Charles Van Riper: As I neared the end of a long career in speech pathology it became evident to me. . . that my professional life had been misdirected. I had concentrated my efforts on relieving stuttering in the adult rather than in children. . . . . This I regret for I was wrong--dead wrong. While I had helped many adults to become reasonably fluent and to live satisfying lives, I had done little to stem the yearly appearance over the horizon of hordes of new stutterers. . . . Even when I took into account the profession I had helped pioneer, the students I had trained, and the books I had written, what had I really accomplished in finding a solution to the ancient problem of stuttering? The answer was appallingly clear. I had been shooting at the wrong target.

The worst of it was that I had been forewarned. . . in the early 1950s, Philip Glasner had reproached me for working so hard with adult stutterers. "Forget them!" he said. ". . . You should be working exclusively with young stutterers, seeking to prevent or to reverse the morbid growth of the disorder rather than trying to treat it after it has become full-blown. What we really need is a nation-wide program focused directly on the very young stutterer."

Although it seemed folly to try to take his advice so belatedly, I surveyed the situation to see what I might do. Obviously most of these young stutterers would be found in the elementary grades of the public schools and could be reached through the public school clinicians. That prospect, however, seemed discouraging. Wingate (1971) had shown clearly that many of these workers were fearful of working directly with young stutterers, and even those who were not afraid seemed to lack confidence in their ability to help them. . . . Most of the clinicians attributed their feelings of inadequacy to their training. Their contacts with young stutterers had been very sparse or nonexistent. . . . Leith (1971) who surveyed the practicum experiences in stuttering of 50 training programs. . . showed that in the average graduate training program there were eight student clinicians for each stuttering child, a situation that can hardly be expected to produce much expertise, confidence, or competence. . . . We do not train specialists. Perhaps we should. . . . Perhaps if I could train a few very competent specialists in stuttering and plant them in a few schools, and if they could indeed demonstrate the value of their services in reducing the number of stutterers or at least reversing the growth of their disorder, we might. . . have the beginning of a solution to the old problem.

So I looked over our own current crop of graduate students and finally persuaded one of them, Carl Dell, to take an extra year on his M.A. and to prepare himself under my direct tutelage for a public-school position as a stuttering specialist. . . .

During the first semester he read and discussed with me most of the literature on the treatment of the young stutterer. We critically reviewed and discussed videotapes of other clinicians working with stuttering children or their parents, identifying the possible objectives of each clinical interaction, recognizing the ineffective or successful procedures, and inventing alternative or better ways of achieving the same goals. He also worked intensively with one young stutterer in sessions that were videotaped, and these were viewed together critically. . . . This tutorial training was focused on problem solving--the problems involving motivation. confrontation, and modification--and also on defining and seeking to develop the characteristics of a skilled and competent clinician.

During the second semester, Dell worked with a small group of young stutterers, . . . but I also arranged for him to visit a large number of school systems and to observe and do trial therapy. . . an experience that he said later was very valuable. It provided an opportunity to know, not only the setting, but also the attitudes toward such a specialist of public-school clinicians, classroom teachers, administrators, and parents.

Toward the end of the second semester we confronted the task of placement. . . . I persuaded the Speech Foundation of America, (ed. now Stuttering Foundation) to provide funds for a two-year demonstration project on the condition that I agree to supervise it closely. . . .

The setting was hardly ideal. There were 20 school systems in the district, each served by a public-school clinician, and some of these were an hour in traveling time from the others. The scheduling problems were horrendous. The young stutterers were referred to the specialist by the public-school clinicians, and from an initially screened pool of 60, 38 children judged as most needing treatment were chosen for his case load. Several recycling block scheduling systems were devised and revised during that first year, and only direct individual treatment was administered, though there were frequent conferences with parents, teachers, and the public-school clinicians. . . .

Of the 38 children in the specialist's case load, nine became so fluent, not only in the therapy room but in the classroom, playground, and at home, that they were dismissed as no longer needing the specialist's services. Four (mostly high school students) dropped out of the program for various reasons. Of the remainder (25) all but one showed improvement, often marked, as revealed in changes in their charted profiles of frequency, duration, tension, and avoidance. Reports from teachers and parents indicated that the children were talking more and stuttering less frequently and severely. Our criteria for dismissal and improvement were stringent. . . . The stuttering children below the fourth grade made greater gains than those in the upper elementary grades. None of them became more severe during this period. . . . Their concerns and poor attitudes about their stuttering had decreased. . . . The results seemed better than I had expected but I kept my fingers crossed. Would they relapse over summer vacation? . . . .

In September all the children, including those dismissed, were rechecked. None of those discharged from treatment had relapsed; they simply were not stuttering. Of those in the improved category, only three of the 25 were stuttering more frequently or more severely than they had done at the end of the school year. Most of them maintained their gains. Some were better, more fluent. Most were about the same. Hesitantly I concluded that the stuttering specialist could not only free a substantial number of child stutterers from their fluency difficulties but could also stem and reverse the growth of the disorder. . . .

During the second year of the project. . . the specialist in stuttering concentrated his efforts on fewer and younger children, since it was this group that had shown the most remission or improvement. Early in the fall semester his caseload consisted of only 17 children, seven of whom were from the improved group of the preceding year while 10 were new clients. All were enrolled in the first four grades. Again the block scheduling was used and direct therapy given but the children were seen more frequently. More time was also spent by the specialist in the role of a consultant to other public-school clinicians, some of whom were working with his former clients. He also became involved in more parent and teacher conferences and public relations. I personally interviewed some of the public-school clinicians and found that they not only considered the specialist program valuable but were interested in learning how to help the young stutterers in their own caseloads. . . .

During this second year, as children were discharged from treatment new ones were substituted in their place. Altogether, 23 young stutterers received the specialist's services. At year's end, 13 had been dismissed, eight showed substantial improvement, and two made no gain whatsoever. Two days were spent in checking these children, and it was evident that Dell had been conservative in his evaluations of success or improvement. It seemed apparent that this pilot project had demonstrated the usefulness of employing a specialist in stuttering in these public schools.

But . . . what would happen when the specialist's services were no longer completely funded by the Speech Foundation of America? The answer is that Dell was rehired. . . .

Carl Dell: In 1971 I returned to Kalamazoo Michigan after spending four years in the army. Although I graduated from college in '66' with a BA in English I enrolled in Western Michigan University's graduate program in Speech Pathology. My first task was to take all the undergraduate courses in an accelerated fashion before beginning the graduate program. While I was still taking undergraduate courses Van Riper offered me the opportunity to train, under his tutelage, to become a specialist in the area of stuttering in children. I trained with him for three semesters before beginning employment with the Kent Intermediate School District in Grand Rapids, Michigan. I would drive to Kalamazoo every Friday after work and meet with Van Riper to go over my experiences that week. We talked about the therapy for each child along with my journal entries for the week. The journal contained all the people I talked to during the week. These people included the 65 SLP's in the district, the director of special education, school principals, teachers, counselors, social workers, superintendents, parents, etc. etc. We also discussed the workshops and in-service presentations I conducted during those two years.

While attending Western I accompanied the student teaching coordinator on her rounds visiting students and supervisors in the neighboring districts. The general purpose of this was to familiarize myself with the inner workings of the public school and specifically the public school SLP. I met principals and other school personal during those visits. My purpose, was to gain insight into what the reaction of school personnel might be to my new position. If I was to be hired as a specialist in their district what questions and suggestions would they have? How would they feel about having a non-mandated employee in their district? This was excellent training as I had never been a student teacher or had any internship experience. My first day on the job was much less stressful because of this training. I felt comfortable in the school setting and thought I had, at least, a modicum of insight into the daily lives of school SLP's.

Obviously, the major aspect of my training was geared to children who stutter. Van Riper used all his contacts in the Kalamazoo area to recruit children to come in for stuttering therapy at Western's clinic. I remember during my last year of training working with individual children as well as children in groups. All my therapy sessions were recorded for viewing in the late afternoon and evenings. Van Riper had spent most of his life working with adults and came to the conclusion late in life that perhaps his time would have been better spent with children. We were attempting to modify adult stuttering therapy (MIDVAS) and adapt it to children. Certainly, there were many changes, sometimes large and other times subtle that were required if we were to be successful with children who stutter. I was 30 at the time, an army veteran, former college football player and all around tough guy. While watching video of my therapy he relentlessly demanded to know, "Why did you do that?" "Why did you say that?" "Why did you move your arm that way?" "Why don't you shut up and let the child talk?" I remember occasionally going to the restroom where I would wipe tears of frustration and anger from my face then going back into the video room for more criticism. It was intense with many shouting episodes during those sessions. I learned to appreciate how every word, every action was important in the therapeutic process. He was teaching me to be a therapist. Although it was disorder specific I have found over the years those skills are applicable across disorders. I have been forever grateful for my year as Van Riper's student clinician/punching bag.

My employment as Stuttering Specialist began in August of 1974 when working with young stuttering children was considered by some to be inappropriate. Wendell Johnson's diagnostogenic theory was still considered by many to be valid. So there were a few of the 65 SLP's in the district who didn't accept me in the beginning. But most were happy to have me on staff to consult with them about the stuttering children on their caseload or to have me do a diagnostic evaluation, talk to parents or to actually put a child from their school on my caseload.

Prior to my first day the district had a mandatory meeting where I was to be the featured speaker. It gave me an opportunity to introduce myself to all the SLP's in the district. In my presentation I talked about my respect for their work. I was there to work with them. My goal during the presentation was to demonstrate my desire to fit in, not horn in. They were in charge! I worked for them. Whatever they wanted me to do I would be there. I was always watchful over the six years of my employment never to show any disrespect. I never took over their office while I was in their building. I did therapy in the hallway, cafeteria, gym, and yes the boiler room at times. I was determined never to embarrass them in front of parents, teachers etc. This was not difficult since they were all fine people who I respected and still consider my friends.

Another aspect of my position was to advocate for stuttering children and their families. There were speeches to professional groups, various educational professionals as well as civic and parent groups. Newspaper and television interviews were part of the responsibilities. I recorded all these events and Van Riper would evaluate my performance during those Friday meetings.

There is not enough space here to discuss stuttering therapy but I cannot resist mentioning a change I made after the second year which resulted in a big increase in therapy successes. After two years of relative success with young stutterers I divided the district up into two sections (north and south) I began seeing children 4-5 days a week rather than the traditional bi-weekly approach. Children in the northern parts of the district were seen during the fall and children in the south during spring. Parents were initially unhappy when their children were not seen for an entire semester but this turned to joy when they saw the progress made during the intensive semester. Four to six weeks was the typical duration of therapy once I introduced this "block" system of scheduling. It was my most important discovery during the six years working in the schools.

Nina Reardon-Reeves: Although the concept of utilizing a specialist to treat children who stutter in a school setting is not new, the development of board recognition for fluency specialization has created a resurgence of the idea that fluency specialists can be utilized in school districts throughout the country.

Below, you will find a brief overview of some of my experiences as a fluency specialist in the schools. I must say from the outset that this has been the best professional experience I have had in my 20+ years as a speech-language pathologist. This is, indeed, the place where a significant difference can be made for children who stutter and their families.

In the beginning

I began my career as an itinerant school based speech pathologist in small rural communities of Illinois. My interest in stuttering emerged as a result of two events. My son began to stutter at the age of 5 and I began to treat a student who stuttered in one of my schools. It became patently clear that I was not prepared to deal with either. Soon after I applied for and was accepted to a 2-week intensive experience the subject stuttering at Northwestern University in Chicago, IL. My son developed through his stuttering but still, I was "hooked" on fluency disorders and have devoted most of my professional career to treating children affected by this intriguing speech disorder. After becoming a Board Recognized Fluency Specialist I began to think about how I could best utilize my knowledge and skills in public schools.

In 2005 I moved to Texas. The move created an opportunity for me to try something that I had been dreaming of; becoming a fluency specialist in a school setting. I approached a small, but rapidly growing suburban school district near Dallas (Frisco ISD) regarding the concept of creating a part-time staff position of "district fluency specialist." For a "trial period," it was agreed that I would spend one day per week in the district; one-half day as a traveling itinerant SLP for general services of private school students and one-half day as an "on-call" fluency consultant to the district's 27 speech-language pathologists. This initial program lasted for 5 months in an informal capacity. The consultations and other staff development sessions that took place during this time were well received by the district SLPs as well as the lead SLPs and special education administration.

The following academic year, I was re-hired at FISD as the district fluency specialist with a free-hand in creating the vehicles with which to fulfill the mission and vision I had outlined the previous year. That mission was to enhance the effective treatment of stuttering in preschool and school age children. Everyone involved with the initial development of the concept agreed that in order to do this, my charge was to create opportunities for the clinicians to enhance their knowledge, understanding, skills and comfort level in serving children with fluency disorders.

What surprised me

Many aspects of this process did (and continue to) surprise me. The fact that FISD was willing to create the position at all was a big, albeit pleasant, surprise. The Director of Special Education Services was genuinely interested and enthusiastic about the idea. It turned out that the lead SLPs in the district had already been discussing the need for more knowledge and skills in recognizing, evaluating and treating children who stutter.

The other surprise was the warm reception I received from the school district SLPs. It confirmed for me what I had experienced in my travels as a presenter of continuing education seminars; most SLPs want to "do better" and feel more comfortable in their abilities to provide therapy for children with fluency disorders. The clinicians were quite excited about the possibilities ahead.

What has gone right

From the beginning, I have been provided the time and resources necessary to make this concept a success. Also, it was important that I not be perceived as someone who was there to critique or "take over" their stuttering caseload. A few meetings with the lead SLPs, myself and the district SLPs put everyone's potential concerns aside. I have substituted for therapists, learned the paperwork from top to bottom and attended as many meetings as my part-time schedule would allow. In other words, I have tried to become a comfortable fixture in the district; a professional who is not there to criticize but to offer assistance, observations, constructive feedback, resources and mentoring as needed.

Another successful aspect of the program is the use of the broad-based knowledge of the fluency specialist. This has become apparent to me on more than one occasion over the past few years. One cannot be a "one trick pony." All aspects and resources of fluency therapy must be within the purview of the specialist who trains and mentors other professionals. It is imperative not only to have a broad base of knowledge and skills but to be flexible in their application because in the public schools, complicated cases are the rule rather than the exception. There is no "one way" of achieving goals in fluency therapy. The best help for the children who stutter we serve is to provide therapists with a "thinking clinician" framework of therapy with a solid basis of principles of therapy from which they can draw to find individualized methods of serving the children on their workloads.

Without an atmosphere of collaboration, success is difficult to achieve. I cannot stress enough that many of the projects we have undertaken at FISD have been TEAM efforts with committees of passionate SLPs with volunteer spirits.

So far

In the first 2.5 years of this position, many goals have been accomplished. To date, many resources and programs have been put into place: including increased stuttering resource packets, enhanced training in all aspects of assessment and treatment of fluency disorders, tracking systems for workloads, email newsletters for parents of children who stutter, on-call consultations for district SLPs, parent and youth education and support events and preschool fluency group programs.

Room for growth

As with any new program, it is important to assess the progress and make adjustments where necessary. Several areas have emerged as needing further development including more effective time management and task allocations, literature review sessions for increased access to current evidence-based practice in fluency disorders, and use of video assessments and therapy sessions to provide an "on your own time" opportunity for professional development.

Hope for the future

The Frisco ISD program has met with great success. Surveys of the SLPs (pre and post) have indicated a significant increase in confidence and comfort levels in treating children who stutter. Further, more formalized studies of this consultative model of utilizing fluency specialists in the schools are indeed warranted. I am happy to report that last year, another district (Garland ISD) created a part-time fluency specialist position (2 days per week for 60 SLPs). Still another district (Grapevine-Colleyville ISD) has contracted services on a monthly basis.

It is my hope that these programs can be a model for others across the country and beyond. Expansion of the concept of fluency specialists for school districts is extremely important if we are to create better therapy options for children in the early stages of dealing with stuttering.

Leith, W. R., Clinical Training in stuttering therapy: A survey. Asha, 13, 6-8 (1971).

Wingate, (1971)

-Discussion-