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

Salomone, Erica; Settanni, Michele; Suma, Katharine; Ferrara, Federica; Foletti, Giulia; Salandin, Arianna; Brown, Felicity L.; Pacione, Laura; Shire, Stephanie; Servili, Chiara; Adamson, Lauren B.

doi:10.1007/s10803-021-05297-x

Cited by 17 publications

(33 citation statements)

References 54 publications

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“…They also reported stronger confidence in caregiving. They felt capable of interacting with their children, facilitating their development, and coping with the stress of caregiving, which is consistent with previous studies ( 31 , 32 ). This effect persisted for 3 months or more, indicating long-term changes in the caregivers' behaviors and attitude.…”

Section: Discussionsupporting

confidence: 92%

“…The significant improvement of children's communication is also found in the pilot groups in India ( 31 ). To be noted, the improvement of children's gesture use in communication, which is a crucial component in CST, was reported in the randomized controlled trial study in Italy ( 32 ). However, there was no item assessing the gesture use in the communication subscale of ATEC, yielding a limitation of this study.…”

Section: Discussionmentioning

confidence: 92%

“…The adaptations were tested in the pilot stage to ensure the program is feasible and acceptable for dissemination in the local context. The program had been adapted and implemented in both low-income countries and high-income countries ( 30 – 32 ). The previous studies indicated that the WHO CST program is both acceptable and relevant to the low-resource contexts (e.g., Ethopia and India) ( 30 , 31 ) and to the high-resource context (e.g., Italy) ( 33 ).…”

Section: Introductionmentioning

confidence: 99%

“…The previous studies indicated that the WHO CST program is both acceptable and relevant to the low-resource contexts (e.g., Ethopia and India) ( 30 , 31 ) and to the high-resource context (e.g., Italy) ( 33 ). A pilot randomized controlled trial study in Italy reported the promising effectiveness on joint engagement of caregiver–child interaction, parent stress, parenting self-efficacy and child gestures ( 32 ). The Taiwan CST team began adaptation and field testing in 2016, completed these steps in early 2019, and advanced to promotion in 2019.…”

Section: Introductionmentioning

confidence: 99%

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Promotion and implementation effectiveness of World Health Organization's Caregiver Skills Training program in Taiwan

et al. 2022

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The World Health Organization (WHO) developed the Caregiver Skills Training for Families of Children with Developmental Delays and Disabilities (CST) with support from Autism Speaks to address the resource gaps and worldwide needs for interventions for children with developmental disorders or delays, especially those with autism spectrum disorder (ASD), and their families. Evidence has indicated that parent-mediated interventions benefit both caregivers and children by strengthening caregivers' knowledge and confidence and children's social communication skills and behavioral regulation. The CST-Taiwan team began the prepilot field trial in 2017 and developed the project to serve families in various locations. This study (1) delineated the adaptations and promotion of CST-Taiwan; (2) determined the program's effectiveness in the promotional stage, in terms of caregiver and child outcomes, and (3) examined the maintenance of its effects. The materials, delivery, and facilitator training procedure of the original CST were adapted to Taiwan. The quantitative data indicated that CST-Taiwan is a promising program, it positively affected caregiver knowledge and confidence and reduced the severity of the children's autistic symptoms. The 3-month follow-up results suggested that the effects persisted. Thus, CST-Taiwan, and its promotional strategies are feasible and effective.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Promotion and implementation effectiveness of World Health Organization's Caregiver Skills Training program in Taiwan

et al. 2022

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“…The CST's preliminary data from different geographical regions emphasize the adaptation process as essential to ensure its implementation and sustainability. The program was designed to be implemented globally and suitable for low-resource contexts and has shown good acceptability in high-income settings too ( 40 , 41 ). Thus, the WHO-CST is a sustainable and valid program to implement in the rural US.…”

Section: Introductionmentioning

confidence: 99%

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

Montiel-Nava

Tregnago²,

Marshall³

et al. 2022

Front. Psychiatry

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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.

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

Cited by 17 publications

References 54 publications

Promotion and implementation effectiveness of World Health Organization's Caregiver Skills Training program in Taiwan

Promotion and implementation effectiveness of World Health Organization's Caregiver Skills Training program in Taiwan

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

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

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