|About the presenter: Kevin A. Eldridge M.S., CCC began working with children and adults who stutter and their significant listeners more than 10 years ago. After practicing five years in a rehabilitation setting, he opened a private practice. He is currently pursuing a Ph.D. in communication disorders at the University of Pittsburgh under the guidance of Scott Yaruss. Kevin's research focuses on the relationship of linguistic factors to the occurrence of disfluencies in young children near the onset of stuttering.|
||About the presenter: Brett Kluetz, MA CCC-SLP is currently pursuing a Ph.D. in Communication Disorders at the University of Pittsburgh under the guidance of J. Scott Yaruss, Ph.D. She is interested in pursuing research on the interaction of motoric and linguistic factors that may occur at the onset of stuttering.|
||About the presenter: Joseph Donaher MA., CCC/SLP is the Program Coordinator of the Stuttering Program at the Center for Childhood Communication at the Children's Hospital of Philadelphia. He teaches graduate level courses on stuttering and fluency related disorders at Temple University where he is currently pursuing his Ph.D. under the guidance of Woody Starkweather.|
Lately, there has been much discussion regarding the doctoral shortage in the field of communication disorders. Nancy Creaghead, 2002 president of the American Speech-Language, Hearing Association (ASHA), recently stated that the doctoral shortage is, "one of the most critical problems facing our discipline" (Creaghead, 2002). Keenly aware of this fact, on May 16 - 19, 2002, six doctoral students with an interest in fluency disorders met at The Center for Childhood Communication of the Children's Hospital of Philadelphia for the first ever Summit of Doctoral Students Specializing in Fluency Disorders. These students represented doctoral programs from Temple University, University of Pittsburgh, University of Louisiana, University of South Alabama, and City University of New York. These young professionals came together at this point in their careers to facilitate future collaboration, and to discuss a number of concerns facing the field of communication disorders in general, and stuttering in particular.
Prior to the summit, the participants identified areas of concern and prepared individual summary presentations for the first day of the meeting. Following these presentations, it was determined that the following topics would be discussed in more detail:
The ideas and suggestions discussed below should not be viewed as overt criticisms of the field. Rather, the topics discussed in this paper represent the principle areas identified as potential obstacles that the participants will face as future researchers and instructors in the field. By addressing these "perceived obstacles," these participants are challenging themselves to become involved and make a difference. This paper also calls upon the current leadership in the field to 1) continue their efforts to improve the lives of those who stutter, and 2) remain open to new ideas to address the challenges facing the field.
The first topic discussed during the summit was the current status of research pertaining to fluency related disorders. Fluency disorders research has not always met the high standards required of research in other fields. For example, studies in fluency journals are often beset by sampling errors and biases secondary to small sample sizes. They often focus heavily on statistical significance while ignoring clinical significance and often lack clinical relevance. They frequently misinterpret negative effects, lack replication, draw conclusions based on inconclusive or irrelevant effects, and are not always theory driven (Conture, 2001; Jones, Gebski, Onslow, & Packman, 2002; Young, 1994).
There are a number of concrete steps that researchers in the field can take to raise the standards of research. These include;
A primary goal of the Doctoral Summit was to facilitate open discussion and future collaboration. Such collaboration both within the field of fluency disorders and across related fields is integral to advance the current knowledge base. Researchers from other disciplines or specialties could offer significant insight into a number of areas that could dramatically expand the current view of stuttering. Collaboration with researchers from other fields also has the potential to recruit doctoral students from these disciplines into the area of fluency disorders. Opportunities for collaboration could also be enhanced by publishing studies in disciplines outside of speech-language pathology (e.g. educational, medical or psychological journals). As the influence of other fields increases, it will become necessary to increase our understanding and willingness to utilize a wider variety of methodological designs, including outcome studies, longitudinal studies, etiological explorations, qualitative descriptions, quality of life indices, etc.
The standard of research in any field is highly dependent upon the expectations of the consumers of that research. It follows then, that by increasing present and future clinicians' understanding of the clinical relevance of research, the standards of research in the field may also increase. University programs should stress the importance of research early on at the undergraduate and graduate levels by rewarding students for getting involved with research. Clinical supervisors could help foster an appreciation of the vital connection between research and treatment goals by encouraging master's level students to do clinical treatment research with clients assigned to them in the university clinics.
The self-help movement and other non-profit organizations working toward the prevention and improved treatment of stuttering can also play a role in raising the research standards in the field. Conferences, such as the one recently sponsored by the National Stuttering Association titled Pioneering Stuttering Research in the 21st Century, is an example of the cooperation and initiative of interested parties that are needed to meet the research challenges facing the stuttering community. In addition to these cooperative endeavors, the self-help and non-profit organizations need to encourage clinicians to keep up to date on the latest trends in research and be weary of new clinical programs that propose quick cures or unrealistic results.
The second major area discussed during the summit was the level of clinical competency pertaining to fluency related disorders. Parents of children who stutter and adults who stutter often complain about the level of clinical competency in stuttering intervention. Clinicians also report feeling inadequate in the treatment of fluency and fluency related disorders (Brisk, Healey, & Hux. 1997). These clinicians suggest that the paucity of clinical experience is due to both the low incidence of stuttering and the lack of clinical instruction available at the university level.
In 1993, ASHA eliminated the requirement that accredited programs in speech-language pathology offer a specific number of clinical and course hours in fluency and fluency related disorders, or any other specific disorder type (ASHA, 1994). This resulted in many programs dropping fluency-related requirements entirely or limiting them to brief discussions as part of a survey course in speech disorders (Yaruss & Quesal, 2002). Consequently, many speech-language pathology students have experienced a reduction in training relative to those trained before the new standards were instituted.
Recognizing the need for post-graduate training in fluency disorders, The Stuttering Foundation of America (SFA) has offered continuing education experiences for more than a decade. In recent years, ASHA's Special Interest Division 4, Fluency and Fluency related Disorders (SID4), has also offered CEU's. Beginning in 1998, the International Stuttering Awareness Day (ISAD) Online Conference has been available for continuing education credit. And most recently, The National Stuttering Association (NSA) was accredited by ASHA as an official CE provider in the summer of 2002, thereby providing clinicians with yet another source of continuing education.
However, many clinicians who treat clients with a broad range of communication disorders have not taken advantage of these advanced clinical courses in stuttering. It is common to hear clinicians report that since stuttering only accounts for a small percentage of their caseloads, they could not justify allocating a great deal of time to gaining increased instruction and clinical skills in stuttering. The ASHA's SID4 has recognized this problem and is concerned that additional deregulation secondary to the new standards effective in 2005 will further erode the quality of clinical intervention aimed at people who stutter. Division 4 has spearheaded the development of The Specialty Board of Fluency Disorders (SBFD) and is now finalizing the process of certifying new clinical specialists.
While part of the solution is to continue to expand continuing education opportunities and "fine-tune" the process of specialty recognition, more action is needed. Another possible solution to the perceived lack of clinical competency is the expansion of programs offering a clinical doctorate. While many programs offering a clinical doctorate currently focus on medical speech-language pathology, individuals with an interest in fluency disorders could obtain more specialized training in the treatment of stuttering. Individuals with a clinical doctorate would be uniquely able to communicate to master's students the important relationship between clinical practice and research. Collaboration between individuals with a clinical doctorate and those with a traditional research degree also offer the possibility of increasing the number and quality of clinical research projects being carried out and subsequently published.
With the change in ASHA standards, self-help groups and professional organizations will need to become even more involved with professionals treating those who stutter. In addition to expanding their continuing education programs for professionals in the field, these organizations will need to educate consumers, educators, and legislators. We live in a consumer driven society. Change within an organization often comes quickest when those on the outside demand they do so.
As stated previously, ASHA no longer requires accredited programs in speech-language pathology to offer courses in stuttering as part of their masters training. Schools must merely demonstrate that their students have acquired specific knowledge on a variety of disorders, including stuttering. In an effort to gauge how this change has effected training regarding fluency related disorders, a survey was conducted of ASHA accredited graduate programs. The results indicated that 25% of the speech-language pathology masters programs surveyed allowed students to graduate without ever having taken a stuttering course, 65% of programs surveyed allowed students to graduate without clinical contact with a single individual who stutters, and at least 40% of the surveyed programs did not have a professor with a major interest in stuttering (Yaruss & Quesal, 2002). It should be noted that these percentages might even be lower, since only 56% of the accredited speech-language pathology programs responded to the survey. The results of a recent informal survey of ASHA accredited programs offering doctoral study, suggested that (a) only 18 programs offering doctoral education have a current member of the SID4 on staff, (b) there are currently less than 15 active programs in the United States that offer advanced doctoral study with a professor that specializes in fluency disorders, and (c) less than 15 doctoral students consider fluency disorders to be their major area of study (ASHA & CAPCSD data, 2002; J.S. Yaruss & R.W.Quesal, personal communication, May, 2002).
One possible short-term solution for the shortage of doctoral-level professors with an interest in fluency disorders is the collaboration between different departments and clinics in order to provide training and mentorship in the nature and treatment of stuttering. Universities could establish externships focusing on stuttering research and training opportunities for master's and doctoral-level students with professors at other institutions and within the private sector. This could link departments with doctoral programs that do not have a professor in stuttering to a stuttering clinician/researcher in a "master's" only department. This has become increasingly feasible with the advancement of technology and the initiation of distance learning.
Another solution would be to encourage professors with an interest in stuttering to involve master's level students in research by offering incentives. Universities or not-for profit organizations might provide small grants that would be used for stuttering research involving master's students. Thus, there may be an increased interest and motivation for students to get involved in fluency research and possibly return for a doctoral degree. Universities must also recognize that the benefits of having a fluency specialist/professor on faculty extend far beyond the scope of stuttering intervention. Fluency specialists are generally familiar with current research in a variety of diverse areas (e.g., speech-motor, psycholinguistic, neurological, cognitive/ affective behavior, etc). Furthermore, fluency specialists often encompass counseling strategies to work with the emotional and cognitive impact that stuttering has on the individuals. Consequently, these specialists are adept at behavioral approaches to therapy as well as more integrated approaches that consider the multidimensional nature of communication disorders.
ASHA's Special Interest Division 4: Fluency and Fluency Related Disorders could also take a more prominent role in the promotion of doctoral education specializing in the area of stuttering. They could offer funding for students to attend and present at their yearly leadership conference, or they could include doctoral students on the steering committee. Although ASHA has developed resources to advise students on the process of pursuing doctoral study, the serious shortage of doctoral students suggests more needs to be done. One alternative would be to use current doctoral students and young faculty to recruit new doctoral students. ASHA could take advantage of the passion and interest that these current and future educators and researchers possess in order to publicize the benefits of pursuing an advanced degree. Doctoral students could be encouraged to develop brochures, speak to student groups like NSSHLA and promote the benefits of a doctoral degree. Current and future doctoral students also have a responsibility to fill the academic positions being vacated by others interested in fluency disorders. By further developing and increasing the number of mentoring programs and initiatives for undergraduate, master's, and doctoral students, ASHA can encourage students to meet this charge.
While the challenges facing the stuttering community are great and the future of academic and clinical training are unclear, the time to make fruitful change is upon us. This report represents the culmination of a three-day summit attended by six doctoral students specializing in fluency disorders. In addition to providing an opportunity for these future researchers to forge personal and professional relationships that will facilitate future collaboration, they identified a number of challenges facing the field. Attention was focused however, not on problems, but on developing possible solutions. It is the hope of these students that this document will lead to open discussions by all members of the stuttering community, resulting in advancements in research, clinical competencies, and university-level education.
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