and these are summarised
in table 2.
The Intensive Fluency Programs
Implementation
In 1996, following consultation with Dr Susan Block at La
Trobe University and a consideration of the research available
in the area of fluency, the decision was made to run an
Intensive Fluency Program for secondary school students
who had moderate to severe stuttering. The activities in the
sessions were based on the intensive programs being run at
La Trobe University (Block, Onslow, Packman, Gray, &
Dacakis, 2005; Block, Onslow, Packman, & Dacakis 2006).
The Intensive Fluency Program was conducted over a week.
This included an instatement phase which was the explicit
teaching of smooth speech strategies such as gentle onsets
and linking. Once students had mastered the technique,
transfer tasks in real-life situations were implemented in the
program. Parents were present throughout each day of the
program and were trained to identify dysfluencies and
provide appropriate feedback. At the end of each day, home
practice tasks were required to be completed. Follow-up
maintenance sessions were then provided at each
participant’s school to aid generalisation of skills. Parents
were expected to attend all sessions. The close involvement
of parents within the program and with the home practice
tasks supported the CEOM agent training service delivery
philosophy.
Initially at CEOM, Intensive Fluency Programs were only
run for secondary school-aged students. Over the years
the programs were extended to include primary school-
aged students. These programs were run during the school
holidays. This ensured minimal impact on existing high
caseloads of speech pathologists during the peak periods
of the school term. This timing also avoided the issue of
students missing five days of school.
Ongoing data six months post fluency intensive programs
was available for 32 students. These results revealed a
positive gain in students’ stuttering outcomes, with an
average reduction of 7.8% syllables stuttered in secondary
students and of 4.9% syllables stuttered in primary students.
The average number of speech pathology hours required
for the intensive program and maintenance sessions was 29
hours.
Table 1. Summary of Intensive Program speech data
(%SS)
Secondary Primary
students students
Number of students commencing program 17 15
Mean pre treatment 10.91% 8.88%
Mean post intensive 1.49% 3.89%
Mean gain post intensive 7.87% 4.99%
Mean number of SP hours 29 29
Mean age 14 9.5
Challenges
The Intensive Fluency Programs conducted by the CEOM
speech pathologists indicated poorer outcomes for primary
school-aged students compared to secondary school-aged
students. This may not have been due to the age of the
students involved in the treatment but rather to the selection
process. In many instances primary school-aged children
were referred for Intensive Fluency Programs when
Table 2. Involvement in the Lidcombe Program
Students commencing the Lidcombe Program 27.5% (n =22)
Students not commencing the Lidcombe Program 72.5% (n =68)
Reasons for not commencing the Lidcombe Program:
Still deciding 22.4%
Good progress, thus not necessary 17.2%
Commitment 13.8%
Student compliance 3.4%
Other treatment priorities 6.9%
Older student 22.4%
No agent 8.6%
Receiving private speech pathology treatment 1.7%
Other: Parent choice 1.7%
Private speech pathologist recommendation 1.7%