Sustaining Community Implementation of a Caregiver-Mediated Intervention- Learnings From the WHO-Caregiver Skills Training in India.
Caregiver coaching dies when the bus fare runs out—lock it into the local health calendar and train a champion before you leave.
01Research in Context
What this study did
Sengupta et al. (2025) asked 42 parents, trainers, and health officials in India what kept the WHO Caregiver Skills Training alive after the research team left.
They ran focus groups and interviews in four cities.
No numbers, just words: what worked, what broke, and what they wish they had known on day one.
What they found
Everyone loved the program: kids talked more, parents felt confident, and neighbors asked how to join.
But buses were late, fathers worked six days, and centers ran out of toys.
Without a local leader and a public-health slot on the calendar, groups slowly stopped meeting.
How this fits with other research
McCammon et al. (2022) showed a 5-minute self-guided video can teach U.S. parents mand training with no extra staff.
That looks like a contradiction: why can’t Indian parents just watch a clip?
The difference is setting power: U.S. families had stable Wi-Fi and toys at home; Indian families faced shared poverty and long bus rides, so they needed a physical group and a paid local coach.
Mae Simcoe et al. (2018) proved a hospital autism pathway cut stays by 40 % when leadership built autism time into every shift; Koyeli echoes that rule—survival needs a system slot, not just a good curriculum.
Sivaraman et al. (2020) reviewed global telehealth ABA and listed cultural fixes: translate, match trainers, simplify handouts.
Koyeli adds a next step: after you adapt, embed the course inside the city health calendar so the next budget line keeps it alive.
Why it matters
If you coach caregivers anywhere with thin resources, copy the WHO-CST lessons: start with a local champion, schedule booster meet-ups inside existing clinics, and hand the toy bag to the city health office so they own the supply line.
Do that on day one, or your beautiful program will fade the day the grant ends.
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02At a glance
03Original abstract
PURPOSE: The World Health Organization's Caregivers Skills Training (WHO-CST) program has been culturally adapted and implemented across diverse low-resource regions as options to promote developmentally disabled children's development. However, beyond initial feasibility and acceptability, little is known about the long-term sustainability of the program in lower-middle income countries, such as India. The current study explored stakeholders' experiences of sustaining implementation of the WHO-CST in India. METHODS: Twenty-eight semi-structured interviews were conducted with organizational heads (n = 9), course facilitators (n = 10), and caregivers of children with developmental disabilities (n = 9). Participants had engaged with the WHO-CST across 10 community-based organizations. Using an iterative and inductive qualitative method, four overarching themes were generated. RESULTS: 'Bridging the Gap' recognized ways in which stakeholders gained knowledge and skills. 'Always about Logistics and Time' acknowledged the existing implementation hurdles, while sustainability was promoted by 'Support and Investment' in local adaptations and strategic resource allocation. 'Nothing, Nothing was in Vain' revealed that, irrespective of current implementation status, the WHO-CST has positively impacted communities. CONCLUSION: Despite its positive reception, long-term sustainability of the WHO-CST program remains a challenge in India. For the WHO-CST to sustain and have an enduring impact, there is a necessity for phased training approaches, systemic capacity building, integration within large-scale public health systems and enabling policy shifts to enhance long-term viability and accessibility.
Journal of autism and developmental disorders, 2025 · doi:10.21037/pm.2019.08.02