How progress is assessed: The following assessments are used:

Transcription

1 Band Four Group Programme for year olds who Stammer Intensive integrated group therapy, follow up and individual therapy as required for one year for 10 to 14s who stammer and their parents/carers. This banding provides a one-year programme of group therapy for children aged 10 to 14 who stammer and their parents / carers. These cases are often more complex and some of the children have co-occurring conditions, such as Autism or ADHD. Up to 10 children attend the two-week intensive course in a group and their parents attend in a separate parents group, both of which are for 5 to 6 hours every day for two weeks. The children s group activities focus on fluency techniques, confidence building and developing social communication skills. The parents group explores how the parents and the wider family can support the changes that the children are making. Following the two-week course, regular group follow-up days are arranged for both parents and children throughout the year and additional individual therapy sessions are arranged as necessary. Introduction This intensive therapy programme integrates speech restructuring, management of speechrelated anxiety (using cognitive behaviour therapy and solution focused therapy approaches), and communication skills awareness training (Cook & Botterill, 2005). Early evidence supporting the efficacy of this intervention is provided by Millard (2011). Stammering is part of a system (Biggart, Cook, & Fry, 2006) and this programme is unique in offering the opportunity for the whole family to be involved and supportive of the child s progress. Group therapy with families is highly specialised work. It helps families to address many of the demands that they have to face in relation to the complexity of demands and emotions linked to stammering. What is provided: Band 4 funding covers the following: 10 days of intensive, group therapy provided by specialist speech and language therapists at the Michael Palin Centre. This includes a children s group and parallel parents group which, where applicable, both parents attend; a one-day liaison and observation opportunity at the Centre for each child s named local therapist; 4 one-day whole-group follow up days at 6 weeks, 4 months, 8 months and one year after the course; individual therapy as required during the one year period, where this is requested and where practical for the family. This can be in the form of one day individual topups for families who live further away; liaison with and support of local therapy that families access in the following year. collection and analysis of data;

2 loan where necessary, of a Flip camera for each family to record speech samples at home at set intervals. This is returned to the Michael Palin Centre at the end of the year; and two clinical reports, with one being written immediately after the course and the second at the end of the year. Predicted outcomes: Children attending the group will typically report: improved fluency, resulting in greater academic involvement, for example: asking or answering more questions; contributing more in discussions; participating in presentations to larger groups; improved confidence resulting in increased social inclusion, for example talking more to friends and family; participating in more social activities; trying new experiences and showing greater independence; a reduction in the impact of stammering on their communication skills; and a reduction in the impact of stammering on their well-being. That parents attending the group will typically: report that the child s fluency has improved and that the impact of the child s stammering on them as parents has reduced; report that they have more knowledge about stammering; and report that they have more confidence about how to support their child. Individual outcomes vary depending on the needs of each individual. We anticipate the following treatment gains: increased ability to manage moments of stammering; reduction in the duration of moments of stammering; increase in confidence in communicating including starting conversations; reduction in the negative impact of stammering on quality of life; reduced use of avoidance; increased social engagement in education; and improved well-being. Typically at the end of the year-long programme clients are equipped with the skills they require to manage their stammering more effectively. They are discharged from therapy at this stage. How progress is assessed: The following assessments are used: The Palin Parent Rating Scale (Palin PRS) (Millard et al. 2009; Millard & Davis, in press). This parent-completed series of scales measures parents perception of: - the impact of stammering on their child; - the severity of their child s stammer and the impact of it on them as parents; and - their knowledge and skills in managing their child s stammer. A personalised rating scale from 0-10 where 10 = best hopes and 0 = opposite. This is used to help clients to identify goals and reflect on signs of change. The Stuttering Severity Instrument-4 (Riley, 2008). This provides a measure of the severity of stammering in a recorded speech sample, taking into account the frequency of stammering (% stammered syllables), the average duration of moments of stammering and the degree to which physical struggle and concomitant features are present. An overall severity score is generated along with percentage stammered syllable scores for each speaking task. Recordings are made in the child s own environment using Flip cameras provided by the Michael Palin Centre where necessary. Change may be seen in any or all of the domains measured. The Overall Assessment of the Speaker s Experience of Stuttering School Age (OASES-S) (Yaruss & Quesal 2010). This questionnaire measures the impact of

3 stammering on the individual in terms of their own reactions to stammering, their ability to communicate in everyday situations, and quality of life. Scores range from 1 (Mild) 5 (Severe). Communication Attitude Test part of Behavior Assessment Battery (Brutten & Vanryckeghem, 2008). Assessment schedule Data is collected at the following points: 3 months before the course (where applicable). Immediately before the course. Immediately after the course. 6 weeks after the course. 4 months after the course. 8 months after the course. One year after the course. Further information about the structure and content of the course, or any aspect of data collection and reporting can be obtained by contacting the Centre directly. Evidence base for Band 4 (10-14s intensive integrated group therapy programme) There are two research papers about the 10-14s intensive course at the Michael Palin Centre. Caughter & Dunsmuir (in review) An Exploration of the Mechanisms of Change following an Integrated Group Intervention for Stuttering, as perceived by School- Aged Children who Stutter. Millard, S.K. (2011) Intensive group therapy for children who stutter: Early evidence. Perspectives on Fluency and Fluency Disorders 21, Service Evaluation The graphs below show the progress made by a group of children who attended the Easter 2015 intensive course. The Easter intensive course for young people aged between 10 and 14 was successful in reducing the frequency of stammering for up to one year after the 2 week course (Graph 1). There was also a reduction in the children s negative attitudes towards their communication (Graph 2), and a reduction in the impact that their stammer has on them (Graph 3). Using the Palin Parent Rating Scales, parents also report a reduction in the impact on the child (Graph 4) and severity of stammering beyond the clinic (Graph 5). There is a reduction in parental anxiety (Graph 5) and parents also notice that they have acquired more knowledge and confidence in managing the stutter (Graph 6). These improvements are maintained for up to one year post course, however, there is a notable shift in children s attitudes to communication and reactions to their stammering (Graphs 2 & 3) 8/9 months post course. These periods of relapse are a normal part of the process of change and may be in part attributable to the start of the new academic year, with class and school changes. During this time parents knowledge and confidence in managing the stammer is high and one interpretation of the data, is that they are able to successfully assist and support the children to return to post course levels.

4 Graph 1: Percentage of syllables stammered Graph 2: Communication Attitude Test score (child scores) Graph 3: OASES score (children s rating of impact) Graph 4: parents ratings of impact on the child Graph 5: Severity of stammering and impact on the parents Graph 6: parents knowledge about stammering and confidence in managing it

5 Publications by the specialist MPC team In addition, we include a list of the most relevant publications by the specialist team at the Michael Palin Centre about treatment for this age group: Berquez, A., Hertsberg, N., Hollister,J., Zebrowski,P., & Millard, S. (2015). What do children who stutter and their parents expect from therapy and are their hopes aligned? Procedia - Social and Behavioral Sciences, 193: Nicholas, A. (2015). Solution focused brief therapy with children who stutter. Procedia - Social and Behavioral Sciences, 193: McAllister, J., Kelman, E., & Millard, S. (2015). Anxiety and cognitive bias in children and young people who stutter. Procedia - Social and Behavioral Sciences, 193: Harley, J (2015) Bridging the Gap between Cognitive Therapy and Acceptance and Committment Therapy (ACT). Procedia Social and Behavioual Sciences, pp Available online at Kelman, E., & Wheeler, S. (2015). Cognitive Behaviour Therapy with Children. Procedia - Social and Behavioral Sciences, 195: Millard, S.K. & Davis, S. (in press). The Palin Parent Rating Scales: Measuring stuttering from parents perspectives. Journal of Speech, Language and Hearing Research Kelman, E., Berquez, A. & Cook, F. (2012) Listening to young people who stammer: The Stammering Information Programme. In S. Roulstone & S. McLeod, (Eds) Listening to children and young people with speech, language and communication needs.(pp ) Kelman, E. & Whyte, (2012) A. Understanding Stuttering and Stammering. Jessica Kingsley Publishing Berquez, A., Cook, F.M., Millard, S.K. & Jarvis, E. (2011) The Stammering Information Programme. A Delphi Study. Journal of Fluency Disorders, volume 36, issue 3, pages Botterill, W. (2011) Developing the therapeutic relationship: From expert professional to expert person who stutters. Journal of Fluency Disorders 36, Biggart, A., Cook, F. & Fry, J. (2006) The role of parents in stuttering treatment from a Cognitive Behavioural Therapy perspective. Proceedings of the Fifth World Congress on Fluency Disorders, Dublin, Ireland, 25 28th July, Botterill, W., Biggart, A. & Cook, F. (2006). An Evaluation of a National Teaching Programme. Proceedings of the Fifth World Congress on Fluency Disorders, Dublin, Ireland, 25 28th July, Cook, F., & Fry, J. (2006). Connecting stuttering measurement and management:iii Accountable Therapy. International Journal of Language and Communication Disorders, 4, Taylor and Frances, United Kingdom. Cook, F., & Botterill, W. (2005) Family-based approach to therapy with primary school children: throwing the ball back. In R. Lees and C. Stark (Eds.). The Treatment of Stuttering in the Young School-aged Child. London: Whurr. Botterill, W., & Cook, F. (2004). The why and how of parent groups. In A. Packman, A. Meltzer and H.F.M. Peters (Eds), Proceedings of the Fourth World Congress on Fluency Disorders, 2003: Theory, research and therapy in fluency disorders (pp ). Nijmegen, The Netherlands: University of Nijmegen Press. Millard, S.K., & Rustin, L. (2003). Children s drawings as a measure of change. In K.L. Baker and D.Rowley (Eds.), Proceedings of the Sixth Oxford Dysfluency Conference (pp ). York: York Publishing Press Rustin, L., Cook, F., Botterill, W., Hughes, C., & Kelman, E. (2001). Stammering: A practical guide for teachers and other professionals. London: David Fulton. Rustin, L., & Botterill, W. (2000). A family approach to communication skills training in stuttering children. In H.G. Bosshardt, J. S. Yaruss., and H.F.M. Peters (Eds.), Proceedings of the Third World Congress on Fluency Disorders: Theory, research, treatment and self-help (pp ). Nijmegen, The Netherlands: University of Nijmegen Press. Rustin, L., & Kuhr, A. (1999). Social skills and the speech impaired (2 nd Edn). London: Whurr. Rustin, L. (1995). Parents and families of children with communication disorders. Folia Phoniatrica Logopedia, 47(3), Rustin, L., & Cook, F. (1995) Parental involvement in the treatment of stuttering. Language, Speech and Hearing Services in Schools, 26(2), Rustin, L., & Kuhr, A. (1989). Social skills and the speech impaired (1st Edn). London: Taylor and Francis.

6 "We saw immediate improvement in Sam's stammer and even though it hasn't gone away completely, it no longer seems such a problem" "The experience of attending MPC with our son for 2 weeks has brought us closer together as a family especially as his sister was able to join us for one day" "We don't worry about his future as an adult stammerer as he has been given the confidence and tools to deal with it"