ACQ Vol 12 No 3 2010

The Intensive Fluency Programs Implementation In 1996, following consultation with Dr Susan Block at La Trobe University and a consideration of the research available in the area of fluency, the decision was made to run an Intensive Fluency Program for secondary school students who had moderate to severe stuttering. The activities in the sessions were based on the intensive programs being run at La Trobe University (Block, Onslow, Packman, Gray, & Dacakis, 2005; Block, Onslow, Packman, & Dacakis 2006). The Intensive Fluency Program was conducted over a week. This included an instatement phase which was the explicit teaching of smooth speech strategies such as gentle onsets and linking. Once students had mastered the technique, transfer tasks in real-life situations were implemented in the program. Parents were present throughout each day of the program and were trained to identify dysfluencies and provide appropriate feedback. At the end of each day, home practice tasks were required to be completed. Follow-up maintenance sessions were then provided at each participant’s school to aid generalisation of skills. Parents were expected to attend all sessions. The close involvement of parents within the program and with the home practice tasks supported the CEOM agent training service delivery philosophy. Initially at CEOM, Intensive Fluency Programs were only run for secondary school-aged students. Over the years the programs were extended to include primary school- aged students. These programs were run during the school holidays. This ensured minimal impact on existing high caseloads of speech pathologists during the peak periods of the school term. This timing also avoided the issue of students missing five days of school. Ongoing data six months post fluency intensive programs was available for 32 students. These results revealed a positive gain in students’ stuttering outcomes, with an average reduction of 7.8% syllables stuttered in secondary students and of 4.9% syllables stuttered in primary students. The average number of speech pathology hours required for the intensive program and maintenance sessions was 29 hours.

everything else seemed to have failed. In comparison, secondary school-aged students who undertook the Intensive Fluency Programs tended to be recommended for these as a next logical step in fluency support after initial assessment. Qualitative data regarding the factors that appeared to influence outcomes for the primary school-aged population was collected from the clinicians involved in the Intensive Fluency Program. These factors included: internal locus of control (the desire in the individual to achieve change), strong parental support and the presence of ongoing social or emotional factors such as trauma experienced as a refugee or family break up. The Lidcombe Program Implementation In more recent years, given the growing body of evidence of the effectiveness of the Lidcombe Program of Early Stuttering Intervention with school-aged children (Lincoln, Onslow, Lewis, &Wilson, 1996), it was felt that this program needed to be incorporated into the CEOM service delivery model. During the Lidcombe Program, at stage 1, weekly sessions with the parent and child occur where the focus is on training the parent to implement verbal contingencies and accurately provide severity ratings. These verbal contingencies and severity ratings are implemented daily within the home environment. Once consistent low levels of stuttering are achieved, students move onto stage 2 which no longer requires weekly sessions and the focus is the maintenance of fluency. The modelling of activities for parents and the monitoring of implementation of activities in the sessions were seen to be effective forms of agent training that integrated well with the agent training philosophy of the CEOM speech pathology service. As part of the implementation, the Lidcombe Program Training Consortium was contacted. Dr Elisabeth Harrison and Ms Stacey Sheedy came to Melbourne and worked with the 20 speech pathologists at the CEOM over three days. This resulted in 2 full days of training in the Lidcombe Program of Early Intervention, half a day training in Management of Stuttering in School-age Children and half a day to discuss ways of incorporating this model into existing CEOM service delivery with the challenges of high caseloads. Of the 80 students who were offered the Lidcombe Program only 22 (27.5%) commenced the program. There were a number of reasons for this and these are summarised in table 2. Table 2. Involvement in the Lidcombe Program Students commencing the Lidcombe Program 27.5% (n =22) Students not commencing the Lidcombe Program 72.5% (n =68) Reasons for not commencing the Lidcombe Program: Still deciding 22.4% Good progress, thus not necessary 17.2% Commitment 13.8% Student compliance 3.4% Other treatment priorities 6.9% Older student 22.4% No agent 8.6% Receiving private speech pathology treatment 1.7% Other: Parent choice 1.7% Private speech pathologist recommendation 1.7%

Table 1. Summary of Intensive Program speech data (%SS)

Secondary Primary students students

Number of students commencing program 17

15

Mean pre treatment

10.91% 8.88%

Mean post intensive

1.49% 3.89%

Mean gain post intensive

7.87% 4.99%

Mean number of SP hours

29

29

Mean age

14

9.5

Challenges The Intensive Fluency Programs conducted by the CEOM speech pathologists indicated poorer outcomes for primary school-aged students compared to secondary school-aged students. This may not have been due to the age of the students involved in the treatment but rather to the selection process. In many instances primary school-aged children were referred for Intensive Fluency Programs when

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ACQ Volume 12, Number 3 2010

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