JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Theme 3: The therapeutic journey The beginning

He’s had a really positive outcome…in terms of his speech, significant changes for him. Not having to choose which one we treated first. (PA2) Because even though a lot of work was involved and it was time consuming, it worked. (PA4) One parent made comment in relation to comparisons around delivery of stuttering versus SSD treatment. This carer was more comfortable delivering treatment for SSD: “I think [treating] the sounds was more comfortable for me than the stutter” (PA4). Discussion This study explored the perspectives of four parents whose children had undertaken direct, concurrent treatment for co-occurring stuttering and SSD. Participants reported positive experiences for themselves and their children. However, they identified some aspects that clinicians may find helpful to consider when planning treatment using this concurrent form of service delivery. A strong pattern to emerge from the data was that parents were surprised by the degree to which they were involved in their child’s therapy and had expected that attending clinic visits alone would “fix” the communication issues. This finding is similar to those reported by Hayhow (2009) and Goodhue et al. (2010) about parent experiences using the Lidcombe Program, in that parents were not initially expecting to be so involved in their children’s stuttering treatment. Similarly, Watts Pappas et al. (2016) found that parents had a preference for the clinician to lead the delivery of SSD treatment; however, some had an expectation that there would be a home practice element. These results highlight the need to provide accessible information to parents before the commencement of concurrent treatment, particularly in relation to their roles in treatment. In this way, clinicians would ensure the delivery of the “best available evidence concerning the preferences of a fully informed patient” (Dollaghan, 2007, p. 2) in accordance with Dollaghan’s 3-tiered model of evidence- based practice. The parents in this study reported that this sense of responsibility weighed on them at times, and with this, came feelings of anxiety and nervousness. Some parents, however, felt empowered by this responsibility. Parents may benefit from the opportunity to discuss with the clinician the implications of their role as their child’s primary change agent. In addition, clinicians may need to be mindful of the level of support that a parent needs, particularly at the start of treatment. Anecdotally, clinicians have reported being wary around treating stuttering and SSD concurrently due to the potential for confusing either the parent and/or the children. The findings reported by the parents in this study do not support this. No parent perceived that treating co-occurring stuttering and SSD was particularly difficult, nor did they believe their children to be confused by this type of service delivery. The types of tasks given to parents for home practice in SSD were similar to those reported by Sugden et al. (2018): for example, phonological and/or articulatory production practice, sound stimulation embedded into daily routines, book-reading, listening/perception tasks, etc. No parent in this study reported that they found these home practice tasks for SSD particularly complex. Clinically, the selection of home practice tasks should be individualised for the family and take into consideration the caregiver’s skillset and competence (Sugden et al., 2018). In relation to home treatment of stuttering, reports from the surrounding literature on parent perceptions on the complexity of the Lidcombe Program have found that parents do not find the

Parents commented on feeling nervous about their therapy skills, and anxious about delivering treatment correctly. However, confidence was not static: “I got more confident as time went on” (PA4). No parent mentioned that they found home treatment for either disorder difficult, though one did think the learning curve was a steep one: You’re learning a new skillset overnight. You’re not learning it, practising it, building it up, and then using it … I actually found myself going, “Wow, you know, this is like day one of a job where no one’s given you any training before.” (PA4) Barriers and facilitators to treatment Parents identified several barriers to implementing treatment. These included having to rely on their child’s compliance to participate in treatment, competing demands in relation to employment, and finding time to do the treatment as well as spending time with their other children: He [the child] had a day where he went, “Nope, I’m not doing this”, and that was a barrier. (PA2) There were times I doubted myself because I just didn’t have time that day [to do treatment]. (PA1) Sometimes she [sibling] would be there and she was a mild distraction. (PA1) Facilitators to the treatment process were also mentioned. The one most commonly discussed was the structured delivery of treatment, that is, the discrete focus of treatment goals both in the clinic (within the same session) and at home (at different times of the day): I actually found being able to do one at one point in the day and the other at the other point of the day quite good. (PA2) I thought it was fine to come in [to the clinic] and do the Lidcombe Program, and then we would focus on the speech program. (PA1) Another facilitator mentioned was the timing of clinic visits. Parents felt that having weekly clinic visits was an effective strategy for holding them accountable on a regular basis. It allowed enough time to implement treatment at home, and was not too long that the parent felt lost if they had questions or wanted clarification: I think the accountability was good … showing up once a week and having face-to-face [clinic visits]. (PA1) Finally, all parents mentioned the use of tangible rewards as important motivators for their children. These were seen as important, and were required to keep the children’s motivation high for a long period: … to find a motivation as a reward, we’d do a star chart. There had to be a high-end reward for him (PA3) Looking back All parents regarded their overall experience of concurrent treatment for stuttering and SSD as being positive. While acknowledging treatment as demanding, time-consuming and effortful, parents felt that the process was effective and worthwhile: I could not see any negatives with doing the Lidcombe and the speech together. (PA1)

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JCPSLP Volume 21, Number 2 2019

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