WHERE THERE IS NO PEDIATRIC PHYSIOTHERAPIST: A CASE STUDY FOR A SCALABLE TRAINING PROGRAM FOR LAY INTERVENTIONISTS IN NORTHERN CAMBODIA

R. Crockett¹, K. Clark², S. Luy¹

¹Safe Haven, Intervention, Siem Reap, Cambodia, ²Safe Haven, Physiotherapy, Siem Reap, Cambodia

Background: Following the decimation of medical services during nearly 3 decades of war, Cambodia relied on multiple levels of physiotherapy/rehabilitation education and training (1). Currently, Cambodia has a severe shortage of physiotherapists– 0.18/10,000 population compared to 3.9/10,000 population in the world (2) – and no Occupational or Speech Therapy schools in the country. Of practicing physiotherapists, very few work in rural areas or the multidimensional field of childhood development. Responding to this unmet need, pediatric interventionists were trained on the job in one small Cambodian organization to work with children with disability and developmental delay.

Purpose: To scale up a 1-year training program for entry-level pediatric interventionists to identify and provide therapeutic care for children with disability and developmental delay in rural Northern Cambodia.

Methods: Safe Haven, a small NGO based in Siem Reap, Cambodia partnered with the Cambodia Integrated Early Childhood Development (IECD) Activity to train 4 lay people for 1 year to become pediatric interventionists(4).
Beginning December 1, 2021, training activities (approximately 20% lecture, 80% experiential) included the Cambodian Developmental Milestone Assessment Tool (cDMAT) and Stimulation Guide (5) as well as technical English language skills to help access disability resources and international trainers. Experiential learning consisted of rural field visits with the Safe Haven multidisciplinary team, for individual and group family sessions. Trainees began by observing sessions of experienced Safe Haven interventionists and gradually leading treatments with less support, measured using a quantitative Skills Checklist. Entry-level interventionists are defined as scoring 100% on all priority items of this checklist for a caseload of 25 clients.
Upon completion of training, the 4 interventionists will move to work in two northern Cambodia provinces, with a total population of 936,376 (6), currently served by 1 physiotherapist. Ongoing individual supervision and group training will consist of monthly meetings and quarterly in-person training for continued skill development. Safe Haven will then repeat the training program for a second cohort of 4 trainees.

Results: Four people were hired including 1 from one of the target provinces; 3 men/1 woman, ages 26-31. All 4 earned a high school diploma; 2 have university diplomas in fields unrelated to children or disabilities. One previously worked as a Special Education assistant, and one has a physical disability.
With 80% of the IECD training complete, the trainees are treating and completing visit documentation independently for at least 15 clients. Trainees are completing assessments at 50-100% skill proficiency, including all 4 domains of the cDMAT.

Conclusions: Preliminary results suggest that by the end of a 1-year, full-time didactic and experiential Interventionist training program, 4 lay people are on track to score 100% on all priority training activities and be independent in identifying and providing entry-level intervention for children with disability or developmental delay.

Implications: In countries where professional rehabilitation education cannot meet the demand, scalable, thorough training models are necessary to create a supply of entry-level, pediatric rehabilitation workers who can provide needed services to children with disability and developmental delay.

Funding acknowledgements: The Cambodian IECD Project is implemented by Research Triangle Institute and funded by the United States Agency for International Development.

Keywords:
Pediatric rehabilitation
Laypeople training

Topics:
Community based rehabilitation
Education: clinical
Paediatrics

Did this work require ethics approval? No

Reason: Ethics approval was not required because this abstract describes an innovative way in which a thorough, laypeople training program was scaled up to meet the great need for pediatric rehabilitation workers in rural Cambodia. Regardless, the organization's Executive Director, representing the Board of Directors, and the Country Director representing staff have written a letter of support, declaring adherence to the highest level of ethical values by staff in all areas of practice.