Title: Evaluating Palin Stammering Therapy for Children: a feasibility study
Funder: Department of Health and Social Care

Abstract: Background Stammering in the school years can have a significant impact on a child s ability to integrate, participate and progress in school. There are potential long term implications for mental health and well-being. However, while there is empirical evidence to support intervention with children under 7, adults and older teenagers, there is little empirical evidence to support any approach with this children who stammer aged 8-14 years and many speech and language therapists report a lack of knowledge and confidence to work with this group. Aims of the study The aim of a full scale trial will be to assess the effectiveness of Palin STC (an integrated therapy programme with school-aged children who stammer) in generalist Speech and Language Therapy NHS centres such as typically offer services locally for children. Initial efficacy of Palin STC in a specialist setting has been established. Before a full trial can be undertaken, several questions regarding acceptability, participation and adherence with respect to both the research and the therapy programme by children, parents and speech and language therapists, need to be addressed through this feasibility study: 1. Recruitment and attrition rates will be established to inform the number of sites and participants required for the full trial 2. Response to intervention: The outcome data will inform the power analyses and numbers required for the full study. 3. Acceptability of the intervention and trial methods 4. The fidelity of treatment delivery by speech and language therapists 5. Suitability of Cost-Effectiveness Measures: Feasibility of collecting health services-use data, for relative cost-effectiveness Method Design Two-arm feasibility cluster-randomised controlled trial of Palin STC intervention with treatment as usual control arm. Participants Speech and language therapists from non-specialist clinic settings in Hackney NHS Trust and North East London Foundation Trust will be recruited and randomly allocated to one of two groups: a Palin STC treatment group or a treatment as usual control group. Children who are referred to these services will be invited to participate if they are aged 8-14, have a stammer, want therapy and have a parent that can attend the therapy. Children (n = 50) will be randomly allocated to a speech and language therapist in one of the two groups. Measures Children and parents will complete assessments and questionnaires at the start and end of therapy and six months after the start of therapy to measure stammering and the impact it has on functioning, participation and well-being. Qualitative interviews with therapists, parents and children will explore the acceptability of and adherence to the research and therapy. Palin STC sessions will be video recorded to evaluate speech and language therapists adherence to the therapy. The mode of delivery, number, duration and content of treatment as usual sessions will be recorded on a checklist. Analyses Response to intervention measures and the cost-effectiveness of the approach will be analysed using descriptive statistics only. Interviews will be analysed qualitatively. Recruitment and attrition rates, and details of what constitutes treatment as usual , will be evaluated.

Lay abstract: Stammering (otherwise known as stuttering) can have a long term impact on a child s development. This might include reduced self-esteem or increased anxiety, finding it harder to make friends and not participating in class. With approximately 66,000 school-aged children who stammer in England, there is a need to develop a therapy programme that is effective, cost-effective, and available to families through their local services. So far, there has been research into the effectiveness of therapy with young children and adults who stammer, but not into how to help school-aged children who stammer. The specialist team at the Michael Palin Centre for Stammering have developed a therapy programme for children aged 8-14 and their parents, called Palin Stammering Therapy for Children (Palin STC). Helping children to be more confident communicators is the main goal. To achieve this, the therapy focuses on three areas: building communication skills; finding ways to manage unhelpful thoughts and emotions; and, speech tools to reduce struggle when speaking. Parents are also part of the therapy process and are involved throughout. There is research to show that this programme helps families when it is delivered at the Michael Palin Centre. However, we would like to find out whether the programme would be as helpful for stammering children in other places, too. To find out whether it is effective and worth the cost, we need to test it with a large number of people. Firstly, we need to carry out a small study with smaller numbers of people, to see whether a larger study could work. This is the purpose of this study. Speech and language therapists from non-specialist services who agree to take part will be randomly placed into one of two groups: a Palin STC treatment group, or a treatment as usual group. Speech and language therapists in the Palin STC group will be trained in the programme, and those in the other group will carry out treatment as they usually would. Children and parents will complete questionnaires at the start and at the end of therapy, and six months after the start of therapy. Interviews will be conducted with therapists, parents and children at these times. This study will tell us if the research and therapy methods are acceptable, how many therapists and children we need, how many are likely to take part and whether the speech and language therapists are able to carry out the programme in local clinics. This information will allow us to decide if we can conduct a full trial to study whether Palin STC can be delivered by other therapists and whether it is as helpful to parents and children outside the Michael Palin Centre.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH