Thank you for taking the time to learn about the Blank Center CARE (Communication, Advocacy, Resiliency, and Education) Model, a distinct approach to treatment that rests on the evidence-based understanding that when children, teens, and adults (1) learn communication is not defined or limited by fluency, (2) learn to share about their stuttering meaningfully, (3) develop the resiliency needed to navigate adversity, and (4) are knowledgeable about stuttering, they are empowered to Dream. Speak. Live.
Importantly, the Blank Center CARE Model was developed, and continues to be revised, based on the lived experiences of the stuttering community we are honored to serve, starting with one brave young man who I had my first opportunity to provide stuttering treatment to 30 years ago. It is painful to share that I made this young man, Kevin, practice speaking without stuttering, and when he tried as hard as he could, but still stuttered, I told him to try harder. And, when he tried harder, but could not speak without stuttering, I advised him to come back to therapy when he was ready to do the hard work needed to be fluent.
In hindsight, I knew in my head and heart that I was hurting rather than helping this young man, but I had limited knowledge of any alternative. This experience set my life on a course to develop an approach to stuttering that rejects society’s traditional definition of ‘fluency’ and instead focuses on teaching and practicing skills that empower children, teens, and adults to stutter openly, speak confidently, communicate effectively, and advocate meaningfully.
Through philanthropic support and external funding, I have expanded my team to include a diverse group of talented researchers and clinicians who do and do not stutter, who are dedicated to giving of their lives to making a difference in the lives of people who stutter. Their combined expertise has and continues to further strengthen the Blank Center CARE Model.
The motivating rationale for the Blank Center CARE Model (discussed in this Stuttering with Confidence Podcast, ESPN feature) is that fluency is not required to communicate effectively and that people who stutter can accomplish anything they set their minds to. These are cathartic concepts for the estimated 78 million adolescents and adults who stutter worldwide and continue to suffer devastating psychosocial, academic, vocational, and financial consequences due to the misperceptions that they have to learn to speak without stuttering to be accepted and to excel within society.
Inspired by Kevin, what started in a temporary office with only a handful of student volunteers has grown into a global mission. Today, the Arthur M. Blank Center for Stuttering Education and Research is comprised of three branches: the Michael and Tami Lang Stuttering Institute, the Dr. Jennifer and Emanuel Bodner Developmental Stuttering Laboratory, and the Dealey Family Foundation Stuttering Clinic. Our guiding principle, ‘Dream. Speak. Live.,’ embodies all of what we value and hope for those we have the privilege of working with. Unlike fluency centered approaches that are rooted in ableism, and impose societal pressures to conform to speaking fluently, we support the speaker who stutter’s authenticity and spontaneity in the communication exchange.
By proactively preventing the perspective that effective communication requires fluency, or by successfully letting go of that perspective, the Blank Center CARE Model instills in all participants: What you have to say is important, and never let stuttering stop you from pursuing your dreams, speaking from your hearts, and living your life to the fullest.
This message is at the core of the Blank Center slogan, Dream.Speak.Live.
However, unfortunately, as one of our Blank Center participants, age 79, reports, most children who stutter do not have mothers, or other loved ones, or even professionals encouraging them to speak. Without that critical encouragement, as soon as children who stutter enter into the school system, they begin to be taught, either implicitly or explicitly, that it is not ok to stutter. Thus, paradoxically, in a genuine attempt to help these young children who stutter to integrate within a fluent world, speech-language pathologists and teachers cause irreversible harm.
For example, to avoid potential embarrassment or discomfort for stuttering, children who stutter are provided accommodation wherein they are “protected” from having to contribute to class discussions, give presentations, and/or be asked direct questions. To add insult to injury, in the limited times when they are called on or expected to contribute, they are penalized for stuttering when they speak. As shared by one of our Blank Center participants, age 14, most young children who stutter spend years of therapy being taught to try to speak without stuttering, and, for many, trying to speak without stuttering means avoiding talking as much as possible.
The immediate and long-term effects of fluency conformity during the school-age years are not trivial. A large amount of data indicates that preschoolers, school-age children, and adolescents who stutter report negative attitudes toward communication. Their rejection of the way they talk causes them to engage in unhealthy coping strategies (e.g., social avoidance, rejection of social networks, reduced social activity) that exclude them from protective mechanisms known to improve quality of life (e.g., peer and familial support). These negative self-perceptions lead many to lament how different their lives would have been if only, as is shared by one of our Blank Center participants, age 25, as a child they could have been taught that it is truly ok to stutter.
Furthermore, as these young children grow older, they report higher levels of communication apprehension and social anxiety. Consequently, as is highlighted by one of our Blank Center participants, age 36, adults who stutter suffer markedly increased isolation, lower levels of self-esteem, limited self-efficacy, and overall decreased quality of life, as well as reduced engagement and attainment in academic and vocational environments. These negative consequences that began during their early school-age years are not dependent on the frequency and/or severity of stuttering, but on the efforts that were made to either keep them from talking in class, or to require them to speak fluently when they did talk.
In fact, for those persons who stutter who are perceived by listeners to be among the most fluent speakers, they still describe being trapped within the confines of the words they can say without stuttering. They develop tricks such as scripting out every word in advance, whispering, changing words, substituting sounds, and even changing their names. And, the impact on quality of life of these attempts to hide their stuttering can be debilitating. As one of our Blank Center participants, age 27, shared, trying to pass as fluent leads to unbearable shame and self-loathing that prevents full engagement in life. This is true, not only for persons for whom their overall frequency of stuttering is high, but also for those whose stuttering is remarkably low.
Importantly, as shared by another Blank Center participant, age 22, if they can learn to focus on how well they communicate, rather than how fluently they speak, they can begin to view their speech, and themselves, in a more positive light. Yet, many speech-language pathologists, and by proxy, parents of children who stutter, are concerned that targeting anything other than fluency will somehow cause the child to feel less confident when communicating.
However, targeting behaviors related to communication competence in the school-age years has been proven to provide immediate academic and social benefits to children who stutter, as well as long-term psychosocial and vocational gains. As is articulated by one of our Blank Center participants, age 12, talking about stuttering with others actually increases self-confidence and decreases concerns about stuttering while speaking. Additionally, as is further shared by another Blank Center participant, age 7, teaching others about stuttering is empowering and provides opportunities to make positive changes in the world for all persons who stutter.
The Blank Center CARE model is particularly crucial to the social and academic wellbeing of young children as focusing on effective communication has been documented as a protective factor against bullying. Bullies tend to select victims who demonstrate unskilled communication skills and appear less confident, and more anxious, cautious, and sensitive. Contrastively, as one of our Blank Center participants, age 8, boldly shared, they learn that if someone treats them differently because they stutter, that is a reflection of that person, not of them.
Notably, children whose stuttering frequencies are high and have strong communication skills are less likely to be targeted by bullies, while those whose stuttering frequencies and communication skills are low are more likely to be bullied. This suggests that bolstering effective communication skills is particularly crucial for children who stutter, regardless of frequency. Furthermore, research shows that focusing on fluency for those persons whose stuttering persists past the age of seven, only serves to make them feel more inferior regarding their communication, as is noted by one of our Blank Center participants, age 19, and increases their vulnerability to bullying.
Additionally, the frequency of stuttering is on a continuum, such that some people stutter more often than others, and within each person, there is variability in their daily, monthly, yearly stuttering frequency. And, counterintuitively, frequency does not equate with severity, as a person who stutters may perceive stuttering as severely impacting their daily life even if the frequency is low, and, similarly, they may stutter on nearly every word, but consider the severity, or rather the life impact to be mild. Yet, all too often, the public media perpetuate what one of our Blank Center participants, age 28, describes as the “hero’s journey” of stuttering, which falsely suggests that if they can be more confident in themselves, they will no longer stutter.
This “hero’s journey” is in direct contradiction of the substantial data that indicate if children are still stuttering at age seven or older, they will likely continue to stutter for the rest of their lives, no matter how confident they are. Nevertheless, as is noted by the parent of one of our Blank Center participants, age 3, who herself is a pediatrician, the vast majority of treatment programs are not evidence-based, and many propagate the falsehood that eliminating stuttering is a prerequisite for effective communication. However, as one of our Blank Center participants, age 23, eloquently shares, fluency is then obtained at the expense of natural, effective communication. Children, teens, and adults consistently report that trying to speak without stuttering compromises their desire to communicate as it is unnatural, effortful, and incongruent with their identity.
In contrast to this standard practice, the Blank Center CARE Model teaches persons who stutter of all ages that communication is not defined by fluency and that numerous verbal and nonverbal aspects of communication can be addressed to strengthen the quality and effectiveness of interpersonal exchanges and public speaking. This fundamental difference in our approach is what has resulted in our receipt of unwavering support from many talented public ambassadors who stutter, including, most recently, Shaquille O’Neal and Christiaan Bezuidenhout.
Through the Blank Center CARE Model, participants engage in a broad range of activities designed to address the affective and cognitive consequences of stuttering, as well as activities designed to enhance communication skills including (but not limited to) content (language use, organization), vocal variety (rate, intonation, pitch), nonverbal communication (gestures, body position, eye contact, facial expression, reflective listening). As expressed by one of our Blank Center participants, age 31, shifting to learning to focus on communication rather than eliminating stuttering has a profound, positive impact on their lives in a matter of months, which is particularly freeing for those who have previously received years of ineffective therapy focused on fluency.
The Blank Center CARE Model instills in our participants, at the earliest possible age, to never let stuttering stop them from being who are they are born to be, as is shared by one of our Blank Center participants, age 5. The Blank Center CARE Model also focuses on the importance of a strategy unique to speakers who stutter – self-disclosure, where they learn to share about their stuttering in a manner that is positive and unapologetic, as is demonstrated by one of our Blank Center participants, age 8. As is further revealed by one of our Blank Center participants, age 6, despite the misguided perspectives of most speech-language pathologists that children are not capable of understanding what stuttering is and that discussing stuttering could result in the child feeling more negative about their speech, young children do understand and can insightfully articulate how to communicate more effectively and how to talk about stuttering in a way that is not self-deprecating.
Once Blank Center CARE participants succeed through our program, no matter the age, they are no longer afraid to engage in even the most challenging speaking situations, as is shared by one of our Blank Center participants, age 9. They are also inspired to encourage others who stutter to navigate the same path, as is demonstrated by one of our Blank Center participants, age 10. Perhaps, what might be of most importance is that, despite the absence of fluency focus, the substantial gains in communication that our participants experience, directly contribute to reduced stuttering and/or reduced fear of stuttering as a natural byproduct of participation. This is demonstrated by one of our Blank Center participants, age 14, at the beginning of treatment versus at the end of treatment, and is also demonstrated by another Blank Center participant, age 21, at the beginning of treatment versus the end of treatment.
Along with learning more about how to implement our daily CARE programming, we also invite all who have access to this manual to learn more about our annual intensive signature program “Camp Dream. Speak. Live.” in multiple cities and states across the nation as well as worldwide. “Camp Dream. Speak. Live.” empowers children who stutter across cultural and linguistic backgrounds to learn how to stutter openly and speak confidently, communicate effectively, and advocate meaningfully so that stuttering never stops them from living their lives to the fullest. Consistent with our daily CARE, this program is offered at no cost to children and their families, ensuring that every person who stutters has access to quality care. Together, these children are bravely sharing What they wish people knew about stuttering, and their unique messages, one by one and cumulatively, are helping us to teach the world about what stuttering is and, importantly, what stuttering is not.
Finally, all people who stutter, as is shared by one of our Blank Center participants, age 8, just want to be treated like everyone else. Unfortunately, however, many spend most of their lives being socially isolated, rejected, bullied, and traumatized. Applications of the Blank Center CARE model (based on decades of research and captured in the videos embedded here as well as located on our YouTube and social media) aim to proactively prevent young children from ever experiencing this stigmatization (#PreventTheIceberg) and save the lives of older children, teens, and adults who have already experienced these consequences to some degree.
We need your help to change more lives.
To that end, I sincerely hope this opening letter and the videos integrated throughout, provide you with additional insight regarding the rationale for the Blank Center CARE Model. I also invite you to visit the Blank Center on The University of Texas at Austin campus, and/or at our first satellite center, recently opened in Atlanta, Georgia. At either location (or both), you will have the chance to meet with and hear the impact of our program directly from our participants of all ages, and their loved ones. In fact, when Arthur Blank first came to visit our program – he wanted to hear directly from our participants. Their testimonials (captured here) changed Arthur’s life and inspired him to help us change many more lives.
Thank you for giving your time to learn more about the Blank Center CARE Model, especially for every way you give of your life to positively impact the lives of people who stutter. Together, the Blank Center community of clinicians, researchers, students, and professionals are excited for you to experience our CARE in action, and, above all, to observe the positive, life-changing impact on persons of all ages who stutter worldwide. Thank you for joining our efforts to ensure that all persons who stutter of all ages across all racial, ethnic, cultural, and linguistic backgrounds have a sense of belonging in their community and in the world. In enacting life-changing CARE for the individuals who stutter your support, you will support them to stutter openly, speak confidently, communicate effectively, and advocate meaningfully.