Client Evaluations of The Swedish Comprehensive Stuttering Program (CSP)

Author: Elisabeth Jörgensen, Dept of Caring Sciences, University of Örebro, Sweden. Presented at the 3^rd world Congress, International Stuttering Association (ISA), University of Gent, Belgium july2001

Over the last decade, in Sweden, there has been a movement among People who Stutter (PWS) to gain access to a variety of different approaches to the treatment of stuttering, and especially to intensive speech training. Financial support for an evaluation project was granted to Helena Forne - Wästlund, Speech and Language Pathologist, by the Swedish Ministry of Social Affairs. The Comprehensive Stuttering Program (CSP), including Precision Fluency Shaping Program (PFSP), as provided by Robert Kroll, PhD at Stuttering Center, Speech Foundation of Ontario, Canada served as a model of this project. It is a structured comprehensive treatment that deals with both the speech behaviour and the socio-psychological problems of the individual who stutters. The individual part of the intensive clinical training and home training was partly done with assistance of a computerized program.

As an independent investigator for the project, my role was to administer questionnaires to each participant, examining their personal outcomes of treatment . An independent investigator was employed, in order to give each individual the opportunity to respond as freely and candidly as possible. The evaluation is continuous, and has been carried on even after the formal end of project. In this poster session, I will present the evaluations of 30 Clients*, six month after the intensive treatment. They examine the following factors:

1. Previous treatment

2. The reasons "why" they wanted to enter the Comprehensive Stuttering Program, including PFSP speech - training.

3. Their own evaluation of personal outcome following CSP treatment.

4. If they recommend CSP treatment to others.

(* 2 clients out of 32 (6%) dropped out at an early stage of treatment, and did not participate in this study)

DIAGRAM 1:

Comments: Some of the participants indicated two or three different kinds of treatments. Five indicated no previous treatment. This is why the percentage scores and the number of persons is not valid in this section. As "Other Treatments", the following treatments were indicated: Psychotherapy, Hypnosis and Acupuncture.

DIAGRAM 2: Indicated personal outcome of previous treatments - benefits (N=30)

A lot: 1 client (ie 3%)

Some: 14 clients (47%)

None: 11 clients (37%)

No idea: 4 clients (13%)

DIAGRAM 3: Ways of receiving information about the CSP treatment including PFSP (N= 30)

Comments: The respondents in the two groups "Information Through Media" (N 7, 23 %) and "Gathered Information By Themselves" (N 20, 67%) are considered people active in trying new ways of treatment for dealing with their stuttering and its related problems.In all, those two groups (N 27) comprised 90% of the sample. The third group, "Recommended by Speech Pathologist", included only 2 persons (7%). This could indicate a low level of acceptance among professionals to concider new methods of treatment. These findings suggest the importance of the continuous "push-and-pull" phenomenon that exists between People Who Stutter (PWS) and the professional community in the initiation of ongoing development of treatments and clinical research.

DIAGRAM 5:

Comments: All participants indicated positive outcome of treatment. For 29 out of 30 participants, benefits (positive outcome of treatment) exceed costs (negative outcome of treatment) . In addition to the main categories, several participants comment's mentioned an increased awareness of stuttering or fluency due to increased knowledge. Most importantly, they indicated an increased overall sense of self-confidence.

Fourteen participants out of 30 indicated some disadvantages, mainly that they find the training a bit tedious and repetitiveness (6 persons). Three persons indicated too much focus on stuttering. Five have various comments. All of these, except one, consider that the advantages exceed the disadvantages. They generally believe that they have the capacity to continuously improve their speech fluency in the future.

Comments from clients, representative of the findings of this study:

" I do believe in this way of treatment. The results are dependent on yourself, how much you are actually training. Everything that helps me gain control over my speech is worth a lot".

" This treatment gives an increased awareness of why you stutter. Because of this, it makes it easier to understand the purposes of the Speech Targets and how they are being performed. It also increases your self confidence in general”.

”Thanks to the Speech Targets I've learnt, it is much easier to talk”.

”I like this treatment, because it is a new way of thinking and management of speech behaviour".

” This treatment has helped me more than anything else”.

” I am convinced that this method will help me. If it can help me, it can help others,as well"

" You have to be highly motivated to change your speech behaviour. This way of treatment is comprehensive and strucured and brings me the efficient tools for modifying my speech pattern".

"It makes you increase your awareness of stuttering. At the same time, you are doing something concrete against stuttering, and that is a good way of treatment, beneficial for many people."

" Because it is excellent. You learn how to get control over your voice".

One negative answer, not representative of the findings of study (3%):

”I cannot recommend this treatment program, because it only deals with a small part of the stuttering problem".

CONCLUSIONS:

1. Previous treatment:

Comprehensive Stuttering Program (CSP), including Precision Fluency Shaping Program (PFSP), is something new to Swedish Speech Pathology, and was introduced by this Swedish Project. That is why this treatment is something new to People Who Stutter and Clinicians. The responses of PWS represent an overview of current therapy formats available in Sweden: Non - avoidance, Stutter-free Speech, Voice training, (most frequent), as well as psychotherapy, hypnosis and acupuncture.

2. The reasons why they wanted to enter the Comprehensive Stuttering Program, including PFSP speech training:

The reasons "why" can be found in their personal outcomes of previous treatments. 47% indicate some benefit from previous treatments, 37% indicate no benefit from previous treatments - in all 84 %. Only one person (3%) got a lot of beneficial gains from of previous treatments.This low score could be explained by the following: If you are satisfied to a great extent from the treatment you have received, you probably do not have any personal need to try to find something else. Moreover, this group shows a high degree of independent initiative in gathering of information, which could show a high degree of other personal needs than current therapy formats can give.

3. Their indicated personal outcome of CSP treatment:

Six months after the intensive program, all participants indicated some kind of positive outcome of treatment. For 29 out of 30 (97%), the positive outcome of treatment exceeds the negative. Positive outcome is primarily expressed in terms of "less stuttering" and "increased control of fluency and speech situations". Diagrams 6 to 8 show a high degree of self-confidence and optimism for the future: continuous improvement of fluent speech and communicative skills. All of them (100%) indicate optimism in terms of gains in fluency (diagram 6). 83% indicate good or improved communicative skills within a year. All of them seem to have reached realistic goals: that improvement depends on their increased control of more fluent speech and ongoing training. (Diagram 7)

4. If the Comprehensive Stuttering Program (CSP) is recommended to others:

97 % indicate YES.