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Improving Diagnostic Capacity for Autism Spectrum Disorder in a Developing Country: A Model Public/Non-Governmental Organization (NGO) Partnership Program
Accurate identification and treatment of autism spectrum disorder is considered a critical public health challenge even in well-resourced communities. In a developing country, the ability to actualise better services is further limited by resource challenges regarding funding, management support, political support, infrastructure constraints, and the limits of human resources. While clinical practice recommendations for identification/diagnosis of ASD support the use of structured/standardized tools, these tools and supportive training opportunities for use are often lacking with limited financial support available across resource strained public health systems. The current project utilized external funding support from a NGO to train professionals within the public health system to utilize standard tools for screening and diagnosis of autism.
Objectives:
We studied the impact of a NGO sponsored training in altering practice within the public health system for physicians, psychologists and therapists.
Methods:
In April 2015, a local Rotary Club, a Child Health Department of a tertiary institution, a Community Paediatric team in a Regional Health Authority (RHA) and the Training Department of the RHA came together to host training in specialised tools used for screening and diagnosis of Autism (Screening Test for Autism in Toddlers, STAT, Autism Diagnostic Observation Schedule-2, ADOS-2). In parallel a steering committee comprising all stakeholders was formed to discuss impact, use, and future directions. The project funded by the Rotary Club sponsored formal ADOS-2 and STAT training by a certified trainer from an external U.S. based university. The Training department of the RHA and the Rotary club worked together to oversee the administration of the project. The training was carried out in a public teaching hospital. Professionals trained included doctors, psychologists and therapists.
Results:
23 professionals comprising 2 child psychiatry and 2 child development services within the public health service received ADOS-2 training. 42 professionals representing all 5 RHAs received STAT training. In the year following training, some 42 ADOS-2 assessments and 75 STAT assessments of young children were conducted within the public health system with 3 out of 5 represented regional health authorities (RHA) incorporating use. In addition, the NGO investment led to an additional joint partnership supporting provider training in an evidenced-based parent training program. Subsequently, within the calendar year following training 60% of RHAs held parent training sessions for local families.
Conclusions:
In keeping with the United Nations mandate for upgrading services for Autism this Public/NGO partnership has served to bolster our capacity in a developing country. Given the constraints, financial and otherwise, this type of partnership may the way forward in developing countries. While the partnership has bolstered capacity and spurred additional collaborations, further supports and strategies beyond just provision of training and instruments is necessary to achieve wide-scale systems change and improvements in care within developing countries.