What works and how: Adult learner perspectives on an autism intervention training program in India

Flexible and blended

Trainees benefited from a blended format of online and face-to-face teaching and supervision. The modular framework and opportunity for online supervision enabled full-time professionals from different parts of the country the flexibility to practice and learn simultaneously. One trainee from Goa said,

To go out for three months at a stretch would have been impossible. The fact that it was for 6 days at a time … was very appealing for me. I would learn for six days and then come back and practice it … go back to supervision. Another thing that really appealed to me was the fact that there were supervision sessions … they could be video- skyping me while I work with the kid and I talked about it to my supervisor.

Immediate transfer of learning

This format of the program also allowed participants to directly implement the strategies they had learnt at their own work situations. In the words of one of the trainees,

What I liked about the program is that it was planned in such a way that when we went back, we had some 2 and a half weeks to work extensively with the child and come up with some of the issues we were facing.

Participants found this structure and design helpful because it helped them identify strengths and gaps in their own learning that could then be addressed during supervision. An occupational therapist from Mumbai articulated initial challenges that were addressed through supervision:

Initially when it started it was a little overwhelming … because I was a little mixed up with is this is this DTT ¹ , is this PRT ² … but gradually when I came back to my workplace and I started working is when I realized that it happens quite smoothly, and we move from this to that easily.

Respectful

The adult learners in the study valued a respectful stance demonstrated by their supervisors toward their prior learning, experiences, and needs. Such an approach enabled the creation of a mutually respectful relationship among equals, rather than one based on hierarchy or power. An occupational therapist shared her experience of supervision:

Through the sessions there was a lot of respect given to the professionals or the fields they came from. We are not students at all … we felt like ok we are doing good work. It’s just probably little bit extra which might help us.

Non-judgmental

Trainees unanimously spoke of a supervisory approach that was flexible and non-judgmental. One of the trainees felt that this climate of acceptance in supervision allowed her to explore her own journey of learning without the fear of making mistakes, “Nobody is judging me, and I can make mistakes and it’s ok to make mistakes.” Others identified transformative experiences in supervision where moments of critical reflection were stimulated, “… (there were) places where I had aha moments, they made me re-think, re-evaluate my structure, my knowledge about what I know.”

Responsive

Supervisors were seen as accessible, approachable, and supportive. Responsiveness came up as a highly valued supervisor quality in numerous narratives. Trainees felt positively about the fact that their needs and queries were immediately addressed. One of the participants remarked,

They were very proactively there, giving feedback, and we discussed everything. I was very confused whether I should do it in a way or not do it, and how do I do it and immediately she boosted my confidence up there. They would constantly keep us going, keep us motivated.

Participants were also asked to list limitations that they experienced during the program and offer suggestions for improvement. One participant felt that the modules packed in a lot of content which could often become overwhelming. Another indicated that the course did not focus enough on working with adolescents and high-functioning children on the spectrum, while one participant cited the need to shadow more senior clinicians in practice. Poor Internet connectivity was an occasional challenge to optimal supervision quality, especially for trainees who attended supervision over Skype. Three of the local trainees also commented on how it was difficult to take time off from busy professional schedules to meet supervision commitments, useful as they were.

Overall, participants’ responses suggested that teaching and supervision that were grounded in andragogical principles and responsive to the needs of adult learners translated into an empowering learning climate. This andragogical approach was experienced as transformative, and participants linked it to a significant impact on their practice.

Clinical assessment

Participants highlighted that the program facilitated maturation in their process of assessment and gathering comprehensive information to set goals, through usage of the forms and checklists provided in the program as well as through skills in prioritizing areas of work/need with families. For example, one participant described a change as follows:

If parents would come and tell me that these are the issues, I would try to work on all of them. But now I don’t do that. I pick up a specific goal, I break it down and I work according to it. So definitely that is something that has changed post AITP.

Reflecting on the impact of undergoing the training, one of the participants lucidly described, “I feel hugely empowered. I feel so equipped that I have started working with a child who is not part of [organization name] at all, on my own. That kind of confidence I have.”

Interventional approaches

A major part of the impact of AITP for participants was in increasing knowledge and skills of different evidence-based interventional approaches for ASD. According to one of the participants,

When they started with DTT, PRT, developmental, I did not know the core names or theory behind it. I would just try things, from what I knew, what the parents told me. Now I have back-up knowledge of when do you use it, why do you use it.

Several participants discussed how the program taught them how to individualize an approach:

… it would strike me that this same strategy is working with a particular child, but why is it not working with the second child? Then I did my AITP program, I learnt that you need to start where the child is and you have to work out what the child likes, and not what you want to do.

Shift in clinical approach

Participants described changes to their overall process of working and holistic changes in their thinking. For many of them, this specifically meant adopting a child-friendly and family-centered perspective. Some participants traced a shift from an earlier professional-directed approach that focused on “making them [children with autism] do things” to a more child-led approach that worked with the child’s interests, likes, and dislikes. A behavior therapist working at an organization in Goa traced the change in his approach post the AITP program:

… the procedure was that if they could not sit on the table and do the activity, they would have to use physical prompting to force them to sit on the chair and force them to do activities … there was no messing around, that they have to come and they have to sit eventually.

Learning about play was fantastic … my therapies are now child-led, family-centered. There’s no physically forcing my kids to do anything. It’s getting them engaged, getting them to play, communicate, imitate, all by just using child-led techniques.

Participants also described process changes in the way they worked with families, specifically in becoming more sensitive to their needs, involving families to a greater extent in therapy and their own movement from an expert position to a more collaborative role. As one of the participants shared, “I am okay with understanding that parents need respite, I think I have become more accepting and humble.”

Other participants discussed taking into account concerns and desires of the family in conducting an intervention rather than adopting an authoritative, expert position:

Before, I would never ask them what they want to teach their child. It would always be, I feel this is what your child needs to learn, you have to go back and do it. Now I ask them what they want to teach their child.

Transfer of knowledge to others

Several participants described how they used their newly enhanced knowledge and skills to share learning with colleagues at their parent organizations, either informally or through formal trainings. In the words of one of the participants, “After each module I came back to my organization and had a detailed, almost a 2 hour workshop where I tried to follow the way you all have shared, and my colleagues participated.” Others described more informal ways of sharing their learning, such as through helping colleagues when they had difficulties in sessions, informal conversations, and giving them resource material. Transfer of knowledge was not merely restricted to colleagues in parent organizations but also other beneficiaries such as parent groups and teachers.

Shift in approach to service delivery of the organization

Participants unanimously described a shift in approach toward service delivery across the organization, which seemed to be facilitated by AITP. Multiple participants spoke about specific ways in which their colleagues had begun to adopt a more child-friendly and functional approach. One participant, a professional at a 150-employee wide organization, mentioned a change in her organization as follows, “I see them definitely now following the child’s lead- that is something which has happened.” Willingness to implement new strategies was noted among other colleagues. One participant, a special educator at a mainstream school, elaborated, “The most important thing is that, teachers are on board and now they come and say ‘I cannot understand this, please come to my class and show me how can I implement this strategy’, which is amazing.”

Expansion and increased utilization of organizational services

A combination of processes such as transfer of knowledge, reorganizing spaces, and approach shifts catalyzed the expansion of services offered for ASD by individuals and their organizations. One of the participants mentioned that a second unit of her center had started services for children with ASD, whom she was mentoring. Another participant, like several others, reported an increase in caseload, which she was able to take on because of increased confidence in being able to work effectively with children on the spectrum:

Before AITP, I had about 4-5 kids and now it has gone to 10 … Initially also, I would get cases with autism, but I would get a little overwhelmed and I would tell them that I won’t mind if we refer the kid out. Now I am very consciously ready and well equipped to take on the kids.

The improvement in quality and expansion of services at organizations encouraged utilization of services by families. One participant, a special needs teacher at a mainstream school, described an unprecedented increase in the number of new admissions of children with special education needs:

The trust of the parents, the image of the school has grown by leaps and bounds. We are now known in the circle, we are the top school spoken about in terms of inclusive education. Normally, a parent comes up and says ‘From X source, we heard that you are doing a fantastic job with the children in the school setup,’ which is a very humbling appreciation.

Developing skills in children

Participants described how children who came to them for therapy progressed in their development of specific skills. Several participants described how parents noted improvements in speech and communication, a primary deficit area for children with ASD. As one of the participants shared, “… the parents come and say that the child looks more attentive, the child seems a lot more active, the child is sitting and doing this work for this amount of time.” Others described changes in functional skills for children, such as learning to travel independently by public transport. Some therapists also saw a decrease in the amount of time required to see a positive change, from months to weeks.

Impact on families

Participants felt better equipped to help parents acquire new knowledge and skills, such as using fewer words and waiting longer for children to respond, that in turn helped them to understand and engage with their child better. This, coupled with children’s own enhanced skills, strengthened the connection in the family. One participant described a powerful moment emerging out of teaching a specific intervention technique to a parent:

During one parent teacher interaction, I did a ten minute demonstration of Dawson’s imitation with two-three parents. One of the parents came up to me and said, “My child has never imitated me. Can you teach me?” She learnt it and did it in front of me-and her 12 year old looked at her for the first time. It was a very emotional moment.