"I'm so glad you are here! Will you be taking over all of our stuttering students?" This question from a colleague began one of the first conversations I had after arriving at Frisco (Texas) Independent School District. It was my first week in the role of staff fluency specialist.
As part of the critical effort to keep administrators informed about services, challenges, and task completion, fluency specialist Nina Reeves (left) discusses goal setting with an administrator.
The question took me by surprise—but the frustration behind the question did not. I knew from experience that working with stuttering was not a favorite among most speech-language pathologists, no matter what their work setting.
My heart (and career) has always been in school-based treatment, so when I moved to Texas in 2005, I was hopeful that one of the larger districts in the area would share my vision that a fluency specialist would be a wonderful addition to its staff. Although the idea of employing a board-recognized specialist in fluency disorders for a stand-alone position in the public schools had yet to be widely attempted, it seemed a logical next step as specialty recognition grew within the profession of speech-language pathology.
Of course, I knew I was treading into uncharted waters—even Charles Van Riper had discussed the idea of a fluency specialist in the public schools as "training for a job that didn't exist" (Van Riper, 1977). After many discussions with colleagues, long hours of proposal writing, and several face-to-face meetings with special education administrators, Frisco ISD was the first to give the idea a try in 2006.
The lead speech-language pathologists and the special education administration at Frisco ISD knew what research has repeatedly shown: SLPs often rate their comfort and confidence levels in assessing and treating fluency disorders as below that of other communication disorders (Brisk, Healey, & Hux, 1997; St. Louis & Durrenberger, 1993). These decision-makers understood the clinicians' discomfort with stuttering—and that this reluctance was not unique to their district—and were open to initiating a cutting-edge program to improve the situation.
In the Beginning...
The Stuttering Focus Initiative (SFI) began in 2006 at Frisco ISD, in one of the fast-growing suburbs in the sprawling metroplex near Dallas-Fort Worth. The initial mission of the SFI was to enhance the quality of service delivery to students who stutter and their families by providing educational and consultative services to the SLPs and district staff. Once FISD made the decision to move forward, the next step was to develop the program goals and objectives.
We started the process with collaborative meetings and needs assessment surveys that helped us frame the initial job description and create a list of roles and responsibilities for the new position.
Initially, two objectives were given equal weight in the development of my role within the district:
- Establish ongoing staff development opportunities in the area of fluency disorders.
- Create a process for one-to-one collaboration with campus SLPs.
My role was not to take over as case manager for individual students who stutter, but rather to mentor and support the SLPs who had these students on their workloads.
The Stuttering Focus Initiative includes five components, each designed to enhance clinicians' competence, confidence, and comfort in providing fluency intervention.
My colleagues in all of the districts expressedthe desire to increase their competence and confidence in working with students who stutter. They were not comfortable with the status quo of their current assessment and intervention capabilities. To address this problem, the SFI established a broad spectrum of continuing education opportunities, including required annual full-day and half-day seminars on a variety of topics related to fluency disorders. We also offered optional monthly workshops designed to address more specific topics of interest to district SLPs. These in-service trainings sought to disseminate best-practice information, provide hands-on treatment strategy role-plays, and discuss solutions for difficult cases.
"On-the-ground" collaboration has been a major focus of the initiative. Each clinician can request personal consultations with me to discuss individual case concerns. The most common issues are usually related to difficult assessments, ongoing treatment planning, and parent or teacher collaboration issues. Face-to-face consults allow for practical demonstration of the concepts discussed in staff developments. Most important, consultative meetings allow clinicians an opportunity to attempt new activities with support and on-the-spot problem-solving.
As the SFI grew, it was obvious that available resources did not align with the district clinicians' level of newly acquired knowledge and skills. Many critical elements for enhanced assessment procedures, as well as consistent procedures for report writing and treatment planning, were missing or becoming outdated. With the district's expanding use of "shared drive" technology, I created and disseminated assessment forms, flow charts, and helpful hints for report writing and parent collaboration. Worksheets and unit activities were developed for presenting concepts at various stages of treatment, and for various age and cognitive levels of students on our workloads.
I also requisitioned and assembled age-related resources for each campus. These "stuttering kits" were filled with materials for SLPs, teachers and parents, and children who stutter. The list of desired materials was long and the budget was short, so we established a lending library at the central administration building; clinicians could try out the lending library materials to guide their decisions for individual campus purchases. It also expedited the acquisition of new materials by avoiding the delay usually associated with mass purchases for each campus library. The administration approved this "try it before you buy it" concept, which was then replicated by other FISD departments and other area school districts.
We also want to keep district SLPs informed about current research and stuttering support organization resources. I disseminate information about research, happenings within ASHA and state and local associations, and announcements of events and/or resources from the many nonprofit organizations that provide services for children who stutter and their families.
Education and Outreach
Understanding the needs of parents and teachers of students who stutter was a priority from the early stages of the SFI. Clinicians often commented that parents and teachers shared their feelings of uncertainty and unfamiliarity with the facts about stuttering and how to help their children at home. These concerns highlighted yet another challenge for the district SLPs, as they reported feeling less than adequate in their abilities to educate and support parents and teachers on fluency-related topics.
The SFI addressed these issues by establishing parent education events, where parents learn more about stuttering and clinicians learn how to educate and counsel parents. The events presented answers to frequently asked questions, and several guest speakers (an adult and a teenager who stutter) shared their personal experiences. Participants were then encouraged to ask questions and engage in discussions. Over time, parent education opportunities expanded, as it became apparent that most parents had difficulty attending evening events. FISD now offers annual evening events and quarterly breakfast "brown bag" parent meetings.
Early Childhood Stuttering
Within the first year of the SFI, clinicians spotlighted the need for more information and services for preschool students identified with fluency disorders and expressed a desire to expand parent training and inclusion in the process of intervention. To meet this goal, we established the preschool fluency intervention groups (PFIGs). To my knowledge, the Frisco Independent School District is the only public school district in the country to implement these types of services for preschoolers who stutter.
The PFIG program was designed to provide opportunities for me to co-teach with and mentor the SLPs providing intervention for preschool children who stutter. When possible, these students are placed in homogeneous groups. Each child receives group or individual intervention to meet his or her needs while parents participate in training sessions and support/discussion groups. Several SLPs and I provide parents with information about stuttering, as well as training in specific communicative modifications for home implementation. Parents also receive recordings of example sessions to support their training and to allow other family members (who may not be able to attend intervention sessions) opportunities to view communicative modeling. Parents and caregivers also receive instructions on tracking and documenting their child's fluency skills weekly. The parents' observations are an essential component for appropriate individualized treatment planning and intervention.
Over the past six years as a public school fluency specialist, I have encountered a number of unexpected revelations:
- The program concept was accepted in a number of districts (I have worked with five so far).
- I was universally welcomed and appreciated by colleagues, students, and families.
- I was frequently challenged to expand my own knowledge.
- I needed to be on the cutting edge of broad-based information related to fluency disorders.
- The program's success and growth expands every year.
- The program was flexible and could be adapted to meet the needs of a variety of districts.
Does it Work?
Monitoring program effectiveness has been an essential component of the SFI from its inception. To document and track progress of clinician confidence and competence in assessment and treatment of stuttering, questionnaires and needs assessment surveys were administered at various points (e.g., one year, two years, five years). Targeted feedback forms were also created for parents of children in the PFIG program to garner their comments on how to improve fluency programs and services.
Three districts collaborated in the data collection efforts. The districts (Frisco ISD, McKinney ISD, Garland ISD) each had employed me as a fluency specialist, but approached their programs in different ways. The variability of the programs posed challenges to data collection efforts, but doing so was imperative for the growth and development of the respective initiatives.
FISD used anonymous surveys to collect data from SLPs to measure their overall comfort levels and competence in assessing and treating fluency disorders. Anonymity was maintained to increase the likelihood of honest and complete answers. The same questionnaire was administered before the start of the program and at the end of the first year of the SFI. Analysis of the pre- and post-survey results indicated a marked improvement in the areas of assessment, initial intervention services, and overall clinician comfort level in working with children who stutter. Recently, a five-year follow-up questionnaire was sent to SLPs who were part of the original data collection. Results are not yet available.
Finding a balance in working with administrators has been challenging. It's important to keep the administration informed about services, challenges, and specific task completions. Most administrators want to be informed of overall challenges and triumphs of the initiative. They appreciate annual reviews of goals and objectives and expect outlines for making changes to enhance overall program effectiveness.
Building for the Future
The Frisco ISD Stuttering Focus Initiative is looking toward the future. Budget cuts and uncertain funding sources are forcing adjustments to create a cohesive strategy for ongoing success. Contingency plans are being formed to ensure a successful program for the long term.
From the very beginning, the idea of "growing our own" specialists in fluency disorders was a priority. Over time, we have identified SLPs within the district who have expressed an interest in and an affinity for working with students who stutter. These clinicians have attended the bulk of staff development opportunities, collaborated and consulted with the fluency specialist on numerous occasions, and expressed a desire to enhance their clinical skills in treating students with fluency disorders.
This group of clinicians is preparing to embark on a 12-month intensive training program that will include all aspects of assessment and treatment of children with fluency disorders. These motivated professionals have volunteered to be trained to assist their colleagues in providing fluency disorder assessment and intervention at FISD, and will receive support from the special education administration for their extra duties. The program will provide intensive training modules to allow each professional to choose a niche area for development. Each will then be responsible for taking over certain aspects of staff development, caseload management development, and/or consultation with district colleagues on a variety of fluency disorder topics. The goal of this aspect of the initiative is to allow FISD to continue to support its campus-based SLPs for the long term.
Clearly, school districts vary in their administrative philosophies and service implementation; given this reality, initiatives such as FSI must be flexible to adapt to those differences. Because we developed this program from the ground up, there were no preset limits or programmed ways to accomplish goals. The success of this cutting-edge initiative brings hope that every district, once administrators realize the need for increased training and more effective services in the area of fluency disorders, can create a long-term plan for meeting the district's needs.
Working with students who stutter is as challenging as it is rewarding. Children who stutter need knowledgeable and confident SLPs, and school-based SLPs want to help children who stutter. Working together to raise the bar for effective service delivery is the key to making both of these goals a reality.