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JCPSLP Volume 19, Number 3 2017 153
reflection on Lidcombe Program procedures, as
encouraged by the questions outlined in this study,
ultimately leads to modification of clinical practice that
enhances client outcomes. Future translational research
about the Lidcombe Program could utilise the present set
of reflective clinical questions as it directs attention to any
departures from the documented Lidcombe Program
process (Packman et al., 2016).
Conclusion
Students and SLPs who are learning the Lidcombe
Program and developing new clinical skills may particularly
benefit from applying the reflective questions to their work
with clients as they encourage reflective practice, appear to
positively inform problem-solving and may help promote
treatment fidelity. The reflective clinical questions have been
added as an Appendix to the Lidcombe Program Treatment
Guide (Packman et al., 2016). The Treatment Guide
suggests that, in the event that a child may not be attaining
clinical progressive benchmarks, SLPs use the reflective
questions to facilitate problem-solving and refine practice;
areas that the authors recommend are the focus of future,
larger scale research studies.
References
Arnott, S., Onslow, M., O’Brian, S., Packman, A., Jones,
M., & Block, S. (2014). Group Lidcombe Program treatment
for early stuttering: A randomized controlled trial. Journal of
Speech, Language and Hearing Research, 57, 1606–1618.
Bridgman, K., Onslow, M., O’Brian, S., Jones, M., &
Block (2016). Lidcombe Program webcam treatment for
early stuttering: A randomized controlled trial. Journal of
Speech, Language and Hearing Research, 59, 932–939.
Harrison, E., Ttofari, K., Rousseau, I., & Andrews, C. (2003).
Troubleshooting. In M. Onslow, A. Packman, & E. Harrison.
(Eds.), The Lidcombe Program of early stuttering intervention:
A clinician’s guide (pp. 91–99). Austin, TX: Pro-Ed.
Higgs, J., & Jones, M. (2008). Clinical decision making
and multiple problem spaces. In J. Higgs, M. Jones, S.
Loftus, & N. Christensen (Eds.), Clinical reasoning in the
health professions (pp. 3–18). Sydney, NSW: Butterworth-
Heinemann Elsevier.
Jones, M., Onslow, M., Packman, A., O’Brian, S., Hearne,
A., Williams, S., … Schwarz, I. (2008). Extended follow-up
of a randomized controlled trial of the Lidcombe Program of
Early Stuttering Intervention. International Journal of
Language and Communication Disorders , 43, 649–661.
Jones, M., Onslow, M., Packman, A., Williams, S.,
Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised
controlled trial of the Lidcombe Programme of early
stuttering intervention. British Medical Journal, 331,
659–663.
Mamede, S., & Schmidt, H. G. (2004). The structure
of reflective practice in medicine. Medical education, 38,
1302–1308.
Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection
and reflective practice in health professions education: A
systematic review. Advances in Health Sciences Education,
14 , 595–621.
Martz, W. (2009). Validating an evaluation checklist using
a mixed method design. Evaluation and Program Planning,
33 , 215–222.
O’Brian, S., Iverach, L., Jones, M., Onslow, M.,
Packman, A., & Menzies, R. (2013). Effectiveness of
the Lidcombe Program for early stuttering in Australian
community clinics. International Journal of Speech-
Language Pathology , 15, 593–603.
overlooked. It helps you to reflect in more detail re
treatment. (SLP 2)
Very good checklist – allowed me to pinpoint issues
in the treatment which then gave the treatment more
direction. Some questions difficult to answer, e.g.’ in
“Rate – did the number of verbal contingencies appear
to be sufficient to decrease the stuttering during each
day?” – sometimes hard to know. (SLP 3)
Discussion
Reflective practice is a desirable component of evidence-
based clinical practice, and is regarded by many as
essential for development of professional competence
(Mann, Gordon, & MacLeod, 2009). Reflective clinical
practice is associated with development of professional
expertise (Mamede, & Schmidt, 2004) and is endorsed as
an occupational competency standard for Australian SLPs
(Speech Pathology Australia, 2011). Problem-solving by the
treating SLP is inherent in the Lidcombe Program treatment
process (Packman et al., 2016) and hence reflective clinical
practices are a desirable component of the treatment
process. However until now, there has not been an
established method to support SLPs with their problem-
solving throughout Lidcombe Program treatment. While the
Swift et al. (2012) checklist focuses specifically on parent
delivery of treatment in a practice session, the Lidcombe
Program is implemented in many and varied settings
beyond practice sessions. Therefore, a process was
undertaken to develop and provide preliminary validation of
a number of reflective questions to assist SLPs to detect
variations in their clinical procedures from those
recommended in the Lidcombe Program Treatment Guide.
The O’Brian et al. (2013) translational report found that
SLPs who had formal clinical Lidcombe Program training
had improved Lidcombe Program community outcomes.
Therefore, the international Lidcombe Program Trainers
Consortium, the body that runs the formal Lidcombe
Program training, was actively involved in validating and
refining each reflective question.
To explore whether the reflective questions had clinical
applicability, four SLPs applied the questions to a client
case and subsequently completed a short self-report
survey about their clinical usefulness. These SLPs had
varied experience in treating children who stutter, ranging
from an SLP with less than one year of experience to a
more specialist SLP with 12 years experience. All four
reported that the reflective questions supported them to
think about their clinical practice, problem-solve and modify
their clinical practice with the Lidcombe Program in light of
their reflections. This suggests that the reflective questions
about the Lidcombe Program were useful for supporting
SLPs of varying experience. All agreed that they identified
one or more clinical practices to improve upon and that the
benefits of the tool justified the time spent completing the
questions, again suggesting positive clinical utility.
Limitations
While this preliminary study found that SLPs with varying
experience reported the reflective questions to be of clinical
value, it is acknowledged that participant numbers in both
the expert panel and the field study participant groups were
small and constituted samples of convenience. Thus, these
preliminary results should be interpreted cautiously. Future
research is warranted to determine the heuristic value of the
reflective clinical questions for a larger group of SLPs
practising across a diverse range of settings. In addition,
further studies are required to determine whether focused