Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial
A South African team is testing whether 12 sessions of caregiver coaching, led by local preschool staff, beats usual care for 150 toddlers with autism—results pending.
01Research in Context
What this study did
Franz et al. (2023) wrote a plan for a big test in South Africa. They will train 150 caregivers of two- to four-year-olds with autism.
Local preschool staff, not autism experts, will give 12 coaching sessions. The team will compare this new help to the help families already get.
What they found
There are no results yet. The paper only tells us how the study will run. We have to wait until about 2027 for answers.
How this fits with other research
Malucelli et al. (2021) in Turkey saw gains after 12 weeks of parent coaching. ACACIA copies the 12-session dose but swaps hospital staff for community coaches.
Geoffray et al. (2025) ran a large European test of a similar toddler program and saw no added benefit. ACACIA hopes that using cheaper, local coaches will beat this null result.
Kaiser et al. (2022) showed Black US families felt stronger and happier when cultural healing was baked into parent training. ACACIA extends this idea by shaping the same kind of cultural fit for South African families.
Why it matters
If Franz’s team shows that everyday preschool workers can coach caregivers and lift child skills, you could copy the model in any low-resource area. Watch for the 2027 data before you redesign your own parent program, but start thinking now about who in your community could play the coach role.
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02At a glance
03Original abstract
While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world’s children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18–72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. Participant enrolment started in April 2023. Estimated primary completion date is March 2027. The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators.
medRxiv, 2023 · doi:10.1101/2023.09.10.23295331