Abstract
Globally, 52.9 million children under the age of 5 experience a developmental disability, such as sensory impairment, intellectual disability, and autism spectrum disorders. Of these 95% live in low-and-middle-income countries. Most of these children lack access to care. In light of the growing evidence that caregivers can learn skills to support their children’s social communication and adaptive behavior and to reduce their challenging behavior, the World Health Organization developed a novel Caregiver Skills Training Program (CST) for families of children with developmental disorders or delay to address such treatment gap. This report outlines the development process, content, and global field-testing strategy of the WHO CST program. The CST program is designed to be feasible, scalable, and adaptable and appropriate for implementation in low-resource settings by nonspecialists. The program was informed by an evidence review utilizing a common elements approach and was developed through extensive stakeholder consultation and an iterative revision process. The program is intended for a global audience and was designed to be adapted to the cultural, socioeconomic, geographic, and resource context in which it is used to ensure that it is comprehensible, acceptable, feasible, and relevant to target users. It is currently undergoing field-testing in more than 30 countries across all world regions.
Highlights
Around 250 million children, or 43% of all children younger than 5 years, in low- and middleincome countries (LMICs) are at higher risk of not reaching their developmental potential due to stunting, poverty, and disadvantage [1]
In 2016, it was estimated that globally 52.9 million children younger than 5 years experienced a developmental disability, such as sensory impairment, intellectual disability, and autism spectrum disorders, and 95% of them lived LMICs [2]
The program is based on the assumption that caregivers of children with developmental disorders or delays can and should be supported in both tapping into their existing competences and developing new skills that can foster their child’s learning, social communication, and adaptive behavior
Summary
Around 250 million children, or 43% of all children younger than 5 years, in low- and middleincome countries (LMICs) are at higher risk of not reaching their developmental potential due to stunting, poverty, and disadvantage [1]. To this end, during the first home visit, the nonspecialist provider works jointly with each family to identify two “target routines” (semistructured opportunities for learning and development, as explained below) that match the interventionist’s observations about the child’s needs and developmental level, while meeting the family’s priorities and daily activities These target routines are regularly revised during the program to ensure that they continue to be appropriate. The evidence-based principles illustrated above are taught to caregivers using accessible language as key messages (general psychoeducational messages about developmental disorders and delays) and tips (hands-on strategies and skills for interacting with the child) The latter are shown during the group sessions through adult-learning techniques such as group discussions, modeling, and guided role playing (Table 2). Since fidelity of implementation is key to optimal child outcomes [41,42,43], the WHO CST Team encourages the assessment of fidelity in all phases of field testing
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