JCPSLP Vol 17 No 3 2015

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Fresh science and pioneering practice
JCPSLP Volume 17, Number 3 2015 125
Kate Bridgman
(top), Susan
Block (centre),
and Sue O’Brian
KEYWORDS
LIDCOMBE
PROGRAM
PAEDIATRIC
STUTTERING
TELEPRACTICE
TREATMENT
Webcam delivery of the
Lidcombe Program
Insights from a clinical trial
Kate Bridgman, Susan Block, and Sue O’Brian
for young children, and ensures more equitable service
delivery for rural and remote preschool-aged children and
their families. A Phase I study showed that webcam delivery
of the Lidcombe Program was a viable treatment delivery
model (O’Brian, Smith & Onslow, 2014). The findings paved
the way for a randomised controlled trial (RCT) comparing
standard in-clinic Lidcombe Program treatment with home
webcam delivery (Bridgman, 2014) that is the basis for
observations made in this article.
The trial utilised a parallel, open plan noninferiority RCT
design involving preschool-aged children with stuttering.
The control group received standard delivery of the
Lidcombe Program (Packman, et al., 2011) in a traditional
clinic setting. The experimental group received the
Lidcombe Program within their homes using a computer,
a webcam, the Internet and a live video calling program
(Skype). The use of webcams and live video conferencing,
compared to previous, low-tech telehealth (phone and
mail) trials of the Lidcombe Program, allowed the principles
of standard delivery of the Lidcombe Program to remain
relatively unchanged. The SLP–parent–child triad was
preserved, with all parties maintaining live interactions.
Real-time measurements, observation and education for
parent implementation of the program were also achieved
through this medium. Thus, treatment could be delivered in
accordance with the program treatment guide (Packman et
al., 2011, p. 1).
Forty-nine children were randomised to the trial. The
participant group consisted of 37 boys and 12 girls, aged
3 years 0 months to 5 years 11 months at the time of
assessment. The mean age of the clinic group was 4
years 2 months (SD = 9.8 months) and for the webcam
group 4 years 5 months ( SD = 9.5 months). The primary
outcome measure (treatment efficiency) was the number
of consultations and SLP hours required for children to
attain Stage 2 of the Lidcombe Program, in which children
display little or no stuttering over a sustained period of time.
The secondary outcome measures – stuttering reduction
as measured by parent-evaluated severity ratings and
percentage of syllables stuttered – were used to evaluate
treatment efficacy. Quantitative and qualitative data were
also obtained from parent questionnaires. The number of
weeks to attain Stage 2 entry was also measured.
Results from this trial were extremely encouraging
with many families seeming to prefer this method of
delivery. RCT results hope to be detailed in an upcoming
publication.
Webcam delivery of the Lidcombe Program
for preschool children who stutter was
recently found in a randomised control trial to
be effective and efficient. This paper details
the unexpected clinical observations that the
speech-language pathologist (SLP) made
while treating preschool families via webcam
during the trial. These included observations
regarding participant convenience, behaviour,
attendance, treatment preparation, readiness,
and representativeness, as well as clinical
boundaries and relationships.
Recommendations are made for SLPs
considering webcam intervention with
children who stutter. Some of these
recommendations may also be relevant to
SLPs engaging in webcam treatment delivery
with other client groups.
Early intervention, in particular the Lidcombe
Program, provides children who stutter with the
best opportunity to overcome their stuttering
(Jones et al., 2005) and to avoid the lifelong complications
associated with the disorder. The Lidcombe Program
is a behavioural treatment for early stuttering. Parents
attend weekly consultations with their child and a speech-
language pathologist (SLP), during which they are taught to
administer verbal contingencies for stuttering and stutter-
free speech in the child’s natural environment (Packman, et
al., 2011). The first stage of the program involves parents
learning to administer parent verbal contingencies to the
child’s speech in everyday conversations. The second stage
commences once the child has achieved no stuttering,
or minimal stuttering in their speech. Treatment is then
gradually withdrawn. Despite the potential benefits of the
Lidcombe Program, many children are unable to access
this efficacious treatment due to distance and lifestyle
factors (Verdon, Wilson, Smith-Tamaray, & McAllister, 2011).
One solution to this problem is to deliver the treatment
via webcam over the Internet. This service-delivery model
was designed to increase access to timely, best-practice
intervention for those who are currently unable to access
treatment (Lowe, O’Brian, & Onslow, 2014). It also reduces
the costs and resources involved with outreach service
provision, provides more convenient home-based treatment
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED