From engagement to competency: The pathway to making disability naïve frontline workers competent in the delivery of an evidence-based autism intervention in New Delhi, India

Abstract

BackgroundAs countries like India improve access to maternal and infant care, the health systems need to develop services that enable all children to thrive. A key demographic which needs to be supported are children with disabilities, such as autism. With an estimated prevalence of one percent, there are over five million young children who need services to support their needs. However, the paucity of specialist care makes access to interventions difficult. In this context a public health research not-for-profit is evaluating the effectiveness of the task-sharing approach to support the delivery of an evidenced social communication intervention for young children with autism. This paper describes the process of engaging and training the non-specialist frontline Accredited Social Health Activists (ASHAs), who are embedded within the Ministry of Health and Family Welfare under the Delhi State Health Mission, to deliver a complex intervention for autism to inform the future scalability of services for neurodevelopmental disorders.MethodsThe present study describes the process which included (i) engagement meetings, (ii) recruitment, (iii) training, (iv) internship, and (v) competency evaluation. The shortlisted ASHAs received a 7-day classroom training followed by an internship period with practice cases. Finally, competency assessments, comprising of a test of knowledge and skills through role-plays, was administered.ResultsTwenty three Primary Urban Health Centers across seven districts of Delhi were approached and 408 ASHAs were engaged in initial meetings. Telephonic screening with 127 ASHAs resulted in 72 ASHAs being selected for in-person interviews. Of the 45 ASHAs who attended, 33 were shortlisted for training and 18 completed it. Fifteen ASHAs entered the internship of which 7 ASHAs achieved competency.Discussion and conclusionThere was significant attrition along the pathway to having a competent non-specialist worker deliver a complex autism intervention. The lessons learnt from this process can inform the possibility of developing a cadre of disability specific frontline health workers who can deliver evidence-based interventions for neurodevelopmental disorders under supervision.

Enhancing access to autism diagnostic services for children in the community

“…How general pediatrician assessment applies to health systems outside of North America remains unknown-especially in systems that do not have a clear general versus specialty delineation in the area of children's healthcare or in regions with different socio-cultural compositions and needs. Foundational work in India has used community health visitors to conduct screening and intervention; such models could potentially be extended to support autism diagnosis (Naithani et al, 2022).…”

Re-imagining the care delivery system for chronic conditions

“…As one example, the NGO Sangath has pioneered the deployment of ASHA towards the task of detecting and treating depression (with an evidence-based brief psychological treatment) in Madhya Pradesh or delivering an evidence-based parent-mediated intervention for autism in New Delhi. 3 , 4 While these examples demonstrate the feasibility, acceptability and effectiveness of these approaches, it is imperative for the Government to launch a national initiative to expand this community-based workforce to address the needs of persons with chronic conditions or disabilities. The incorporation of ASHA in a range of initiatives aimed at health promotion, prevention, early detection and referrals for chronic conditions and the launch of the Community Based Inclusive Development (CBID) programme to create a pool of grassroot rehabilitation workers at the community level, who can work alongside the ASHA to handle cross-disability issues and facilitate the inclusion of the persons with disabilities in the society, are welcome steps in that direction.…”