Work Setting: Schools
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An interprofessional team collaborated with the parents of a 10-year-old boy struggling with moderate-to-severe stuttering. By applying their expertise to group therapy, individual therapy, and family counseling services, the team members helped the boy and his family successfully manage his stuttering and enjoy better communication. After 6 months, formal assessments indicated improvement in the student’s reaction to his own stuttering and increased interaction in classroom and social settings.
Juan is a 10-year-old boy diagnosed with moderate-to-severe stuttering. He has been receiving speech therapy services off-and-on since he was 4 years old. Juan received an individualized educational program (IEP) in first grade and has continued to receive speech therapy services. Juan is currently in fourth grade and will transition to a new school in the fall.
Juan was receiving speech therapy services for 30 minutes per week in a group setting. Therapy services focused primarily on speech modification and stuttering modification techniques. However, Juan’s teachers and parents reported that he was becoming increasingly frustrated with his stuttering and with his difficulty in communicating with others. Juan began to withdraw from social situations and class participation because students made fun of his stutter. Juan’s grades began to suffer, and he told his parents that he wanted to quit the band because he didn’t want other band members to find out that he stutters.
Juan’s school-based speech-language pathologist (SLP) and his parents agreed that an outside consultation with another SLP who specializes in stuttering—and perhaps individual treatment, as well—would be helpful.
The IPP team included the following members:
The interprofessional team met to develop an assessment and treatment plan. The team was coordinated by an SLP, who was responsible for keeping a calendar and for ensuring that updated information was available to the team.
Both the school-based SLP and the private SLP who specializes in stuttering conducted assessments and formal testing with Juan to determine his current level of stuttering and its impact on Juan’s quality of life. They also reviewed Juan’s readiness for individual and group treatment in school-based and clinical settings.
Results of the stuttering assessment indicated disfluency rates ranging from 7% during conversational speech with the clinicians to 16% during oral reading, and 14% in classroom observation. Juan’s stuttering had a moderate-to-severe impact on him, his overall communication, and his quality of life.
As part of the assessment, the school-based SLP collected input from Juan’s teachers and band instructor. Classroom teachers reported that Juan was a bright student, but he was hesitant to speak in class and was reluctant to start conversations with his peers. They reported that Juan’s peers often asked him about his stuttering, but he didn’t know how to respond. Lacking a background in stuttering, Juan’s teachers weren’t sure how to help.
The private SLP worked with Juan’s parents to get their input. Juan’s parents reported that his stuttering, and resulting frustration, appeared to be increasing at home. Juan’s parents reported that they sometimes had difficulty following through with behaviors at home (e.g., getting Juan to bed on time). They were referred to a family counselor.
The IPP team discussed the results of these assessments and agreed on a treatment plan. The school-based SLP provided group therapy focused on speech modification, Juan’s knowledge of stuttering, his improved reactions to his own stuttering, and his overall communication skills. The private SLP’s individual therapy focused on similar skills. The SLPs maintained close collaboration to ensure that both professionals were targeting similar goals.
In addition, family counseling sessions focused on helping his parents follow through with discipline at home. Juan’s parents had previously worried that disciplining Juan could make his stuttering more pronounced. Collaboration with SLPs helped the parents understand that discipline should not be ignored for children who stutter. Ongoing consultation with teachers ensured that treatment goals for Juan were carried over into the classroom. Teachers were given a log to rate his progress in participation and his reactions to stuttering.
After 6 months, a new assessment indicated that Juan’s reactions to his stuttering have improved. Juan’s teachers noted increased levels of participation and discussion with his peers. Juan gave a presentation to his classmates and teachers to help educate them about stuttering. His social interactions improved. He agreed to continue with the band and attended a summer camp for children who stutter.
The IPP team communicates weekly to check Juan’s response to treatment, and the team holds scheduled meetings every 4–6 weeks during the school year. The SLP will coordinate ongoing intervention services with Juan’s family.
At monthly evaluation meetings, Juan’s IPP team members discuss reflections, needs for adjustments in treatment, and conflicts.