Providers’ Perspectives on Autism Service Access in the West Bank: an Application of the Three Delays Model

Abstract

Little is known about autism service barriers in the West Bank. The current study elicited the perspectives of Palestinian service providers (n = 7) at West Bank agencies serving children with autism and other special needs. Data were analyzed using qualitative grounded theory methods. Using the Three Delays Model as an organizing framework, we identified complex, interrelated themes related to children’s access to autism services. Providers reported stigma, gender-based caregiving disparities, and social isolation increased family burden and impacted parents’ willingness to seek services. However, once parents sought professional assistance, they often faced a second delay of economic and physical barriers to reach disability service agencies. Themes related to the third delay, the quality of services, were the most commonly reported and included nonexistent screening practices, inappropriate diagnostic procedures, limited availability of autism-related therapies and other services, and insufficient service coordination and staff training. Additionally, providers reported children with autism were routinely denied access to schools, exacerbating stigma and other challenges faced by these children and their families. Our findings suggest improvements in provider training and overall autism service quality will positively impact parents’ willingness to engage in services and build family-provider partnerships. Eliminating educational barriers can potentially create opportunities to improve overall service quality. Providers offered suggestions to decrease the impact of delays relating to physical barriers such as military checkpoints, including increasing community-based and in-home services. Other novel applications of the Three Delays Model to frame barriers to disability services in resource-poor regions are discussed.