JCPSLP Vol 17 No 3 2015

child close by. Then, once the child is required to talk with the SLP, the parent should be asked to have prepared some toys or items of interest to assist discussion. The SLP may suggest that the parent prerecord an audio or video sample that demonstrates the child stuttering, or parent–child treatment. These recordings can be shared with the SLP via email or a secure file sharing website, as is currently recommended in the standard treatment guide. During initial sessions, the SLP may also engage in a brief discussion about positioning, recommending that seating be considered to allow the child to sit on his or her own chair ensuring the child is fully visible on the computer screen. If using a laptop, the SLP and parent may discuss where would be appropriate to set up for the consultation. If possible, a room away from other family members and household distractions rather than open living spaces should be used. Webcam consultation guidelines should also be explained. These could include: (1) the SLP will place the call at the scheduled time, (2) the parent must remain with the child at the computer; the child is not to be left alone, and (3) the parent is asked to cater for siblings during this time to avoid disruption. For the majority of webcam consultations during the trial, the SLP placed the call and was greeted by the participating family who were ready to start. Some parents preferred to have initial discussions without their child and then call the child into the room when required. When parents had prepared their children, telling them in advance they would be having the consultation, the children would come immediately and be compliant. When parents had not pre-warned their children about the consultation, the children would often protest about being removed from the activity they were engaged in. Furthermore, parents who did not prepare an activity to occupy their child during the parent–SLP discussion were often interrupted, or the child would leave the room. The same situation arose when parents had not pre-planned their treatment resources. They would either select items they could quickly access or attempt to deliver treatment without appropriate games or resources, which often led to the child being uninterested and the conversation dissolving. This ad-hoc approach also limited the feedback the SLP could give the parent about treatment, because it was not representative of the treatment parents provided at other times during the week. Defining the clinical space Clinical space and rules or boundaries were largely pre-defined and understood by the majority of webcam families. However, a subset of families did not adhere to

common or assumed clinical boundaries. Several parents often left their children at the computer without warning, answered their phones during sessions, and attended to non-treatment-related tasks. Beyond the consultation, this same group of webcam families cancelled consultations or communicated if they were running late less frequently than the remaining webcam families. They forgot several consultations or asked to have consultations shortened due to competing lifestyle demands. Such behaviour suggests the need to explicitly define clinical boundaries when using webcam as the service-delivery model. Behaviour management The greatest challenge for the SLP delivering the webcam treatment was behaviour management. This issue was twofold. Initially, webcam children at times appeared to be less compliant. Superficially, their reduced compliance could have been attributed to the service-delivery model (i.e., webcam versus clinic consultation). However, when the “difficult” children were observed more closely, there appeared to be some common variables: their parents had not prepared them for the consultation and were not prepared themselves. These children were often not seated appropriately and were not given things to do during the initial parent–SLP discussion. In these families, the parents appeared less direct or controlling in the general management of their child, allowing the child more freedom in behaviour and compliance. It became evident that with these families, the success of the consultation was largely based on the parents’ ability to control their children’s behaviour rather than the SLP’s ability. On reflection, it was these incidents that highlighted a difference in SLP, parent, and child behaviour across the two settings. Within the clinic, the SLP was direct with respect to the rules of the clinic room, how the resources were to be used, and what behaviour was acceptable. During webcam consultations, the SLP did not have a physical space to assist with setting the boundaries. Rather, the treatment space, for the children at least, was within the family home. Consequently, the children tended to behave in the same manner they did at home. An additional issue related to clinical space concerned safety and duty of care. Within the clinical environment, if a parent leaves a child with an SLP, the SLP is responsible for what happens to the child. The SLP and child share the same environment so the SLP can intervene, physically if required, to maintain the child’s safety. During a webcam consultation, however, the SLP cannot do so, raising concern as to the SLP’s responsibility for a child who is

Screenshots of webcam delivery

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JCPSLP Volume 17, Number 3 2015

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