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[Preprint]. 2023 Sep 11:2023.09.10.23295331.
doi: 10.1101/2023.09.10.23295331.

Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial

Lauren Franz  1   2   3 , Marisa Viljoen  3 , Sandy Askew  2 , Musaddiqah Brown  3 , Geraldine Dawson  1 , J Matias Di Martino  4 , Guillermo Sapiro  4 , Katlego Sebolai  3 , Noleen Seris  3 , Nokuthula Shabalala  3 , Aubyn Stahmer  5 , Elizabeth L Turner  2   6 , Petrus J de Vries  3
Affiliations

Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial

Lauren Franz et al. medRxiv. .

Update in

Abstract

Background: While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care.

Objectives: First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa.

Methods: This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants.

Results: Participant enrolment started in April 2023. Estimated primary completion date is March 2027.

Conclusion: The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators.

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Figures

Fig 1.
Fig 1.. Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) schedule of enrolment, interventions, and assessments
(ADOS-2: Autism Diagnostic Observation Schedule, Second Edition; VABS-3: Vineland Adaptive Behavior Scales-3; Griffiths III: Griffiths Scales of Child Development, Third Edition; JERI: Joint Engagement Rating Inventory; PSOCS: Parent Sense of Competence Scale; PSI-SF: Parenting Stress Index-Short Form; CSQ - Caregiver Strain Questionnaire; SRS-2: Social Responsiveness Scale, Second Edition; S2K: SenseToKnow mobile app; -t1: Pre-randomization; 0: Baseline Assessment; t1: Intervention delivery; t2: Repeat Assessment – Proximal outcome; t3: Repeat Assessment – Distal outcome; t4: Repeat Assessment – Proximal; tx: close out)
Fig 2.
Fig 2.. EPIS constructs to identify implementation determinants for scale-up
Fig 3.
Fig 3.. Flow diagram of participant enrolment, group allocation, and follow-up of the individually randomized group treatment RCT with delayed intervention control
See this image and copyright information in PMC

References

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