Eight-Month Parent Outcomes of an Acceptance and Empowerment Training Model in India

Background:

Parent training programs rarely have an explicit focus on improving parenting practices, parent problem-solving, or stress management (Brookman-Frazee et al, 2006). Along with increased self-efficacy, these are all aspects of parent empowerment. A focus on parent empowerment and psychological acceptance are particularly appropriate for many low and middle income countries, where mothers often shoulder full responsibility for both care and education of their children with disabilities in addition to the demands of the family and household. In addition, there is often a deeply entrenched belief that parents should not question teachers and other professionals. Teaching parent skills and increasing parent knowledge alone is not sufficient to shift these powerful dynamics. The Parent Child Training Program (PCTP) was developed in India in 2000 with parental acceptance of the child and empowerment as explicit program goals. The program additionally aims to provide practical and theoretical knowledge on autism and behavior management. Training takes place over a 3-month period, with the parent and child attending together. To date, the PCTP has trained over 400 participants.

Objectives:  

This study presents eight-month outcomes from a mixed-method evaluation of the PCTP training program. It provides the first data that we are aware of to examine longer-term outcomes of parent training in a developing country.

Methods:  

Three consecutive cohorts of families (n=48 total) participated in the evaluation. Participants joined from a wait-list and entered on a first-come, first-served basis. Diagnosis was confirmed using the ADOS and SCQ. Both parents were interviewed at the start and end of the 3-month program. Mothers were again interviewed eight months after their completion of the program. Measures consisted of a combination of 1) standardized, Western instruments 2) tools developed specifically for this evaluation, and 3) qualitative data collection. 

Results:  

Cohorts did not differ in demographic characteristics or baseline outcome measures. The statistically significant gains achieved by the post-test were maintained across all parent outcome measures at eight months, including empowerment, acceptance, knowledge of autism, sense of competence, and decreased stress (all p<.001). In addition, parent empowerment significantly increased between the post-test and follow up period (p<.01). Mothers were able to articulate gains they perceived in their children and in their own lives in response to open-ended questions at eight months. These data were coded using standard procedures, and maternal perceptions of change were consistent with the quantitative measures. 

Conclusions:  

The PCTP was developed specifically to meet the needs of families in India, where disability remains highly stigmatizing and services are limited. Using both standardized measures and those developed for this study, the current evaluation provides an estimate of project impacts in key parent outcomes eight months following the completion of a training program. The acceptance and empowerment focus of this model offers a novel way to conceptualize parent training, adds value to knowledge and behavioral training alone, and has high relevance for families in situations where cultural, economic and other contextual factors may be similar to those in India.