Autism Caregiver Coaching in Africa

摘要 在全球范围内，越来越需要实施以社区为基础的服务，以支持提高质量 of life of autism自闭症people.早期自闭症干预是至关重要的，因为它可以显着改善儿童和 家庭成果，但世界各地存在执行差距。这些差距在非洲最为明显，到2050年， 鉴于非洲缺乏专家， 对非专家的干预将是一项关键的执行战略。自然主义发展行为 干预（NDBI）是一类早期自闭症干预方法，可以通过以下方式有效地提供： 照顾者通过杜克大学和开普敦大学之间的合作，我们的团队奠定了 为自闭症儿童提供创新和可扩展的辅导干预奠定了基础。我们系统地 在南非的背景下，调整了护理人员的NDBI辅导， 教育部雇用的非专业幼儿发展从业人员。在 建议的研究，我们将通过实施第1类混合有效性实施，在基础工作的基础上再接再厉 在南非现有的护理系统内，由非专家提供的教练干预试验。 我们的目标是通过开展研究，在非洲实施一个可行的、可扩展的自闭症早期干预模式 在以社区为基础的环境中，有文化和语言多样的参与者， 利益相关者的观点，并纳入任务转移。在拟议的研究中，我们将根据我们目前的 与家庭，从业人员和政策制定者的关系，通过正规化这些关系，并包括其他 关键的利益相关者群体，如南非自闭症自我倡导者通过社区学术 伙伴关系是环境规划信息系统执行框架中的一个关键桥梁因素。该项目主要有三个方面 目标.首先，评估非专家提供的NDBI护理人员辅导的现实效果， 改善母婴互动模式和儿童发展成果，并评估成本- 这种做法的有效性。第二，确定执行决定因素，为扩大规模提供信息。三是 扩大非洲自闭症研究能力，提高可扩展性。该项目还提供了一个独特的机会， 研究自闭症相关行为和现象学的变异性。因此，我们将评估 对干预的反应受照顾者和维度儿童特征的调节。此外，使用 创新的数字评估方法，改变自闭症相关的维度量化措施 行为将被检查。最后，自闭症相关行为的跨文化差异将被 通过与美国研究中收集的现有定量表型数据进行比较进行评估。这项研究是及时的 它将为扩大非洲自闭症早期干预提供信息。评估可扩展的 在南非这样面临重大背景挑战的环境中进行干预， 研究结果对面临类似挑战的世界许多地区的生态有效性和相关性。

ABSTRACT Globally there is a growing need to implement community-based services that support improvements in quality of life of autistic people. Early autism intervention is critical because it can significantly improve both child and family outcomes, but implementation gaps exist worldwide. These gaps are starkest in Africa, where by 2050, iven the lack of specialists in Africa, task shifting early autism intervention to non-specialists will be a key implementation strategy. Naturalistic Developmental Behavioral Interventions (NDBI), are a class of early autism intervention approaches, that can be effectively delivered by caregivers. Through a partnership between Duke University and the University of Cape Town, our team laid the groundwork for an innovative and scalable coaching intervention for young autistic children . We systematically adapted a caregiver coaching NDBI for the South African context in which coaching is effectively delivered by non-specialist Early Childhood Development practitioners employed by the Education Department. In the proposed study we will build on our foundational work by conducting a type 1 hybrid effectiveness implementation trial of the coaching intervention, delivered by non-specialists, within an existing system of care in South Africa. Our goal is to implement a feasible, scalable early autism intervention model in Africa by conducting research with culturally and linguistically diverse participants in community-based settings, that is inclusive of diverse stakeholder perspectives and incorporates task-shifting. In the proposed study, we will build on our current relationships with families, practitioners, and policy makers by formalizing these relationships and including other key stakeholder groups such as South African autistic self-advocates through a community-academic partnership, a key bridging factor in the EPIS implementation framework. The proposed project has three main objectives. First, to evaluate the real-world effectiveness of non-specialist delivered NDBI caregiver coaching for improving patterns of caregiver-child interaction and child developmental outcomes, and assess the cost- effectiveness of this approach. Second, to identify implementation determinants to inform scale-up. Third, to expand African autism research capacity to enhance scalability. This project also offers a unique opportunity to study variability in autism-related behaviors and phenomenology. We will therefore assess the degree to which response to intervention is moderated by caregiver and dimensional child characteristics. In addition, using an innovative digital assessment method, changes in dimensional quantitative measures of autism-related behaviors will be examined. Finally, cross-cultural differences in dimensional autism-related behaviors will be evaluated via comparison with existing quantitative phenotypic data gathered in U.S. studies. This study is timely and innovative and will inform scale-up of autism early intervention in Africa. Assessing the impact of a scalable intervention in an environment like South Africa which faces significant contextual challenges, increases the ecological validity and relevance of findings for many regions of the world that face with similar challenges.