Implementing Esdm in Africa - Is Caregiver Coaching Acceptable in South Africa and Which Joint Activity Routines Can We Target?

Background:

A small but expanding evidence-base from low-and middle-income countries demonstrates that caregivers can be engaged to deliver early ASD intervention. In caregiver-mediated early ASD intervention, caregivers are taught strategies to embed learning in everyday activities with their child. To date, there are no published studies in sub-Saharan Africa regarding the acceptability of a caregiver coaching approach. In addition, limited African data exist about narratives of joint activity routines between young children with ASD and their caregivers.

Objectives:

In this formative study, we assessed the acceptability of a caregiver coaching approach and examined descriptions of joint activity routines.

Methods:

Focus groups and in-depth interviews were carried out with a lower socio-economic, multi-cultural group of 28 caregivers of young children with ASD in Cape Town, South Africa. In addition, four in-depth interviews with 6 caregivers of children with ASD who received two pilot sessions of parent coaching (1 in-clinic and 1 in-home) were conducted. Data were translated, transcribed, and coded using content analysis.

Results:

Caregivers who received pilot coaching sessions found the approach acceptable and noted that both they and their children had acquired skills as a result. For example, some caregivers noted they were able to use strategies to capture their child’s attention, and reported that their children had gained personal independence/activities of daily living skills such as feeding themselves with a spoon or brushing their teeth. They described low-resourced home environments, with limited living space and access to child play materials. Caregivers reported regularly engaging in joint activity routines with their young children with ASD. Some but not all caregivers routinely joined in play with their child and intuitively incorporated learning opportunities into joint activity routines. Caregivers were aware of child affect and social cues. Multiple child play partners, particularly in sensory social routines, including grandparents, siblings, aunts, and uncles were reported by caregivers. Daily routines that occurred on a regular basis included meal and bath time. Some caregivers noted that their children were aware of steps of the routine and would participate, for example they would help lay the table and say the evening prayer before dinner time.

Conclusions:

Descriptions of joint activity routines and perception of the acceptability of a caregiver coaching approach in South Africa suggest that caregiver-mediated interventions may be feasible in low-resourced South African settings. The challenges of in-home implementation given limited resources, however, require careful consideration.