Acceptability and feasibility of the World Health Organization’s Caregiver Skills Training implemented in the Italian National Health System

Abstract

The Caregiver Skills Training programme is an evidence-informed group intervention developed by the World Health Organization to counter the treatment gap for neurodevelopmental disorders in children. We examined feasibility and acceptability of Caregiver Skills Training in public child neuropsychiatry services in Italy. Following a formative adaptation process and a pre-pilot implementation, the programme was piloted in six centres. Caregivers of children (2–5 years) with autism spectrum disorder were randomised to either Caregiver Skills Training ( n = 43) or treatment as usual ( n = 43). Professionals’ and caregivers’ experiences in the treatment arm were examined with focus groups and questionnaires. The programme was largely considered acceptable, relevant and feasible. Specific implementation challenges and suggestions for optimising the package are discussed. Lay abstract Across the globe, children with neurodevelopmental disorders, including autism, have limited access to care through public services. To improve access to care the World Health Organization developed a novel, open-access programme: the Caregiver Skills Training programme. The Caregiver Skills Training consists of nine group sessions and three individual home visits, focused on training the caregiver on how to use everyday play and home routines as opportunities for learning and development. We implemented Caregiver Skills Training in public child neuropsychiatry services in Italy and examined with questionnaires and focus groups how feasible it was to deliver the programme in public health settings and how acceptable and relevant it was for caregiver users. We found that the Caregiver Skills Training was largely considered acceptable and relevant for families and feasible to deliver. We discuss potential solutions to address the specific implementation challenges that were identified, such as strategies to improve training of interventionists and overcome barriers to caregiver participation.

Pilot Randomized Controlled Trial of the WHO Caregiver Skills Training in Public Health Services in Italy

“…The feasibility of delivery, as reflected in high fidelity of implementation, high attendance rates and good selfreported viability of delivery, combined with the high acceptability to the target beneficiaries, provide evidence in support of the scalability of the CST in public health services in Italy. The user-facing intervention materials (participant booklets), the contents covered during the sessions and the training methodology were found to be well received and in line with caregivers' needs, confirming the qualitative analysis of post-intervention feedback (Salomone et al, 2021). With respect to feasibility assessment, it is noteworthy that the fidelity of implementation of CST strategies in interaction with children during the home visits, while overall acceptable, was lower for some interventionists (Salomone et al, 2021).…”

“…The home visits were delivered at participants' homes and lasted 1.5 h. Clinicians' intervention fidelity was checked during the program delivery and was acceptable both for the integrity of group sessions delivery and the fidelity of implementation of CST strategies in direct interaction with the child during the home visits. (For further detail on the intervention procedure, see Salomone et al, 2021).…”

“…Focus groups and interviews were conducted with interventionists and caregivers immediately post intervention. For the full set of measures, including qualitative data from focus groups, see Salomone et al (2021). 'Unsatisfactory' levels were set at ≤ 3 on 1-5 scales.…”

“…Interventionist ratings (n = 101) of acceptability to caregivers and feasibility of delivery were above satisfactory levels in, respectively, 97% and 86% of ratings across sessions and dimensions (perceived relevance, acceptability, agreement and participation; complexity and amount of contents, preparedness to deliver). For a break-down of acceptability and feasibility ratings per session, see Salomone et al (2021).…”

“…We then conducted an effectiveness-implementation hybrid pilot randomized controlled trial (RCT) in public Child Neuropsychiatry services of the Piedmont region in Northern Italy. Reported here are the clinical outcomes of the pilot RCT; the formative adaptation process and acceptability and feasibility data from the trial are reported elsewhere (Salomone et al, 2021).…”