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of the ASRC (n.d.). The speech restructuring technique is taught through observation, imitation, and self-evaluation. The client is encouraged to use their smartphone or computer tablet to record their own attempts at reproducing the speech restructuring model, for comparison and evaluation. During the instatement stage clients will practise the speech restructuring technique between clinic or Internet webcam consultations, and collect samples of that practice for review with the clinician. Discussion will take place on how that will occur – whether through self-recording using a smartphone, recording onto a voicemail, or sharing audio- visual samples using the Internet. The choice of technology will be guided by the client’s usual habits, preferences, and goals. The clinician will strategically link speech practice with phone, webcam Internet or iPad use, and often all of these, to exploit conditioning to that technology. In this manner, irrespective of method of treatment delivery – in-clinic or telepractice – technology supports the strong focus on self-monitoring and self-management of the Camperdown Program. Self-monitoring has been found to provide some protection against relapse (Bothe, Davidow, Bramlett, & Ingham, 2006). Stage III: Generalisation The focus of stage III of the program is to transfer the speech technique to everyday speaking environments. During this stage, a regular individualised speech practice routine is established, generalisation of stutter-free speech is facilitated, and problem-solving strategies are encouraged. Technology can assist these processes in many ways. For example, clients will continue to evaluate their use of the speech restructuring technique through self-recording. Portable recording systems on smartphones allow clients to unobtrusively record themselves practising their speech restructuring technique in a variety of everyday situations, chosen by them. In this way, speech technique practice and evaluation can be taken into the workplace, school, and home. Practice can also be made more interesting by guiding clients to web-based resources. One resource developed specifically to facilitate generalisation of fluency gains is Scenari-Aid (Meredith, n.d.). Scenari-Aid is a software program that allows clients to choose from a hundred simulated scenarios in which to practise. For some clients, this form of practice may be very helpful in desensitising them to increased anxiety in social situations. For others who are more impacted by social anxiety, desensitisation alone may be insufficient and cognitive behaviour therapy may be recommended. CBTpsych (Helgadottir, n.d.) is a fully automated on-line cognitive behaviour treatment that has been developed specifically to address anxiety in adults who stutter. Clients complete this program without the assistance of a clinician and without needing to attend a clinic. Phase I and II trials confirm the efficacy of this treatment (Helgadottir, Menzies, Onslow, Packman, & O’Brian, 2009). Adherence is a key determinant to treatment success and lack of adherence is common not only for stuttering treatment, but also for voice disorders treatment (Van Leer & Connor, 2012) and indeed many medical treatments. At this stage of treatment, adherence to weekly consultations is critical for the development of good problem-solving skills. Good problem-solving skills are needed to address challenges clients encounter as they attempt to generalise their new speech technique. However, treatment adherence

before our first meeting with them. If our profession mirrors the experience of other similar disciplines, our clients seek information about stuttering on websites, blogs, podcasts, YouTube videos and social media. They come to us more informed about stuttering and more aware of treatment choices and their evidence bases. They also, more than ever previously, have access to videos of influential people in politics, sports, and entertainment discussing their own experiences of stuttering and stuttering treatment. They may be well informed or misinformed. In any scenario, the client we first meet for assessment is likely to feel more empowered and is a more critical consumer of our service (McMullan, 2006). If the purpose of assessment is to determine the client’s needs and challenges, technology makes it more valid, easy, and accessible. Technology can provide speech samples that are relevant, representative and natural, taken from conversations with people with whom the client usually interacts, in the places that they occur (Karimi, O’Brian, Onslow, & Jones, 2013; O’Brian et al., 2013). Published manuscripts of clinical trials have used these methods (for an example, see Carey et al., 2010). These recordings can be emailed or shared ahead of assessment, or produced at assessment on a smartphone, iPad, or laptop to be heard during the consultation. A client who is reporting some anxiety in social situations may be asked to complete a web-based assessment, for example the assessment of Unhelpful Thoughts and Beliefs About Stuttering Scale (UTBAS; Iverach et al., 2011; St Clare et al., 2009) or the Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995). At assessment, clinicians may refer clients to websites, electronic books, publications, and consumer blogs or podcasts to supplement informational counselling. The use of technology in the Camperdown Program Stage I: Teaching treatment components A core component of the Camperdown Program is stuttering severity measurement, and a 9-point severity rating scale (O’Brian et al., 2010) is used for that purpose. For both in-clinic and telepractice clients, training in how to use a severity rating scale can be enhanced through observation of stuttering samples of others available on YouTube or from the clinician’s own collection. To record stuttering severity ratings, a client may be provided with a variety of options. Ratings may be documented on-line, for example using Google docs or Excel graphs on a laptop or iPad, or by using a paper chart accessible on the Australian Stuttering Research Centre (ASRC; 2015) website. The aim is for clients to be provided with a method of recording stuttering severity scores that is the least intrusive and most convenient, as this is likely to facilitate treatment adherence. Stage II: Instatement Having taught the client a means of measuring and recording stuttering severity, the clinician instates stutter- free speech. While traditionally a clinician models the speech restructuring technique for the client, the Camperdown Program uses technology to allow teaching of a standardised speech restructuring model. This avoids relying on clinician skill to model correctly (Onslow & O’Brian, 1998). The client can choose to learn the speech restructuring technique from a man or woman, adolescent or adult, all examples can be downloaded from the website

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www.speechpathologyaustralia.org.au