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can be tested by the demands of needing to attend clinic on a weekly basis. Technology facilitates adherence and makes therapy less onerous when phone or webcam Internet consultations replace in-clinic appointments. Of course for some clients, adherence will have been facilitated from the outset through telepractice. Irrespective then of where they occur, at these consultations clients, together with the clinician, will begin to problem solve challenges and determine how much practice is needed, what type, and where in order to optimise progress. Technology can also assist if motivation becomes an issue. Introducing clients to a web-based motivational reward system, for example Beeminder (n.d.), allows clients to set goals, receive prompts, track practice, and even reward themselves. Other computer applications may facilitate adherence in other ways. HABITRPG (n.d., role play game) is a video game application to help develop new habits. It “gamifies” the life of the user by turning tasks (for example, speech practice activities) into monsters they have to conquer. The better the user is at sticking to a goal, the more progress is made in the game. New alternatives are likely to continue to become available. These applications are particularly suitable for adolescents as this population is likely to be very familiar with technology and find it enjoyable. Stage IV: Maintenance During the maintenance stage, clients continue to develop problem-solving skills to assist maintenance of their behaviour change over time. The aim is to reduce reliance on the clinician and to increase client self-reliance to deal with fluctuations in stuttering. There are different ways technology can be used here. First, webcams can assist clients to be involved in self- help groups, and to attend them more regularly, even when time and distance are an issue. Self-help groups may provide support and encouragement as well as an opportunity for speech practice. There is evidence that support groups can benefit psychological well-being in people with chronic mental illness, depression, anxiety, and bereavement (Pistrang, Barker, & Humphreys, 2008), and in people who stutter (Bradberry, 1997). The groups may also provide added opportunity for speech practice when family members or friends are included. A second way that technology can be used is by allowing consultations to continue with minimal inconvenience to the client, through telepractice consultations. Stuttering is a relapse-prone disorder and failure to complete maintenance stages of treatment places clients at increased risk of this occurring. Maintenance of gains may therefore be facilitated in this manner. Finally, technology provides the opportunity for clients to capture examples of their own speech restructuring technique, for them to continue to observe and evaluate, as described during the generalisation stage. Self-evaluation of speech is a prerequisite to effective self- management. Technology enables this process to occur with minimum effort and maximum validity. Conclusion This paper has presented some options for incorporating technology into practice. Using the Camperdown Program as an illustration, it has described how technology permeates that clinical practice, well beyond the realm of telepractice. Technology may be integrated at any or all stages of treatment to help with stuttering or social anxiety, incorporating clients, family members and other speech pathologists. It has the potential to make treatment more

engaging, realistic, consistent, convenient, motivating, and meaningful. While this paper has presented a description of the roles technology plays in adult and adolescent stuttering treatment, technology arguably may play as many or more roles in stuttering treatment for children. In time, technology is likely to drive the development of new and creative treatments. Clinicians are, however, cautioned that the ubiquitous nature of technology in our society today presents the possibility that technology will be used in clinical practice with insufficient care and thought. This may pose a number of risks. First is the risk that technology will be used with insufficient clinical evidence. Second is the risk that there will be a lack of consideration of ethical issues of telepractice, for example client confidentiality, privacy, data security and transmission. Third is the legal risk arising in some countries about whether and how the right to engage in telepractice is established, when clinicians work across state or national boundaries. Fourth is the ethical risk of clinicians taking incomplete measures to safeguard clients when online resources are used. It will take collaboration, interest, and effort of clinicians, researchers, program developers and our professional organisations to address these risks, and others presented to us as technology continues to evolve. References Australian Stuttering Research Centre. (n.d.). ASRC Downloads. Retrieved from http://sydney.edu.au/health- sciences/asrc/docs/severity_rating_chart_2015.pdf Beeminder. (n.d.). Be Minded. Retrieved from https:// www.beeminder.com Block, S., Onslow, M., Packman, A., Gray, B., & Dacakis, G. (2005). Treatment of chronic stuttering: Outcomes from a student training model. International Journal of Language and Communication Disorders , 40 , 455–466. Boberg, E., & Kully, D. (1994). Long-term results of an intensive treatment program for adults and adolescents who stutter. Journal of Speech and Hearing Research , 37 , 1050–1059. Bothe, A. K., Davidow, J. H., Bramlett, R. E., & Ingham, R. J. (2006). Stuttering treatment research 1970–2005: I. Systematic review incorporating trial quality assessment of behavioral, cognitive, and related approaches. American Journal of Speech-Language Pathology , 15 , 321–341. Bradberry, A. (1997). The role of support groups and stuttering therapy. Seminars in Speech and Language , 18 , 391–399. Carey, B., O’Brian, S., Lowe, R., & Onslow, M. (2014). Webcam delivery of the Camperdown Program for adolescents who stutter: A phase II trial. Language, Speech and Hearing Services in Schools , 45 , 314–324. Carey, B., O’Brian S., Onslow, M., Block, S., Jones, M., & Packman, A. (2010). Randomised controlled non- inferiority trial of a telehealth treatment for chronic stuttering: the Camperdown Program. International Journal of Language and Communication Disorders , 45 , 108–120. Carey, B., O’Brian, S., Onslow, M., Packman, A., & Menzies, R. (2012). Webcam delivery of the Camperdown Program for adolescents who stutter: A phase I trial. Language, Speech and Hearing Services in Schools , 43 , 370–380. Dictionary.com. (n.d.). Technology. Retrieved from http:// dictionary.reference.com/browse/technology Erickson, S., Block, S., Menzies, R., Onslow, M., O’Brian, S., & Packman, A. (2012). Stand-alone internet speech

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology