JCPSLP Vol 21 No 2 2019 DIGITAL Edition

person or on the phone. The SPA clinical guideline recommends “careful monitoring” to observe for signs of social anxiety or signs of natural recovery (SPA, 2017). The client who engaged in the Westmead Program did not complete the program. It should be noted that the Westmead Program was chosen instead of the Lidcombe Program because the client had commenced the Westmead Program in a research trial and had demonstrated early responsiveness. The client who received hybrid Lidcombe Program–Prolonged Speech (i.e., where a Lidcombe Program approach was supplemented by prolonged speech techniques to achieve fluency) was aged 9 years, 11 months and ceased treatment after 14 sessions, due to parent reported satisfaction with fluency. This treatment approach (which is not supported by clinical trial evidence) was used at the discretion of the treating SLP as the client had previous success with the Lidcombe Program, was too young to commence the Camperdown Program, yet required some speech restructuring strategies (e.g., gentle onset) to produce a fluent onset spontaneously (rather than blocking). Discussion SLPs treating children who stutter are required to translate clinical research outcomes into their clinical practice. Yet, the nature of efficacy research is such that it is designed to demonstrate the effect of a treatment in ideal, highly controlled conditions which do not necessarily reflect a typical clinical setting. SLPs are therefore responsible for adapting treatment programs or conditions based on their clinic and client factors. This five-year file audit of a paediatric stuttering caseload from a general speech pathology clinic was designed to explore the demographics of children who stutter that present for treatment and to compare their characteristics with the eligibility criteria used for participants in published clinical trials. The service types and treatment received are also considered and compared with a published stuttering management clinical guideline. Findings of this audit confirm that a gap exists between stuttering research and practice. In this audit less than half of preschool aged clients and around a third of primary school-aged children referred to the practice met the criteria for clinical trial eligibility. Commonly, children in this audit presented with a co-occurring diagnosis. Such diagnoses presents as a potential confounding variable in efficacy research (where the goal is to create a homogenous sample to ensure validity) (Portney & Watkins, 2009) and so these children are excluded from participation. However, other studies have shown it is not uncommon for children to present to clinics with other

session, the parents of all clients were asked if they were aware of public service SLP options. Forty-eight per cent responded that they did not know about public options; of whom all had children aged 2;0–4;11. Twenty-eight per cent reported they did not have access to public service options, 16% reported the wait was too long and three parents (8%) reported they were aware of public options but were seeking to engage private services. Community caseload clients compared to clinical trial participants Each of the 40 clients was initially assessed against the eligibility criteria for the selected clinic trial studies. Table 2 details the percentage of clients who would theoretically qualify to participate in these clinical trials, along with the reasons why the remaining proportion of clients would be excluded. Overall, 43% of the community caseload were sufficiently homogenous to clinical trial populations. Service types It is apparent that not all clients who presented to the clinic were seeking to commence treatment following the initial assessment. Consequently, three discrete types of service requests emerged during the file audit: assessment only (32.5%), assessment and treatment (57.5%), and a second opinion (7.5%). One child did not attend the first assessment session and declined the offer to reschedule the assessment. Treatment There were four treatment types that emerged from the data. These are listed in table 3 with a comparison of the choice of treatment to the evidence ranking reported in the Speech Pathology Australia Clinical Guideline for Stuttering Management (SPA, 2017). Lidcombe Program Stage 1 sessions were conducted on a weekly or fortnightly basis, except when sessions were cancelled due to child illness or family holidays. Those clients who attended on a fortnightly basis did so due to financial or competing demands that prevented weekly attendance, i.e., co-curricular activities, parent’s work or the needs of siblings. Stage 2 sessions generally followed the recommended schedule of 2 weeks, 2 weeks, 4 weeks, 4 weeks, etc. (Onslow et al., 2017). Following this, the clients were usually reviewed on request (i.e., if the parent observed stuttering or raised concerns). Of the clients who received no direct treatment, 77% were under the age of 4 and 69% aged 3 years or younger, with many seeking assessment close to stuttering onset. Monitoring largely included several sessions with these families (focusing on education, measurement of stuttering, etc.) delivered in

Table 3. Treatment type and distribution

Number of clients

Percentage (n = 33; 82.5%)

Intervention

Evidence ranking* as reported in the Speech Pathology Australia Stuttering Management Clinical Guidelines (2017)

The Lidcombe Program

Level B: Good

25

75.75%

Hybrid Lidcombe Program–Prolonged speech

N/A

1

3.03%

Syllable-timed speech (The Westmead Program)

Level D: Poor

1

3.03%

Monitoring

N/A

6

18.18%

Notes: n = 33 (assessment only clients excluded), *where Level A = Excellent, B = Good, C = Satisfactory and D = Poor

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JCPSLP Volume 21, Number 2 2019

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