Fluency Friday Plus: An Intensive Treatment Program for Children With Stuttering
|About the presenter: Diane Games, M.A. is a licensed and certified Speech-Language Pathologist and co-owner of Tri-County Speech Associates, Inc. a private practice in the Cincinnati area. She is a Board Recognized Specialist in Fluency Disorders and part of the Initial Cadre of fluency specialists. Professional activities have included the presidency of the Ohio Speech-Language-Hearing Association and honors of OSLHA in 1994. She also teaches a graduate level course in Fluency and Fluency Disorders at Miami University. She has presented several workshops on the treatment of fluency disorders and has coordinated the Fluency Friday Plus project in the Cincinnati area for the last four years.
Fluency Friday Plus: An Intensive Treatment Program for Children with Stuttering
by Diane Games
from Ohio, USA
Fluency Friday Plus (FFP) is an intensive day and one half treatment program for children with stuttering (CWS) disorders, K-12th grade. FFP combines supervised practicum experience for graduate students with parent/family education and continuing education opportunities for community Speech-Language Pathologists (SLPs). This project is a collaborative effort involving speech/language professionals in the greater Cincinnati area including university, private practice, hospital and educational work settings. Community speech-language pathologists from each of these settings supervise graduate students from Miami University and the University of Cincinnati who provide the direct treatment during the program. The students receive training from the FFP organizational team in addition to completing a course on fluency disorders at the graduate level. In addition, community professionals attending training programs earn continuing education hours in fluency and fluency disorders. A Parent Program includes speakers, group discussions and a teen panel. Siblings and friends are welcome to join the program on Saturday.
During the Friday and Saturday morning program in 2003, 40 CWS received individual and group treatment developed by 44 graduate students. The FFP organizational team included 10 professionals from the greater Cincinnati area. The team along with 16 community speech language pathologists provided direct supervision of therapy. Approximately 65 parents attended the educational programs and observed treatment. Ten volunteers and eight high school students provided help with organizational and program issues.
The Fluency Component
The Synergistic Model (Bloom and Cooperman, 1999) provides a framework for the FFP program including intensive practice of speech targets, exercises designed to deal with the emotional and attitudinal aspects of stuttering and practice in a variety of situational or environmental domains. While attempts are made to remain consistent with the treatment approach used by the clinician in the primary referral setting, graduate students design activities focused on modifying the rate and tension of speech. Speech targets are taught within the context of becoming a better communicator and practicing tasks of increasing length and complexity. Attitudes and emotions are addressed in individual and group sessions held throughout the day. Communication opportunities include group skits, role-playing, a conversational breakfast, open microphone practice, telephoning, computer access and videotaping.
Emphasis of the treatment program includes reinforcement for message content in addition to utilizing strategies taught in the speech target practice sessions. Group interactions include a range of discussion topics such as teasing and speaking in front of groups. The treatment programs end each day with skits or group activities presented to the parents that allow for speaking and non-speaking roles. Throughout the program, communication attempts, regardless of outcome, are encouraged. Risk taking is valued and promoted!
The Parent Training Program
An educational program for parents and extended family members provides opportunities for parents to enter into discussions on topics of interest. Lectures by experts in the field of fluency disorders are scheduled. At FFP 2003, Donna Cooperman, Ed.D. spoke on "Parenting a Child with a Fluency Disorder". Rodney Gabel, Ph.D. talked about "Thoughts on Coping with Stuttering: One Person's Perspective." A tradition of FFP is the Teen Panel where a group of teens meet with the parents to answer questions and to share their experiences as young people who stutter. This forum enables the teens to speak freely to a large, "listener friendly" audience who respects their courage and values their insights. In addition, break out sessions deal with topics of interest for parents. For example, FFP 2003 had sessions on School Services for CWS, Helping Your Child Handle Difficult Situations, The "latest" in Treatment Techniques, and Insurance and other Resources for obtaining services. Members of the FFP team lead these discussions.
Parents rated the lectures, group discussions and the teen panel as the most effective activities of the FFP program. On a seven-point scale, the parent lectures and activities of FFP were rated at 6.36. Parents also ranked the information received on stuttering at 6.48.
One new feature of the FFP program in 2003 was a Siblings & Friends program held on Saturday morning. Activities were designed to help family members and friends understand stuttering. 2003 also brought the development of the Fluency Friday Plus Web page designed by Victor Pennecamp, a student in program. The web site facilitated the distribution of applications and information to the participants and contained handouts for graduate students, community speech-language pathologists and parents. The web address is http://www.fluencyfriday.org.
Graduate Student Training & Supervisor Interactions
In an attempt to measure changes in the fluency of the CWS, graduate students collect a Standard Speaking Sample (a 100 word count fluency analysis) during the first individual session or prior to FFP where possible. In addition, Minute Speaking Samples are collected at various intervals during the program. Despite the fact that training sessions prior to FFP are provided to the graduate students on sample collection, less than 50% of samples collected in the 2002 FFP program were completed accurately. Form accuracy was only slightly higher in the 2003 event.
Graduate students also receive instruction in using attitudinal assessment tools to diagnose children with stuttering problems. In addition to the speaking samples, The Children's Attitude Test-Revised (1989) and the A-19 scales (1979) are utilized to provide information on attitudes and emotions. Following lectures about fluency therapy, graduate students develop activities and materials for treatment based on information received in the sampling and attitudinal test measures. Supervisors for FFP also attend training sessions conducted by the FFP team and provide feedback and suggestions to the students throughout the program.
Coordination of this experience for the graduate students is challenging. The two university programs, Miami University and the University of Cincinnati, are on different curriculum training schedules. One offers the fluency course during the winter quarter and the other during the fall semester. In general, the amount of supervised clinical exposure to children with stuttering disorders and the knowledge of specific treatment techniques or programs are limited. Coordinating preliminary student clinician and client meetings prior to the FFP event is difficult. This is largely a consequence of the students' difficulty gaining access to their clients because of distance or transportation factors. Despite these barriers, the graduate students rate the experience of FFP as more beneficial in the diagnosis/treatment of stuttering (5.58) than lectures by the FFP team (4.41) or coursework at the university (3.48) on a seven-point scale. They also rate their interaction with their fluency student at 6.46 followed by a 6.1 rating for interaction with their FFP supervisor. These results seem to support the concepts that supervised clinical practicum and exposure to CWS remain valuable in the training experience.
Supervisors rate the graduate students as being prepared for the various diagnostic and treatment activities of FFP with ratings from 5.09 to 6.18 on a seven-point scale. Overall, the supervisors rate the FFP experience as beneficial to parents at 7.0; children with stuttering disorders at 6.91; the graduate students at 6.75 and for themselves as a continuing education program at 6.66.
The Children with Stuttering
Evaluation of the program is completed by the children/students with fluency problems. High school students rate the individual treatment and same age group sessions as the most effective and enjoyable of the program (6.75). They also enjoy the Conversation Breakfast (6.66) and the high school students (6.25). The least favorite aspect of the program for teens is the mixed-age group (3.5). Most teens report a change in their feelings and attitudes about speech following this experience. All report that they would return and that the program is especially important for the younger students.
The junior high age students also rate age group treatment sessions higher that the mixed- age group activities (6.33/5.33). Individual sessions are also rated at 5.66. Elementary students follow a similar pattern.
Outcomes of FFP are also anecdotally recorded following the event with reports from school speech language pathologists that children who participate are taking risks at school. For example, one child volunteered to say the morning pledge of allegiance over the school intercom. Another benefit includes the opportunity for parents to discuss concerns and to learn more about stuttering disorders.
In the Words of One Participant The following passage, written by Victor Pennecamp, a high school student who participated in the project relates one (slightly humorous) version of the events of FFP.
Benefits of the Project
A major benefit of FFP is the collaboration of children and families to share personal experiences. In addition, feedback from referring clinicians indicates that the children improved in their willingness to take risks in speaking and in their understanding of the disorder of stuttering. The experience of working with the children helps the graduate students gain a better understanding of the complexity of the disorder and the synergistic relationship of the factors involved in diagnosis and treatment. Publicity and promotion of the event leads to increased awareness of the disorder of stuttering in the community in general. Through exposure to the project, professional workshops and community presentations result. A major impact of the event is the development of a network of professionals who are highly committed to both the treatment of children who stutter and the exploration of innovative treatment and training options.
Some Additional Thoughts
The development and success of the Fluency Friday Plus project in Cincinnati can be better understood by examining the organizational process involving the community of professionals committed to the success of this program. The idea for our first project, held in the fall of 2000, evolved from attending the Weekend Workshop held at St. Rose College in Albany, New York. The unique blend of mentoring and therapeutic treatment present at the St. Rose program seemed impossible to duplicate in a metropolitan area as diverse as ours. However, a group of dedicated professionals in the area brainstormed the possibilities and formed the framework for FFP.
The first Fluency Friday focused on the intensive treatment for the children and supervised experience training for the graduate students. Parents had access to a room filled with videos, handouts and computers to access web sites for information on stuttering.
Each year, the FFP team expanded the project adding speakers for the parents, a web page and special training lectures for the graduate students. FFP allows practicing professionals to learn about stuttering while contributing to the treatment of children with stuttering. Parents are able to reconstruct and let go of the past, to understand their child's disorder, to share and to find hope. Graduate students are successful in a supportive learning environment. More important, FFP provides treatment and guidance to over one hundred children in the Cincinnati area who struggle daily with stuttering.
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Brutten GJ, Dunham SL. The communication attitude test: a normative study of grade school children. Journal of Fluency Disorders 1989; 14; 371-377.
Games D. Fluency Friday Plus: Intensive Treatment/Training Program. Hearsay Journal of the Ohio Speech-Language-Hearing Association Vol. 16 No.1 2004.
Games D. Wollman I. Cincinnati Fluency Friday. Perspectives on Fluency and Fluency Disorders 2002; Vol. 12; No. 3; 8-9.
Peters, T., & Guitar, B. Stuttering, an Integrated Approach to its Nature and Treatment. Baltimore:Williams & Williams. 1991.