Montiel-Nava Cecilia, Tregnago Megan, Marshall Jeanne, Sohl Kristin, Curran Alicia Brewer, Mahurin Melissa, Warne-Griggs Melissa, Dixon Pamela
Department of Psychological Science, University of Texas Rio Grande Valley-Edinburg, Edinburg, TX, United States.
Easterseals Midwest, Columbia, MO, United States.
Front Psychiatry. 2022 Aug 29;13:909947. doi: 10.3389/fpsyt.2022.909947. eCollection 2022.
For families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) an online, synchronous group format in rural Missouri.
We used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of the program, following the last home visit. Caregivers of 14 autistic children (3-7 years), residents of rural Missouri, completed nine virtual sessions and four virtual home visits.
Four main themes emerged from the focus groups: changes resulting from the WHO-CST, beneficial aspects of the program, advantages and disadvantages of the online format, and challenges to implementing the WHO-CST telehealth. The most liked activity was the demonstration (36%), and the least liked was the practice with other caregivers. From baseline to week 12, communication skills improved in both frequency ( < 0.05) and impact ( < 0.01), while atypical behaviors decreased ( < 0.01). For caregivers' outcomes, only confidence in skills ( < 0.05) and parental sense of competence ( < 0.05) showed a positive change.
Our results support the feasibility of implementing the WHO-CST program telehealth in a US rural setting. Caregivers found strategies easy to follow, incorporated the program into their family routines, and valued the group meetings that allowed them to connect with other families. A PMI such as the WHO-CST, with cultural and linguistic adaptations and greater accessibility telehealth-plays an essential role in closing the treatment gap and empowering caregivers of autistic children.
对于生活在农村地区的自闭症儿童家庭来说，服务获取受限部分是由于提供者短缺和路途时间过长。远程医疗为实施家长介导干预（PMI）的替代交付模式带来了可能性，有可能减少服务获取障碍。本研究旨在评估在密苏里州农村地区以在线同步小组形式实施世界卫生组织-照顾者技能培训计划（WHO-CST）的可行性和可接受性。
我们采用混合方法设计，在基线以及项目结束时（最后一次家访之后）从照顾者和项目促进者那里收集定性和定量数据。14名密苏里州农村地区3至7岁自闭症儿童的照顾者完成了9次虚拟课程和4次虚拟家访。
焦点小组出现了四个主要主题：WHO-CST带来的变化、该项目的有益方面、在线形式的优缺点以及实施WHO-CST远程医疗的挑战。最喜欢的活动是示范（36%），最不喜欢的是与其他照顾者一起练习。从基线到第12周，沟通技能在频率（<0.05）和影响（<0.01）方面均有所改善，而非典型行为减少（<0.01）。对于照顾者的结果，只有技能信心（<0.05）和父母胜任感（<0.05）显示出积极变化。
我们的结果支持在美国农村地区实施WHO-CST远程医疗项目的可行性。照顾者发现策略易于遵循，将该项目纳入了家庭日常活动，并重视使他们能够与其他家庭建立联系的小组会议。像WHO-CST这样经过文化和语言调整且更易获取的PMI远程医疗，在缩小治疗差距和增强自闭症儿童照顾者能力方面发挥着重要作用。
