1. Developing a Parent Skills Training Program for Non-Specialists in Low and Middle income countries
Stephanie Shire
University of California Los Angeles
ABAI Autism Conference 2016
New Orleans

2. Overview Development of PST PST Core Targets
Regional Master Trainer Workshop
What we Learned from the Workshop
Next Steps

3. 1- Development of Pst

4. Development of PST

5. PST Network Meetings Expert Meeting WHO, Geneva June 2014
April 2015
(in photo)
Developed with the Global Community in Mind and Enhanced by Local Adaptation

6. Program Delivery Structure
Caregivers & Children
Non-Specialist Facilitators
Country Master Trainers
WHO PST Team

7. PST will serve: Caregivers and their children age 2-9
Autism and Developmental Delays
No diagnosis required
Living in low resource settings

8. 2- PST Core Targets
Program Content

9. Session
Topic
Home 1
Meet and Greet- Observation and Discussion
Group 1
Introduction and Basic Strategies
Call
Check in and Help
Group 2
Establishing Play and Home Routines
Group 3
Communication 1
Group 4
Communication 2
Home 2
Practice Play and Communication Strategies
Group 5
Preventing Challenging Behaviour 1
Group 6
Preventing Challenging Behaviour 2
Group 7
Preventing Challenging Behaviour 3
Group 8
Problem Solving and Keeping it Going
Home 3
Practice and plan

10. Where Does the Content Come From?
Components from existing practices with their own base of evidence
Joint Attention, Symbolic Play, Engagement and Regulation (JASPER: Kasari et al., 2008; 2010; 2012; 2014; 2015)
Pivotal Response Teaching (PRT: e.g., Koegel & Koegel, 2006)
Discrete Trial Teaching and Positive Behavior Supports (e.g., Bearss et al., 2015)

11. Core Targets Engagement Social Communication Challenging Behaviour
Focus on children’s initiations

12. Engagement Why Joint Engagement?
Coordinate attention between a person and an object
Associated with gains in language (e.g., Kasari, Paparella, Freeman, & Jahromi, 2008)
Picture 2 on the left will be an embedded video “Coordinated Joint Engagement”

13. How to Target Engagement
In PST:
Routines (play and home)
Getting face to face
Focus on following in
Motivating activities
Picture 2 will be an embedded video (“Book Routine”)

14. Social Communication Why Social Communication?
Functional communication system
Prelinguistic and Spoken
Efficient and effective
Get needs met
Express ideas

15. How to Target Social Communication
In PST:
Responding to children’s communication
Imitate and expand
Talk about the child’s focus of attention
Include both requesting and sharing

16. Challenging Behaviour
Why Challenging Behaviour?
More time available for learning
Natural decreases when engagement & communication skills increase
Byproduct of engagement and communication increases
Plus ABCs
Plus prompt hierarchy

17. How to Target Challenging Behaviour
In PST:
Get kids engaged and communicating
Routines
Praise
Visual schedules
ABCs of Behaviour

18. 3- Regional training
Clinical Support and Training

19. China Regional Master Trainer Workshop
GuangzhouSept 2015
Roles
-Doctors (12)
-Research (3)
-Teacher or therapist/clinician (3)

20. Regional Training: Goals
Discuss
Content and instructional methods
Cultural adaptation
Practice
Strategies
Group activities
Live supported practice with children and caregivers
Coach
Practice coaching facilitators

21. 4-What we Learned

22. MT Feedback: PST Content
What we learned from Master Trainers:
Topics
Frequency
MOST
Challenging
Behaviour Management 12
Communication 4
Play 2
Not exhaustive- most frequent answers
Topics
Frequency
LEAST Challenging
Introductory session 7
Teaching a New Skill 4
Keeping it Going/ Self Care 2

23. MT Feedback: PST Teaching Methods
Teaching Activity
Frequency
Most Challenging Activities
Discussion 7
Live Practice 6
Video Feedback 4
Demonstration
Teaching Activity
Frequency
Most Beneficial Activities
Live practice with child 10
Role Play 7

24. 5- Next Steps

25. Global Program with Local Adaptation
Initial Meeting Prior to Regional Workshop
Preparation and adaptation
Preliminary translation
Troubleshoot barriers
Map the regional workshop
Expand Participation
Families and Facilitators
Extend Duration
Add a 5th day

26. Clinical Support
Feedback highlights need for live practice and coaching
How will we do this?
Increase this focus during regional workshop
Plan distal clinical support

27. Autism Speaks WHO Team PST Chiara Servili Andy Shih Shekhar Saxena
PST Consultants (Felicity Brown, Laura Pacione, Erica Saloman)
Autism Speaks
Andy Shih
Lucia Murillo
Kara Reagon
Technical Workshop Participants
PST Network Workshop Participants
Program Reviewers