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From: Chris Lewis
Date: 15 Oct 2006
Time: 21:49:51 -0500
Remote Name: 211.29.214.33
Hi Lisa, Thankyou for your interest and questions. In telehealth Lidcombe Program the speech pathologist and parent establish and regularly confirm agreement for severity ratings (SR) from the audio and/or video samples of the child's conversational speech that are sent by the parent. Parents document the SR straight after recording and this is then discussed at the weekly telephone consultation. Some children will speak with the the clinician on the 'phone and the parent listens in, and this provides an additional, "live" opportunity for comparison of SR. Parents record daily SR as with standard delivery. Most of the difficulties encountered during telehealth are consistent with standard delivery (eg. incorrect use of verbal contingencies), with some issues made more complex (eg. difficulties discriminating unambiguous stuttering from other speech behaviours). Other issues were specific to telehealth (eg. inability to demonstrate and adjust treatment individually). In the recent study (Lewis, et al., 2006) the reduction in stuttering after 9 months was comparable to that achieved in standard Lidcombe Program delivery. As I have mentioned in a couple of previous replies, the majority of children had not completed Stage 1 treatment at 9 months and required a mean of 49 telephone consultations over a mean of 62.9 weeks to reach criteria (that is, stuttering at or below 1%SS, and SR averaging 1, for a minimum of 3 weeks). A recent prospective study of standard Lidcombe Program delivery (Rousseau, Packman, Onslow, Harrison & Jones, 2006) reported a mean of 17.9 clinic visits over a mean period of 25.9 weeks to reach the same criteria. Clinic based Lidcombe Program therefore remains the best practice option with telehealth delivery offering an efficacious alternative for isolated preschool stuttering children and their families. I hope this information is useful. Thanks again, Chris.