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JCPSLP Volume 17, Number 3 2015 131
of the ASRC (n.d.). The speech restructuring technique is
taught through observation, imitation, and self-evaluation.
The client is encouraged to use their smartphone or
computer tablet to record their own attempts at
reproducing the speech restructuring model, for
comparison and evaluation.
During the instatement stage clients will practise the
speech restructuring technique between clinic or Internet
webcam consultations, and collect samples of that practice
for review with the clinician. Discussion will take place on
how that will occur – whether through self-recording using a
smartphone, recording onto a voicemail, or sharing audio-
visual samples using the Internet. The choice of technology
will be guided by the client’s usual habits, preferences, and
goals. The clinician will strategically link speech practice
with phone, webcam Internet or iPad use, and often all
of these, to exploit conditioning to that technology. In this
manner, irrespective of method of treatment delivery –
in-clinic or telepractice – technology supports the strong
focus on self-monitoring and self-management of the
Camperdown Program. Self-monitoring has been found to
provide some protection against relapse (Bothe, Davidow,
Bramlett, & Ingham, 2006).
Stage III: Generalisation
The focus of stage III of the program is to transfer the
speech technique to everyday speaking environments.
During this stage, a regular individualised speech practice
routine is established, generalisation of stutter-free speech
is facilitated, and problem-solving strategies are
encouraged. Technology can assist these processes in
many ways. For example, clients will continue to evaluate
their use of the speech restructuring technique through
self-recording. Portable recording systems on smartphones
allow clients to unobtrusively record themselves practising
their speech restructuring technique in a variety of everyday
situations, chosen by them. In this way, speech technique
practice and evaluation can be taken into the workplace,
school, and home.
Practice can also be made more interesting by guiding
clients to web-based resources. One resource developed
specifically to facilitate generalisation of fluency gains is
Scenari-Aid (Meredith, n.d.). Scenari-Aid is a software
program that allows clients to choose from a hundred
simulated scenarios in which to practise. For some clients,
this form of practice may be very helpful in desensitising
them to increased anxiety in social situations. For others
who are more impacted by social anxiety, desensitisation
alone may be insufficient and cognitive behaviour therapy
may be recommended. CBTpsych (Helgadottir, n.d.) is
a fully automated on-line cognitive behaviour treatment
that has been developed specifically to address anxiety in
adults who stutter. Clients complete this program without
the assistance of a clinician and without needing to attend
a clinic. Phase I and II trials confirm the efficacy of this
treatment (Helgadottir, Menzies, Onslow, Packman, &
O’Brian, 2009).
Adherence is a key determinant to treatment success
and lack of adherence is common not only for stuttering
treatment, but also for voice disorders treatment (Van Leer
& Connor, 2012) and indeed many medical treatments. At
this stage of treatment, adherence to weekly consultations
is critical for the development of good problem-solving
skills. Good problem-solving skills are needed to address
challenges clients encounter as they attempt to generalise
their new speech technique. However, treatment adherence
before our first meeting with them. If our profession mirrors
the experience of other similar disciplines, our clients seek
information about stuttering on websites, blogs, podcasts,
YouTube videos and social media. They come to us more
informed about stuttering and more aware of treatment
choices and their evidence bases. They also, more than
ever previously, have access to videos of influential people
in politics, sports, and entertainment discussing their own
experiences of stuttering and stuttering treatment. They
may be well informed or misinformed. In any scenario, the
client we first meet for assessment is likely to feel more
empowered and is a more critical consumer of our service
(McMullan, 2006).
If the purpose of assessment is to determine the client’s
needs and challenges, technology makes it more valid,
easy, and accessible. Technology can provide speech
samples that are relevant, representative and natural,
taken from conversations with people with whom the client
usually interacts, in the places that they occur (Karimi,
O’Brian, Onslow, & Jones, 2013; O’Brian et al., 2013).
Published manuscripts of clinical trials have used these
methods (for an example, see Carey et al., 2010). These
recordings can be emailed or shared ahead of assessment,
or produced at assessment on a smartphone, iPad, or
laptop to be heard during the consultation. A client who is
reporting some anxiety in social situations may be asked
to complete a web-based assessment, for example the
assessment of Unhelpful Thoughts and Beliefs About
Stuttering Scale (UTBAS; Iverach et al., 2011; St Clare et
al., 2009) or the Depression Anxiety Stress Scales (DASS;
Lovibond & Lovibond, 1995). At assessment, clinicians may
refer clients to websites, electronic books, publications, and
consumer blogs or podcasts to supplement informational
counselling.
The use of technology in the
Camperdown Program
Stage I: Teaching treatment components
A core component of the Camperdown Program is
stuttering severity measurement, and a 9-point severity
rating scale (O’Brian et al., 2010) is used for that purpose.
For both in-clinic and telepractice clients, training in how to
use a severity rating scale can be enhanced through
observation of stuttering samples of others available on
YouTube or from the clinician’s own collection. To record
stuttering severity ratings, a client may be provided with a
variety of options. Ratings may be documented on-line, for
example using Google docs or Excel graphs on a laptop or
iPad, or by using a paper chart accessible on the Australian
Stuttering Research Centre (ASRC; 2015) website. The aim
is for clients to be provided with a method of recording
stuttering severity scores that is the least intrusive and most
convenient, as this is likely to facilitate treatment adherence.
Stage II: Instatement
Having taught the client a means of measuring and
recording stuttering severity, the clinician instates stutter-
free speech. While traditionally a clinician models the
speech restructuring technique for the client, the
Camperdown Program uses technology to allow teaching
of a standardised speech restructuring model. This avoids
relying on clinician skill to model correctly (Onslow &
O’Brian, 1998). The client can choose to learn the speech
restructuring technique from a man or woman, adolescent
or adult, all examples can be downloaded from the website