Stuttering Research and Treatment Around the World: United Kingdom Reflecting on the recent meeting of Special Interest Division 4, Fluency and Fluency Disorders, it is comforting to know that the issues we face in the UK are very similar to those discussed at Division 4, despite our services being organized in very different ways. Historically, treatment for stuttering in ... World Beat
Free
World Beat  |   October 01, 2005
Stuttering Research and Treatment Around the World: United Kingdom
Author Notes
  • Willie Botterill, is a consultant speech and language therapist and clinical manager at the Michael Palin Centre. She has worked as a specialist in the field of stuttering for 25 years and has a special interest in the use of Personal Construct Psychology and Solution Focused Brief Therapy in stuttering, and in group work with parents. Contact her at willie.botterill@nhs.net.
    Willie Botterill, is a consultant speech and language therapist and clinical manager at the Michael Palin Centre. She has worked as a specialist in the field of stuttering for 25 years and has a special interest in the use of Personal Construct Psychology and Solution Focused Brief Therapy in stuttering, and in group work with parents. Contact her at willie.botterill@nhs.net.×
  • Jane Fry, is a developing consultant speech and language therapist at the Michael Palin Centre where she has worked for 13 years. She has additional training in Cognitive Therapy and a special interest in working with teenagers. Contact her at jane.fry@nhs.net.
    Jane Fry, is a developing consultant speech and language therapist at the Michael Palin Centre where she has worked for 13 years. She has additional training in Cognitive Therapy and a special interest in working with teenagers. Contact her at jane.fry@nhs.net.×
Article Information
Speech, Voice & Prosodic Disorders / Fluency Disorders / World Beat
World Beat   |   October 01, 2005
Stuttering Research and Treatment Around the World: United Kingdom
The ASHA Leader, October 2005, Vol. 10, 39-41. doi:10.1044/leader.WB9.10142005.39
The ASHA Leader, October 2005, Vol. 10, 39-41. doi:10.1044/leader.WB9.10142005.39
Reflecting on the recent meeting of Special Interest Division 4, Fluency and Fluency Disorders, it is comforting to know that the issues we face in the UK are very similar to those discussed at Division 4, despite our services being organized in very different ways.
Historically, treatment for stuttering in the UK has been notable for its diversity. Clinicians have drawn on and integrated a variety of approaches across the age range with clients who stutter. Specialist clinicians in the UK may use indirect or direct therapy with young children or a combination of the two. With older children, teenagers and adults, clinicians may integrate fluency management (using aspects of fluency shaping and block modification), communication skills, and cognitive restructuring, with the particular configuration of treatment led by individual client needs.
Interest in and emphasis on the role of psychological change in stuttering has led many clinicians in the UK to develop skills in psychological therapies such as Personal Construct Psychology, Cognitive Therapy, Brief Solution Focused Therapy, and Narrative Therapy and to use these approaches to help clients achieve their goals. This diversity is highly valued as it may be argued that it encourages flexibility and creativity, and the development of clinicians who are able to engage in the process of therapy by understanding and responding to individual needs, goals, and preferences.
Evidence-Based Practice
However, there also is a drive within the National Health Service, led by central government policy, to develop and provide health care that is both evidence-based and cost-effective. A key principle in evidence-based health care is that only interventions that have been objectively evaluated should be included in clinical practice [see Sackett et al. (1996) Evidence-based practice: What it is and what it isn’t. British Medical Journal, 312, 71–72]. The challenge for all health services in the UK at this time, speech and language therapy included, is to reach consensus about what, based on the evidence, constitutes best practice, and to develop clinical guidelines that reflect this.
Despite the apparent advantages of restricting treatment interventions to those that have been objectively evaluated, concerns are voiced in the UK, as elsewhere, about the potential constraints that such a principle may impose on individual clinical decision making and innovation. For example, the complexity of psychological change, fundamental to the process of therapy for many people who stutter, may not be revealed when quantitative research methods, which may be favored in evidence-based practice, are relied on.
Furthermore, limiting “outcome” to elements that can be easily measured may ultimately be too reductionist to be either useful to clinicians or meaningful to clients. In addition, in the field of stuttering, as in many others, the definition of “success” in therapy is highly individual and may best be defined by individual clients rather than either clinicians or researchers. Finally, problems are inherent in generalizing research findings in a disorder such as stuttering that is heterogeneous in nature. The situation is further complicated by the relative scarcity of available research evidence with respect to treatment for stuttering.
While the UK community has made valuable contributions to stuttering research it is imperative that more is undertaken, although here as elsewhere the financial resources to support research initiatives are scarce. Clinicians frequently lack sufficient time, knowledge, and support, and are inhibited by demands of client throughout and are thus less able to systematically evaluate their work. For many clinicians, interest also may be eroded by a perception that evidence-based practice necessarily involves “gold standard” research.
The way that clinical skills development in the field of stuttering is approached in the UK may offer a useful way forward. Emphasis is being placed on developing clinical skills and confidence from a grass-roots level upwards and on demystifying therapy for stuttering through extensive training opportunities from a variety of leading clinicians throughout the country. In this way less experienced clinicians are encouraged to feel more confident in their skills while also being able to seek the support of specialists when required, rather than viewing stuttering therapy as the domain of specialists alone.
In the same way, all clinicians may be encouraged to develop strategies for gathering evidence as part of their practice, using standard activities such as careful recordkeeping, assessment, seeking client feedback, and conducting clinical audits. This “real world” approach has the potential to provide evidence that is practice-based as well as practice that is evidence-based, the bi-directionality of which is intuitively appealing. Within the UK, a significant initiative in this respect is the development of national clinical care pathways, which will chart each client’s progress through therapy and identify points at which clinicians are encouraged to reflect on their practice as part of their clinical decision making.
Ultimately, what emerges in discussions both in this country and elsewhere is that while the process of developing an evidence base and applying it to clinical practice is far from straightforward, it is fundamental to the future development of our profession. This approach offers us challenges as well as opportunities to meet the needs of our clients more effectively.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2005
Volume 10, Issue 14