Identifying the autism spectrum disorder (ASD) at an early age and providing children with appropriate rehabilitation services is crucial for preparing them for an independent life. Caritas Czech Republic (CCR) has been working to provide quality and affordable services for people with ASD since 2015. As a result, the environment for children with ASD and their families in Georgia has significantly improved.
Children with autism spectrum disorder (ASD) and their families in Georgia have been facing various challenges for years. Most of those problems have been related to the early identification of ASD as well as financial and geographical accessability to therapeutic services across the country. One of the main obstacles has been an inappropriate readiness of primary health care (PHC) professionals to identify the risk of ASD and refer children to relevant centers. In addition, the regions have not had the necessary tools for full diagnostics, which is why many parents and children with the risk of ASD had to travel to Tbilisi. A serious challenge has also been the lack of a relevant number of qualified specialists.
Thanks to the financial support from the Czech Development Agency (CzechAid), Caritas Czech Republic implemented a project aiming at expanding and improving the services for people with ASD, as well as professional strengthening of specialists working in the field. Our organization carried out activities with a total budget of up to 255 000 Euros, in close cooperation with Ilia State University’s Child Development Institute and the Georgian Academy of Childhood Disability. The project was elaborated together with the Ministry of Health of Georgia, considering the priorities of the Government of Georgia in the mentioned sector.
Caritas Czech Republic Improved the Quality of ASD Services
Caritas Czech Republic started to improve the environment for children with ASD through educational activities for autism specialists and capacity-building of PHC professionals. With the support of our organization, hundreds of rural doctors were trained to identify the risk of ASD in children. In 2017-2021, Caritas Czech Republic procured and delivered the Autism Diagnostic Observation Schedule (ADOS 2), the so-called golden standard for identifying ASD, to five regions of Georgia. ASD specialists have also been trained on how to use the mentioned tool. As a result, many parents do not have to travel from regions to Tbilisi to diagnose their children.
One of the important components of the project was the provision of quality therapeutic services and approaches to children. Notably, there were not enough qualified specialists to provide Applied Behavior Analysis (ABA) in the regions. The number of supervisors responsible for monitoring provided ABA therapies was also low. With the support from Caritas Czech Republic, Ilia State University’s Child Development Institute trained specialists from the regions in the use of ABLLS-R and EFL tools necessary for the full implementation of ABA therapy and funded 15 specialists to undergo special trainings to become certified supervisors. As a result, not only has the number of qualified specialists and geographical availability of ABA therapy providers expanded, but also the quality of supervision needed for proper therapeutic services has increased.
Diversification of Therapeutic Approaches
The specialists working in the field together with the Ministry of Health of Georgia were emphasizing that the introduction of alternative methodologies to ABA might be more effective in working with children of a particular age or need. In this regard, Caritas Czech Republic introduced two alternative approaches of autism intervention to Georgia – DENVER (Early Start Denver Model) and SCERTS and in 2020, international experts provided trainings for specialists from Tbilisi and regions.
Inclusive Education Component in Kindergartens
Promoting inclusive education in Georgia was another important component of Caritas Czech Republic’s intervention. With this in mind, we have selected three pilot kindergartens across the country (in Tbilisi, Zugdidi, and Telavi) and created a suitable environment for promoting the inclusion of children with ASD in kindergarten activities. With the financial support from CzechAid, our organization equipped the so-called transitional groups for the therapies for children with ASD. In addition, we have provided trainings in inclusive education for teachers of kindergartens and 10 special specialists. As a result, now the state has a ready-made model for inclusive education in kindergartens which can be introduced and implemented in other municipalities throughout the country.
Increased Budget for Autism Programs in Regions
Allocating relevant budget for the involvment of children in municipal autism programs was another very comprehensive issue that Caritas Czech Republic decided to address with regular advocacy meetings with local municipality representatives. During such meetings, our representatives and experts explained why such programs are important and introduced local municipalities to a ready-made budget model for such activities. As a result, in 2020 and 2021, the municipalities of Rustavi, Ozurgeti, and Akhaltsikhe started funding the autism program. Notably, it also became possible to increase the quota of beneficiaries involved in such programs as well as assigned hours of ASD therapies in various municipalities.
Results Achieved on a Central Level
Project activities aimed at several fundamental changes, of which the results achieved at the central level are of particular importance. In 2020, the Ministry of Health of Georgia approved the National Autism Service Standards elaborated by the multidisciplinary working group established under the project. This standard is necessary to ensure the quality of services in the field. Earlier in 2018, the Ministry approved the national protocol – Identification, Diagnosis and Management of Autism Spectrum Disorder, which is a guide for health and autism specialists working in the field. In addition, the Association of Behavior Analysts developed and submitted to Parliament of Georgia a legislative initiative that will lead to the regulation of the activities of behavior analysts in the country.
Tamila Barkalaia, the Deputy Minister of Health of Georgia, sums up the contribution of the Czech Development Agency and the six-year results of Caritas Czech Republic’s work. She emphasizes that the project has achieved long-term results – now the country has accumulated knowledge, a national standard for the provision of services to children with ASD, and trained service providers throughout the country. According to Barkalaia, this will enable the state to establish autism services and quality monitoring mechanisms in all the municipalities of Georgia:
“This is a resource that a country must have in order to provide children with ASD with quality services.”
Rusudan Chkhubianishvili, Caritas Czech Republic’s project manager, notes that with this project, the Czech Republic has provided invaluable assistance in the development and improvement of the quality of autism services in Georgia:
“This support has enabled children with ASD and their families to benefit from exactly the same approaches used in such developed countries as the United States, the United Kingdom, the Czech Republic, and Poland. By raising the qualification of local specialists, the quality of autism services has been significantly improved and, consequently, the satisfaction of children and parents with the achieved results was increased as well”. On behalf of each beneficiary, Chkhubianishvili expresses special gratitude to the Czech people.
by Nina Kopaleishvili
