JCPSLP Vol 17 No 3 2015

Fresh science and pioneering practice

Webcam delivery of the Lidcombe Program

Insights from a clinical trial Kate Bridgman, Susan Block, and Sue O’Brian

Webcam delivery of the Lidcombe Program for preschool children who stutter was recently found in a randomised control trial to be effective and efficient. This paper details the unexpected clinical observations that the speech-language pathologist (SLP) made while treating preschool families via webcam during the trial. These included observations regarding participant convenience, behaviour, attendance, treatment preparation, readiness, and representativeness, as well as clinical boundaries and relationships. Recommendations are made for SLPs considering webcam intervention with children who stutter. Some of these recommendations may also be relevant to SLPs engaging in webcam treatment delivery with other client groups. E arly intervention, in particular the Lidcombe Program, provides children who stutter with the best opportunity to overcome their stuttering (Jones et al., 2005) and to avoid the lifelong complications associated with the disorder. The Lidcombe Program is a behavioural treatment for early stuttering. Parents attend weekly consultations with their child and a speech- language pathologist (SLP), during which they are taught to administer verbal contingencies for stuttering and stutter- free speech in the child’s natural environment (Packman, et al., 2011). The first stage of the program involves parents learning to administer parent verbal contingencies to the child’s speech in everyday conversations. The second stage commences once the child has achieved no stuttering, or minimal stuttering in their speech. Treatment is then gradually withdrawn. Despite the potential benefits of the Lidcombe Program, many children are unable to access this efficacious treatment due to distance and lifestyle factors (Verdon, Wilson, Smith-Tamaray, & McAllister, 2011). One solution to this problem is to deliver the treatment via webcam over the Internet. This service-delivery model was designed to increase access to timely, best-practice intervention for those who are currently unable to access treatment (Lowe, O’Brian, & Onslow, 2014). It also reduces the costs and resources involved with outreach service provision, provides more convenient home-based treatment

for young children, and ensures more equitable service delivery for rural and remote preschool-aged children and their families. A Phase I study showed that webcam delivery of the Lidcombe Program was a viable treatment delivery model (O’Brian, Smith & Onslow, 2014). The findings paved the way for a randomised controlled trial (RCT) comparing standard in-clinic Lidcombe Program treatment with home webcam delivery (Bridgman, 2014) that is the basis for observations made in this article. The trial utilised a parallel, open plan noninferiority RCT design involving preschool-aged children with stuttering. The control group received standard delivery of the Lidcombe Program (Packman, et al., 2011) in a traditional clinic setting. The experimental group received the Lidcombe Program within their homes using a computer, a webcam, the Internet and a live video calling program (Skype). The use of webcams and live video conferencing, compared to previous, low-tech telehealth (phone and mail) trials of the Lidcombe Program, allowed the principles of standard delivery of the Lidcombe Program to remain relatively unchanged. The SLP–parent–child triad was preserved, with all parties maintaining live interactions. Real-time measurements, observation and education for parent implementation of the program were also achieved through this medium. Thus, treatment could be delivered in accordance with the program treatment guide (Packman et al., 2011, p. 1). Forty-nine children were randomised to the trial. The participant group consisted of 37 boys and 12 girls, aged 3 years 0 months to 5 years 11 months at the time of assessment. The mean age of the clinic group was 4 years 2 months ( SD = 9.8 months) and for the webcam group 4 years 5 months ( SD = 9.5 months). The primary outcome measure (treatment efficiency) was the number of consultations and SLP hours required for children to attain Stage 2 of the Lidcombe Program, in which children display little or no stuttering over a sustained period of time. The secondary outcome measures – stuttering reduction as measured by parent-evaluated severity ratings and percentage of syllables stuttered – were used to evaluate treatment efficacy. Quantitative and qualitative data were also obtained from parent questionnaires. The number of weeks to attain Stage 2 entry was also measured. Results from this trial were extremely encouraging with many families seeming to prefer this method of delivery. RCT results hope to be detailed in an upcoming publication.

KEYWORDS LIDCOMBE PROGRAM

PAEDIATRIC STUTTERING TELEPRACTICE TREATMENT THIS ARTICLE HAS BEEN PEER- REVIEWED

Kate Bridgman (top), Susan Block (centre), and Sue O’Brian

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JCPSLP Volume 17, Number 3 2015

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