The World Health Organization has recognised Autism Spectrum Disorder (ASD) as a public health concern and have recommended access to appropriate assessment and interventions. Psychoeducation and parent support soon after diagnosis are considered global best practice. Parent Education & Training (PET) programmes provide education, skills and support to parents. Despite the high need for PET there has been limited research in this field and few programmes are available, particularly in low- and middle-income countries (LMIC). This project aimed to 1) evaluate the evidence-base for a UK-developed PET (EarlyBird/EarlyBird Plus); 2) evaluate the evidence-base for a broader range of PET; 3) generate a framework for evaluating global PET programmes; 4) conduct a comparative feasibility study of two PET programmes in South Africa. The EarlyBIrd/EarlyBird Plus scoping review identified a low level of evidence for the efficacy of the PET, and showed that relatively little implementation science examination of the programmes had been performed to date. Review of a broader range of PET showed very similar findings, suggesting that the field of PET (rather than any specific intervention) was still relatively immature. We proceeded to use an implementation science and participatory approach to generate a multi-stakeholder evaluation framework for PET in future studies. A mixed-methods quasi-experimental design was then used for a comparative feasibility study of two PET in a low-resource South African setting. In the feasibility study parents/carers found both programmes to be acceptable and adaptable for a South African context. Limited efficacy-testing showed positive outcomes for parents, children and families. Application of the Evaluation Framework proved to be a useful structural technique to identify the strengths and weaknesses of PET across the implementation themes of outcomes, processes & procedures, and implementation landscape. Taken together, our results highlighted the relative infancy of this important field of ASD research and identified the need for multi-site, randomized controlled trials of PET, particularly in low-resource settings. In addition, results underlined the importance not only of efficacy of programmes, but of a range of implementation-related factors, that are crucial to ensure sustainable and scalable PET in real-life settings around the globe.

Introduction: Implementing low-intensity interventions, such as group-based parent education and training (PET), is a cost and time effective way of providing early intervention for families and their children with autism spectrum disorder (ASD) in low- and middle-income countries (LMICs). Relatively little empirical research demonstrates the effectiveness of parent education and training in this context. Methods: The study aimed to develop and pilot a group-based parent education and training (PET) programme (COMPAS) and determine its appropriateness and acceptability. Secondly, it aimed to investigate the clinical effectiveness of the programme to improve the communication interaction skills and self-efficacy beliefs of parents of young children with autism. The study followed an exploratory sequential mixed methods research design and used the Replicating Effective Programs (REP) framework. Sixty-one participants took part in the study which consisted of 3 phases. In phase one we developed the programme and teaching materials and activities. In the pre-implementation phase, we collected qualitative and quantitative data via questionnaires from two stakeholder groups (25 parents and 5 autism experts). In the implementation phase, we used a single group pre-test post-test design with 31 parents of children with autism to determine changes in parent-child interaction and parenting self-efficacy. The primary outcome of the implementation phase, parent-child interaction, was measured using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO), and the secondary outcome, parenting self-efficacy, was measured using the Parenting Sense of Competence Scale (PSOC) and the Parenting Self-Efficacy Measuring Instrument (P-SEMI). Results: In the pre-implementation phase, a panel of experts agreed the training content was comprehensive and relevant, and that the manual was user-friendly. After the pilot study parents felt confident that they could use at least one of the strategies taught during everyday routines or play with their child. Results from the implementation phase indicated significant improvement in parenting interactions (p < .05, d = 1.26) and self-efficacy (p < .05, d = 0.35) after the training. Conclusion: We developed and piloted a training programme in a LMIC setting which resulted in increased interaction skills and self-efficacy for parents of young children with autism. This study indicates that brief, group parent education and training in a LMIC is feasible and can be effective in improving parenting skills and feelings of competence.