Evaluating Process and Impact of an Autism Intervention Training Program (AITP) for Professionals in India.

Background: Low & Middle Income Countries (LMIC) like India lack professionals trained specifically for delivery of services to children with ASD. The few existing programs for training parents and non-specialist professionals often address discrete skills like social communication, challenging behaviors etc. There is an urgent need to create transdisciplinary resources trained to address comprehensive challenges associated with ASD across childhood and adolescence, using evidence-based practices.

Objectives: To evaluate the process and early impact of a training program in autism intervention (AITP), piloted by a not-for-profit organization in Mumbai, India for in-service multidisciplinary professionals.

Methods: A 6-month certificate program was piloted at Ummeed in Mumbai, India in 2016 to train in-service professionals in intervention approaches in children with ASD. Informed by the existing evidence base, practice wisdom, community feedback and a formal needs assessment survey, the curriculum was planned to provide participants knowledge and skills in assessment, goal planning, intervention techniques, special issues in autism and engaging families in care for children (1-12 years old) with ASD. The modular course provided information through lectures, practical experiences and on-job supervision via Skype. 12 in-service professionals, with work experience ranging from 2-25 years, representing 12 organizations, from 7 cities across India, including occupational, speech & physiotherapists, psychologists and special educators participated in the pilot.

The training program was evaluated using Kirkpatrick’s Evaluation criteria. Reaction and knowledge were measured via pre-post questionnaires, video samples of work and case presentations. A qualitative approach was used to evaluate therapist perception of change in attitude & behavior and overall impact. Following a constructivist-interpretivist paradigm, in-depth interviews were conducted with 11 participants, transcribed, manually coded and analysed for content.

Results: Participants were motivated to participate due to their inability to see progress in children with ASD using existing skill sets and a desire to learn more. All participants found the AITP content relevant, useful across settings and culturally applicable. They greatly appreciated the value of post training supervision, with non-judgmental, supportive supervisor attitude and peer support. Participants endorsed the value of being taught different approaches to intervention and family centered care.

Participants in early stages of their career described increase in number of children with ASD they work with and improvement in ability to identify red-flags of ASD in undiagnosed children, engagement with families, coordination of care and overall self-efficacy. More experienced participants in positions of responsibility within organizations additionally influenced change in prevalent practices in organizations and trained co-workers, parents and teachers in schools. Parent organizations of 2 participants, catering to children with cerebral palsy in Kolkata and Chennai, started services for children with ASD post their participation in AITP.

Conclusions: This study demonstrates how local clinical and training expertise can be utilized effectively to create a structured yet broad, culturally appropriate training program in Autism intervention for in-service professionals that harnesses and builds on their existing skills. While long term impact needs to be evaluated, current findings can potentially inform development of similar training programs across other LMICs, thereby addressing the needs of multiple stakeholders in the community.