Why one size doesn’t fit all

In the small world of stammering, a huge storm has been raging this week. International sparks are flying because of a proposal by Speech Pathology Australia, (the professional body for speech and language therapists) that the Australian government contribute to the cost of the treatment of preschool children who stutter by providing federal reimbursement for intervention using the Lidcombe Program.

Anyone working in the field of stammering will cheer at the idea of therapy being centrally funded, but only one type of therapy? For a condition which is universally accepted as being complex and heterogeneous? The Lidcombe Program has good research evidence to demonstrate that it is effective. The fact that the Lidcombe Program has evidence from a randomized control trial (RCT) is the basis of SPA’s argument, but the lack of RCT evidence for other approaches does not mean that they are not as effective. It is simply a reflection of a lack of research and resources. There is much evidence to support other interventions for early stuttering.

It is very clear that there is no single approach that is one hundred percent effective for all children, and it is critical that therapists look at each child and family’s needs and decide with them which approach is most suitable. Narrowing this down to one option is a backward step in an age when we value diversity and flexibility in therapy. Clearly, the Australian government will want to put its money into an approach that has been well-researched, but focusing only on the empirical evidence is blinkered. We know that evidence-based therapy also considers the clients’ values (does this approach fit with their ethos?) and their needs (are they able to participate in this approach in the recommended way?), as well as the therapist’s expertise.

At the Michael Palin Centre, all our work begins with a detailed assessment of each child in their family context, funded by Action for Stammering Children. This in-depth conversation with the child and parents helps us to understand what they need and discuss with them what their options are as to the best approach to take, be it the Lidcombe Program, Palin PCI or a range of other options. We and they treasure this opportunity to understand each child and family’s individual needs and then tailor the therapy to what suits them best.

You might be wondering why the international community is responding so vociferously to something that is happening on the other side of the world? Well, when it comes to money and funding, all budgets are limited and becoming increasingly tight. If the Australian government takes this proposal on as it stands, it sets a precedent that may be replicated by other funding authorities. There are implications for children who stammer, their families, the profession of speech and language therapists and service delivery not just in Australia, but all over the world.

Let’s hope that the Australians listen to the concerns being raised by so many of their international colleagues and decide to offer funded therapy to all children who stammer, whichever therapy that may be.

Elaine Kelman Blog