JCPSLP Vol 17 No 3 2015

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JCPSLP Volume 17, Number 3 2015 127
common or assumed clinical boundaries. Several parents
often left their children at the computer without warning,
answered their phones during sessions, and attended to
non-treatment-related tasks. Beyond the consultation, this
same group of webcam families cancelled consultations or
communicated if they were running late less frequently than
the remaining webcam families. They forgot several
consultations or asked to have consultations shortened due
to competing lifestyle demands. Such behaviour suggests
the need to explicitly define clinical boundaries when using
webcam as the service-delivery model.
Behaviour management
The greatest challenge for the SLP delivering the webcam
treatment was behaviour management. This issue was
twofold. Initially, webcam children at times appeared to be
less compliant. Superficially, their reduced compliance
could have been attributed to the service-delivery model
(i.e., webcam versus clinic consultation). However, when
the “difficult” children were observed more closely, there
appeared to be some common variables: their parents had
not prepared them for the consultation and were not
prepared themselves. These children were often not seated
appropriately and were not given things to do during the
initial parent–SLP discussion. In these families, the parents
appeared less direct or controlling in the general
management of their child, allowing the child more freedom
in behaviour and compliance. It became evident that with
these families, the success of the consultation was largely
based on the parents’ ability to control their children’s
behaviour rather than the SLP’s ability.
On reflection, it was these incidents that highlighted a
difference in SLP, parent, and child behaviour across the
two settings. Within the clinic, the SLP was direct with
respect to the rules of the clinic room, how the resources
were to be used, and what behaviour was acceptable.
During webcam consultations, the SLP did not have a
physical space to assist with setting the boundaries. Rather,
the treatment space, for the children at least, was within the
family home. Consequently, the children tended to behave
in the same manner they did at home.
An additional issue related to clinical space concerned
safety and duty of care. Within the clinical environment, if
a parent leaves a child with an SLP, the SLP is responsible
for what happens to the child. The SLP and child share the
same environment so the SLP can intervene, physically if
required, to maintain the child’s safety. During a webcam
consultation, however, the SLP cannot do so, raising
concern as to the SLP’s responsibility for a child who is
child close by. Then, once the child is required to talk with
the SLP, the parent should be asked to have prepared
some toys or items of interest to assist discussion.
The SLP may suggest that the parent prerecord an audio
or video sample that demonstrates the child stuttering, or
parent–child treatment. These recordings can be shared
with the SLP via email or a secure file sharing website, as is
currently recommended in the standard treatment guide.
During initial sessions, the SLP may also engage in a
brief discussion about positioning, recommending that
seating be considered to allow the child to sit on his or her
own chair ensuring the child is fully visible on the computer
screen. If using a laptop, the SLP and parent may discuss
where would be appropriate to set up for the consultation.
If possible, a room away from other family members and
household distractions rather than open living spaces
should be used. Webcam consultation guidelines should
also be explained. These could include: (1) the SLP will
place the call at the scheduled time, (2) the parent must
remain with the child at the computer; the child is not to be
left alone, and (3) the parent is asked to cater for siblings
during this time to avoid disruption.
For the majority of webcam consultations during the
trial, the SLP placed the call and was greeted by the
participating family who were ready to start. Some parents
preferred to have initial discussions without their child and
then call the child into the room when required. When
parents had prepared their children, telling them in advance
they would be having the consultation, the children would
come immediately and be compliant. When parents had
not pre-warned their children about the consultation, the
children would often protest about being removed from the
activity they were engaged in. Furthermore, parents who
did not prepare an activity to occupy their child during the
parent–SLP discussion were often interrupted, or the child
would leave the room. The same situation arose when
parents had not pre-planned their treatment resources.
They would either select items they could quickly access or
attempt to deliver treatment without appropriate games or
resources, which often led to the child being uninterested
and the conversation dissolving. This ad-hoc approach
also limited the feedback the SLP could give the parent
about treatment, because it was not representative of the
treatment parents provided at other times during the week.
Defining the clinical space
Clinical space and rules or boundaries were largely
pre-defined and understood by the majority of webcam
families. However, a subset of families did not adhere to
Screenshots of
webcam delivery