Outcomes of the World Health Organization’s Caregiver Skills Training Program for Eritrean and Ethiopian parents of autistic children in the United States

Autism intervention research has not adequately addressed the needs of Black autistic children and their families, particularly those who are also immigrants to the United States. The World Health Organization designed Caregiver Skills Training (CST), a parent-mediated intervention intended to improve child social communication and behavior, to fill in the global gap of services for caregivers of young children with autism and other neurodevelopmental conditions. While CST has been implemented in Ethiopia, it has not been evaluated for Ethiopian and Eritrean immigrant families in the United States. This single-arm pilot study of CST investigated pre- and post-intervention changes in parent and child outcomes within a sample of 25 mothers of autistic children (ages 2-9 years) in Maryland, Washington, DC, and Virginia. Eritrean and Ethiopian facilitators delivered CST remotely to five parent groups. We used Wilcoxon signed-rank tests and found statistically significant improvements in parents' knowledge, skills, self-efficacy, depression, and empowerment, as well as child communication, sociability, and sensory/cognitive awareness. There were no statistically significant changes in parents' anxiety, stress, and coping, nor some subscales of the empowerment and child outcome measures. We conclude CST is a promising intervention for Ethiopian and Eritrean immigrant families in the United States. Randomized controlled trials are needed to confirm study findings.Lay abstractAutism intervention research has often not included Black autistic children and families, including those who are also immigrants to the United States. The World Health Organization designed Caregiver Skills Training (CST) because there are not enough services for caregivers of young children with autism and other neurodevelopmental conditions. CST is an intervention in which parents receive information on how to support their own and their children's needs in nine group and three individual sessions. While CST has been adapted and piloted in Ethiopia, it has not been evaluated for Ethiopian and Eritrean immigrant families in the United States. In this study, five groups with a total of 25 mothers of autistic children (ages 2-9 years) all received CST from Eritrean and Ethiopian facilitators on Zoom. The participants completed surveys about themselves and their autistic children before and after they completed CST. We found that parents' knowledge, skills, self-efficacy, depression, and empowerment, as well as their children's communication, sociability, and sensory/cognitive awareness improved after they completed CST. We did not find changes in some areas we measured, such as parents' anxiety, stress, and coping. We believe that CST might be a promising intervention for Ethiopian and Eritrean immigrant families in the United States. We recommend that more research should be done to confirm what we found in this study.