Impact of Training Program to Treat Children with Autism in the Brazilian Public Health System

Background: Autism Spectrum Disorder (ASD) affects different areas of the global development of the individual, primarily socialization, behavior, sensory functions and language. Due to the complexity and variability of clinical settings, professionals working with children with ASD need to receive specialized training.

In Brazil, the Unified National Health System provides universal access to health services for the entire Brazilian population. According to the Brazilian public policy, some services are considered strategic for the identification and treatment of children/adolescents with ASD, mainly the Psychosocial Community Care Center for Children and Adolescents (CAPSi) which are day treatment facilities with multidisciplinary teams. However, recent research has indicated the lack of specialized training for the treatment of autism even in the CAPSI units.

Objectives: to develop, implement and to verify the impact of a training program aimed at professionals working with children with ASD in CAPSis, focused primarily on managing problems of behavior, communication and social interaction.

Methods: Design: quasi-experimental. Site: The public health system of the São Paulo city is organized in five regionals. This study was conducted in four out of five existing CAPSI in the northern regional of São Paulo city. Participants: 14 professionals nominated by the four CAPSis. Training program was composed of six stages (total of 16 hours divide in four meetings): (1) pre-intervention observation; (2) meetings with professionals to assess the topics/main needs to the training program; (3) development of materials for training and evaluation; (4) meetings for the implementation of training; (5) Final meeting for discussion of cases (6) distance supervision. Instruments to evaluate the training program: (1) Knowledge, Attitudes and Practices-KAP questionnaire; (2) Videos and questions; (3) Satisfaction Questionnaire.

Results: In general, this work fulfilled the objective of developing and implementing a feasible training program for CAPSI professionals. About the video evaluation, there were increases in the percentage of correct answers in 11 of the 13 videos used in the evaluation of the training. Regarding the three subscales of the KAP survey, there was an improvement in knowledge questions (p = 0.003) and attitudes (p = 0.050), but this difference was not confirmed in the practice category (p = 0.186). Furthermore, the study participants had a positive reaction to the training, since 100% of them evaluated the training program as excellent or good.

Conclusions: this brief and low-cost training program for the care of children with ASD was shown to be feasible with positive results, taking into account the challenges of the reality of the public health system. Two out of the 13 evaluative videos did not show an increase in the mean score after training and some hypothesis have been raised. Upcoming studies should review them, and make necessary changes for better evaluation.