Group: Theodore Renz III, Alyssa Blasko, Emily Tasik, Grace Enriquez, Kathleen Bauer, Lindsey Hunsicker

 

1. Why can’t you use other diagnostic tools already created?
   1. They have low sensitivity and specificity rates across cultures. They are not always feasible in low income countries like Sierra Leone. Most are very expensive. For example, the GARS-3 is the cheapest price per form at $1.24. It is projected that there will be 691,034 children aged 3-5 in 2022. It would cost more than $850,000 ($856,882.16) to screen all of the children in this age range. Which is a substantial amount of money for a country where the average yearly income is $500. Lastly, most require a high level of education to be able to read and respond to the questions (6+ grade US education level), and an even higher level of education to administer, score, and interpret (master’s).
2. What are the cross cultural differences that were mentioned in your presentation that hinder current Western assessments?
   1. Current assessments are tailored to test Western populations. For example, the ADOS 2 uses the song “Happy Birthday” as an assessment tool, this may not be relevant in Sierra Leonean context. 
3. Is your screener going to be free?
   1. Our screener will be available through open access and can be used at no cost. The cost incurred will be through printing cost of the screener. 
4. What partners do you work with in Sierra Leone in order to complete your project?
   1. Thus far, our team has developed partnerships with World Hope International, Sierra Leone Autistic Society, and the University of Makeni.
5. What is your screener dissemination plan?
   1. Our team has a malleable five-year dissemination plan starting with three districts in year one of the roll out and building to 16 districts by year five. 
6. What happens after a person gets screened?
   1. As our team is still working on developing a full roll out plan, we are working with partners to determine the best plan to reduce a bottleneck of children while screening 90% of children by 2026.
7. What does validation of the screener entail? Can you describe it more in detail as well as a timeline.
   1. We’ll administer our larger pool of questions to a number of individuals when we are in the field. The specific number of children that we will be aiming for will depend on the exact number of items we have in our initial pool. Within psychometric literature the standards for the number of people you need to conduct initial validity and reliability statistics varies, but typically recommend a minimum of 300 or 10-25 per item. 
   2. After we get that initial data we’ll perform exploratory factor analysis to determine how well the items are aligning with each other, how reliable they are, and which, if any items, should be removed because they’ll improve the reliability statistics. After we narrow down the items and have our final assessment, we’ll gather additional data and perform confirmatory factor analysis tests to ensure that our initial results hold up with other individuals.
   3. If we are able to gather a large enough number of participants during our initial field work visit than we’ll be able to separate that participant pool in half and perform both the EFA and CFA with that initial data. If not, then complete validation of the tool would be completed after two fieldwork visits, or after we’ve been able to have the community health workers gather additional data. 
8. Who will give the screener in the community? 
   1. Community health workers and teachers will be trained to give the screener. Ideally, our venture aims to have 3 nurses at each healthcare facility and 3 teachers at each school trained.
9. What is your team’s plan to involve schools with your venture?
   1. Our venture plans to train at least three teachers at each school on how to give the screener. Our team also plans to work to provide training on disabilities and autism in schools interested.
10. What are a few cultural barriers that you have encountered in this venture? 
    1. The biggest obstacle for our team is the rooted cultural beliefs about disabilities. Many community members believe disabilities are from “Satan” and are contagious. Many people believe miracle clinics at churches are their only hope to be “cured”. 
11. Do you plan to involve the government of Sierra Leone in the dissemination of your screener? 
    1. We absolutely plan to involve the government of Sierra Leone in the dissemination of our screener. That is a relationship we are still attempting to build; however, once created we know their partnership will help greatly in the acceptance of the screener from the community. 
12. How do you plan on validating that the community health workers (or anyone else that will actually give the screener) are doing it correctly after you and your supervision leave?
    1. We will ensure that the CHWs are administering the screeners to the children because they will be sending data to our team. We hope that by providing specific trainings on the screener and educating the CHWs about autism, they will be administering the screener with validity. We will also have a measurement and evaluation consultant that will analyze the data and conduct observations of the CHWs administering the screener. This information will be compiled and sent to the team for review.  
13. How are children currently being screened in SL, especially with regards to attending institutions like the Sierra Leone Autistic Society? 

Currently Sierra Leone, as a country,  is not screening children for Autism. Our team is still looking to further communicate with our partners, the Sierra Leone Autistic Society, in order to determine what criteria is used to accept children with disabilities into their institution.

14. How do you plan on changing deeply ingrained social attitudes toward disability, especially in a scarcely populated land mass such as SL?

1. 1. Education on the true nature of disability will be a top priority in our screener dissemination plan. We plan on training CHWs (and educators) on not only how to administer the screener but on the basis of disability as well, so that misinformation (ie. “possession”) can be unlearned. 
   2. To ensure the spread of information through remote populations, we will be training CHWs from various regions in the country rather than only from one area.

15. What qualifies your team to conduct this type of research?

As this is our venture’s first year, we are aiming to build credibility through academic publications in peer reviewed journals as well as conference presentations to increase our qualifications and show our contribution to this field.

16.How is autism understood in Sierra Leone?

Mental disabilities are not generally understood in sub-saharan Africa and the limited research previously conducted shows a negative stigma for children with disabilities, some unethical cultural practices of giving the child back to God, and the belief that these disabilities are from witchcraft and demonic possession.

17. How can you determine if this is a successful venture?

We will meet our screening goals for each district (20% Y1, 40%Y2, 60% Y3, 80% Y4, and 100% Y5). The children, by the age of school age, will be screened for autism and will be referred to centers and contacts for support services for their children. 

 18. How can your project be sustainable if you are not charging the country for your materials?

Our venture relies heavily on grants and donations to fund our venture. This research is a game changer for society which will excite donors and grant organizations.

19. How do you know that these are the present attitudes on disability in SL?

We are in the process of publishing a manuscript where data was gathered through interviews and focus groups in 200 participants. From the analysis, we found that their perceptions on disability largely rest on spiritual, or karmic bases. 

20 Do you have any plans to use your screener outside of Sierra Leone?

After the implementation of our screener in Sierra Leone, we aim to further expand its use in the surrounding nations in West Africa, and eventually throughout Sub-Saharan Africa (whom, with the exception of South Africa) are all facing a similar dilemma of a lack of understanding and attention to mental health.