{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T03:08:23Z","timestamp":1780715303030,"version":"3.54.1"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Social validation provides external validity of treatment outcomes from the perspective of untrained observers. To date, clinical efficacy studies of the Blank Center CARE\n                      <jats:sup>\u2122<\/jats:sup>\n                      Model indicate post-treatment gains in communication competence from the perspective of participants and clinicians. A preliminary social validation study corroborated these positive treatment outcomes with ratings from the general public for a single participant in a single context. The present study was designed to replicate and extend these findings by assessing clinical outcomes from the perspective of untrained observers across multiple participants and contexts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Ten adults who stutter provided communication samples one week before and after completing the Blank Center CARE Model treatment. A total of 1,110 untrained observers were recruited. Each untrained observer rated only one participant at one timepoint (pre-treatment or post-treatment) in one context (dyad or presentation), and each participant was asked to provide only one rating (communication competence or stuttering severity).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A significant interaction indicated that post-treatment gains were observed for communication competence, but not stuttering severity, for both contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Present findings provide further social validation of the Blank Center CARE Model of treatment. Untrained observers confirmed that participation in this strengths-based approach significantly enhances communication competence. Notably, these changes were observed regardless of pre- to post-treatment stuttering severity, lending additional support to the premise that changes in communication and fluency are independent constructs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fresc.2025.1541059","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T02:11:04Z","timestamp":1747793464000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Social validation of post-treatment outcomes of adults who stutter who participated in CARE Model treatment: replication and extension"],"prefix":"10.3389","volume":"6","author":[{"given":"Geoffrey A.","family":"Coalson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney T.","family":"Byrd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1097\/TLD.0000000000000270","article-title":"Targeting communication effectiveness in adults who stutter: a preliminary study","volume":"42","author":"Byrd","year":"2022","journal-title":"Top Lang Disord"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1044\/2024_AJSLP-23-00234","article-title":"Self-perceived communication competence of adults who stutter following communication-centered treatment","volume":"33","author":"Coalson","year":"2024","journal-title":"Am J Speech Lang Pathol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1177\/014544557714001","article-title":"Assessing the clinical or applied importance of behavior change through social validation","volume":"1","author":"Kazdin","year":"1977","journal-title":"Behav Modif"},{"key":"B4","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1044\/jshd.5201.30","article-title":"Developing assertiveness during employment interviews with young adults who stutter","volume":"52","author":"Schloss","year":"1987","journal-title":"J Speech Hear Disord"},{"key":"B5","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/0094-730X(87)90031-3","article-title":"Influence of assertiveness training on the stuttering rates exhibited by three young adults","volume":"12","author":"Schloss","year":"1987","journal-title":"J Fluen Disord"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e0303024","DOI":"10.1371\/journal.pone.0303024","article-title":"Observer-rated outcomes of communication-centered treatment for adults who stutter: a social validation study","volume":"19","author":"Byrd","year":"2024","journal-title":"PLoS One"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta20020","article-title":"Non-pharmacological treatments for stuttering in children and adults: a systematic review and evaluation of clinical effectiveness, and exploration of barriers to successful outcomes","volume":"20","author":"Baxter","year":"2016","journal-title":"Health Technol Assess"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/1460-6984.12182","article-title":"The state of the art in non-pharmacological interventions for developmental stuttering. Part 2: qualitative evidence synthesis of views and experiences","volume":"51","author":"Johnson","year":"2016","journal-title":"Int J Lang Commun Disord"},{"key":"B9","doi-asserted-by":"publisher","first-page":"82","DOI":"10.5463\/dcid.v24i1.189","article-title":"Factors related to recovery and relapse in persons with stuttering following treatment: a preliminary study","volume":"24","author":"Arya","year":"2013","journal-title":"Disabil CBR Incl Devel"},{"key":"B10","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3109\/asl2.1995.23.issue-1.04","article-title":"Self-reported factors related to relapse following treatment for stuttering","volume":"23","author":"Craig","year":"1995","journal-title":"Australian J Hum Commun Disord"},{"key":"B11","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1080\/13682820310001598166","article-title":"Protection from harm: the experience of adults after therapy with prolonged-speech","volume":"38","author":"Cream","year":"2003","journal-title":"Int J Lang Commun Disord"},{"key":"B12","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.jfludis.2012.04.002","article-title":"The long term effectiveness of intensive stuttering therapy: a mixed methods study","volume":"37","author":"Irani","year":"2012","journal-title":"J Fluen Disord"},{"key":"B13","year":"2009"},{"key":"B14","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jfludis.2003.11.001","article-title":"A qualitative study of the therapeutic effect from a user\u2019s perspective","volume":"29","author":"Stewart","year":"2004","journal-title":"J Fluen Disord"},{"key":"B15","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/s0094-730x(02)00114-6","article-title":"Speech treatment and support group experiences of people who participate in the national stuttering association","volume":"27","author":"Yaruss","year":"2002","journal-title":"J Fluen Disord"},{"key":"B16","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1044\/2019_JSLHR-19-00068","article-title":"The speaker\u2019s experience of stuttering: measuring spontaneity","volume":"63","author":"Constantino","year":"2020","journal-title":"J Speech Lang Hear Disord"},{"key":"B17","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/S0094-730X(98)00020-5","article-title":"Stories of stuttering: a qualitative analysis of interview narratives","volume":"23","author":"Corcocan","year":"1995","journal-title":"J Fluen Disord"},{"key":"B18","doi-asserted-by":"publisher","first-page":"105960","DOI":"10.1016\/j.jfludis.2023.105960","article-title":"Listener perceptions of stuttering and stuttering modification techniques","volume":"75","author":"De Nardo","year":"2023","journal-title":"J Fluen Disord"},{"key":"B19","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/S0094-730X(99)00022-4","article-title":"Listener response to stuttering modification techniques","volume":"24","author":"Manning","year":"1999","journal-title":"J Fluen Disord"},{"key":"B20","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.jcomdis.2010.09.002","article-title":"Listener perceptions of stuttering, prolonged speech, and verbal avoidance behaviors","volume":"44","author":"Von Tiling","year":"2011","journal-title":"J Commun Disord"},{"key":"B21","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jfludis.2014.12.002","article-title":"Identifying correlates of self-stigma in adults who stutter: further establishing the construct validity of the self-stigma of stuttering scale (4S)","volume":"43","author":"Boyle","year":"2015","journal-title":"J Fluen Disord"},{"key":"B22","volume-title":"How to Navigate Fluency Conformity and Reduce Stuttering Stigma [Keynote Presentation]","author":"Byrd","year":"2021"},{"key":"B23","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1055\/s-0041-1723843","article-title":"The communication benefits of participation in camp dream. Speak. Live.: an extension and replication","volume":"42","author":"Byrd","year":"2021","journal-title":"Semin Speech Lang"},{"key":"B24","doi-asserted-by":"crossref","DOI":"10.1101\/2024.08.22.24311294","article-title":"Camp Dream. Speak. Live: A virtual adaptation. MedRxIv","author":"Byrd","year":"2024"},{"key":"B25","volume-title":"Subgroup on Individuals with Disabilities Report","year":"2022"},{"key":"B26","volume-title":"Guidelines for Assessment and Intervention with Persons with Disabilities","year":"2022"},{"key":"B27","volume-title":"The Blank Center CARE","author":"Byrd","year":"2023"},{"key":"B28","first-page":"1488328","article-title":"CARE Model of treatment for stuttering: theory, assumptions, and preliminary findings","volume-title":"Front Psychol","author":"Byrd","year":"2024"},{"key":"B29","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1044\/persp1.SIG4.55","article-title":"An introduction to camps for children who stutter: what they are and how they help","volume":"1","author":"Byrd","year":"2016","journal-title":"Perspect ASHA Spec Interest Groups"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1000116","DOI":"10.4172\/2472-5005.1000116","article-title":"Participation in camp dream. Speak. Live.: affective and cognitive outcomes for children who stutter","volume":"1","author":"Byrd","year":"2016","journal-title":"J Speech Pathol Therapy"},{"key":"B31","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1055\/s-0038-1670669","article-title":"Exploring the effectiveness of an intensive treatment program for school-age children who stutter camp dream. Speak. Live.: a follow-up study","volume":"39","author":"Byrd","year":"2018","journal-title":"Semin Speech Lang"},{"key":"B32","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1080\/08824098809359810","article-title":"Self-report as an approach to measuring communication competence","volume":"5","author":"McCroskey","year":"1988","journal-title":"Commun Res Rep"},{"key":"B33","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1521\/scpq.16.2.176.18703","article-title":"Assessing the social validity of behavioral interventions: a review of treatment acceptability measures","volume":"16","author":"Finn","year":"2001","journal-title":"Sch Psychol Q"},{"key":"B34","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1044\/2021_LSHSS-21-00069","article-title":"Professors\u2019 perceptions and evaluations of students who do and do not stutter following oral presentations","volume":"53","author":"Werle","year":"2022","journal-title":"Lang Speech Hear Serv Sch"},{"key":"B35","doi-asserted-by":"publisher","first-page":"3405","DOI":"10.1044\/2022_JSLHR-22-00118","article-title":"The impact of self-disclosure and strategies for communication competence on professors\u2019 perceptions and evaluations of students who do and do not stutter","volume":"65","author":"Werle","year":"2022","journal-title":"J Speech Lang Hear Res"},{"key":"B36","volume-title":"Early Childhood Stuttering: For Clinicians by Clinicians","author":"Yairi","year":"2005"},{"key":"B37","volume-title":"Stuttering Severity Instrument-Fourth edition (SSI-4)","author":"Riley","year":"2009"},{"key":"B38","volume-title":"The Blank Center CARE","author":"Byrd","year":"2023"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.3758\/s13428-021-01694-3","article-title":"Data quality of platforms and panels for online behavioral research","volume":"54","author":"Peer","year":"2021","journal-title":"Behav Res Methods"},{"key":"B40","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1016\/j.jesp.2009.03.009","article-title":"Instructional manipulation checks: detecting satisficing to increase statistical power","volume":"45","author":"Oppenheimer","year":"2009","journal-title":"J Exp Soc Psychol"},{"key":"B41","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"B42","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jfludis.2017.06.001","article-title":"Rethinking covert stuttering","volume":"53","author":"Constantino","year":"2017","journal-title":"J Fluen Disord"},{"key":"B43","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.jfludis.2014.12.001","article-title":"Beliefs of teachers versus non-teachers about people who stutter","volume":"43","author":"Arnold","year":"2015","journal-title":"J Fluen Disord"},{"key":"B44","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.jfludis.2017.03.001","article-title":"A country-wide probability sample of public attitudes toward stuttering in Portugal","volume":"52","author":"Valente","year":"2017","journal-title":"J Fluen Disord"},{"key":"B45","doi-asserted-by":"publisher","first-page":"106056","DOI":"10.1016\/j.jcomdis.2020.106056","article-title":"Stigma and the Hispanic stuttering experience: a qualitative study","volume":"89","author":"Dean","year":"2021","journal-title":"J Commun Disord"},{"key":"B46","doi-asserted-by":"publisher","first-page":"106456","DOI":"10.1080\/02699206.2018.1481145","article-title":"Perceptions of and beliefs about stuttering in the Hispanic\/Latino community","volume":"111","author":"Medina","year":"2024","journal-title":"J Commun Disord"},{"key":"B47","article-title":"Stuttering in the workplace: Employers\u2019 attitudes, employability ratings, and hiring decisions. Under review","author":"Young","year":"2024"},{"key":"B48","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jcomdis.2009.09.002","article-title":"University students\u2019 perceptions of the life effects of stuttering","volume":"43","author":"Hughes","year":"2010","journal-title":"J Commun Disord"},{"key":"B49","first-page":"237","article-title":"Examining the relationship between perceptions of a known person who stutters and attitudes toward stuttering","volume":"41","author":"Hughes","year":"2017","journal-title":"Can J Speech Lang Pathol Audiol"},{"key":"B50","volume-title":"The Nature of Prejudice","author":"Allport","year":"1958"},{"key":"B51","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1037\/0022-3514.90.5.751","article-title":"A meta-analytic test of intergroup contact theory","volume":"90","author":"Pettigrew","year":"2006","journal-title":"J Pers Soc Psychol"}],"container-title":["Frontiers in Rehabilitation Sciences"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2025.1541059\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T02:11:08Z","timestamp":1747793468000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2025.1541059\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,21]]},"references-count":51,"alternative-id":["10.3389\/fresc.2025.1541059"],"URL":"https:\/\/doi.org\/10.3389\/fresc.2025.1541059","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.10.19.24315802","asserted-by":"object"}]},"ISSN":["2673-6861"],"issn-type":[{"value":"2673-6861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,21]]},"article-number":"1541059"}}