Implementing the WHO caregivers skills training program with caregivers of autistic children via telehealth in rural communities

Abstract

BackgroundFor families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) via an online, synchronous group format in rural Missouri.MethodsWe used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of the program, following the last home visit. Caregivers of 14 autistic children (3–7 years), residents of rural Missouri, completed nine virtual sessions and four virtual home visits.ResultsFour main themes emerged from the focus groups: changes resulting from the WHO-CST, beneficial aspects of the program, advantages and disadvantages of the online format, and challenges to implementing the WHO-CST via telehealth. The most liked activity was the demonstration (36%), and the least liked was the practice with other caregivers. From baseline to week 12, communication skills improved in both frequency (p < 0.05) and impact (p < 0.01), while atypical behaviors decreased (p < 0.01). For caregivers' outcomes, only confidence in skills (p < 0.05) and parental sense of competence (p < 0.05) showed a positive change.ConclusionOur results support the feasibility of implementing the WHO-CST program via telehealth in a US rural setting. Caregivers found strategies easy to follow, incorporated the program into their family routines, and valued the group meetings that allowed them to connect with other families. A PMI such as the WHO-CST, with cultural and linguistic adaptations and greater accessibility via telehealth-plays an essential role in closing the treatment gap and empowering caregivers of autistic children.

Supporting Caregivers Remotely During a Pandemic: Comparison of WHO Caregiver Skills Training Delivered Online Versus in Person in Public Health Settings in Italy

“…In our study we report lower ratings of caregiver participation in virtual CST compared to in-person CST, mirrored by qualitative findings of emotional distance and impotence perceived by facilitators and caregiver difficulties in creating meaningful relationships in virtual CST. These findings are in line with those of Montiel-Nava et al ( 2022 ), who reported that parents receiving CST remotely in rural Missouri seemed more focused understanding the content than in sharing experiences with other parents, and of Taylor et al ( 2021 ), who reported greater reluctance to ask questions, participate in group discussions and connect with other participants in parents enrolled in an online parent training than in those receiving the corresponding in-person training. However, it is important to consider that our findings may also have been affected by emotional reactions to isolation during the pandemic.…”

“…Overall, virtual CST was found to be feasible and accept to caregiver and facilitators, in line with several previous studies that evaluated the acceptability of online parent training interventions for ASD (Baharav & Reiser, 2010 ; Bearss et al, 2018 ; Dai et al, 2021 ; Ingersoll & Berger, 2015 ; Lau et al, 2022 ; Montiel-Nava et al, 2022 ; Pi et al, 2021 ; Pickard et al, 2016 ; Sengupta et al, 2021a ; Tsami et al, 2019 ; Vismara et al, 2018 ; Wainer et al, 2021 ). The online adaptation of CST was delivered with high levels of observer-rated competency and integrity, not differently from the in-person CST.…”

“…Conversely, despite such barriers to feasibility, the acceptability to caregivers is usually high (Baharav & Reiser, 2010 ; Bearss et al, 2018 ; Dai et al, 2021 ; Ingersoll & Berger, 2015 ; Lau et al, 2022 ; Montiel-Nava et al, 2022 ; Pickard et al, 2016 ; Sengupta et al, 2021a ; Tsami et al, 2019 ; Vismara et al, 2018 ; Wainer et al, 2021 ) and, generally, caregivers report high levels of satisfaction (Boisvert & Hall, 2014 ; Pi et al, 2021 ; Sutherland et al, 2018 ). Levels of caregiver involvement are satisfactory and greater in therapist-assisted than in self-directed online programs (Pickard et al, 2016 ).…”

“…We employed a mixed-method approach to report on the process of adapting and piloting a remote-delivery version of the CST. The CST, which is informed by principles of naturalistic developmental behavioural interventions (NDBI: Schreibman et al, 2015 ), has shown good acceptability and feasibility in both high- (Lau et al, 2022 ; Salomone et al, 2021a ; Seng et al, 2022 ) and low-resource contexts (Montiel-Nava et al, 2022 ; Sengupta et al, 2021b ; Tekola et al, 2020 ). The study aims to examine the implementation of CST delivered remotely in public health services in Italy.…”

Video-Feedback Approach Improves Parental Compliance to Early Behavioral Interventions in Children with Autism Spectrum Disorders during the COVID-19 Pandemic: A Pilot Investigation

“…In the last decade, telemedicine [ 14 ] has enriched parent-mediated early interventions [ 15 ]. Several studies, conducted on a variety of treatment models in children and adolescents with ASD, demonstrated that remote interventions are able to promote parent’s learning and caregiving skills, support a reduction of children’s behavioral problems, and contribute to an improvement in autism symptoms’ severity, language, and adaptive skills [ 16 , 17 , 18 ]. Furthermore, a few studies compared tele-assisted interventions with in-person treatments, suggesting a comparable [ 19 ] or even better outcome of the remote program.…”