Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial.
South African school staff will soon test whether twelve short NDBI caregiver visits beat usual preschool services for kids with autism.
01Research in Context
What this study did
Franz et al. (2024) wrote the recipe for a big South African trial. They will train regular Department of Education staff to coach caregivers of preschoolers with autism.
Each family will get twelve one-hour sessions of NDBI coaching in homes or clinics. The trial will compare this group to families who keep getting the usual services.
Results are not in yet; the team will track kids’ social communication and how well coaches stick to the manual. Final numbers are expected in 2027.
What they found
This paper only describes the plan; no child outcomes are reported. The authors show that school staff, not outside clinicians, can be the coaches.
How this fits with other research
Vassos et al. (2023) already showed Project ImPACT parent coaching lifted language and play in Zambia. Franz keeps the same low-cost, task-shared spirit but adds an RCT design and uses South African education workers.
Bao et al. (2017) proved parents can master the Social ABCs script in 12 weeks and boost toddler vocal bids. Franz keeps the 12-session dose but shifts who does the teaching—from parents alone to education staff coaching parents.
Tonge et al. (2014) ran a South African parent-education RCT and saw gains in adaptive skills. Franz updates that model by replacing general education with a specific NDBI coaching package.
Swain et al. (2025) warn that caregiver behavior change is the real lever inside NDBI trials. Franz’s protocol tracks coach fidelity and parent strategy use, aligning with that mediation insight.
Why it matters
If the trial wins, you will have a ready-made way to use existing school staff for caregiver coaching. No new clinicians, no big budget—just twelve structured visits you can drop into public preschool services. Start thinking now about which teachers or early-grade aides you could train if the 2027 data look good.
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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. NCT05551728 in Clinical Trial Registry (https://clinicaltrials.gov).
PLOS ONE, 2024 · doi:10.1371/journal.pone.0291883