Adapting the Who Caregiver Skills Training Programme for Implementation in Ethiopia

Background: The World Health Organization (WHO)’s Caregiver Skills Training Programme (CST) for caregivers of children with developmental disorders (DD) aims to teach caregivers strategies to help them support their child’s development and learning. The programme consists of nine group sessions and three home visits and can be delivered by non-specialists to suit low-resource settings. Ethiopia has a shortage of trained health personnel and severe lack of service provision for children with DD and their families (Tekola et al., 2016); the CST may be able to address this unmet need.

Objectives: Explore the perspectives of caregivers, professionals and other stakeholders to inform adaptation of the WHO CST to the Ethiopian context and culture.

Methods: Four different types of consultations were conducted: i) Stakeholder meetings were held in April 2015; July 2015; August 2016 and August 2017 soliciting input from local psychiatrists, psychologists, Non-Governmental Organisation representatives, and parents of children with DD. The first two meetings focused on local training needs and programme delivery considerations; the third meeting included draft CST training materials, allowing for targeted feedback on programme delivery and content; the forth meeting focused on implementing the programme in rural settings; ii) in August 2016 all draft CST materials were reviewed in detail by the research team; iii) during a Training of Trainers workshop in May 2017 feedback on CST content, length and intensity was received from Ethiopian Master Trainees; iv) two Theory of Change (ToC) workshops (de Silva et al., 2014) were conducted with professionals in Addis Ababa and community stakeholders in rural Sodo to map out how to implement the CST in rural Ethiopia.

Results: The participants of all consultations agreed that the CST programme addresses an urgent need and is relevant to the Ethiopian context. For the programme to be effective, acceptable and feasible in Ethiopia, several recommendations were made: i) there is a need for greater emphasis on psychoeducation, stigma, parental feelings of guilt, and expectations of a cure; ii) in light of context-specific beliefs on parenthood, the training should more strongly highlight the role caregivers can play to support their child’s development; iii) consider the wider family context (e.g. grandparents) who may be able to support the child but could also be a barrier to progress if they resist the training; iv) some materials were too complex for caregivers with limited education. The stakeholder meetings and the ToC workshop in Sodo also highlighted the need for a community-based approach: The CST programme needs to be embedded into wider community initiatives to raise awareness about DD and reduce stigma, and needs embedding in a broader care framework, including referral pathways to other health services (e.g. for comorbid physical problems). A Theory of Change map was constructed showing the underlying pathways and the prerequisites and interventions needed to allow the CST to achieve its impact.

Conclusions: The WHO CST programme addresses a need in Ethiopia, but socio-cultural and contextual adaptations are likely to increase its relevance and impact. An adapted CST is currently being piloted in Ethiopia.