JCPSLP vol 19 no 3 2017 low res. pdf

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Supporting social, emotional and mental health and well-being: Roles of speech-language pathologists
JCPSLP Volume 19, Number 3 2017 151
KEYWORDS
LIDCOMBE
PROGRAM
PRESCHOOL
REFLECTIVE
QUESTIONS
STUTTERING
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
Stacey Sheedy
(top) and Verity
MacMillan
(Arnott, Onslow, O’Brian, Packman, Jones, & Block, 2014;
Bridgman, Onslow, O’Brian, Jones, & Block, 2016; Jones
et al., 2005).
There are two stages of the Lidcombe Program. The aim
of stage 1 is for the child to attain no stuttering or almost no
stuttering. It requires the parent to deliver treatment to the
child every day and to attend the clinic weekly until program
criteria are met. The median treatment time for stage 1
completion is 16 weeks (Onslow, 2017). Subsequently,
stage 2 commences. The aim of stage 2 is for the child to
maintain no stuttering or almost no stuttering for a long and
clinically significant period. During stage 2, the speech-
language pathologist (SLP) guides the parent to gradually
and systematically withdraw treatment while maintaining
treatment gains. During stage 2, clinic visits occur less
often, contingent on maintenance of treatment gains.
While the procedures in the Lidcombe Program are
clearly documented in the Lidcombe Program Treatment
Guide (Packman et al., 2016), SLPs both within Australia
and internationally have required training in the program as
benchmarks were reportedly difficult to attain. Hence, the
Lidcombe Program Trainers Consortium was established
in 2004 to provide 2-day training workshops. There are
consortium members in 11 countries across Europe,
North America, Asia, New Zealand and Australia. A recent
study (O’Brian et al., 2013) reported that community SLPs
who had received consortium training administered the
treatment more comprehensively and attained better clinical
outcomes than those who did not receive that training. This
raises the possibility that such training is causally related to
better treatment outcomes.
Clinical skill is an essential component of evidence-based
practice (Sackett, Rosenburg, Gray, Haynes, & Richardson,
1996). Consequently, to assist SLPs to optimise their
clinical skills with the Lidcombe Program, the Stuttering
Unit at Bankstown in Sydney offers a consultation service.
Two-thirds of such consultations are prompted because
children do not progress through the program as expected
(Harrison, Ttofari, Rousseau, & Andrews, 2003). Sources
of departure from the Treatment Guide that might be
responsible are well known (Harrison et al., 2003; Packman
et al., 2016). Examples include: inconsistent or non-existent
collection of severity ratings by parents, incorrect verbal
contingencies for moments of stuttering, failure to do
practice sessions daily, and sensitive children who react
negatively to verbal contingencies.
Clinical reasoning is built on robust knowledge and is
dependent on critical thinking and reflective self-awareness
(Higgs & Jones, 2008). Reflective clinical practice promotes
The Lidcombe Program of early stuttering
intervention is an evidence-based behavioural
treatment originally developed for children
younger than 6 years. Problem-solving is
inherent during Lidcombe Program treatment.
Therefore a number of reflective questions
were devised to assist speech-language
pathologists (SLPs) to detect clinical procedures
that vary from those recommended in the
Lidcombe Program Treatment Guide and to
employ suitable strategies. A two-stage
validation process of the reflective questions
was conducted. First, questions were
developed and then revised with input from
the members of the international Lidcombe
Program Trainers Consortium. Then feedback
on their clinical usefulness was obtained from
public health SLPs. The outcomes of each
stage of validation are reported and
implications for speech-language pathologists
delivering the Lidcombe Program discussed.
The Lidcombe Program is a behavioural treatment
originally developed for young children who stutter.
The Lidcombe Program Treatment Guide (Packman
et al., 2016) outlines the clinical process. Parents or carers
(referred to hereafter as parents) provide verbal
contingencies after stutter-free speech and after moments
of stuttering during conversational speech. At the beginning
of the program, these contingencies are provided during
practice sessions, usually implemented once and
sometimes twice per day for 10–15 minutes each time. As
treatment progresses the parent starts to deliver verbal
contingencies during naturally occurring conversations
throughout the day. The Lidcombe Program is supported
by randomised clinical trials and experiments, translational
research, meta-analysis and treatment process research
(for an overview see Packman et al., 2016). The treatment
has an odds ratio of 7.5 for children to attain below 1.0 per
cent syllables stuttered at follow-up (Jones et al., 2005;
Onslow, Jones, Menzies, O’Brian, Packman, & Menzies,
2012). Sustained treatment effects were shown for most
children in the Jones et al. (2005) trial at a mean of 5 years
post-randomisation (Jones et al., 2008). The efficacy of the
treatment has been shown with three randomised trials
Lidcombe Program
Development and validation of reflective questions
Stacey Sheedy, Verity MacMillan, Sue O’Brian, and Mark Onslow