Stuttering Intervention in Three Service Delivery Models (Direct, Hybrid, and Telepractice): Two Case Studies


  • Daniel T. Valentine University of Montevallo



This study assessed outcomes in stuttering intervention across three service delivery models: direct, hybrid, and telepractice for two 11-year old children who stutter. The goal of the study was to investigate whether short-term goals were maintained through the telepractice sessions. The Stuttering Severity Instrument, Fourth Edition (SSI-4) was administered to each child before and after each intervention period and weekly fluency samples (percentage of stuttered syllables in a monologue) were obtained in each of the 10-week intervention periods. In addition, the Communication Attitudes Test-Revised was used to assess the children’s attitudes toward speaking. Following the telepractice period, parents and children completed a questionnaire concerning the therapy experience via telepractice. Both children continued to improve fluency as measured by the weekly fluency samples. SSI-4 severity ratings improved for one child and remained consistent for the other. These outcomes appear to demonstrate that telepractice is viable for improving and maintaining fluency.


Author Biography

Daniel T. Valentine, University of Montevallo

DTV is an assistant professor in the department of communication science and disorders at the university of montevallo, alabama. His research interests are in the ares of stuttering and school-age language disorders.


American Speech-Language-Hearing Association. (2014). Professional issues: Telepractice. Available from

Armfield, N.R., Gray, L.C., & Smith, A.C. (2012). Clinical use of Skype: A review of the evidence. Journal of Telemedicine and Telecare, 18, 125-127.

Blaiser, K.M., Behl, D., & Callow-Heusser, C. (2013). Measuring costs and outcomes of tele-intervention when serving families of children who are deaf/hard-of-hearing. International Journal of Telerehabilitation, 5(2), 3-10.

Brutten, G.J. (1997). Communication Attitudes Test. University of Nebraska-Lincoln. Retrieved from

Carey, B., O’Brian, S., Onslow, M., Block, S., Jones, M., & Packman, A. (2010). Randomized controlled non-inferiority trial of a telehealth treatment for chronic stuttering: The Camperdown Program. International Journal of Language and Communication Disorders, 45, 108–120.

Cohn, E.R. (2012). Tele-ethics in telepractice for communication disorders. Perspectives on Telepractice, 2(1), 3-15.

Cohn, E.R., Brannon, J., & Cason, J. (2011). Resolving barriers to licensure portability for telerehabilitation professionals. International Journal of Telerehabilitation, 3(2), 31-33.

Conture, E.G. (2001). Stuttering: Its nature, diagnosis, and treatment. Boston: Allyn and Bacon.

Denton, D.R. (2003). Ethical and legal issues related to telepractice. Seminars in Speech and Language, 24, 313-322.

Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16, 134-139.

Halpern, A.E., Ramig, L.O., Matos, C.E, Petska-Cable, J.A., Spielman, J.L., Pogoda, J.M., …McFarland, D.H. (2012). Innovative technology for the assisted delivery of intensive voice treatment (LSVT LOUD) for Parkinson disease. American Journal of Speech Language Pathology, 21, 354-367.

Harris, E., Onslow, M., Packman, A., Harrison, E., & Menzies, R. (2002). An experimental investigation of the impact of the Lidcombe Program on early stuttering. Journal of Fluency Disorders, 27, 203-214.

Harrison, E., Wilson, L., & Onslow, M. (1999). Distance intervention for early stuttering with the Lidcombe Program on early stuttering. Advances in Speech Language Pathology, 1, 31-36.

Hill, A.J., Theodoros, D.G., Russell, T.G., Cahill, L.M., & Ward, E.C. (2006). An Internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study. American Journal of Speech-Language Pathology, 15, 45–56.

Howell, S., Tripoliti, E., & Pring, T.R. (2009). Delivering the Lee Silverman Voice Treatment (LSVT) by web camera: A feasibility study. International Journal of Language and Communication Disorders, 44, 287–300.

Irani, F., & Gabel, R. (2011). Intensive stuttering therapy with telepractice follow-up: A case study. Perspectives on Fluency and Fluency Disorders, 21, 11-21.

Gabel, R., Irani, F., Palasik, S., Swartz, E., & Hughes, C. (2010). Treatment outcomes of the intensive stuttering therapy for adolescents and adults. In A.E. Harris (Ed.), Speech Disorders: Causes, Treatment, and Social Effects (pp. 139-159). New York, NY: Nova Science Publishers.

Georgeadis, A.C. Brennan, D.M., Barker, L.M., and Baron, C.R. (2004). Story retelling performance and subject feedback from adults with neurogenic impairments in both face-to-face and remote videoconference settings. Clinical Aphasiology, 18, 639–652.

Guitar, B. (2013). Stuttering: An integrated approach (4th edition). Baltimore: Lippincott Williams & Wilkins.

Karp, W., Grigsby, R., McSwiggan-Hardin, M., Pursely-Crotteau, S., Adams, L., Bell, W.,…Kanto, W.P. (2000). Use of telemedicine for children with special health care needs. Pediatrics, 105, 843-847.

Kully, D. (2000). Telehealth in speech pathology: Applications to the treatment of stuttering. Journal of Telemedicine and Telecare, 6, 39–41.

Lincoln, M.A., & Onslow, M. (1997). Long-term outcome of early intervention for stuttering. American Journal of Speech-Language Pathology, 6, 51-58.

Lewis, C., Packman, A., Onslow, M., Simpson, J.M., & Jones, M. (2008). A phase II trial of telehealth delivery of the Lidcombe Program of early stuttering intervention. American Journal of Speech-Language Pathology, 17, 139-149.

Manning, W.H. (1996). Clinical decision making in the diagnosis and treatment of fluency disorders. Boston: Delmar Publishers.

Mashima, P.A., Birkmire-Peters, D.P., Holtel, M.R., & Syms, M.J. (1999). Telehealth applications in speech-language pathology. Journal of Healthcare Information Management, 13, 71–78.

O’Brian, S., Onslow, M., Cream, A., & Packman, A. (2003). The Camperdown Program: Outcome of a new prolonged-speech treatment model. Journal of Speech, Language, Hearing Research, 46, 933-946.

O’Brian, S., Packman, A., & Onslow, M. (2008). Telehealth delivery of the Camperdown Program for adults who stutter. Journal of Speech, Language, and Hearing Research, 51, 184–195.

O’Brain, S., Smith, K., & Onslow, M. (2014). Webcam delivery of the Lidcombe Program for early stuttering: A phase I clinical trial. Journal of Speech, Language, and Hearing Research, 57, 825-830.

Onslow, M., Packman, A., & Harrison, E. (2003). The Lidcombe Program of Early Stuttering Intervention: A clinician’s guide. Austin, TX: Pro-Ed

Reardon-Reeves, N. & Yaruss, J.S. (2013). School-age stuttering therapy: A practical guide. McKinney, TX: Stuttering Therapy Resources, Inc.

Riley, G. (2009). Stuttering Severity Instrument (4th ed.). Austin, TX: Pro-Ed.

Sicotte, C., Lehoux, P., Fortier-Blanc, J., & Leblanc, Y. (2003). Feasibility and outcome evaluation of a telemedicine application in speech-language pathology. Journal of Telemedicine and Telecare, 9, 253-258.

Schwartz, H. (1999). A primer for stuttering therapy. Boston: Allyn and Bacon.

Theodoros, D., Hill, A., Russell, T., Ward, E., & Wooten, R. (2008). Assessing acquired language disorders in adults via the Internet. Telemedicine and e-Health, 14, 552–559.

Wertz, R.T., Dronkers, N.F., Bernstein-Ellis, E., Shubitowski, Y., Elman, R., Shenaut, G.K.,… Deal, J.L. (1992). Potential of telephonic and television technology for appraising and diagnosing neurogenic communication disorders in remote settings. Aphasiology, 6, 195–202.

Wilson, L., Onslow, M., & Lincoln, M. (2004). Telehealth adaptation of The Lidcombe Program of early stuttering intervention: Five case studies. American Journal of Speech- Language Pathology, 13, 81–93.

Yaruss, J.S. (1998). Real-time analysis of speech fluency: Procedures and reliability training. American Journal of Speech-Language Pathology, 7, 25-37.

Yaruss, J.S. & Quesal, R. (2010). Overall assessment of the speaker's experience of stuttering. Minneapolis, MN: Pearson.



How to Cite

Valentine, D. T. (2015). Stuttering Intervention in Three Service Delivery Models (Direct, Hybrid, and Telepractice): Two Case Studies. International Journal of Telerehabilitation, 6(2), 51–64.



Case Studies