ArticlePediatric medicine (Hong Kong, China)2019
Sustainable implementation of early intervention for autism spectrum disorder through caregiver coaching: South African perspectives on barriers and facilitators.
Article in Pediatric medicine (Hong Kong, China), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Examining the Efficacy of Culturally Responsive Interventions for Autistic Children and Their Families: A Meta-Analysis.Journal of autism and developmental disorders · 2025Pooled it
- Parent-mediated Paediatric Autism Communication Therapy (PACT): a focus group study of parental experience.Child and adolescent psychiatry and mental health · 2026Article
- Sustaining Community Implementation of a Caregiver-Mediated Intervention- Learnings From the WHO-Caregiver Skills Training in India.Journal of autism and developmental disorders · 2025Article
- Adapting an early autism caregiver coaching intervention for telehealth delivery in low-resource settings: A South African study of the 'what' and the 'why'.Autism : the international journal of research and practice · 2025Article
- Facilitators and barriers to implementation of early intensive manual therapies for young children with cerebral palsy across Canada.BMC health services research · 2025Article
- Feasibility of the Autism NavigatorAutism : the international journal of research and practice · 2024Article
- Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines.The South African journal of communication disorders = Die Suid-Afrikaanse tydskrif vir Kommunikasieafwykings · 2024Article
- A global scoping review of adaptations in nurturing care interventions during the COVID-19 pandemic.Frontiers in public health · 2024Article
- Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial.PloS one · 2024Article
- Intervention in autism based on Early Start Denver Model in a multiethnic immigrant setting-experiences of preschool staff involved in its implementation.Frontiers in child and adolescent psychiatry · 2024Article
- Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial.medRxiv : the preprint server for health sciences · 2023Article
- Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa.Child and adolescent psychiatry and mental health · 2023Article
- Conducting caregiver focus groups on autism in the context of an international research collaboration: Logistical and methodological lessons learned in South Africa.Autism : the international journal of research and practice · 2023Article
- Improving access to early intervention for autism - findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa.Research square · 2023Article
- Barriers and facilitators to implementation of developmental screening and early intervention in Canadian organizations following completion of a training and coaching model: a thematic analysis.Frontiers in health services · 2023Article
- A virtuous circle: Stakeholder perspectives of a short-term intensive parent training programme delivered within the context of routine services for autism in China.Autism : the international journal of research and practice · 2022Article
- Patterns in reporting and participant inclusion related to race and ethnicity in autism intervention literature: Data from a large-scale systematic review of evidence-based practices.Autism : the international journal of research and practice · 2022Article
- Bringing Parent-Child Interaction Therapy to South Africa: Barriers and Facilitators and Overall Feasibility-First Steps to Implementation.International journal of environmental research and public health · 2022Article
- Exploring contextual adaptations in caregiver interventions for families raising children with developmental disabilities.PloS one · 2022Article
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Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundA lack of specialists, and insufficient infrastructure and funding to scale early interventions for autism spectrum disorder (ASD) characterize low-resource settings. Integration of early intervention methods that utilize non-specialists, and involve caregivers, into existing systems of care, offers the best hope to address such unmet needs. In South Africa, a caregiver coaching intervention, informed by principles of the Early Start Denver Model (ESDM) was adapted for delivery by non-specialist Early Childhood Development (ECD) practitioners. This study explored perceived barriers and facilitators to sustainable implementation of this approach.
methodsNine stakeholders including caregivers, ECD practitioners, ECD school supervisors, and certified South African ESDM therapists involved in intervention implementation were purposively sampled, and individual in-depth interviews were conducted. Interviews were transcribed verbatim and thematically analyzed.
resultsImplementation facilitators included: ECD practitioner ASD knowledge and ongoing supervision; a positive coaching experience; and clear illustration of intervention concepts. Implementation barriers included: complexity of some intervention and coaching concepts; logistical challenges such as time constraints and internet access; and mismatch between video content and the South African context. Facilitators to sustain the intervention included perceived positive child and caregiver outcomes; and ongoing supervision. Barriers to sustain the intervention included socio-economic contextual factors.
conclusionsIn spite of the potential for positive child and caregiver outcomes from caregiver coaching, broader contextual and system-level issues such as poverty, the need for ongoing supervision, and access to local coaching materials in South African languages, may challenge sustainable implementation. Findings from this study will inform tailoring of the intervention training and supervision approach for next step evaluation.
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Registered trials
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