ACQ Vol 12 no 1 2010

or improved upon their negotiated criteria. C3 showed a marginal increase in SRs and %SS from those gained at the end of the weekly treatment phase. It is noteworthy that C5 did not require all elements of PS to control his stutter. Discussion Teaching PS in a one-hour weekly format was an effective service delivery model for these clients. Despite treatment visits being spaced a week apart, clients were able to learn the PS pattern, vary their naturalness levels and apply PS in everyday situations to reduce their stuttering severity, as evidenced by beyond clinic SRs. As previously stated, one client, C3, showed an increase in severity at the end of maintenance. This increase, however, still fell within the range of his maintenance criteria and was at levels that C3 reported being satisfied with. In describing the outcomes of a One-Day Instatement Program for PS Harrison et al. (1998) reported that 24 treatment hours were required for clients to reach the maintenance phase. For the Camperdown Program outcomes, O’Brian et al. (2003) reported an average of 20.1 hours (range 13–29 hours) to reach the maintenance phase. Block et al. (2005) reported that 45 hours were required to complete the instatement and transfer phases of a 5-day intensive PS treatment. The treatment duration for the five clients presented in this paper was an average of 23 hours (range 8–43) and is comparable to these other publications. For certain clients providing PS treatment on a weekly basis can be advantageous. Weekly treatment can be tailored to individual client needs particularly in regards to their goals, learning styles, and circumstances. This is of great consequence for clients who require an interpreter or have limited English competency. Additionally, some clients (e.g., C5) may not require all elements of PS to control their stutter so treatment can be flexible. Further, when clients are treated in a non-intensive weekly format, generalisation of PS is not likely to be adversely affected. Clients can ease into the use of PS during everyday life situations (Onslow & Packman, 1997). Finally, many speech pathology clinics would be able to implement this service delivery model. For example, weekly treatment is potentially more accessible to isolated or rural clinicians who may not have appropriate resources to provide a group intensive treatment format and smaller clinics who may not receive sufficient numbers of adult referrals in order to form a group. There are disadvantages of weekly treatment. For some clients, treatment may take longer than reported in the more recent intensive format literature. It is difficult to determine whether clients treated individually are potentially “missing” valuable learning experiences that may take place in a group/intensive format. For example, being able to interact and practice with other people who stutter or being exposed to using PS for an extended period of time. Hearne et al. (2008) hypothesised that for adolescents, the group component of the intensive day of the Camperdown Program may be beneficial due to peer support. This may be relevant to adults. Lastly, more intensive practice of PS may be indicated if the client is not progressing in a weekly format. The method described in this paper is one way of teaching PS. There are alternative methods described in the literature that clinicians might consider, in particular that described in the Camperdown Program (O’Brian et al., 2003; Carey et al., 2008). Clinicians need to consider the literature as well as clients’ needs and responsiveness to various teaching methods when deciding how to implement treatment.

Outcomes for the reported clients have been gained retrospectively through a file audit and are therefore limited in generalisability. However, there is little outcome information in the literature on weekly PS treatment to guide clinicians. Hence, this paper provides some preliminary information indicating that for some adults who stutter, a one-hour weekly PS treatment program may be a viable option to consider. References Block, S., Onslow, M., Packman, A., Gray, B., & Dacakis, G. (2005). Treatment of chronic stuttering: outcomes from a student training clinic. International Journal of Language and Communication Disorders , 40 ,(4), 455–466. Carey, B., O’Brian, S., Onslow, M., Block, S., & Jones, M. (2009). A randomised controlled non-inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program. International Journal of Language and Communication Disorders (electronic publication ahead of print, retrieved 22 April 2009). Harrison, E., Onslow, M., Andrews, C., Packman, A., & Webber, M. (1998). Control of stuttering with prolonged speech: preliminary outcome of a one-day instatement program. In A. K. Cordes and R. J. Ingham (Eds.), Treatment efficacy for stuttering: A search for empirical bases (pp. 191–212). San Diego, CA: Singular Publishing Group. James, J.E. (1981). Behavioral self-control of stuttering using time-out from speaking. Journal of Applied Behavior Analysis , 14 , 25–37. James, J.E., Ricciardelli, L.A., Hunter, C.E., & Rogers, P. (1989). Relative efficacy of intensive and spaced behavioural treatment of stuttering. Behaviour Modification , 13 , 376–395. O’Brian, S., Onslow, M., Cream, A., & Packman, A. (2003). The Camperdown Program: Outcomes of a new prolonged speech treatment model. Journal of Speech, Language and Hearing Research , 46 , 933–946. O’Brian, S., Packman, A., & Onslow, M. (2008). Telehealth delivery of the Camperdown Program for adults who stutter: A phase 1 trial. Journal of Speech, Language, and Hearing Research , 51 , 184–195. Onslow, M. (1996). Behavioural Management of Stuttering . San Diego, CA: Singular Publishing Group, Inc. Onslow, M., & Packman, A. (1997). Designing and implementing a strategy to control stuttered speech in adults. In R. F. Curlee and G.M. Siegel (Eds.), Naturalness and treatment of stuttering new directions . (pp. 356–376). Needham Heights, MA: Allyn and Bacon. Packman, A., Onslow, M., & Van Doorn, J. (1994). Prolonged speech and the modification of stuttering: Perceptual, acoustic, and electroglottographic data. Journal of Speech and Hearing Research , 37 , 724–737. Wendy Lloyd has worked at the Stuttering Unit, Bankstown Health Service, for 6 years. Wendy treats adults and children of all ages who stutter and provides phone consultations to speech pathologists across Australia. Wendy contributes to the Continuing Professional Education in Stuttering (CPES) program run in conjunction with the Australian Stuttering Research Centre and Macquarie University through clinical observation days and workshops.

Correspondence to: Wendy Lloyd

Locked mailbag 1600 Bankstown, NSW, 2200 phone: + 61 2 9780 2766 email: wendy.lloyd@sswahs.nsw.gov.au

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ACQ Volume 12, Number 1 2010

ACQ uiring knowledge in speech, language and hearing