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

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.

Parents of children with ASD (N = 86; mean age 44.8 months; 67 boys) were randomized to either WHO Caregiver Skills Training (CST) delivered in public health settings in Italy or enhanced treatment-as-usual. Primary blinded outcomes were 3-months post-intervention change scores of autism severity and engagement during caregiver-child interaction. CST was highly acceptable to caregivers and feasibly delivered by trained local clinicians. Intention-to-treat analysis showed a large and significant effect on parent skills supporting joint engagement and a smaller significant effect on flow of interaction. Expected changes in child autism severity and joint engagement did not meet statistical significance. Analysis of secondary outcomes showed a significant effect on parenting stress, self-efficacy, and child gestures. Strategies to improve the effectiveness of CST are discussed.

The Interplay of Communication Skills, Emotional and Behavioural Problems and Parental Psychological Distress.

We investigated the mechanism of impact of poor communication skills and emotional and behavioural problems in children with ASD (22-61 months) on parental psychological distress. Participants were dyads enrolled in two pilot intervention studies; the dataset includes cross-sectional data at baseline (N = 82). We postulated an indirect effect of child expressive and receptive communication on parent psychological distress, through child emotional and behavioural problems. The effect of receptive skills on parent psychological distress was fully mediated by child emotional problems: lower receptive skills were associated with higher levels of emotional symptoms, which in turn predicted higher parent psychological distress. Expressive skills did not show either direct or indirect effects. Findings are discussed in light of children's marked 'receptive disadvantage' communication profile.