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Empowering Caregivers in the Everyday Lives of Children Who Stutter


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[00:00:00] 

Intro

Kate Grandbois: Welcome to SLP nerdcast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy 

Amy Wonkka: Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each 

Kate Grandbois: episode of this podcast is a course offered for ashes EU.

Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com.

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Kate Grandbois: specified. We hope you enjoy 

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Episode

Kate Grandbois: Hello, everyone. Welcome to SLP Nerdcast. We are here with two guests today who are in a different time zone, which is always really exciting for us. Welcome, Jacqueline Morton and Ronan Miller. Hello. [00:02:00] Hello. Thank you for having us. Thank you for being here. You're here today to discuss empowering caregivers in everyday lives of children who stutter.

Amy Wonkka: But before we get started, can you please tell us and our listeners just a little bit about yourselves? Shall I start? Go for it. Um, okay. I'm Jacqueline and I am a speech and language therapist and a mum of two boys. Um, I worked in the NHS. in the northeast of England for a long time. Um, and then when I had my second child, I came out of the NHS and got quite interested in conscious parenting, mindful parenting, respectful parenting, that kind of world, thinking, my goodness, I don't know how to parent.

Jaclyn Morton: What am I going to do here? Um, and so, yeah, so I got into that world a little bit. And [00:03:00] the reason why that's kind of important, I think, is I really, really care about parents. I really think that we've got a difficult job and being conscious about parenting, I think can be really helpful to ourselves and to our little people.

So then I came back into the speech and language therapy world. Um, and I work independently now with families and children who stutter. And I also do workshops for parents around the idea of minding less. So, um, that's, that's kind of me in a nutshell, really. And Ronan, before you tell us about you, for all of our American counterparts and listeners, what is the NHS?

Oh yes, the National Health Service. So, um, where people don't have to pay and they come and see us. What is really tricky, that sounds wonderful, doesn't it? But what's very, very tricky about the NHS is we have [00:04:00] mega long waiting lists. Um, so that kind of timely approach that, you know, All of us therapists would love to give is sometimes not available as, as well as many other positives.

But yeah, that's definitely a factor. Interesting. Well, we could have a whole episode on the cultural intersections of, of medicine and therapy, but that's not what we're here to talk about. Um, Ronan, why don't you tell us a little bit about yourself? Yes. So I'm Ronan. I'm a person in stammers and I guess a researcher in some regard.

Ronan Miller: I completed my PhD looking at the experiences of people who stammer, uh, in foreign language learning. Um, and that was in some ways based around my own kind of interest in languages and, uh, experiences teaching English, uh, learning Spanish. [00:05:00] and finding myself in the stammering community and trying to link all of that up in a, in a way that could potentially be helpful for people.

Um, and I'm also a volunteer with Stammer Children, which is another UK organization. And yeah, I've been working with for a bit over a year on some ways. That we can potentially bring help to more parents, more carers of children who stammer. Um, we're aware that that's a challenge that is out there, a challenge not just for speech therapists, but also for the families as well.

So we've been trying to do something there. Well, we're very excited for this conversation. Um, just second, before we get into the content, I do have to read our learning objectives and disclosures. I also just want to second, um, what Jacqueline said [00:06:00] about the, how hard it is to be a parent and how, you know, it, it took me personally becoming a parent to realize all of the horrible things I had said to parents as a therapist, because living it is a really, it's a really unique experience.

Kate Grandbois: So I'm very excited. to center the experiences of parents and have, you know, hold space for that, um, in this conversation. But before we get there, I will read our learning objectives and disclosures. Learning objective number one, describe the importance of caregiver involvement in the therapy process for children who stutter and how this can impact the effectiveness of therapy.

Learning objective number two. Describe how technological advancements can facilitate support for families within speech language pathology. And learning objective number three. Describe the collaboration between healthcare professionals and technology developers in creating applications like Penguin Stammering Support.

 Disclosures course disclosure. This course focuses on an app called PEnguin Stammering Support. As this app is unique, the course, focuses on [00:07:00] and only covers information that pertains to this technology.

Kate Grandbois: Jacqueline's Financial Disclosures. Jacqueline is an employee of Benet Talk, the company that builds the penguin and Super Penguin apps. Jacqueline owns an independent practice working with children who stutter and their families. Jacqueline's non financial disclosures. Jacqueline volunteers for the British Stammering Association, also referred to as STAMA, a charity organization.

She also runs workshops for parents and SLPs called Minding Less About Stammering. Ronan's financial disclosures, Ronan is an employee of Benitoch, Ronan's non financial disclosures, Ronan volunteers for the British Stammering Association, also referred to as STAMA, a charity organization.

Ronan also volunteers for a non profit called Action for Stammering Children. Kate, that's me, my financial disclosures. I am the owner and founder of Grand Blanc Therapy and Consulting and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children.

I'm also a member of the Berkshire Association for [00:08:00] Behavior Analysis and Therapy. 

Amy Wonkka: Amy's financial disclosures. That's me. I am an employee of a public school system and co founder of SLP Nerdcast. And my non financial disclosures are that I'm a member of the American Speech Language Hearing Association Special Interest Group 12, which is AAC.

Um, and I participate in the AAC Advisory Group for Massachusetts Advocates for Children. All right, we've made it through the disclosures and the learning objectives. Now onto the good stuff. Jacqueline and Ronan, why don't you So I'm going to start us off just by telling us a little bit about the first learning objective.

Why is it important to have caregivers be involved in therapy for children who stutter? 

Jaclyn Morton: Okay, I'll, I'll open this one, Ronan, if that's all right. 

Ronan Miller: Go ahead. 

Jaclyn Morton: Um, oh my goodness. So if we think about stammering.

You know, against, say, I don't know, speech sound disorders [00:09:00] or whatever. We can sort of get little people in, work on their speech, and then they can go. With stammering, we don't know whether that child is going to stop stammering, or if they're going to go on to stammer into adulthood. Lots of children stop, but then we've got a percentage of children who will go and stammer into adulthood.

It's very much part of that human, you know, it's a neurological thing, that's the way the brain is wired. Some people are born with stammery brains. And this sense of us as therapists being kind of in charge of therapy, in my mind, just sits really uncomfortably. It's actually not about us. It's about us.

If we can take the time with parents. And when I say take the time, sometimes that can be really [00:10:00] difficult in itself because we have children coming in to the clinic. Sometimes we might have, again, I'm talking about sort of an NHS framework, but sometimes we might just have six sessions. We've got parents coming in with, Potentially expectations of how can you fix my child?

And that is because, you know, we look on the internet. We're kind of in this sort of scrambling as a parent of, Oh my goodness, my child just started stammering. What on earth do I do? We come across things like, okay, this is how we overcome stammering. This is how we stop stammering. This is how we cure stammering.

It's all there. And it's all very, very attractive to parents. So parents can come in with that, those sort of expectations very, very naturally. And as parents, we don't want to see our little people struggle. If then we kind of turn it on its head and think, okay, parents are actually the most important person for us to be taking the time with at this point.[00:11:00] 

Often the little person doesn't have a problem with stammering. That's a generalization. But so often it's the parents who have all of that anxiety. That anxiety, that Those kind of thought processes of how can I make this stop? How can I fix this? They can immediately feed in to the little person inadvertently, you know, we do it with love We say things like slow down or take your time or because we think I can't I don't want to see this struggle so That, the parent is actually the first step on the chain and it is, is the parent who's going to be the supporter of that little person all through their life if they continue to stammer, you know, that advocacy and I'm going to say the word acceptance loosely because We don't necessarily need parents to be, like, flying the Stammering Pride flag.

They don't need to [00:12:00] love it. However, that sense of, okay, this is my stuff as a parent that's going on. I don't like this, or I'm struggling with this. And then separating that from, but actually I think this is the best way for my child to be a confident communicator. So work around that, I think, is, is one of our most important roles.

Kate Grandbois: You just said so many things that made me want to high five you through our zoom screen here 

Ronan Miller: completely 

Kate Grandbois: I that was just so well said and I I wanted to scream, you know here here again multiple times I I think One of the things that struck me most about what you just said was this idea of separating a parent's need, a parent's anxiety, because it's true, I mean, you know, you worry about your kids at night when they're, you know, sick, or when, you know, we, it's our main jobs is to keep children, I always say to my kids, my number one job is [00:13:00] to keep you safe, and my second job is to keep you happy, right?

But when there's something wrong with our kids, It can be a major source of anxiety, and I love the idea of coaching families to identify their anxiety versus their child's experience, right? Because those are two different things, but when your kid is really little, there can be such a blend there. Oh, 

Jaclyn Morton: absolutely.

Can I share with you one of my favorite quotes? Always. This is, um, by Alfie Cohn, who wrote the book Unconditional Parenting. I will just double check that, but this is the quote. So, it, he says in his book, Is it possible that what I just did or said to my child had more to do with my needs, my fears, my upbringing, than what's really in their best interest?

And that sticks on [00:14:00] my fridge, like obviously you can't see it, but I have that on my fridge as just a daily reminder because this stuff is difficult and it's not about perfection. It is not, but it's about being conscious and just checking in every day and stuff like that really helps me.

Kate Grandbois: This podcast is not about me, but I feel seen. That's all I want. That's all I want to say. I really, I love this. I love it. And another word that you use in your. Um, in your, the talking points that you sent over was the word stigmatize. And I, I feel like that, that concept, that ableist kind of, you know, cultural concept that we have, it's, is a part of that.

Can you talk about that a little bit?

Ronan Miller: Is this for me to pick upon, Jacqueline, you think? 

Jaclyn Morton: This is yours. 

Ronan Miller: Well, it's a big, big topic, and I think there's probably people more qualified to talk on it than me, but [00:15:00] I think in relation to our objective to try and support parents, um, as Jacqueline said, advocacy is kind of a part of that. So if you're accompanying your child through different stages in their life, you know, moving into school, for example, and then various stages of school, I think being able to understand stammering as what it is rather than maybe how it has been perceived and stigmatized, um,

I'm not sure if I've expressed that in the right way, but how it has been perceived and the ways in which it has been stigmatized, um, is helpful for parents to then be able to advocate for their child as they move through these different social spaces. [00:16:00] Um, and then you can tell me Jacqueline, but I think one of the hopes in therapy is that by equipping parents with that kind of insight and knowledge and understanding and, and powering them in that way, we also setting the stage for the child to kind of take on some of that and be able to build from that place as well.

Um, because we're aware, you know, research shows that having a stammer can, uh, impact your life in a variety of ways, whether that's as you move through education or professional opportunities or in social situations. So, I think for parents to be kind of on, on the train, on the boat, not sure the right analogy, in [00:17:00] the gang, um, and then use some of that knowledge and that insight, uh, in how they bring up their child who stammers could potentially improve the, the situation for that child as they grow up.

And not just for them but obviously we're, we're thinking about. broader changes that we can perhaps try and facilitate as well. I hope that makes sense. 

Jaclyn Morton: It really does, and I think what's interesting is, you know, there's a huge movement within the Stammering, Stuttering community around acceptance. When a parent comes into a clinic, they don't want to hear that.

They don't want to hear you've just got to accept it. Because this will impact on their child's life. It's not all kind of unicorns and roses. There will be bumps across the road. And I think this is why it's important to speak to parents [00:18:00] about what their role is as well. You know, we've got a separate role.

And as parents, they don't need to fix this, their job in a way is to be able to, as Ronan said, kind of advocate or be the ally or be able to validate those feelings like, yeah, this is just really hard at the minute, but also not for us to necessarily come in with our parenting cape, which again is, mine's always on, and I actually have to take it off sometimes.

Well, now my 11 year old tells me, take it off, mom. I don't need it, but, um, you know, it's that this, this is going to be a struggle, but I trust you. And so this is what the kind of app sort of does, tries to set up as well. It's like, we trust you parents for you to trust your child. We can model slowing down [00:19:00] and making space for stammering for you to model that to your child.

And so again, in that chain, that first person is the parent, because then if we miss out the parent and go straight to the child, who's got their back in everyday life, you know, who, who's there. And. Being able to really, really be clear about that role of. You might not like this. It's going to be hard to see a child struggle.

I'll just give a quick example. Um, a parent of mine had said, because I talk about being okay with being uncomfortable. It's all right for us to be uncomfortable in this space as a parent of a person who, who stammers. It's okay, actually, just to be comfortable. Therapists to be really uncomfortable in that situation as well, like, that's a whole other thing, but I really like that sense of being uncomfortable.

I don't like it at all, but being able to stay in it I think is really important. So this mum, do you have ice cream vans in America? [00:20:00] We do. Like, yeah. They 

Kate Grandbois: even play a song. Yeah. Well, I won't sing it for you, but there's, there's, there are singing ice cream trucks here. 

Jaclyn Morton: Yeah. Brilliant. So that, that, so the mum was in this massive, massive, massive queue with the child.

He had quite a significant stammer, quite a lot of tension going on. There was lots of kind of blocking. This child isn't really that bothered about his stammer. The mum is really, really bothered about the stammer. So we've done quite a bit of work with, with mum. She knew that people were, it was a really hot day and people were getting a bit edgy and everyone was just wanting the ice cream and they were tired.

And she's thinking, oh my goodness, he's going to go up there, he's not going to be able to get his words out and people will be even more irate. So all of this kind of reel of information and thoughts were going through her head and she just had, she was incredible and she stuck with it. With that child, the child [00:21:00] went and asked for a strawberry ice cream, stammered all the way through it.

The ice cream man just made space and, um, he got his ice cream, his strawberry ice cream. Not even a flicker. She, the mum was in a mess inside, inside. She'd kept it in, but she was thinking, if I'd gone in and said, I'll just say it for you. This, like, I'm really uncomfortable about all of this queue of people here.

I'll just say it for you. We talked about if that had been the situation, which would have been fine. We looked at that other side of the coin of That message would have been, I kind of don't trust you to do this, or you're gonna stammer and it's not okay to stammer in front of lots of people. And so, she had that distinction, which, you know, I think is just a great gift, really.

If we can be able to give that, and they can give that to the little people, then I think that's wonderful. [00:22:00] Have I gone off on? 

Kate Grandbois: That was a wonderful story, and I think a wonderful illustration of an adult being with themselves and making space for their own anxieties and sitting with discomfort, which is, you know, something that culture, at least here in the States, is not easy to do.

It's not something that we're taught to do. Um, you know, we've shoved down the feelings and don't ever speak of it again. So having that story really just illustrated the importance of slowing down and self awareness and accepting our own discomfort. 

Ronan Miller: I wanted to check and I wanted to, um, Just come back to something that you mentioned.

And I understand that for some parents coming into therapy, um, the ideas around acceptance and things like that are a challenge. Um, and I myself, [00:23:00] as opposed to stammerers, have found that journey from kind of wanting to stammering and hide as much as possible to slowly kind of becoming more and more, um, accepting of it and meeting all the people who stammer and all of the amazing things that community can bring and being exposed to new ways of thinking about stammering, which I think is the important thing that even if the parents aren't receptive to it in that moment or open or that's not the way they want to go with things.

Just being aware that there are other options about how we think about it, you know, because I think, at least for me, and I think people, um, of my age, we were really brought up with only one way of thinking of it, which was, this isn't good, let's try and get rid of it, you know, um, and [00:24:00] you, I know I did, I needed other.

reference points to be, I wasn't able to create a new, uh, theory about stammering from my own experiences, you know, so I needed those external, um, people to kind of bring that in to view for me, and I think it's the same for parents as well, that, you know, we can encourage them to move away from the idea of trying to fix things, but we can also show them that there's, a world in which stammering isn't a problem.

It's not something bad. Maybe there's even benefits to it. I know that people I know in the stammering community, myself included, would be able to, uh, identify some. So I think that's an important aspect of it as 

Jaclyn Morton: well. And I think as well, you know, we have lots of parents, I'm saying parents, but you know, I haven't said this, caregivers, anyone [00:25:00] important in the little person's life, um, who are actually pretty chilled with the stammer.

Like I think, I do think society is, you know, there was actually a poll by Stammer from the British Stammering Association and I won't give the number but there was something, some really quite large percentage of children who were actually kind of quite accepting of their stammering from quite a young age.

So I do think there is a really positive societal shift and I get a lot of parents who come in and. It is just to get, like, well, I'm, if this is it, I'm fine with it. If it means they're going to stammer, I'm fine with it, but I just need to know that I'm doing my best. And that again is, is a similar concern.

So it may not be, Oh, I just want rid of it. I, you know, it's not all like that, you know, parents need to know really [00:26:00] quite immediately. This is why we've kind of created this app so parents can get the information right from that moment. And then those parents like, ah, okay, right. All I need to do is just continue to see my whole child, have my focus on that kind of.

You know, not just on the stammer, but all of the wonderful other things that they're doing. And so, ah, I can rest easy now. That's just as important as those parents who are like, Get rid of it. I just don't want it. I can't handle it. You know, because I think actually that's less and less from all my times of working.

So I do think we've got a really positive societal shift, which makes me very, very happy. 

Kate Grandbois: I want to hear more about the app, but before we get there, I want to circle back to one of the things you mentioned, which I think is a really important point, um, in terms of the role of the parents and caregivers, is that we as therapists are transient, and I think this kind of, you know, [00:27:00] touches on our role and our healthcare systems, which is, you know, different where you are versus where we are, but an SLP is going to be in the life of a child for one school year before they move on, maybe a few, um, if it's through a private care setting, it sounds like you all have long wait lists and short visit limits, but you know, insurance has visit limits.

We're transient. We're not a permanent part fixture of a child's life. by design, right? And I think by not centering, I just, I really love the way you're by refocusing on the parent, you're creating an ally for life, you're creating a support person for life, which is so important. 

Jaclyn Morton: Yeah, because without that, we've got a little person who's growing up that could be feeling potentially lonely.

And also if mom or dad is saying, you did really well today, you didn't stammer. Oh, that's [00:28:00] fantastic. But again, with love, again, with real appreciation of when you do this, you don't stammer. And then all of a sudden that little person who wants to please their mum and dad is thinking, mum doesn't like it actually when I stammer.

So I'm going to find ways not to stammer. I know ways where I can be fluent. And I know if I don't say that word, or if I don't put my hand up in that class, then you did it. And so it goes on. So a week. To me, it's kind of, well, it's huge. It's huge. And also to empower parents, because parents will be doing some really good stuff already.

But they might be thinking, oh, well, what do I need to do with the stammer? So often, they will be making space, but they don't know if that's actually Because actually making space and doing less Is what we're actually presenting to the parents. And so [00:29:00] we often need to be doing something, you know, give me something to be, to be doing.

Um, but actually if we can say to parents that what you are doing, there is a very active way of supporting your little person to be able to say what they want to say and they're like, oh, well I can do that. So if we can find ways that par things that parents are doing already, of which there will be loads, then again, it's.

And it is about relate, this is what we talk about in the app as well, it is about relationship and it is about connection and it is about so much more than. You know, the stammer. The stammer is actually a little bit irrelevant, you know, when I speak to some parents and I'll say, they might come in and say, Oh, well, they stammer so much more when they're tired.

Or, you know, they just, if we're not in routine and I, and again, I try and maybe take it a little bit away from that stammer talk. Ah, okay. So Katie loves to have routine and she loves to have structure. So it's about what things does Katie [00:30:00] feel at her most comfortable with? kind of calm or what, what environment does Katie thrive in?

Let's do more of that. And they know, we don't know. We don't know the answer to that. So, yeah, to be able to take us out of it, we can sometimes. Especially with these little ones. I think we have a different role with children who are coming in who are really, really struggling with their stammer. We, you know, we're not talking about that at this point.

But I think for these kind of younger ones, we maybe need to kind of get down off our box. And put parents up 

Kate Grandbois: there instead. Pick off the expert hat, right? Because we're, we're there to facilitate and support, not be experts full of ego. 

Jaclyn Morton: Yeah. Which is hard again for us therapists sometimes. You know, it's, we need to just, all of this stuff that we're talking about in terms of giving parents, we need to do for ourselves.

We need to check in with [00:31:00] our thinking. And this is why I do a course for therapists. Also can I just say a massive disclaimer, I'm no expert at this. come from lots and lots and lots of mistakes, lots of reflection, lots of goofiness and just tripping up all over the place, you know, and it's not smooth.

This is not an easy path. This is a harder path. Um, but I think if we can take the time as therapists to look at our own thinking, to look at our own role. And as I say, I do that workshop for therapists and, um, which talking to 160 therapists is really, really scary. It's the hardest bit of my year, but it's well received, so yeah, all these wonderful open hearted therapists who are willing to look at themselves.

It's brilliant. 

Kate Grandbois: That's awesome. I wonder if you could tell us a little bit about the [00:32:00] role of technology here. So now that we've kind of established the importance of the caregiver, the importance of our own professional humility, centering the needs of the family and the, and the parents, What what role does technology play?

I mean, it's, you know, 2024. I don't, you know, I don't spend five minutes of my day without interacting with some piece of technology. So how is how is our current technological climate kind of impacting this work?

Ronan Miller: Go for it. What I should disclaim. I'm not a speech therapist. I have gone back to school to try and join you all in the on the box, but I'm not there yet. Um, hopefully one day soon. 

Announcer: One 

Ronan Miller: day. Okay. Yeah. On the ground. Um, so I can talk to you about this from my perspective, which is kind of from, uh, I put, I'm a person who stammers, which obviously has [00:33:00] an influence, but also, um, yeah, from a research perspective, I'm just trying to kind of identify problems, I guess, and think of potential solutions.

Um, so what we're doing isn't particularly groundbreaking. Um, you know, technology is used across healthcare in lots of ways which we won't go into, but there's, uh, many examples where apps are used to kind of bridge, bridge the gap a little bit between, um, in person sessions with a professional of some kind, and then the everyday life, which is the much more significant portion of time for most people.

And I think in lots of areas, the idea of transfer or [00:34:00] generalization is a challenge, both from a clinical perspective and for the person who's receiving help. So, Um, examples maybe, for example, in mental health support, there are in our context in the UK apps that are used in the NHS to support people who are receiving mental health support from professionals, but in maybe other moments of the day when they when they need support.

something, there is an option there for them. So it's about bridging this gap in our, in our world of stammering and speech therapy, a significant challenge in the UK is providing access to support in a timely fashion. So unfortunately there's not [00:35:00] enough, uh, speech therapy for speech therapy support for the demand.

And that means that people can be waiting.

anywhere really from six weeks to six months or more, uh, to receive support. So in that period of time, there's a lot of space there for the kind of things we've discussed, the challenges, the anxiety, um, to arise and for parents to be unsure about how, how to support. So technology offers kind of potential solution there.

And as you say, we all, well, the vast majority of people now own a smartphone and use apps for various aspects of their everyday life. So having one there for something like this also kind of makes [00:36:00] practical sense for lots of people. And there's a shift, it seems, with Some healthcare organizations, I'm not sure if it's this way in the U S towards encouraging kind of self management is, is the term people use.

So providing people with, uh, resources that can potentially help them on the day to day and reduce their need to access, um, in person support. Obviously we, we want that support to be there. We're not trying to replace that. Um, But we're also aware that maybe with this extra support, we can kind of make space for other people who might be more in need.

Um, so it's about finding the balance there. And yeah, just kind [00:37:00] of does, I mean, I could talk about this for a long time. I'll try not to, but it's about immediacy of information for people. It's about, um,

helping them make small changes potentially. every day that will contribute to something greater, and it's about improving access, ultimately. And for people who stammer and their families, there's not been many options for support. In some places, there are no options for support. So bringing another option to the table was, uh, something important, I think, for, for us in this, in our work.

As I say, our work is a reflection of a broader. Uh, series of changes that I think are happening across [00:38:00] healthcare as well.

Jaclyn Morton: We've had some really good feedback from therapists about how it can reduce their, their time, clinical sessions, but also that perhaps parents are already coming with a slightly different mindset through this, the apps kind of just 10 days at like five minute videos. So they're kind of often a bit more in the zone, which can help therapists, um, like, Oh, okay.

Right. So you're thinking about that already, which, which is great. And also, I think it's having kind of parents a bit more kind of, I guess, primed or that's a silly word to use, but, um, but maybe even a bit more relaxed or a bit more confident. Like, that's really great for therapists, so I [00:39:00] feel like this can really be a support for therapists, as well as a support for parents, um, and already we've, we've kind of introduced some certain topics or certain concepts, 

Kate Grandbois: so I, I love that you mention, um, you use the word primed and I could see how that would be a really good word because I'm, I'm thinking about myself.

I'm thinking about my own experiences as a parent and how a lot of this is hard emotional work for me. the family for the mom for the dad for the caregiver. And when you're in therapy, as a parent, you know, you've got the therapist there, you've got the kid there, if you have a toddler, you're trying to maybe make sure the toddler isn't climbing on the couch or breaking a toy, I get out, it's it's a there's a lot going on.

And I can imagine that by having access to access to technology with short digestible pieces of information, there's a little bit more room for self reflection, [00:40:00] for quiet thinking, for kind of digesting that information at a pace that feels more personal, um, as opposed to, you know, I've taken my own children to therapy and I'm just thinking, thinking of like, you know, there's not a lot of self reflection when you're listening and digesting and parenting all at the same time.

So this kind of gives that nice separation there. 

Jaclyn Morton: Well, that was something that I was a bit reluctant about, actually. I didn't know if it would work. Like, I'm used to working in a clinic setting, or I'm used to working in people's homes, and I ask a lot of questions and be guided by parents. I use a lot of solution focused therapy.

I'm thinking, how on earth can we put this into an app? Do you remember, Ronan, right? 

Announcer: Mm hmm. Early 

Jaclyn Morton: stages, I don't know if we can make this happen. Like, how can we have empathy? How can we make it feel nurturing? How can we be able to have that reflective space within the app. And [00:41:00] you're right, Kate, I feel like I've been very surprised by this, that It actually has allowed more space for that.

You know, we're not saying anything so different from what you might see on a sheet, like a handout type thing. Oh, we are, we are actually going a bit deeper actually than what you get off a handout. Um, but I think by, one thing that was really, really important when we were writing this is, Can we make sure, because one size does not fit all, you know, how can we write an app, a generalized app, but really still get deep into that kind of nitty gritty stuff that I think is so important.

Um, and I do think we've got it rolling actually. I do feel like we, we, we got that. That was the, one of our most important objectives to be able to have that. [00:42:00] And in a clinic setting. Unless you've got a whole hour with just the parent, which I do love to do, but I think it can be luxury. I think there is something about the reflective questions and also saying it says things like these are some things that you could try what's best for your family.

Like, again, it's that you're in charge here. We'll just suggest a few things. We'll facilitate. I didn't know if that was appable, if that's a word. Um, But I realise now that I think it is. And also, again, it's, it's, it's not about us. It's not us saying, right, again, I'm thinking UK. Your name's now at the top of the waiting list.

You come into the clinic. Like, that's us, isn't it? That's us in our terms. Like, oh, we're ready to see you now. Whereas an app goes straight into that parent's, I need some help right now. So they're in charge then of, of, you know, their [00:43:00] therapy or their situation. And I think technology can do that really, really wonderfully.

Ronan Miller: I agree. And I think just to add on to a couple of things there, one is the, I mean, I can look at this slightly from the outside, but I see Jacqueline's work and the impact that that has. And I think how amazing it is that parents anywhere really around the world could have Jacqueline in their pocket.

giving them a bit of a talk and helping them through the day. She will cringe at me for saying that, but I know that's true. 

Kate Grandbois: For those of you who can't see, she is cringing. She's cringing right now. 

Ronan Miller: I know that that's a hugely valuable thing when you don't have. access to any immediate support, to have, you know, someone like Jacqueline who [00:44:00] thinks about this stuff so, um, in such a way that it's, yeah, I think that's incredible that we can facilitate that to people.

And then I like that Jacqueline's brought some examples in from her work. So just an example of a couple of things that we've, we've, we've learned from people who have used the app. One is that we've not designed the app at all for children. It's not, designed at all for children to use, only, uh, the adults who are supporting them.

However, had a couple of stories where the app has, we've talked about bridging gaps, the app has bridged gaps between a child who stammers and the parent, um, who weren't able to talk about it. They had become kind of a, uh,

abu, um, subject, which, [00:45:00] can happen with Hammering, you know people who stand there sometimes don't want to talk about it People around them aren't quite sure how to get those conversations happening but we had a great, um piece of feedback a great story of a parent using it with their child and they would Go through The content and then talk about that stuff So that was kind of opening those conversations up and equally um, we've heard about parents kind of Using it as a team, I guess, in a way.

So we're really kind of, uh, seeing how people adapt it and use it in ways that make sense for them, you know, and I think that's a really interesting, um, aspect of, of this way of providing help as well.

Amy Wonkka: So when you think about the collaboration between, you know, the healthcare side of things and the technology side of [00:46:00] things, and kind of how that relationship has worked for you guys as being part of this app development, um, and then using it, Jacqueline, in your practice moving forward, what are some, what are some real press points for you?

Pluses or maybe some barriers that you had through that process. I know one of the things you mentioned, Jacqueline was concerned about not being able to have that reflective relationship with your clients. Um, are there any other pieces just having gone through? Because I, I, I wouldn't have the first idea to sign an app as an SLP.

So sort of what has that process been like? Yeah. Um, I'm going 

Jaclyn Morton: to say, thank goodness for Ronan.

Who, yeah, who is, who is, was able to kind of allow my fluffy, verbose, kind of passionate, all of that stuff. And then we've got a wonderful, wonderful [00:47:00] software team, wonderful software team. Ronan could just take all of that kind of stuff. Fluffy stuff. Um, and not, not let the passion go from it. And then the, the software team very, very wonderfully put it in.

And, um, I think

there is a sort of sense of, you know, we, I think there is a little bit of a, um, what's the word kind of, I think speech therapists can be a bit scared of. of technology, actually. Um, I know I was before I came into this. However, I did see it as a wonderful platform to be able to get information so quickly to parents.

And that was the thing for me. But I think we can be a bit [00:48:00] reserved around it and what's going to happen, you know, in the future and what's going to happen to us and what's going to happen to that relationship. And, but I think, as Ronan said, Another option is just wonderful that fits in with parents lives and being able to go on and have workshops and do it on an evening so you don't have, you know, toddlers climbing all over and have all of that come into your own space.

I think I'm going to say especially for stammering, but I bet other therapists will be maybe thinking that this could work in their areas too, but for stammering, that sense of us coming to the families rather than the families coming to us, and I think technology is just a wonderful way of doing that.

But I do think we still need to keep the heart in, in, in technology. Um, and that was one of my reservations really. [00:49:00] Um, is there anything else Ronan that. In terms of that. 

Ronan Miller: Yeah, I think the challenge is as you say kind of maintaining that fuzziness and the human aspect of it that is 

Jaclyn Morton: Because if you just said that word that would have been that wouldn't have been okay, but 

Ronan Miller: So, yeah 

Kate Grandbois: It's good.

Yeah, you know good it was perfect 

Ronan Miller: maintaining that is the challenge I think and Trying to kind of as you say, maintain empathy and the kind of, I guess, vibe that you might try and create in a therapy room or space. The challenge is trying to create something that approximates that. Because so 

Jaclyn Morton: much in therapy, I think, is about the relationship.

Ronan Miller: Yeah. 

Jaclyn Morton: And we're not trying to replicate that at all. And there are other, as we know, [00:50:00] other bits of technology that. Don't think about that. And we're certainly not trying to be, although Ronan, you did say therapist in the pocket, but you know, it is just about being able to, to be an adjunct to that, to that therapy and fill those gaps.

Um, but also if it means that parents can kind of go into this app and get that reassurance and don't need therapy, you know, winner, winner, chicken dinner. Like I love that expression. That 

Kate Grandbois: was so great. 

Jaclyn Morton: It's great. It's great. Everyone wins, you know, it's great for the service. It means someone who perhaps does need that support can be, it can take that time.

So yeah, that's great too. 

Ronan Miller: No, I think thinking about our collaboration and our work, um, I think trust is [00:51:00] important when you've got these kind of two, you know, potentially, not conflicting, but, you know, not quite sure how these things fit together. And I'd like to give a shout out to Kirsten Howes, who was a big part of this project in linking Jacqueline and I up.

She kind of, identified things in both of us that she thought could work together and, um, did that. Hurston is a great, uh, speech therapist, also a person who stammers and is also deputy CEO of Stammer, which is the leading charity in the UK for stammering. Um, so I think that facilitated kind of the the, the trust that we, we built on, um, and [00:52:00] as Jacqueline said, she wasn't quite sure.

Um, I found it a challenge transferring all of those ideas into, as Jacqueline says, like an amplified way. I'm not a technology person, so I'm not, I wasn't responsible for any of the software analysis. Jacqueline said we have a great team around us who have, who have played a vital part in this, but I try to kind of translate the work that Jacqueline did and present it in a way that would in, in the most simple terms, fit on a screen, you know?

Um, we're kind of restricted by the, uh, the technology as well as It provides us with opportunities, but it's also restrictive in a way. We have to kind of work within those, uh, spaces. And I [00:53:00] think we can get a bit carried away with technology and think that's going to fix everything or sort of everything.

Some people don't want to receive help in that way and that's completely fine. Some people don't have a phone, you know, Like, we also have to think about the fact that this isn't just, uh, the only way we should be trying to help people. Um, but if there's an opportunity there to provide another option for people, then I think it is, is kind of worth exploring.

And I think something that is important as well is the way that you guys as therapists can kind of personalize the experience on the fly, in a way, um, in front of, of a person and adapt with your, um, [00:54:00] insight and experience and knowledge. And that's very hard to replicate. Um, we, we're working on ways to do that now with kind of the next version.

of the Penguin app, which reports to the Penguin now. Um, but yeah, that is a challenge that I think is key and we need to be aware that it's not a one size fits all. Some people benefit from different information at different points in their experience. So yeah, just kind of keeping all of those things in mind as well, I think is uh, an important part of the process.

It's a challenge, but the challenges are what makes it rewarding in a way, I think. So that's kind of how we've, we've approached it to now. 

Amy Wonkka: Earlier in our conversation, we were talking about how important it is for caregivers to have the knowledge and with that [00:55:00] knowledge, it's going to help them in building more positive relationships.

I was wondering if you could just tell me and our listeners a little bit about what the Penguin app looks like. So what I'm picturing in my mind is sort of some digestible bits of caregiver information to help give people some of those basics that they might get in an initial few therapy sessions.

But I wonder if you can just help us like visualize what it looks like a little bit. 

Kate Grandbois: Yeah. Before you tell us that I'm realizing that we have forgotten to mention something that's very important, which is that this is free. Is that correct? 

Ronan Miller: Yes. So people can find 

Kate Grandbois: free resource for people to download. And I am feeling like we should have mentioned that earlier, but you know, we love free stuff.

Ronan Miller: Yeah. So yeah, you can find it on Android, iOS, all of that stuff. Um, I'll tell you, I think, and then Jacqueline can tell you, and let's see if it matches or not. Um, so we designed it as kind of like a 10, it's a [00:56:00] 10 day thing. So we didn't want people to kind of rush through it. We wanted to kind of. model a bit of, you know, let's slow things down a little bit, get reflective.

Um, so we encourage people to take it day by day if that works for them, obviously spread it out further if you'd like. Um, and we were very conscious of time. So we know time is limited. Parents, uh, are particularly under time pressures. Um, so we wanted to keep things kind of short and sweet, but without compromising on the information or the messages that we were giving to people.

So another aspect of the challenge was to try and condense things and be quite succinct with how we were, uh, presenting it. 

Jaclyn Morton: Neither Ronan or I are [00:57:00] succinct. 

Ronan Miller: Yeah, 

Jaclyn Morton: that was a challenge. How could as you 

Ronan Miller: may have as you may have learned from it on this recording, um 

Jaclyn Morton: Each other's work more words out more words out more words, 

Ronan Miller: but that's the trust, you know We're just we're there.

So yeah providing that to people And we wanted it to be not overwhelming Want it to be supportive, not time consuming, but give enough, you know, so all of this kind of, um, balancing between these things so it's that's basically How people will experience the app if they if if they have a look I think Um, and we try to order is ordered This is, I guess, in a way I'm contradicting myself because we basically created an order of, in which the information comes, which, this is one of the limitations I think, potentially, with the app, but we were imagining, [00:58:00] um, people who maybe hadn't had much support before, and were kind of more or less starting from a place of, you know, Not much insight.

So we were very careful about the order in which we presented information to people and the things we were suggesting to them and asking them to reflect on as well. So there's, there was that aspect of it as well, which I recognize now might not be the best case for everybody. Um, And that's what we're, we're trying to work out how to kind of, uh, improve that moving forward.

But yeah, so there was a flow of things which was also important to us in how we, we created the, the content that was there. Jacqueline, do you want to take over and stop me rambling? 

Jaclyn Morton: So we have this wonderful little character called Bene the penguin, and he's the main, or actually I don't know if it's a he, 

Ronan Miller: I don't know either.

Jaclyn Morton: Um, and [00:59:00] he's very, very cute and just, it turns out everyone loves a penguin. But Ronan came up with the idea because if you, in the slammering world, we think about icebergs and what we see above the waterline, the bit that you can see is kind of what other people see, but then below the waterline, underneath the water, it can be so much more in terms of emotions and frustrations or excitement or all of these different types of emotions.

So, and penguins are on. Icebergs. So, Bene is the star of the show, and then we have a little video, and it's, it is a bit cringe because it's mine and Ronan's voice, so I do day one and he does day two. Um, and it's, it, we've got this kind of lift music behind it, haven't we? It's like all very kind of calming, um, but people seem to like that, they kind of like that, but it's a bit cringey to listen back to.

I think it's 

Ronan Miller: worth saying as well, we did this almost as an [01:00:00] experiment, um. 

Announcer: Yeah, 

Ronan Miller: uh, we didn't really think about it too much. So there's definitely things we would change. Maybe the lift music would 

Jaclyn Morton: Well, you made up that music as well Yeah, 

Ronan Miller: yeah, and now I'm 

Jaclyn Morton: Questioning what I was up 

Ronan Miller: to At that time 

Announcer: I just want to 

Ronan Miller: jump in Jacqueline Because I don't think I can take credit for the penguin Um, our amazing illustrator of Ermine, who you can find on Instagram, her handle is at just ter.

She's a person who's ERs as well, and. Just creates the most, most amazing, um, artwork around stuttering and the experience of it as well. Uh, and I was fortunate enough to meet her a few years ago and fortunate enough that she was up for being involved in this project as well. So I think the Penguin [01:01:00] credit should go, go to her.

Just wanted to add that. 

Jaclyn Morton: And so we have these five minute little videos that you can listen to or you can just, you can read. then an activity for parents to kind of reflect on and how it might fit into their lives, then we have like a little takeaway page. And because I'm such a big fan of quotes, we have a quote every day.

But again, I think it's another way of parents thinking about things. So it's, it's full of these kind of little sort of mindful quotes, which, um, Yeah, I don't know how people have taken to the quotes, but it's part, part of it, isn't it? Um, and so some of the content includes things like how can you help, um, where is your focus?

So we talk about focus being on the stammer or focus on the whole child. Um, a little bit about slowing down your life, if that's applicable to you, or slowing down your pace. [01:02:00] Um, however you might interpret slowing down. Taking time in talking. Um, and we bring in about kind of the whole family situation and It's, it's not about creating this really artificial situation so the child can just take the whole kind of stage, but about how that can fit in with busy family life.

A little bit about talking about stammering with your little person, supporting struggle and then next steps. So it is kind of the basics within that. Um, but I do think because it's a human voice, then it does give that bit of extra rather than say like a handout or something. So yeah, so. Uh, go on and have a look and, and see what you think and see if it's helpful to you, to you, 

Ronan Miller: or, sorry, Jacqueline, I didn't mean to interrupt you, that 

Jaclyn Morton: I, I was just waffling at that 

Ronan Miller: point.

Okay. Um, and that, you know, I have to think about the research side of things as well. And [01:03:00] we, within the app, we've included a self-report, just a really short, kind of five items, self report, uh. assessment. I guess you could call it evaluation, which we modeled on various validated measures, but we decided that we wanted to make something that was a bit more user friendly in that sense and not too overwhelming and not too kind of rough because some of the the way, uh, questions are phrased in, you know, the real Uh, style can be a bit intimidating, I think, which is what we were trying to move away from a little bit with the app.

So we do ask parents to, um, reflect on a few things at the beginning, at the end and at the end of their journey with the app. And we've been pleasantly surprised by the outcomes of that. And it, it, [01:04:00] really seems that I think I'm right in saying that, um, 70 percent of the people who've used the app, which is now, uh, in, in their thousands have seen significant kind of changes to, uh, things like concern about stammering or confidence in the support that they're able to provide for their child and things like this.

So that's been, um, A rewarding thing to see as well. And another part of the app, sorry Jacqueline, just to say that, we haven't mentioned it, but another part of the app that we were very conscious about was including a stammering voice as well as a speech therapy voice as a way of kind of, yeah, just giving parents.

as much of a big, I don't know if this is the right way to imagine it, but like the [01:05:00] big picture view, you know, um, and it just so happens that it's us because no one else would do it, but, you know, it would have had the same, maybe not the same impact, but, uh, yeah, we're not voiceover artists by any means, but we tried our best to kind of, uh, present that as well to parents as a way of.

showing them that stammering is okay, you know. And 

Kate Grandbois: well, I, I am so excited to share this with our audience. I will say that while you were speaking, I downloaded the app and I can attest that the background music that you used is very relaxing. It's very relaxing. There you are. So I want to say quickly that we will link the app in our show notes.

It is free. [01:06:00] This is a really, it seems like a really wonderful resource for a variety of reasons on only centering caregiver, parent, family perspectives and values, which is part of this speech language pathology evidence based practice model. But another reason it dawned on me while you were speaking is that there are very few instances where Um, parent and caregiver training or parent and caregiver counseling is billable.

So we have this really difficult intersection with our infrastructure and our industry as well in terms of parents getting direct access to the care that they need. So, um, we will link all of this in the show notes as we, in our last final minutes. Do you have any, any last, any final thoughts that you would like to share with our audience?

Jaclyn Morton: I wish I could come up with something really wise at this point. You've said so many wise things already. I think you're off the hook. 

Ronan Miller: Winner, winner, chicken 

Jaclyn Morton: dinner. I [01:07:00] do think as therapists, you know, we're talking about being reflective and we're talking about this kind of different way of working. I think if we can just be curious.

And then that will show curiosity to our parents, like with us kind of modeling what we would like our parents to deliver to our little people. And I think that's what we do with the app as well. We, we're modeling within that. And actually, I think I was, again, a little bit worried about that. We wouldn't be able to do that, but I think we have.

So I think as long as we are clear in our intentions and what we want to be able to deliver and then, and modeling that, I think. is so much, it's a harder path, but so much more in it than just telling. And I think that in parenting too, which is why parenting is really hard.

Ronan Miller: Um, that was quite wise. I think I am [01:08:00] struggling to find wise words, but I think what I would like to say is to encourage the professionals that are listening, the speech pathologists who work with children who stammer to really

look to the stammering community. And there's so many amazing organizations out there. Um, NSA in the US, Friends, Space, um, to name a few. And

I strongly believe that for children who stammer, it's, uh, really important to let them know that there's other people like them out there, um, doing all kinds of things. the stammering, the stammering experience, the stammering experience as a child can be quite [01:09:00] restrictive, um, if you don't have, you know, the right kind of support perhaps.

So yeah, I think that's just, I guess, a personal plea to try and kind of bring, bring that into these children's world and yeah, see how they react to that. 

Kate Grandbois: That was lovely. Thank you both so much for taking the time to come on the show and share all of your knowledge and all of these resources.

Everything that you've mentioned will be listed in the show notes as a resource. You've also sent over some literature that is, you know, behind a lot of the concepts and things that you've brought to the table today. So thank you again so much for being here. It was so wonderful having you. 

Ronan Miller: Thank you for having us.

It's been a pleasure. 

Kate Grandbois: Thank you so much. Thank you so much for [01:10:00] joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.

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