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

Ferrante, Camilla; Sorgato, Paola; Fioravanti, Mariachiara; Pacione, Laura; Arduino, Giuseppe Maurizio; Ghersi, Sabrina; Scattoni, María Luisa; Servili, Chiara; Salomone, Erica

doi:10.1007/s10803-022-05800-y

Cited by 3 publications

(5 citation statements)

References 65 publications

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“…Finally, although some studies have reported high levels of acceptability related to telehealth-based caregiver interventions (Pickard et al, 2016;Sengupta et al, 2021), in this current study, reported perceptions of satisfaction and knowledge gained were lower for participants of virtually-held classes regardless of class topic or instructor. This finding is consistent with lower levels of acceptability found in another recent caregiver education study deliver virtual services, but in this case direct intervention (Ferrante et al, 2022).…”

Section: Discussionsupporting

confidence: 89%

“…There is an abundance of research on the efficacy of group‐based and individualized parent training interventions for ASD and I/DD (Bearss et al, 2015; Ferrante et al, 2022; Machalicek et al, 2015; Neece & Lima, 2016; O'Donovan et al, 2019; Ragni et al, 2022). However, in the absence of or while waiting for therapeutic interventions, caregiver education classes are one mode of reaching families to provide general, supportive guidance and strategies on topics related to I/DD.…”

Section: Introductionmentioning

confidence: 99%

“…There is an abundance of research on the efficacy of group-based and individualized parent training interventions for ASD and I/DD (Bearss et al, 2015;Ferrante et al, 2022;Machalicek et al, 2015;Neece & Lima, 2016;O'Donovan et al, 2019;Ragni et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

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Caregiver education programme on intellectual and developmental disabilities: An acceptability and feasibility study in an academic medical setting

Stone‐Heaberlin,

Blackburn,

Qian

2023

Child

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BackgroundChildren and adolescents with intellectual and developmental disabilities (I/DD), including autism spectrum disorder, benefit from a variety of specialized interventions. However, there are barriers that impact families' ability to access such services for their children. While not intended as a replacement for individualized or group‐based interventions, educational classes may be an option in providing supplemental resources and support to families of individuals with I/DD. This study was a programme evaluation that examined the feasibility and acceptability of a Caregiver Education Program that was created in an outpatient specialty clinic of an academic medical centre, designed to provide educational information on a variety of topics relevant to children and adolescents with I/DD (e.g., toilet training, understanding behaviour and managing anxiety).MethodThe review included 1027 participants from 40 classes led by licensed clinicians, trainees, and/or experienced caregivers. Classes occurred approximately one time per month over the course of three‐and‐a‐half years and targeted caregivers of children and adolescents with I/DD and community‐based professionals in the field of I/DD. Participants were able to attend one or multiple classes, based on their interest in the given topic. Participants were asked to complete post‐training surveys at the end of each session as part of ongoing programme evaluation.ResultsParticipants reported a high level of satisfaction and increased knowledge as a result of participating in classes, and higher knowledge gained and higher satisfaction for in‐person classes compared to virtual classes.ConclusionsThis programme is one model of education delivery with high acceptability and feasibility, designed to support families and increase access to information beyond specialized interventions. Future directions include improving the model of programme data collection, examination of the programme's generalization to practice and to other communities, and an emphasis on culturally responsive curricula.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Caregiver education programme on intellectual and developmental disabilities: An acceptability and feasibility study in an academic medical setting

Stone‐Heaberlin,

Blackburn,

Qian

2023

Child

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“…Findings from the study demonstrate that an acceptable, feasible, open access caregiver‐mediated intervention implemented in the community can lead to a sustained improvement in the quality of the caregiver–child dyadic interaction through enhancing caregiver's skills supportive of such interaction. The WHO CST has been shown to be feasible and acceptable across both low‐and‐middle‐income countries (Montiel‐Nava et al, 2022; Sengupta et al, 2021; Tekola et al, 2020) and high‐income countries (Ferrante et al, 2022; Lau et al, 2022; Salomone, Ferrante, et al, 2021; Seng et al, 2022), with evidence of treatment effects on caregiver skills and overall quality of the dyadic interaction (Salomone, Settanni, et al, 2021). The current study shows that it is precisely this improvement of caregiver skills that in turn can promote social communication outcomes in the child.…”

Section: Discussionmentioning

confidence: 99%

Treatment mechanism of the WHO caregiver skills training intervention for autism delivered in community settings

Settanni,

Suma,

Adamson

et al. 2023

Autism Research

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This study examined the mechanism of effect of the WHO Caregiver Skills Training (CST) through secondary analysis of a pilot RCT conducted in community settings. Participants were 86 caregivers (77% mothers) of children with ASD (78% male, mean age: 44.8 months) randomized to CST (n = 43) or treatment as usual (n = 43). The primary outcomes, measured at baseline (t1), immediately post‐intervention (t2), and 3 months post‐intervention (t3), were derived from the coding of caregiver‐child free play interactions with the Brief Observation of Social‐Communication Change (BOSCC) and the Joint Engagement Rating Inventory scale (JERI). At t3 positive treatment main effects had been observed for caregiver skills supportive of the interaction and for flow of the interaction (JERI), albeit only non‐significant changes in the expected direction for child outcomes: autism phenotypic behaviors (BOSCC), joint engagement and availability to interact (JERI). This study tested the theory of change of CST, hypothesizing that the intervention would lead to an improvement on all child and dyad outcomes through an increase in the caregiver skills supportive of the interaction. Serial mediation analyses revealed that the effect of the intervention was significantly influenced by change in caregiver skills. Participation in the intervention led to notable increases in caregiver skills at t2 and t3, which subsequently contributed to improvements at t3 in flow of the interaction, autism phenotypic behavior, joint engagement, and availability to interact. We confirmed our a priori hypothesis showing that change in caregiver skills significantly mediated the effect of treatment on the dyad primary outcome, as well as on the other child outcomes that had shown non‐significant changes in the expected direction. Implications for intervention design and policy making in the context of public health services are discussed.

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“…Nevill et al (2018) reports that when group-based formats were used, group size was typically small with four-five parents per group. However, some recent studies have also included larger group sizes of eight to 10 parents (e.g., Ferrante et al, 2022;Li et al, 2022).…”

Section: Pms Delivery Approachesmentioning

confidence: 99%

Evaluation of a Two-Tiered Coaching Programme for Parents of Young Autistic Children

van Noorden

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Autism is a form of neurodivergence characterised by differences in social communication, the presence of passionate interests, and a preference for predictable activities and routines. Early support programmes can enhance the development of Autistic children and can lead to improvements in areas such as communication, play skills, cognition, and social engagement. Naturalistic developmental behavioural interventions (NDBIs) are a promising early support approach. Parent-mediated programmes, including parent-mediated NDBIs, are also a promising approach for supporting the learning and development of Autistic children. The rationale for parent-mediated supports includes the possibility that parents are well-placed to deliver teaching and learning opportunities throughout their children’s every-day routines, which may lead to greater consistency of learning and thus improved child outcomes. There may also be benefits for parents who participate in these programmes including improving parental stress and self-efficacy, as well as parent sense of competence and family cohesion. Additionally, parent-mediated approaches are a time and cost-effective alternative to intensive clinician-implemented supports. Despite the theoretical rationale for such approaches however, parent and child outcomes from individual parent-mediated NDBIs are variable. Therefore, more research is needed to understand the impact of parent-mediated NDBIs, and to evaluate adaptations that may improve the fit between parent and child needs, and the models that aim to support them. Tiered programmes or “stepped care” approaches may be an appropriate way to individualise the supports that families receive, while prioritising efficient service delivery. In a multi-tiered approach, individuals receive low-intensity support in initial tiers, and can then step up to higher levels of support if needed. This thesis consists of three main components. The first component was a systematic literature review of single-case evaluations of parent-mediated NDBIs. That review reports on study quality, participants, programme characteristics, aims, and outcomes across 17 studies published in the last 10 years (2014-2013). The second component was an original empirical study using a single-case multiple baseline design. The aim was to evaluate the efficacy of a two-tiered parent-coaching programme based on the Early Start Denver Model (ESDM) – a comprehensive NDBI – for seven Autistic boys (aged 36-52 months) and their parents (5 mothers, 2 fathers). After a 10-week group coaching programme (Tier 1), all parents had increased their use of ESDM strategies. Changes in parent fidelity during the additional individual coaching (Tier 2) were mixed, but all parents maintained higher than baseline levels of fidelity. There were positive changes in parent stress levels pre- post-coaching. Across the two-tiers, positive results were found for most children’s levels of engagement, imitation, and communication. There were significant positive relationships between parent fidelity and both child engagement and child functional utterances.The third component was a qualitative study involving reflexive thematic analysis to analyse parents’ perceptions of participating in the two-tiered support programme. Four key themes and 13 subthemes were developed. The themes centred on (a) programme accessibility and participation, (b) experience of the two-tiered coaching process, (c) commitment and perseverance, and (d) outcomes. Several parents described barriers to accessing this programme including cultural considerations. Parents described many benefits of the two-tiered coaching design, and both strengths and challenges regarding the programme content, duration, process, coaching approach, and child experience. Parents reported both barriers and facilitators to implementing the programme strategies at home. Overall, parents were mostly satisfied with the programme outcomes, citing improvements for their child, themselves, and their families. Together, the results from these studies provide preliminary support for the feasibility, acceptability, and effectiveness of delivering parent mediated ESDM (P-ESDM) in groups, and for individualising supports in additional tiers for some families. More research is needed to see if these findings are replicable with larger sample sizes, and through community rather than researcher implementation. It would also be valuable to explore different approaches to customising supports in more intensive tiers, to better meet the unique needs of individual families.

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

Cited by 3 publications

References 65 publications

Caregiver education programme on intellectual and developmental disabilities: An acceptability and feasibility study in an academic medical setting

Caregiver education programme on intellectual and developmental disabilities: An acceptability and feasibility study in an academic medical setting

Treatment mechanism of the WHO caregiver skills training intervention for autism delivered in community settings

Evaluation of a Two-Tiered Coaching Programme for Parents of Young Autistic Children

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