JCPSLP Vol 17 No 3 2015

Fresh science and pioneering practice

Technology in practice The Camperdown Program Brenda Carey, Sue O’Brian, and Mark Onslow

During the past two decades, new technologies have led to the development of telepractice in medicine generally, and speech pathology specifically. However, more recently, the influence of technology is extending beyond telepractice, affecting all that we do in the clinic. This paper uses the Camperdown Program, a treatment for adolescents and adults who stutter, to demonstrate this idea. It describes how technology may be integrated into the four stages of the Camperdown Program in ways that may make treatment more accessible, realistic, and engaging for clients. Risks to integrating technology into our clinical practice are identified. T echnology has been described as “the branch of knowledge that deals with the creation and use of technical means and their interrelation with life, society, and the environment” (Dictionary.com, n.d.). It influences the way we live, and consequently the way we work. In relation to speech pathology practice, it has long been used in the form of unsophisticated tools like tape recorders and rating machines. In recent years, technology has involved such devices as the Internet, computers and their many applications, iPads, recording devices, and smartphones. Arguably, in the last two decades, the influence of technology has been greatest in increasing access to stuttering treatments through telepractice. Telepractice is “the application of telecommunications technology to deliver clinical services at a distance … for the purposes of assessment, intervention, consultation and/or supervision” (Speech Pathology Australia, 2014, p. 4). Over that time, many children, adolescents and adults in several countries have participated in clinical trials evaluating the efficacy of stuttering treatment delivered by telepractice. There are published telepractice clinical trials ranging from single case studies to randomised controlled trial designs (for a review of these see Lowe, O’Brian, & Onslow, 2014). While technology continues to drive telepractice treatment and research, today its influence arguably extends far beyond telepractice. Given this expanding influence, it seems timely to consider how technology is being used more generally in our clinical practice today. The treatment used in this exploration is the Camperdown Program (O’Brian, Onslow, Cream, &

Packman, 2003). This treatment has been chosen because it has been used both for in-clinic and telepractice clinical trials, and has outcomes from randomised controlled trials that have been published in peer-reviewed journals (Carey et al., 2010). The Camperdown Program is a speech restructuring treatment that was designed for adults (O’Brian et al., 2003) and has since been adapted for use with adolescents (Carey, O’Brian, Lowe, & Onslow, 2014; Carey, O’Brian, Onslow, Packman, & Menzies, 2012; Hearne, Packman, Onslow, & O’Brian, 2008). Speech restructuring refers to the use of a novel speech technique to reduce stuttering (Onslow & Menzies, 2010). Data have been presented for 19 adults who stutter who have participated in two in-clinic treatment trials (O’Brian et al., 2003; O’Brian, Cream, Onslow, & Packman, 2001). In addition, data have been presented for 32 adults who stutter who have participated in three telepractice trials of this treatment (Carey et al., 2010; Erickson et al., 2012; O’Brian, Packman, & Onslow, 2008). Outcomes show that for adults, the program when delivered in-clinic and by telepractice is efficacious, has high client satisfaction, and is more efficient than traditional intensive treatment formats of other programs (for example, see Boberg & Kully, 1994; Onslow, Costa, Andrews, Harrison, & Packman, 1996; Block, Onslow, Packman, Gray, & Dacakis, 2005). Reductions in stuttering have been maintained for 6–12 months post treatment. The mean number of clinician contact hours to the maintenance stage of the treatment has ranged from 8–20. For adolescents, there have been fewer treatment trials. Data have been presented for 20 adolescents who participated in three telepractice and in-clinic trials (Carey et al., 2012, 2014; Hearne et al., 2008). Outcomes for adolescents show more variability in stuttering reduction. In the largest of these trials (Carey et al., 2014), adolescents significantly reduced their stuttering frequency and severity; however, only half of the participants reduced their avoidance of speaking situations. For the three adolescent trials, the mean number of clinician contact hours to the maintenance stage of the treatment has ranged from 11–16. For both adults and adolescents in the Camperdown Program trials, in-clinic and telepractice, reductions in self-reported severity ratings are consistent with those shown from %SS data. Satisfaction outcomes, when obtained, have also been favourable. Assessment Whether the consultation is in-clinic or by telepractice, for most clients engagement with technology often begins well

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS CAMPERDOWN PROGRAM STUTTERING TECHNOLOGY

Brenda Carey (top), Sue O’Brian (centre), Mark Onslow

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology