JCPSLP Vol 17 No 3 2015

The potential for community translation of these findings is considerable. Children as young as 3 years of age can receive the same stuttering treatment within their homes as they would within a clinic, with equally positive outcomes and experience, irrespective of where they live. This finding was significant, given that children as young as 2 years of age can be negatively affected by their stuttering (Yairi, 1983). Clinical insights This article aims to share the clinical observations and recommendations of the treating SLP (first author) in the webcam Lidcombe Program study with the view to empower and up skill fellow SLPs. This article is not a qualitative study of the researchers’ or participants’ experiences, but rather an opportunity to share clinical insights garnered from the trial through observations and informal conversations with study participants over the two-year period the treating SLP spent using webcam delivery. Convenience The first observation related to convenience. The rationale for webcam treatment is typically to increase access to a service for rural and remote populations. The interesting trend in this study, however, was that despite having access to local speech pathology services, the metropolitan parents generally reported webcam treatment to be more convenient than clinic-based consultations. The convenience extended beyond increased access; it provided a family-friendly service option that was easier for families with young children. Families did not have to travel to a clinic; they just had to prepare a few resources and turn on their computer. The inconvenience of travelling to a clinic was reported by families, despite many living within a 10-kilometre radius of the clinic site, hence supporting the notion that even short distances can be a limitation to attending any clinic-based service. Families reported additional benefits, including the fact that they could schedule appointments at times when siblings were out or occupied. Many webcam families were still able to attend consultations even when the participating parent, sibling, or child was unwell. For example, webcam delivery supported the continuous treatment of one child whose parent had a chronic health condition, and many webcam families even continued to attend consultations while holidaying interstate and overseas. Nevertheless, despite these benefits and the fact that outcomes did not differ between webcam and clinic-based delivery groups, a small group of webcam families displayed beyond- consultation behaviours that were not considered to be conducive to positive treatment outcomes. Attendance Statistically, there was no difference in regularity of attendance between the groups. Differences existed in the way families communicated about absences. In the case of webcam families, there were more cancellations on the day of the scheduled consultations, with a large proportion being within 15 minutes of the consultation. Webcam families were also less likely to inform the SLP if they were running late. It is unclear whether these issues were related to treatment readiness, whether the families valued this service delivery less, or perhaps were just influenced by the “convenience” factor. It is also possible that these families would have behaved in the same way if they had been

randomised to the clinic group. An additional point to consider is that of fees or cancellation policies that are present in some clinics and that may support attendance and cancellations in a timely manner. Consultation times To ensure that all families were given equal opportunities, and to avoid bias to either group, consultation times were offered between the standard operation hours of the treatment clinic: 8am to 6pm on weekdays. Consequently, some working parents in both groups had to alter their working hours or days. Clinic children who attended late appointments had rarely been home beforehand, resulting in a late appointment being just an extension of their day outside of the home. These children were typically compliant and engaged for the duration of the consultation. By contrast, the webcam children had returned home from their day at school or childcare, and were often interested in playing within the home, spending time with siblings, or eating, rather than complying with treatment. If children are to attend appointments via webcam, it is recommended that parents be supported in establishing a routine conducive to active engagement in consultations. Treatment preparation and readiness To prepare properly for webcam sessions, first parents needed to organise their day to ensure that they and their children were home for the scheduled appointment. Second, parents needed to source appropriate resources and had to have the severity rating sheet accessible at the computer before the consultation began. Finally, the parents needed to prepare their children for the session, by explaining at what time it would occur, to avoid children protesting at being taken away from a preferred activity unexpectedly. Although the majority of webcam families were ready at the time of their consultation, a small group of families were not, apparently due to a lack of organisation. Although webcam consultations required less organisation on the part of the parents in relation to travelling, parents still needed to organise themselves and their children to participate in the webcam consultation. Failure to prepare resources impacted the family’s ability to participate fully in all Lidcombe Program treatment session components. To help parents prepare themselves and their children for the consultation, it is recommended that the SLP talk in advance about the likely structure of the consultation. When the parent and SLP are involved in discussion, it may be helpful if the parent has an activity set up for the

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology