Naithani Lavangi, Goldie Caitlin, Kaur Abhipreet, Butter Charlotte, Lakhera Shweta, Leadbitter Kathy, Divan Gauri
Sangath, Goa, India.
Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom.
Front Psychiatry. 2022 Jun 29;13:914750. doi: 10.3389/fpsyt.2022.914750. eCollection 2022.
The past decade has seen key advances in early intervention for autistic children in high-income countries, with most evidence based on specialist delivery of interventions. The care gap seen in low- and middle-income countries (LMIC) remains close to 100%. A key challenge in addressing this care gap concerns the paucity of specialists available to deliver services. Task-sharing provides an important potential solution; there is a need to identify interventions that are suitable for scaled-up delivery through task-sharing in low-resourced settings. We aimed to conduct a scoping review to identify studies which reported autism intervention delivered by non-specialists within LMIC and, using established frameworks, specify intervention components with evidence of successful non-specialist delivery.
A scoping literature search, conducted within four databases, generated 2,535 articles. Duplicates were removed, followed by screening of titles and abstracts, with 10% double-rated for reliability. 50 full text articles were then screened independently by two raters. Articles were included if studies: (a) were conducted in LMIC; (b) included samples of autistic children (age < 10); (c) evaluated psycho-social interventions delivered by non-specialists; (d) reported child outcomes; and (e) were peer-reviewed full-texts in English. Two established frameworks - @Practicewise and NDBI-Fi framework - were then used to ascertain the commonly delivered components of these interventions.
Two studies met the inclusion criteria. Both studies evaluated parent-mediated interventions delivered by non-specialists in South Asia. Through the two frameworks, we identified elements and techniques that had been delivered successfully by non-specialists.
There is evidence from two acceptability and feasibility trials that non-specialists can be trained to deliver some intervention elements and techniques within parent-mediated interventions, with good fidelity and acceptability and evidence of effectiveness. The review points up the lack of a widespread evidence base in this area and need for further research in low resourced settings, including well-powered trials and mechanistic analyses to identify active ingredients. A focus on the pre-requisites for non-specialist delivery is critical to reduce inequity and provide universal health coverage within resource-constrained health systems.
在过去十年里，高收入国家在自闭症儿童早期干预方面取得了关键进展，大多数证据都基于专业人员提供的干预措施。低收入和中等收入国家（LMIC）中存在的护理差距仍接近100%。解决这一护理差距的一个关键挑战在于提供服务的专业人员匮乏。任务分担提供了一个重要的潜在解决方案；有必要确定适合在资源匮乏环境中通过任务分担进行扩大规模实施的干预措施。我们旨在进行一项范围审查，以确定报告低收入和中等收入国家非专业人员实施自闭症干预的研究，并使用既定框架，明确成功由非专业人员实施的干预组成部分。
在四个数据库中进行范围文献检索，共生成2535篇文章。去除重复项后，对标题和摘要进行筛选，10%进行双评以确保可靠性。然后由两名评估人员独立筛选50篇全文文章。若研究符合以下条件则纳入：（a）在低收入和中等收入国家进行；（b）包括自闭症儿童样本（年龄<10岁）；（c）评估非专业人员提供的心理社会干预；（d）报告儿童结局；（e）为英文同行评审全文。然后使用两个既定框架——@Practicewise和NDBI-Fi框架——来确定这些干预措施通常提供的组成部分。
两项研究符合纳入标准。两项研究均评估了南亚非专业人员实施的家长介导干预措施。通过这两个框架，我们确定了非专业人员成功实施的要素和技术。
两项可接受性和可行性试验的证据表明，非专业人员可以接受培训，在家长介导的干预措施中实施一些干预要素和技术，具有良好的保真度和可接受性以及有效性证据。该审查指出了该领域缺乏广泛的证据基础，以及在资源匮乏环境中需要进一步研究，包括开展有足够效力的试验和进行机制分析以确定有效成分。关注非专业人员实施的先决条件对于减少不平等和在资源有限的卫生系统中提供全民健康覆盖至关重要。
