Meina Voors1 and Durdana Putker2
1Centrum Voor Stottertherapie Bloemerzdaal, Donkerelaan 64 2061JP Bloemendaal, the Netherlands
2Stottercentrum Zwolle, Huzjgensstraat Ia 8023 AG Zwolle, the Netherlands
A group of speech specialists in the Netherlands have been developing a new system for treating stuttering, where a network of therapists can enroll their patients in different modules of therapy. Cooperation between speech therapists has resulted in an Integrated Care System for stutterers, where individual and group therapies form an ongoing, long- term treatment.
- “Made-to-Measure” Therapy
- Individual and Group Modules
With a grant from’het Prins Bernhard Fonds’, a Dutch fund for cultural and social activities, our association transformed existing group therapies into a more modernized method. In this new format, intensive group therapies with various goals were designed to treat stuttering. These groups included fear reduction for adults, an adolescent group for youth between 12 and 18 years old, a parent-child group for school-aged children and with a grant from Nationale Kollekte Geestelijk Gehandicapten, two groups for people with special needs.
- Case Management
The case management system has four features: individual therapy, evaluation, group therapy and second evaluation.
- The first step is a diagnostic phase, in which all methods of existing diagnostic instruments are used .
- The case manager then decides (with the client or the parents) if the patient should be enrolled in the ICS, or needs a different method of treatment
- If ICS is selected, individual therapy is then organized close to the patient’s home.
- During this initial individual therapy, the case manager conducts an evaluation where new therapy goals are set. L
- Following this individual therapy and assessment, group therapy is then conducted in the most appropriate locale.
In these questionnaires, the satisfaction of the client with both his/her speech performance as well general communication skills are measured through satisfaction indicators. The questionnaires are repeated several times after the completion of group therapy, with clients assessed for at least two years after treatment. The outcomes of such evaluations have thus far been positive, though the number of clients enrolled in the group therapies until now are small, at around 90.
Furthermore, the coaching and educational services provided to general speech therapists are evaluated through anonymous questionnaires. The results of these evaluations have also been positive. Approximately 70 questionnaires have been returned which assessed coaching, and several hundred have been returned which evaluated education.
- Description of different modules
- 1 day training focused on the individual goals of the patient
- 3 day training in a special institute with haptonomic, bioenergetic, creative and speech therapists
- 2 day training focused on stuttering and daily life
- 1 day training utilized as an evaluation day to review personal aims and discuss the future
Intensive therapy group for fluency enhancing techniques
This group works towards maintaining and stabilizing fluent speech by using different fluency techniques. For each client, two appropriate techniques are determined (Cooper 1993, Dahm 1997).
It consists of seven sessions spread over two consecutive days, followed by a one-day session three weeks later. Intensive coaching by a SLP and former group member is provided throughout the treatment, as well as after its conclusion.
Intensive therapy group for adolescents
Adolescents work with their speech in this group to maximize his/ her development into a communicative self-controlling person.
It consists of two training consecutive days in which self-esteem and courage are important themes. After two weeks and five weeks respectively, a one-day training is held where the youth prepare an instructional day for their parents and other persons interested. This is followed by a half-day conclusion.
Parent-Child therapy group
The parent-child group aims to improve Communication skills in parents and children. Parents and children work together, and in separate groups. Parents are taught how to support child and are given a good communication model (using principles from “Quality Parenting”, Albert 1987.)
Children learn to reduce fear and tension around their stuttering, and are assisted in developing a more communicative way of stuttering.
Groups for people with cognitive challenge (in development)
- Additional post- ICS care
The case manager provides open communication between the client and the different therapists in the ICS.
As all therapies are preferably organized as close to the patient’s home as possible, cooperation with general and specialized speech therapists in the Netherlands is vital. Since any care system needs continuous attention and monitoring, the therapists are open for discussion and are willing to integrate new insights to improve treatment.
1Insurance companies in the Netherlands demand healthcare providers to be as transparent in their treatment as possible, including diagnosis, improvement and evaluation
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Appendix 1: Partial Data
Appendix 2: Example of Questionaire
Appendix 3: Example of Condition List