Placement verification and stuttering measurement: comprehensive notes

Placement verification and year‑2 placements: overview and process

• Purpose: prepare for clinical placements in year 2; verification is a NSW Health requirement to ensure safety of clients, staff, and students in health facilities.
• Presenter roles: Sarah introduces placements; Amy explains verification; contact hub details and on-site verification team information.
• Verification status: must be compliant or temporary compliant to attend placement; if not compliant, placement is cancelled and must be rescheduled; impact on progression can be substantial.
• Primary sources of information: Sugar Canvas site (your Speech Hearing undergrad site), Canvas page under modules → orient to practise education; verification hub on Level 2, Susan Wakiel Health Building (Campus Connect hub near gym).
• Panel reminder: preparation timeline to reduce questions; a dedicated Q&A session later in the semester will cover more details.
• Quick action tip: note down questions for later; visit verification hub today (12–2) if you have questions.

What verification covers (Amy’s overview)

• Verification is a NSW Ministry of Health requirement to ensure safety in health facilities.
• Required documents to verify:
  • Evidence of vaccination and serology (e.g., hepatitis B, MMR, varicella, etc.)
  • Criminal record check (police check)
  • Other documents as required by NSW Health (per checklist in Sonia)
• Status options: "compliant" or "temporary compliant"; both must be maintained throughout the degree to stay eligible for placements.
• Consequences of non‑compliance: cannot attend placement; risk to progression and degree completion.
• Where to start: first-year and throughout the degree; monitor status regularly; read the SIS/Canvas immunisation sections for detailed requirements.

Immunisation evidence options and steps

• Two ways to provide immunisation evidence:
  1) Australian Immunisation Register (AIR) + serology as required.
  2) NSW Health vaccination card (written record) completed by a GP.
• AIR option (MyGov/Medicare):
  • If AIR is complete, upload to Sonia; verification team can advise if any gaps (e.g., missing MMR or varicella).
  • If AIR is incomplete, serology can substitute for missing vaccines (where appropriate).
• NSW Health vaccination card (for international students):
  • On-campus University Health Service is recommended for completing the card; they have experience with overseas vaccines.
  • Bring records from home country; multiple doctors may contribute to different sections; must be dated, signed, and stamped; card must meet NSW Health entry standards.
• Hepatitis B specifics (most complex):
  • You must have evidence of age‑appropriate course and serology that meets minimum requirements; both are required to satisfy NSW Health.
  • Determine age-appropriate schedule from AIR or vaccination records; if you had childhood HBV vaccination, you may need serology to confirm protection.
  • If you have age-appropriate vaccination and serology is adequate, you may avoid further vaccines; if serology is below 10, a booster is needed and a repeat serology after 4 weeks (no need to restart full course).
  • If serology remains below 10 after booster, contact Student Verification for next steps (additional vaccines/serology).
  • After booster, serology is recommended at 4 weeks; if it’s ≥ 10, you meet the requirement; if still below 10, coordinate next steps with verification.
• Serology and booster details:
  • A single HBV booster is often sufficient to reach the minimum serology value if previously vaccinated.
  • If serology is already above 10, no further action is needed for HBV.
• Important NSW Health note: temporary compliance in year 1 risks expiring before placement; temporary compliance is not extended.

Police checks and declarations

• Police check: required for all students; valid for 5 years from issue.
• If not an Australian citizen or permanent resident: must provide a NSW Health statutory declaration (completed on the NSW Health statutory declaration form and signed by a Justice of the Peace (JP)). A free JP service is available (e.g., Broadway Shopping Centre 3 days/week).
• Australian police check is compulsory for all students, regardless of status.

Submitting documents and processing workflow (Sonia)

• Submission method: all documents via Sonia (ensure you’re in the correct Sonia account—there are two: verification and speech).
• How to upload:
  • Access New South Wales Health compliance checks, upload documents, click Submit; status should change from Not Complete to Submitted.
  • If documents are correct, status turns green and cleared; if information is missing or incorrect, documents are rejected and you’ll receive an email with what to fix; you can also view notes in Sonia.
• Processing and outcomes:
  • Once all documents are cleared, they are uploaded to NSW Health; you will be CC’d on emails about the submission outcome; the compliance status is updated in both school and verification Sonia within 24–48 hours (up to 1–2 days).
• Practical tips:
  • Sign and date all forms; type signatures are accepted; ensure dates and signatures are legible.
  • For TB/undertaking forms, ensure you save all answers (some forms require you to print or save in a specific way depending on Adobe version).
  • The TB form requires you to self‑assess whether TB testing is required based on a NSW Health high‑incidence country list; only list countries if you have travelled to high‑risk regions for more than 3 months; include country and duration in the form.
  • Ensure every entry on the NSW Health vaccination card is dated, signed, and stamped; complete by a GP or registered health provider.

Important deadlines and policy details

• Deadline to submit documents: 30 September (not necessarily to be verified by then, but submissions need to be reviewed and feedback provided in time).
• Flu requirement: currently not required for first‑year compliance; flu evidence is required if you go on placement between 1 June and 30 September; flu evidence is yearly; flu vaccines after 1 March 2026 are valid for that year’s compliance if placement occurs in that period.
• Flu timing nuance: if you are not going on placement this year, flu documentation is not required for compliance; if you are going on placement during flu season, you must provide flu evidence (annual requirement).
• Help and contact: verification team is available for questions; contact by phone, email, or in person at Campus Connect hub (Level 2, Susan Wickel Health Building) on Tuesdays and Wednesdays 12–2 pm.

Managing questions and on‑the‑ground tips

• It’s common for students to have questions; bring them to the Campus Connect hub or email/call; do not delay—the verification process can affect placement timelines.
• The team emphasizes proactive communication and timely uploads; you can upload partial information and receive feedback rather than waiting.
• Flu note recap: not required this year unless you have a placement during the specified period; plan ahead for subsequent years as the requirement is annual.

Week 2 session: context for later topics in the course

• Purpose of the verification segment in Week 2: ensure students appreciate the timing and importance of verification for placement eligibility.
• Reminder of topics to come in the course (e.g., causal theories and clinical measurement of stuttering) and practical assignments.

Causal theories and clinical measurement (overview from the tutorial content)

• The session also covered foundational stuttering content: causal theories, measurement of stuttering, and how to approach assignments that involve causal models and therapy approaches.
• A brief note: the in‑class quiz discussed in class is not a barrier for undergraduates this year; it is a timed activity for Masters and Week 3 content involves five videos on verbal contingencies used in paediatric treatment (Lincom programme).
• You will have access to assignment materials in Canvas (assignment tab) and will receive information about when content goes live (e.g., around Week 3 recordings and the deadline to complete the quiz by Week 4).

Quick recap of stuttering: why measurement matters in practice

• Measurement is central to progress tracking, accountability, and alignment with evidence‑based practice.
• Who measures and who gets measured:
  • Clinicians and parents/caregivers often measure to monitor severity and progress.
  • Children (8+ years) may be involved in self‑rating to provide autonomy and agency in treatment.
  • Adults are typically measured for progress toward reduced stuttering, not necessarily complete elimination.
• Baselines are established before treatment begins; weekly measurements help adjust goals due to stuttering variability.
• Goals differ by age: children aim for minimal to zero stuttering (clinically possible within the window of opportunity); adults often aim for reduced severity and functional fluency rather than total elimination.
• Specific speaking tasks or life environments may trigger stuttering; identifying these helps tailor therapy (e.g., phone calls, voicemail, large audiences, interviews).
• Measurement data provide objective evidence of progress and support accountability; they are also essential for evaluating alignment with evidence‑based practice and therapy manuals.

Two main measurement methods used in practice

• Percent Syllables Stuttered (percent SS):
  • Definition: percent SS = (number of stuttered syllables / total syllables spoken) × 100.
  • Example: If there are 13 stuttered moments out of 300 total syllables, then
    SS = rac{13}{300} imes 100 = 4.3\%.
  • Pros: universally used, good intra‑ and inter‑rater reliability for experienced clinicians, objective measurement.
  • Cons: can be tedious to count in real time; not always practical for clients to self‑rate; may undercount when there are many repetitive moments in a single syllable (e.g., rapid repetitions within one word).
  • Interpretation anchors: mild < 5%, moderate 10–15%, severe ≥ 20%; ranges may be used (e.g., 8% means mild–moderate stuttering).
  • Practical notes: in live sessions, some clinicians tap syllables on a device or count on paper while listening; newer apps exist but can have reliability variability; training improves accuracy.
• Stuttering Severity Rating (SSR) scales (0–10, previously 0–10 with 0–10 scale, sometimes referred to as a parent SSR when rated by caregivers):
  • Scale: 0 means no stuttering; 1 is extremely mild and often not noticeable outside close circles; higher values indicate greater disruption to speech and message transmission.
  • Usage: used for goals, weekly progress, and home practice; recommended that parents rate at the same time each day to minimize day‑to‑day variability caused by fatigue, mood, or routine changes.
  • Calibration process: to train listeners (parents or clients) to rate severity, ask five questions (hear stuttering; whether a mild observer would notice; whether others would notice; whether there is mild/moderate/severe disruption to speech; overall impression of the degree of disruption).
  • Application: parent or client keeps a 0–10 chart across weekdays; helps track progress and set realistic goals; supports communication with clinicians.
  • Pros/cons: easy to use, good reliability when properly trained; subjective judgments can diverge between clinician and client; can be affected by covert stuttering or avoidance strategies; often used alongside percent SS in the Westmead program and Lincoln program to capture comprehensive information.

When both measures are used together

• Rationale: percent SS and SSR do not always align, especially when a client displays many repetitive movements (multiple repetitions within a moment) that inflate SSR but do not proportionally increase percentile SS due to counting rules.
• Practical implication: use both measures to obtain a fuller picture of the client’s fluency; this is particularly important in some programs (e.g., Westmead) that require both metrics for eligibility/assessment.
• Clinical decision making: comparing measures against evidence‑based practice and treatment manuals helps evaluate progress and adjust therapy goals.

Major theoretical models of stuttering (overview from the lecture)

• Diagnosogenic theory (historical, now considered defunct): stuttering originates from parental labeling and criticism; the Monster Study is a famous ethical violation illustrating this theory; the idea: stuttering begins in the parent’s ear rather than the child’s mouth.
• Interhemispheric interference model (Webster, 1993): stuttering reflects neurological differences; predictions include greater right-hemisphere involvement and weaker supplementary motor area function; studies show altered bilateral activation and structural differences in myelination; PET scans show more left‑hemisphere activation in fluent speakers and more right‑hemisphere activation in speakers who stutter; longitudinal scans show shifts in activation following therapy but reversion can occur with relapse.
• Neuroanatomical findings: differences in myelination and white matter tracts; functional differences exist beyond structure; brain differences may be both cause and consequence of prolonged stuttering, raising questions about causality vs. consequence.
• Multifactorial model (dominant contemporary framework): stuttering arises when environmental demands exceed a child’s capacity; capacity includes motor speech control, language, social and emotional factors, and cognitive abilities; the model informs indirect therapy focusing on reducing environmental demands and improving support systems (parent coaching, reducing stressors, etc.).
  • DCM (Demand–Capacities Model) is a component of the multifactorial framework; therapy targets reducing demands to better align with the child’s capacity.
• PNA model (Pacman & Atkinson): a moment‑level model explaining when a stuttering moment occurs, not the underlying disorder; three coexisting factors needed for a stuttering moment:
  1) Impaired neural processing (biological basis) with emphasis on myelination and neural efficiency;
  2) Linguistic trigger (e.g., syllabic stress, linguistic complexity, multi‑syllable words, embedded clauses);
  3) Modulating factors (physiological arousal) such as stress, anxiety, excitement, and cognitive load that increase demands on processing.
• Practical takeaway: these models guide assessment and tailoring of therapy—understanding when and why moments occur helps select goals and tasks (e.g., reducing cognitive load, altering linguistic complexity, modulating arousal).

Activation, recovery, and variability in stuttering

• Recovery prevalence: estimates range widely (roughly 40–90% natural recovery) depending on methods and definitions; a newer study (COVID era) showed that recovery rates depend on how recovery is defined by speaker, parent, or clinician, implying variability in epidemiological estimates and the need for standardized definitions.
• Factors associated with recovery (statistical associations, not guaranteed predictors): gender (girls more likely to recover), onset language skills, and certain stuttering behaviours (e.g., avoiding whole‑word repetitions and strong consonant production) have shown correlations with recovery.
• Genetic basis: family history is a risk factor and shows a genetic contribution; however, genetics are predispositional rather than deterministic.
• Twin studies: concordance rates higher in identical twins than fraternal twins (evidence for genetic contribution); estimated concordance ~80–85% depending on sex for twins, supporting a genetic component but not a sole determinant.
• Candidate chromosomes and genes: chromosome 12, chromosome 13 (and possibly others) are discussed as potential genetic loci; GNPTAV gene mentioned as linked to other speech/language disorders and a possible contributor to stuttering in some research; the extent of direct causation remains under investigation.
• Animal models: mouse models with gene mutations show altered vocalizations, suggesting a potential link between gene function and speech motor control; the translational value is debated, but such models help illustrate possible mechanisms.
• Cautions: public discussions and anecdotes (e.g., about high‑profile individuals) can offer intuitive ideas but should be treated cautiously in clinical education and not used to draw causal inferences.
• Clinical takeaway: genetics and neurobiology contribute to susceptibility but are not determinative; therapy should still focus on early intervention, environment, and individual needs.

Impact of stuttering and environmental factors

• Quality of life: stuttering is associated with decreased quality of life in many adults, particularly in moderate to severe cases that require ongoing adaptation.
• Education: stuttering can influence educational choices and performance; avoidance of presentations and reduced participation can affect academic achievement.
• Occupation: biases in hiring and promotion; some leaders may avoid roles that require extensive speaking; consequences include limited career advancement.
• Interpersonal relationships: social anxiety and avoidance of social interactions can occur; stuttering may influence dating, friendships, and peer relationships.
• Social stimuli and audience effects: stuttering severity can be influenced by audience size, perceived friendliness, status of conversation partner, and emotional state; more pressure can increase stuttering in many individuals.
• Conditions that can reduce stuttering (therapeutic and device‑based strategies):
  • Altered prosody or delayed auditory feedback (DAF) to alter timing and perception;
  • Speeasy/Speech‑aid devices that provide real-time auditory feedback; may reduce stuttering temporarily during performance events;
  • Singing, rhythmic speaking, or speaking in unison (chorus reading) to reduce stuttering; rhythmic and syllable timing can lower disfluency;
  • Whispering and talking to oneself; adopting a different voice or accent; singing engages different brain networks and can reduce stuttering in many individuals.
• Language and cognitive strategies: pacing, breath control, and other speech strategies may help some individuals reduce stuttering in specific tasks.
• Anecdotal notes: examples from public figures and clinical anecdotes illustrate how strategies like accent changes or singing can temporarily reduce disfluency in specific contexts, but these are not universal cures.

Measurement and clinical practice in treatment planning

• Why measure: establish baselines, track progress weekly (because stuttering is highly variable), inform clinical goals, monitor environmental triggers and task‑specific disfluencies, and ensure alignment with evidence‑based practice.
• Who measures: clinicians, parents, and the clients themselves (when developmentally appropriate) contribute to measurements.
• Baselines and goals: define baseline severity, set realistic weekly goals, and tailor tasks to reduce the most critical conditions (e.g., telephone calls, public speaking).
• Trigger tasks and life contexts: identify which tasks elicit the most stuttering to target therapy effectively (e.g., voicemail, phone calls, interviews, presentations).
• Accountability and progress reporting: data‑driven progress helps manage expectations and adjust treatment plans; ensures therapy aligns with research‑based outcomes.
• Naturalness and rate control: for adults, some treatments aim to preserve natural speech while achieving fluency; rate control and syllable timing (e.g., syllable‑time speech) can be used to improve fluency while maintaining naturalness.

Practical implementation: an example workflow for students and clinicians

• Start with a clear verification plan for year‑2 placements (as detailed above), including AIR/NSW Health vaccination card, hepatitis B plan, police check, and SoniA submissions; address any gaps with the verification team early.
• Schedule a visit to the Campus Connect hub for individual questions and document submission walkthroughs (Tuesdays–Wednesdays, 12–2 pm).
• Prepare for the Week 3 assignment quiz on verbal contingencies (open after the last tutorial; due Week 4 by 5 pm on the specified date); review the Lincon and Westmead components in your course materials.
• For stuttering measurement, practice both percent SS and SSR scales; learn how to calibrate SSR ratings with the five guiding questions; simulate counting syllables with real samples; review the formula and ensure consistent data collection.
• When reading and interpreting literature on causal theories, maintain a critical stance on causality versus correlation; appreciate how multifactorial and PNA models inform assessment and therapy planning.
• Consider ethical implications in research and clinical practice; reflect on historical cases (e.g., the Monster Study) to highlight why ethics review is essential in any intervention or study involving people who stutter.

Quick glossary of key terms and formulas

• Percent SS (syllables stuttered):
  • Definition: $SS = \frac{N<em>{stuttered}}{N</em>{total}} \times 100$
  • Where $N<em>{stuttered}$ is the number of stuttered syllables and $N</em>{total}$ is the total number of syllables spoken.
• Severity Rating Scale (SSR): a 0–10 scale (with 0 = no stuttering, 10 = extremely severe); often used with a 0–10 chart completed daily by parents or clients.
• DBS/TB evidence: assess TB risk per NSW Health high‑incidence country list; TB testing is required if you are born in or have travelled for more than 3 months to high‑risk countries; a blood test is the typical method.
• Compliance status:
  • Compliant: fully compliant with verification requirements;
  • Temporary compliant: valid for a limited period; needs timely completion of outstanding requirements; not extended under any circumstances and can risk placement if not updated.
• Key deadlines: 30 September (document submission deadline); 1 June–30 September flu period (flu evidence required if on placement during this window).

Ethical and practical implications

• Verification is legally required to ensure patient and staff safety; non‑compliance can affect degree progression and patient care.
• Historical ethics lessons (e.g., Monster Study) underscore the necessity of ethics approval and careful handling of research participants, especially vulnerable populations.
• Balancing clinical needs with privacy and consent when handling medical and background information.
• Clear communication with students and families to reduce anxiety around the verification process and to promote timely completion of requirements.

Quick takeaways for exam preparation

• You should understand the purpose, requirements, and workflow of NSW Health verification, including what documents are needed, how to submit them, and the consequences of non‑compliance.
• Be able to describe the difference between AIR-based immunisation evidence and the NSW Health vaccination card, including when each is used and who should assist (e.g., University Health Service for international students).
• Know the HBV specifics: age‑appropriate vaccination, serology threshold of 10, and the booster/serology testing sequence if serology is below 10.
• Memorize the police check requirements and the statutory declaration process for non‑citizens.
• Recognize the timing and process of submitting documents via Sonia and the meaning of status updates (Not Complete → Submitted → Green/Cleared).
• Understand the flu policy and the annuality of flu evidence within the placement window.
• Be familiar with the main stuttering theories (diagnosogenic, interhemispheric interference, multifactorial model with DCM, and the PNA model) and how they influence assessment and therapy planning.
• Know the two main measurement methods (percent SS and SSR), how to calculate and interpret them, and why both can be useful in clinical practice.
• Be able to discuss how CBT‑like parenting, environmental modifications, and indirect therapy fit within the multifactorial framework (DCM) to reduce the demands placed on the child.
• Remember the practical examples of triggers and strategies that reduce stuttering (chorus reading, singing, DAf, Speeasy device, rhythm, etc.) and how to apply these in therapy.
• Be aware of the ethical considerations in research and clinical practice and the importance of standardized definitions in epidemiology of stuttering recovery.

Quick reference: scenarios and reminders

• If you are international: plan to use NSW Health vaccination card; the University Health Service can assist with completing the card and ordering serology if needed.
• If you are in first year and eligible for temporary compliance: proceed to complete and submit tasks promptly to avoid end‑of‑year issues and placement delays.
• If you have questions about which documents are missing or how to fill a specific form, contact the verification team via the Canvas page or visit Campus Connect hub during the posted hours.
• For the upcoming assignment (verbal contingencies): review the assignment tab on Canvas; be prepared for a 15‑minute quiz with multiple choice questions about observed contingencies in videos; deadline is Week 4 (Aug 25, 5 pm).

End of notes