CoChat
Sign Up
Cited by 27Health Policy Implementation ScienceAutism Spectrum Disorder ResearchFamily and Disability Support Research

Sustainable implementation of early intervention for autism spectrum disorder through caregiver coaching: south African perspectives on barriers and facilitators

Open access
Makombe, Chipo Belindah T., Shabalala, Nokuthula, Viljoen, Marisa, Seris, Noleen, de Vries, Petrus J., Franz, Lauren·2019·Pediatric Medicine
DOI 10.21037/pm.2019.07.08PMC PMC6746419
Open this paper in CoChat — free account

Abstract

BACKGROUND: A 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. METHODS: Nine 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. RESULTS: Implementation 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. CONCLUSIONS: In 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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.21037/pm.2019.07.08

Cites

8 of 8 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 32

  1. [1]Elsabbagh M, Divan G, Koh YJ, Global Prevalence of Autism and Other Pervasive Developmental Disorders. Autism Res 2012; 5: 160– 79. 22495912 PMC3763210
  2. [5]Global Research on Developmental Disabilities Collaborators. Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Global Health 2018; 6: e1100– e1121. 30172774 PMC6139259
  3. [6]Weitlauf AS, McPheeters ML, Peters B, AHRQ Comparative Effectiveness Reviews. Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update 2014. Available online: https://www.ncbi.nlm.nih.gov/books/NBK241444/ 25210724
  4. [8]Strauss K, Mancini F, Fava L. Parent inclusion in early intensive behavior interventions for young children with ASD: A synthesis of meta-analyses from 2009 to 2011. Res Dev Disabil 2013; 34: 2967– 85. 23816632
  5. [10]Peters-Scheffer N, Didden R, Korzilius H, Cost comparison of early intensive behavioral intervention and treatment as usual for children with autism spectrum disorder in the Netherlands. Res Dev Disabil 2012; 33: 1763– 72. 22705454
  6. [11]Eldevik S, Hastings RP, Hughes JC, Meta-Analysis of Early Intensive Behavioral Intervention for Children With Autism. J Clin Child Adolesc Psychol 2009; 38: 439– 50. 19437303
  7. [14]Morris J, Belfer M, Daniels A, Treated prevalence of and mental health services received by children and adolescents in 42 low-and-middle-income countries. J Child Psychol Psychiatry 2011; 52: 1239– 46. 21554305
  8. [15]de Vries PJ. Thinking globally to meet local needs: autism spectrum disorders in Africa and other low-resource environments. Curr Opin Neurol 2016; 29: 130– 6. 26886354
  9. [16]Reichow B, Servili C, Yasamy MT, Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Review. PLoS Med 2013; 10: e1001572. 24358029 PMC3866092
  10. [17]Wong VC, Kwan QK. Randomized Controlled Trial for Early Intervention for Autism: A Pilot Study of the Autism 1-2-3 Project. J Autism Dev Disord 2010; 40: 677– 88. 20020319
  11. [18]Tsang SK, Shek DT, Lam LL, Brief Report: Application of the TEACCH Program on Chinese Pre-School Children with Autism--Does Culture Make a Difference? J Autism Dev Disord 2007; 37: 390– 6. 16906461
  12. [21]Divan G, Vajaratkar V, Cardozo P, The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting. Autism Res 2019; 12: 328– 39. 30095230
  13. [22]Schreibman L, Dawson G, Stahmer AC, Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. J Autism Dev Disord 2015; 45: 2411– 28. 25737021 PMC4513196
  14. [23]Guler J, de Vries PJ, Seris N, The importance of context in early autism intervention: A qualitative South African study. Autism 2018; 22: 1005– 17. 28914083 PMC5832543
  15. [26]Franz L, Adewumi K, Chambers N, Providing early detection and early intervention for autism spectrum disorder in South Africa: stakeholder perspectives from the Western Cape province. J Child Adolesc Ment Health 2018; 30: 149– 65. 30403918 PMC6301128
  16. [28]van Schalkwyk GI, Beyer C, de Vries PJ. South Africa and Autism In: Volkmar FR. editor. Encyclopedia of Autism Spectrum Disorders. New York, NY: Springer New York, 2015: 1– 7.
  17. [29]Springer PE, van Toorn R, Laughton B, Characteristics of children with pervasive developmental disorders attending a developmental clinic in the Western Cape Province, South Africa. South African Journal of Child Health 2013; 7: 95– 9.
  18. [30]Mayosi BM, Benatar SR. Health and Health Care in South Africa—20 years after Mandela. N Engl J Med 2014; 371: 1344– 53. 25265493
  19. [31]Khalfani AK, Zuberi T. Racial classification and the modern census in South Africa, 1911–1996. Race and Society 2001; 4: 161– 76.
  20. [35]Ramseur K 2nd, de Vries PJ, Guler J, Caregiver descriptions of joint activity routines with young children with autism spectrum disorder in South Africa. Pediatr Med 2019. doi: 10.21037/pm.2019.03.04. PMC6481954 31032484 · DOI
  21. [36]Damschroder LJ, Aron DC, Keith RE, Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009; 4: 50. 19664226 PMC2736161
  22. [38]Curran GM, Sullivan G, Mendel P, Implementation of the CALM intervention for anxiety disorders: a qualitative study. Implement Sci 2012; 7: 1– 11. PMC3319426 22404963
  23. [39]Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225– 30. 14568747
  24. [40]Gagliardi AR, Alhabib S; members of Guidelines International Network Implementation Working Group. Trends in guideline implementation: a scoping systematic review. Implement Sci 2015; 10: 54. 25895908 PMC4409784
  25. [41]Fischer F, Lange K, Klose K, Barriers and Strategies in Guideline Implementation—A Scoping Review. Healthcare 2016; 4: 1– 16. 27417624 PMC5041037
  26. [42]Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006; 3: 77– 101.
  27. [43]Wetherston V, Gangat S, Shange N, The views and knowledge of parents of children with autism spectrum disorder on a range of treatments. South African Journal of Child Health 2017; 11: 117– 21.
  28. [44]Harrison AJ, Long KA, Manji KP, Development of a Brief Intervention to Improve Knowledge of Autism and Behavioral Strategies Among Parents in Tanzania. Intellect Dev Disabil 2016; 54: 187– 201. 27268474
  29. [45]Hampton LH, Harty M, Fuller EA, Enhanced milieu teaching for children with autism spectrum disorder in South Africa. Int J Speech Lang Pathol 2019: 1– 11. [Epub ahead of print]. PMC7373342 30724622
  30. [46]Cheremshynski C, Lucyshyn JM, Olson DL. Implementation of a Culturally Appropriate Positive Behavior Support Plan With a Japanese Mother of a Child With Autism: An Experimental and Qualitative Analysis. J Posit Behav Interv 2012; 15: 242– 53.
  31. [47]Chambers NJ, Wetherby AM, Stronach ST, Early detection of autism spectrum disorder in young isiZulu-speaking children in South Africa. Autism 2017; 21: 518– 26. 27335105
  32. [49]Franz L, Viljoen M, Seris N, Pilot Study to Improve Access to Early Intervention for Autism in Africa. Poster presented at the 10th Anniversary Conference: Global Mental Health Research without Borders, in Bethesda, MD, USA 2019, April.

Cited by

Sorted by citations

Authors
Makombe, C. B. T., Shabalala, N., Viljoen, M., Seris, N., de Vries, P. J., & Franz, L.
Affiliations
University of Cape Town (ZA)
Corresponding author
Franz, Lauren
ORCID
Venue
Pediatric Medicine
Publisher
AME Publishing Company
Published
2019-08
Volume
2
Pages
39-39
ISSN
2617-5428 (ISSN-L)
DOI
10.21037/pm.2019.07.08
PMC
PMC6746419
OpenAlex
W2968442784
Cited by
27
References
8
Citations by year
2026: 2 · 2025: 4 · 2024: 8 · 2023: 5 · 2022: 7 · 2021: 1
FWCI
2.73
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Pediatric Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5r21mh120696-02)
  • National Institute of Mental Health (R21‐MH‐120696, K01MH104370)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
autism spectrum disorder, early intervention, caregiver coaching, Early Start Denver Model, implementation barriers and facilitators, intervention sustainability, supervision, resource-limited settings, South Africa, socioeconomic factors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review