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JCPSLP
Volume 17, Number 3 2015
Journal of Clinical Practice in Speech-Language Pathology
randomised to the clinic group. An additional point to
consider is that of fees or cancellation policies that are
present in some clinics and that may support attendance
and cancellations in a timely manner.
Consultation times
To ensure that all families were given equal opportunities,
and to avoid bias to either group, consultation times were
offered between the standard operation hours of the
treatment clinic: 8am to 6pm on weekdays. Consequently,
some working parents in both groups had to alter their
working hours or days. Clinic children who attended late
appointments had rarely been home beforehand, resulting
in a late appointment being just an extension of their day
outside of the home. These children were typically
compliant and engaged for the duration of the consultation.
By contrast, the webcam children had returned home from
their day at school or childcare, and were often interested in
playing within the home, spending time with siblings, or
eating, rather than complying with treatment. If children are
to attend appointments via webcam, it is recommended
that parents be supported in establishing a routine
conducive to active engagement in consultations.
Treatment preparation and readiness
To prepare properly for webcam sessions, first parents
needed to organise their day to ensure that they and their
children were home for the scheduled appointment.
Second, parents needed to source appropriate resources
and had to have the severity rating sheet accessible at the
computer before the consultation began. Finally, the
parents needed to prepare their children for the session, by
explaining at what time it would occur, to avoid children
protesting at being taken away from a preferred activity
unexpectedly. Although the majority of webcam families
were ready at the time of their consultation, a small group
of families were not, apparently due to a lack of
organisation. Although webcam consultations required less
organisation on the part of the parents in relation to
travelling, parents still needed to organise themselves and
their children to participate in the webcam consultation.
Failure to prepare resources impacted the family’s ability to
participate fully in all Lidcombe Program treatment session
components.
To help parents prepare themselves and their children
for the consultation, it is recommended that the SLP talk
in advance about the likely structure of the consultation.
When the parent and SLP are involved in discussion, it
may be helpful if the parent has an activity set up for the
The potential for community translation of these findings
is considerable. Children as young as 3 years of age can
receive the same stuttering treatment within their homes as
they would within a clinic, with equally positive outcomes
and experience, irrespective of where they live. This finding
was significant, given that children as young as 2 years
of age can be negatively affected by their stuttering (Yairi,
1983).
Clinical insights
This article aims to share the clinical observations and
recommendations of the treating SLP (first author) in the
webcam Lidcombe Program study with the view to
empower and up skill fellow SLPs. This article is not a
qualitative study of the researchers’ or participants’
experiences, but rather an opportunity to share clinical
insights garnered from the trial through observations and
informal conversations with study participants over the
two-year period the treating SLP spent using webcam
delivery.
Convenience
The first observation related to convenience. The rationale
for webcam treatment is typically to increase access to a
service for rural and remote populations. The interesting
trend in this study, however, was that despite having access
to local speech pathology services, the metropolitan
parents generally reported webcam treatment to be more
convenient than clinic-based consultations. The
convenience extended beyond increased access; it
provided a family-friendly service option that was easier for
families with young children. Families did not have to travel
to a clinic; they just had to prepare a few resources and
turn on their computer. The inconvenience of travelling to a
clinic was reported by families, despite many living within a
10-kilometre radius of the clinic site, hence supporting the
notion that even short distances can be a limitation to
attending any clinic-based service.
Families reported additional benefits, including the fact
that they could schedule appointments at times when
siblings were out or occupied. Many webcam families were
still able to attend consultations even when the participating
parent, sibling, or child was unwell. For example, webcam
delivery supported the continuous treatment of one child
whose parent had a chronic health condition, and many
webcam families even continued to attend consultations
while holidaying interstate and overseas. Nevertheless,
despite these benefits and the fact that outcomes did not
differ between webcam and clinic-based delivery groups,
a small group of webcam families displayed beyond-
consultation behaviours that were not considered to be
conducive to positive treatment outcomes.
Attendance
Statistically, there was no difference in regularity of
attendance between the groups. Differences existed in the
way families communicated about absences. In the case of
webcam families, there were more cancellations on the day
of the scheduled consultations, with a large proportion
being within 15 minutes of the consultation. Webcam
families were also less likely to inform the SLP if they were
running late. It is unclear whether these issues were related
to treatment readiness, whether the families valued this
service delivery less, or perhaps were just influenced by the
“convenience” factor. It is also possible that these families
would have behaved in the same way if they had been