Alice Anne G. Farley1 and Judith H. Martin2
1Speech Pathology Practice and Steps to Fluency, 7436 Forest Court, Irmo, SC 29063
2Department of Comm. Sciences and Disorders. University of South Carolina, Columbia, SC 29208
Inspired by presentations made at the 2002 SID#4 Albuquerque Leadership Conference, two ﬂuency specialists from South Carolina were challenged to inaugurate an intensive gathering of school-age ﬂuency clients that would also provide training for parents, students, and clinicians. The University of South Carolina offered the site and sponsorship for the continuing education project. Tuition support was obtained from the SC State Department of Education and the National Student Speech-Language- Hearing Association. The Roundup showcased Steps to Fluency © Farley, a color—coded treatment program, combining ﬂuency shaping and stuttering modification. Two training days for SLPS / SLP students preceded the Roundup.
- Providing an intensive day of treatment for children and teens who stutter.
- Bringing together stuttering clients from around the state of South Carolina
- Acquainting parents with current information on stuttering
- Educating parents on appropriate responses to disﬂuent speech
- Facilitating knowledge of and practice of ﬂuency targets from both the Speak More Fluently and Stutter More Fluently approaches
- Allowing an opportunity to practice ﬂuency targets in a variety of formats
- Fostering family members’ interaction with families of others who stutter
- Assisting school therapists in formulating goals and objectives for each respective stutterer for the next school year
- Providing continuing education credit for practicing clinicians 10. Providing practicum experience for student clinicians
Applications for participation were received from 35 school clinicians and 22 graduate students. Application required a commitment to a three-day schedule that involved Training Day One (Friday, April 11, 2003), Training Day Two (Friday, August 1, 2003) and the Fluency Roundup (Saturday, August 2, 2003). It also required commitment to master the STF program manual and the accompanying tape between training sessions. Facilitators attended two additional three—hour tutorials. Each participating clinician was expected to invite at least one child accompanied by one or two family members to the Saturday roundup. April’s Training Day One was attended by 26 SLPS /20 SLP students plus 6 Leaders/Facilitators. August’s Training Day Two attendance was 20 SLPs/ l6 SLP students plus 6 Leaders/Facilitators. The actual Roundup attendance totaled 99: 19 school clinicians, 18 school age children (grades 1 through 10); 36 family members; 16 SLP students; 6 Leaders/Facilitators and 4 helpers/ guests. Children and clinicians were divided among four breakout groups according to age/ability (Mustangs, Broncos, Appaloosas, Palominos). A Western theme prevailed.
Training Day One (7 Hours)
Training Day Two (7 Hours)
Fluency Roundup (8 Hours)
Steps to Fluency © represents a combination of the ﬂuency shaping and the stuttering modiﬁcation methods for treating stuttering. Fluency shaping therapy elicits, promotes and reinforces ﬂuency while stuttering modiﬁcation therapy teaches block management and control.
The child needs to:
- Understand stuttering
- Understand his/her stuttering
- Understand the process of speaking
- Understand how his/her stuttering deviates from normal speaking
- Learn techniques that will aid in the management of blocks
- Become comfortable with a new way of speaking
- Substitute new, easy speaking patterns for stuttering
- Learn to “loosen up, lighten up and let go” during speaking
Understand the “colors of speech” and the progression to “earned green speech”
There are three ways for the child to achieve smooth speech:
- Speak More Fluently SMF (Fluency Shaping)
- Stutter More Fluent._y - STMF (Stuttering Modiﬁcation)
- Combination Approach
When the child begins the program Steps to Fluency ©, he/she has two colors of speech: red and green. Early in the process of therapy he/she is taught orange speech targets, which will eventually replace red speech production. Orange speech becomes the new speech pattern, an exaggerated, regulated, heightened way of initiating and completing utterances. At the conclusion of therapy, he/she will want to retain some usage of orange speech to assure the gradual habituation of his/her new, ﬂuent speech. Note the circles (Figure 1) as follows:
Figure 1. Progression of Therapy
There are many aspects of stuttering that can be brought under Voluntary control. Initially, it is helpful, as well, to regulate the ﬂuent or non-stuttered speech. In STF this act or procedure is called “speaking beneath the umbrella of orange speech”. Speaking under the “umbrella of orange speech” is the part of the program (Fluency Shaping) that teaches the child how to “get into speech, get through speech and get out of speech”: by using exaggerated, but natural, patterns of onset and continuity.
Usage of the targets “beneath the umbrella” should result in (Farley, 1995):
- Fewer blocks
- Less severe blocks
- Easier to manage blocks
Block corrections are all about learning how to loosen up, lighten up, and let go of tension during speaking. As the child uses block corrections and gains control of his/her speech mechanism he/she will gain conﬁdence in becoming a ﬂuent stutterer. For block exits to be correct, the person who stutters must not push out of a word but go through a period of adaptive stuttering. In Steps to Fluency ©, this process is called the “25—50—25 rule”. The stutterer must go through orange before coming out of the word. That is to say, that 25% percent of the word may be red, 50% must be orange and the exit may be up to 25%t green. Thus, the desired operant behavior receives the strongest practice response. The segue between the umbrella and Van Riper is often feigned block corrections (see Bailey, et. Al., 1985) a form of voluntary stuttering. In the Steps to Fluency © program, the child is able to move between stuttering modiﬁcation (Figure 3) and ﬂuency shaping protocols in order to tailor the program.
Figure 2. Umbrella of Orange Speech (careful, regulated talking)
Figure 3. Steps to control
Van Riper’s (l973) program is as follows with Steps to F laency © and SFA (Starbuck, 1972) phraseology added:
Steps to Fluency © is based on the assumption that the over-learning of correct and exaggerated speech patterns involving breathing, phonation, articulation and resonation, results in the habituation of integrated speech and the extinction of stuttered speech. Combining ﬂuency shaping and stuttering modiﬁcation assures that if ﬂuency is not facilitated, strategies are in place to promote control of all speaking. In the training manual, an acronym (TEST) is used to describe the program. It is as follows:
- Teach the targets and techniques necessary to assure production of easy speech ° Elicit the newly learned targets in a variety of exercises
- Strengthen the newly learned targets in a variety of settings
- Transfer the newly learned and habituated skills to all speaking situations
Lastly, the generalization process includes the involvement and cooperation of signiﬁcant others. The parent training portion of Steps to Fluency © as well as other current available resources were presented at the Roundup and addressed during the two (2) training sessions. Topics of importance included:
- Creating a favorable environment (harmony and structure) for the child who stutters.
- Understanding. the progression and patterns of stuttering and therapy.
- Modifying adult speech patterns as an agent of positive change in the child’s speech.
- Exploring alternate ways of practicing with the child
One hundred percent of the school clinicians indicated strong agreement with the statement “I will enter the school year with a ‘jump start’ on my client’s goals and objectives and incorporate new information.” One hundred percent also strongly agreed with the statement “The Fluency Roundup was beneﬁcial to my professional growth.” To date there are no data to support the use of the program with people who stutter but evaluation responses indicated an appreciation for its use as a training tool. The SC Department of Education has committed ﬁnancial support for a second Roundup in 2004 and there are plans to document future therapy outcomes using Steps to Fluency ©.
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