Treatment Goals For Fluency Disorders in the Context of the WHO ICF Framework
The WHO ICF framework can be used to describe the following comprehensive set of treatment goals for fluency (Coleman & Yaruss, 2014; Yaruss, 2007; Yaruss & Quesal, 2004, 2006).
Impairment In Body Function
Treatment Goals Related to Increasing Speech Fluency and Reducing the Severity of Disfluencies
Examples of specific treatment goals include:
- reducing the frequency and severity of disfluencies;
- reducing physical concomitant behaviors and learned escape/avoidance behaviors;
- reducing tension and effort in communication (during both fluent and disfluent speech).
Activity Limitations and Participation Restrictions
Treatment Goals Related to Reducing the Adverse Impact of Disfluency on the Speaker's Life, Including Improving Functional Communication Abilities Across Situations and Ensuring that the Speaker is Able to Communicate Effectively
Examples of specific treatment goals include:
- ensuring that the speaker is able to communicate effectively in various speaking situations (e.g., at school, in social settings, at home);
- minimizing the impact of stuttering or cluttering on the speaker's ability to achieve educational objectives and interact with others;
- reducing the impact of stuttering or cluttering on the speaker's perceived quality of life (e.g., by improving satisfaction with communication, reducing concerns about the impact of stuttering or cluttering on life as a whole);
- habituating and generalizing new behaviors for increased comfort, spontaneity, and naturalness in functional communication across a range of situations.
Personal and Environmental Context
Treatment Goals Related to Increasing Helpful Coping Reactions on the Part of the Speaker, As Well As Reducing Negative Responses by Those in the Speaker's Environment (e.g., Parents, Teachers, Peers, and Others)
Examples of specific treatment goals include:
- reducing negative emotional responses (e.g., anxiety, shame, frustration, fear, and apprehension) to stuttering or cluttering and to communication in general;
- increasing self-confidence about, participation in, and enjoyment of communication;
- increasing knowledge about stuttering or cluttering, taking the initiative in educating others, and advocating for appropriate accommodations;
- developing and maintaining support systems, including family involvement, support groups, teachers, mentors, and peers;
- increasing competence in responding to questions about stuttering or cluttering and managing teasing/bullying and other listener reactions;
- developing self-therapy, self-management, and problem-solving skills.
Coleman, C., & Yaruss, J. S. (2014). A comprehensive view of stuttering: Implications for Assessment and Treatment. SIG 16 Perspectives on School-Based Issues, 15(2), 75-80.
Yaruss, J. S. (2007). Application of the ICF in fluency disorders. Seminars in Speech and Language, 28(4), 312-322.
Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update. Journal of Communication Disorders, 37(1), 35-52.
Yaruss, J. S., & Quesal, R. W. (2006). Overall Assessment of the Speaker's Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Journal of Fluency Disorders, 31(2), 90-115.
