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reflection on Lidcombe Program procedures, as encouraged by the questions outlined in this study, ultimately leads to modification of clinical practice that enhances client outcomes. Future translational research about the Lidcombe Program could utilise the present set of reflective clinical questions as it directs attention to any departures from the documented Lidcombe Program process (Packman et al., 2016). Conclusion Students and SLPs who are learning the Lidcombe Program and developing new clinical skills may particularly benefit from applying the reflective questions to their work with clients as they encourage reflective practice, appear to positively inform problem-solving and may help promote treatment fidelity. The reflective clinical questions have been added as an Appendix to the Lidcombe Program Treatment Guide (Packman et al., 2016). The Treatment Guide suggests that, in the event that a child may not be attaining clinical progressive benchmarks, SLPs use the reflective questions to facilitate problem-solving and refine practice; areas that the authors recommend are the focus of future, larger scale research studies. References Arnott, S., Onslow, M., O’Brian, S., Packman, A., Jones, M., & Block, S. (2014). Group Lidcombe Program treatment for early stuttering: A randomized controlled trial. Journal of Speech, Language and Hearing Research , 57 , 1606–1618. Bridgman, K., Onslow, M., O’Brian, S., Jones, M., & Block (2016). Lidcombe Program webcam treatment for early stuttering: A randomized controlled trial. Journal of Speech, Language and Hearing Research , 59 , 932–939. Harrison, E., Ttofari, K., Rousseau, I., & Andrews, C. (2003). Troubleshooting. In M. Onslow, A. Packman, & E. Harrison. (Eds.), The Lidcombe Program of early stuttering intervention: A clinician’s guide (pp. 91–99). Austin, TX: Pro-Ed. Higgs, J., & Jones, M. (2008). Clinical decision making and multiple problem spaces. In J. Higgs, M. Jones, S. Loftus, & N. Christensen (Eds.), Clinical reasoning in the health professions (pp. 3–18). Sydney, NSW: Butterworth- Heinemann Elsevier. Jones, M., Onslow, M., Packman, A., O’Brian, S., Hearne, A., Williams, S., … Schwarz, I. (2008). Extended follow-up of a randomized controlled trial of the Lidcombe Program of Early Stuttering Intervention. International Journal of Language and Communication Disorders , 43 , 649–661. Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised controlled trial of the Lidcombe Programme of early stuttering intervention. British Medical Journal , 331 , 659–663. Mamede, S., & Schmidt, H. G. (2004). The structure of reflective practice in medicine. Medical education , 38 , 1302–1308. Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education , 14 , 595–621. Martz, W. (2009). Validating an evaluation checklist using a mixed method design. Evaluation and Program Planning , 33 , 215–222. O’Brian, S., Iverach, L., Jones, M., Onslow, M., Packman, A., & Menzies, R. (2013). Effectiveness of the Lidcombe Program for early stuttering in Australian community clinics. International Journal of Speech- Language Pathology , 15 , 593–603.

overlooked. It helps you to reflect in more detail re treatment. (SLP 2) Very good checklist – allowed me to pinpoint issues in the treatment which then gave the treatment more direction. Some questions difficult to answer, e.g.’ in “Rate – did the number of verbal contingencies appear to be sufficient to decrease the stuttering during each day?” – sometimes hard to know. (SLP 3) Discussion Reflective practice is a desirable component of evidence- based clinical practice, and is regarded by many as essential for development of professional competence (Mann, Gordon, & MacLeod, 2009). Reflective clinical practice is associated with development of professional expertise (Mamede, & Schmidt, 2004) and is endorsed as an occupational competency standard for Australian SLPs (Speech Pathology Australia, 2011). Problem-solving by the treating SLP is inherent in the Lidcombe Program treatment process (Packman et al., 2016) and hence reflective clinical practices are a desirable component of the treatment process. However until now, there has not been an established method to support SLPs with their problem- solving throughout Lidcombe Program treatment. While the Swift et al. (2012) checklist focuses specifically on parent delivery of treatment in a practice session, the Lidcombe Program is implemented in many and varied settings beyond practice sessions. Therefore, a process was undertaken to develop and provide preliminary validation of a number of reflective questions to assist SLPs to detect variations in their clinical procedures from those recommended in the Lidcombe Program Treatment Guide. The O’Brian et al. (2013) translational report found that SLPs who had formal clinical Lidcombe Program training had improved Lidcombe Program community outcomes. Therefore, the international Lidcombe Program Trainers Consortium, the body that runs the formal Lidcombe Program training, was actively involved in validating and refining each reflective question. To explore whether the reflective questions had clinical applicability, four SLPs applied the questions to a client case and subsequently completed a short self-report survey about their clinical usefulness. These SLPs had varied experience in treating children who stutter, ranging from an SLP with less than one year of experience to a more specialist SLP with 12 years experience. All four reported that the reflective questions supported them to think about their clinical practice, problem-solve and modify their clinical practice with the Lidcombe Program in light of their reflections. This suggests that the reflective questions about the Lidcombe Program were useful for supporting SLPs of varying experience. All agreed that they identified one or more clinical practices to improve upon and that the benefits of the tool justified the time spent completing the questions, again suggesting positive clinical utility. Limitations While this preliminary study found that SLPs with varying experience reported the reflective questions to be of clinical value, it is acknowledged that participant numbers in both the expert panel and the field study participant groups were small and constituted samples of convenience. Thus, these preliminary results should be interpreted cautiously. Future research is warranted to determine the heuristic value of the reflective clinical questions for a larger group of SLPs practising across a diverse range of settings. In addition, further studies are required to determine whether focused

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