JCPSLP Vol 21 No 2 2019 DIGITAL Edition

cases was the integral role of parents in delivering treatment at home for both disorders. Recent surveys conducted in Australia have found that clinicians frequently involve parents in the treatment of their child’s SSD (McLeod & Baker, 2014; Sugden, Baker, Munro, Williams, & Trivette, 2018; Watts Pappas, McLeod, McAllister, & McKinnon, 2008). Sugden et al. (2018) reported that the most commonly reported method of parental involvement was implementation of treatment at home, which the majority of clinicians reported using almost 99% of the time. Although treatment at home is considered essential in treatment for SSD in order to deliver the child optimal cumulative intervention intensity (Warren, Fey, & Yoder, 2007), there is limited research that explores parents’ perceptions about their involvement. Watts Pappas, McAllister, and McLeod (2016) sought information about the experiences of seven parents regarding their involvement in their child’s (ages ranging from 3;0 to 5;1 years) treatment for SSD. Parents were interviewed three times over the duration of their children’s treatment. Three major themes emerged from analysis of interview responses: “(1) Doing the right thing by my child; (2) Factors impacting on the intervention; and (3) Reflecting on the experience of speech intervention” (p. 230). Within these themes, parents were found to be generally satisfied with the levels of their involvement in their children’s intervention. The authors surmised that this was perhaps due to the less pervasive nature of the child’s difficulties (i.e., the children presented with mild to moderate SSD), leading to parents to be more eager to participate in home practice, with a preference for clinicians to lead goal-setting and the within-clinic sessions. Another finding from the study was that the parents were not initially expecting to be involved in their child’s treatment, as they perceived this to be the role of the SLP. Two studies have reported parent experiences of their involvement in their child’s stuttering treatment, and specifically with the Lidcombe Program. Hayhow (2009) conducted interviews with 14 parents whose children had undertaken treatment in the UK, aiming to explore parents’ own experiences with delivery of the Lidcombe Program. The ages of the children were not reported in this paper. Thematic analysis revealed three different “journeys” of parents’ experiences: “(1) The Lidcombe Program as a straightforward journey; (2) The journey starts well but hits problems; and (3) A problematic journey from the start” (pp. 22–24). The authors concluded that parents’ experiences delivering treatment to their children were influenced by their child’s own journeys through the treatment process. That is, if the child’s treatment was relatively simple and straightforward, parents’ experiences were more positive compared to those parents whose children’s treatment journey were more complex in nature. Though this data gave preliminary insight into how parents experienced their journeys through treatment of stuttering, parents were only interviewed once (or sometimes twice) across the duration of treatment. Aiming to gather more in-depth information from parents around their experiences delivering the Lidcombe Program, Goodhue, Onslow, Quine, O’Brian, and Hearne (2010) interviewed 16 mothers of preschool age children who stutter (ages ranging from 3;0 to 6;0 years). Sixteen mothers were interviewed nine times across the entire duration of treatment to ascertain barriers and facilitators to the day-to-day delivery of treatment. Parents were initially interviewed pre-treatment and then regularly across a six- month treatment period (140 interviews in total, collectively). Three major topic areas were identified: “(1) Implementation of the therapy; (2) Perception of the program; and (3)

Emotions mothers reported during the program” (p. 74). Some of the main findings identified by parents around implementation of the program were around remembering and finding time to actually implement treatment, the feeling that delivering treatment allowed for quality time spent with their child, and improved parenting skills. Parents perceived that they initially expected treatment to take less time, and that they would not be as involved as they were in the treatment process. Although parents reported that the program itself required strong commitment on their part, overall they found the program effective and relatively simple to deliver. A mixture of emotions were reported from parents around feeling empowered, responsible, anxious, guilty, and distressed. Similar to the findings of Hayhow (2009), parents in this study had more positive emotions when they felt their children were doing well in treatment. Watts Pappas et al. (2016), Hayhow (2009), and Goodhue et al. (2010) have all reported on parents’ views and perceptions around their involvement in the treatment of a single communication disorder. However, none reported whether or not the participants’ children had co-occurring communication disorders; and one study screened out said comorbidities (Goodhue et al., 2010). Although reporting on different communication disorders, these three studies do have some similarities. One is that parents do not initially expect to be as involved in their child’s treatment. Another is that, although parents are generally happy to be involved in their child’s treatment journey, their overall experiences in this process appear more positive when their child’s journey (and/or diagnosis) is less complex in nature, and they are responding well to treatment. To date, no treatment research reports have documented parent perceptions of their involvement in treatment when their children have co-occurring disorders. Since stuttering and SSD do co-occur, and preliminary evidence suggests treating both disorders concurrently may be efficacious, there is a need to investigate parents’ perceptions regarding treatment of two disorders at the same time. In order to holistically evaluate any treatment approach, it is important to gather perspectives from all key stakeholders involved in the treatment process. Therefore, the aim of this study was to explore parents’ experiences of their involvement in their children’s treatment of two co- occurring disorders: stuttering and SSD. Method Study design This study used a qualitative methodology underpinned by a constructivist knowledge claim, thereby allowing the researchers to position themselves as authors who describe meaning from the participants’ own viewpoints (Mills, Bonner, & Francis, 2006). A series of semi-structured interviews were used to explore parents’ perceptions about their involvement in treatment for co-occurring stuttering and SSD in their children. Participants Participants ( n = 4) were mothers of children who had undertaken direct, concurrent treatment for co-occurring stuttering and SSD in a research project as previously described (Unicomb et al., 2017). All parents from the original trial were contacted by the researchers and given written information about the follow-up interviews. Ethical approval was obtained (H-2011-0383) to re-contact these parents and children as part of a long-term follow-up study on outcomes of the original trial. Signed, written consent

Elisabeth Harrison

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JCPSLP Volume 21, Number 2 2019

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