**1. Introduction**

There are different applications for technology in the field of healthcare and training [1]. The electronic technologies as a flexible modality provided different forms of application ranging from ordinary day-to-day applications of messaging, phone calls, emails, voice messages, video recording to high technologies such as programs for special purposes, complex equipment to reduce the likelihood of reducing educational, administrative, and fiscal resources, and extend the coverage of the knowledge with a more reasonable effort. Smartphones and other mobile devices technology are more accessible because of their widespread availability and flexibility for being applied by different groups of people with different levels of knowledge [2]. Using available technologies cost-effectively provides a unique

platform to healthcare, engagement, and intervenes with a different group of individuals such as people with special needs. As Camden et al. [3] concluded in their review, "Available communication technology can be particularly well suited to implementing best practices for children with disabilities when the focus of the therapies is on supporting the children and their families, problem-solving with them to foster the child's development and functioning." Hence, the application of telecommunication facilities has rarely been studied for children with developmental disabilities, a promising result has been reported for groups such as children with autism spectrum disorders (ASDs) based on the available data. Additionally, there is evidence for using communication technology for individuals with ASD at different age levels. Pilot findings indicate improved aspects of the services and potential benefits [4]. Parents are deemed active agents in this approach and through accessing proper training and continuous supervision; they can deliver the intervention more effectively [5]. Improving parent knowledge, increasing the level of fidelity in parent intervention, and improving reciprocity and communication abilities for children with ASD are reported in a review on different studies about parent-mediated online training [6, 7]. The term "online parental support services" is a general term to indicate the application of electronic technology in delivering training services to boost parental knowledge in caregiving for their children as a way for delivering professional caregiving services at a distance through connecting the service provider to parents. This type of service is also used for online supervising the activities such as intervention, assessment, and consultation [8].

Different forms of online services have previously been available for parents of children with various types of developmental disabilities; hence, this approach has been brought to attention after the lockdown due to the COVID-19 pandemic and its potential brought to attention from different perspectives. This approach was substituted with the traditional face-to-face approach to provide several services from diagnosis to rehabilitation, training, and caregiving for different types of developmental disabilities. This newly focused approach has advantages over previously practiced methods of service and support provision and might be added to the list of publicly accessible services for individuals with developmental disabilities and their families and parents even after the lockdown.

A part of the finding of this study has already been published in the form of a feasibility study in 2020 [9], but in this chapter, extensive findings of this study will be presented in more detail.

A series of studies from 2010 to 2013 was undertaken in Iran to understand parental knowledge needs and to address these needs [10–12]. The outcome was a tailored parent-focused program [13, 14]. A biopsychosocial model of disability is considered for the program. There were different booklets on different aspects of ASD in a lay language on different issues regarding ASD and a toolkit consisting of a set of practical advice in the printed form to boost parental knowledge through activities of daily living and play. The printed matters offer practical information and applicable advice to improve communication and to extend its levels at different stages of child development. Parents are prepared with basic knowledge on the understanding of their child's level of abilities and disabilities employing simple self-completed checklists. Modifying environments to address the child's sensory preferences and various strategies to impact different developmental areas were also considered in the preparation of the booklets. It was also expected that the booklets would enable and empower parents to make decisions about what their child needs to learn.

Based on the WHO [15] and UNESCO [16] recommendation, care providing centers for individuals with ASD similar to all other caregiving centers stopped their routine services and adopted self-induced lockdown. This recommendation was a general obligation for all educational and daycare centers around the world. *Online Training for Parents of Individuals with Autism Spectrum Disorders during COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.102949*

Lockdown in Iran lasted over 2 months from March to May 2020. Application of telecommunication facilities to deliver different services at a distance and connecting caregiving centers to parents were the most applicable approach during this time. There are over a hundred caregiving centers for individuals with ASD in Iran that provide daily care for children with ASD in an age range from 3 to 14 years old. These centers are under the umbrella of the Iranian Social Welfare Organization (ISWO). Daily educational and rehabilitation services are provided by these centers and are they are active for 4 hours in the morning to provide these services. The government pays for most of the services. Caregiving centers have the right to provide afternoon services that include rehabilitation, vocational and extracurricular services through expenses paid by parents.

#### **1.1 Iran profile**

The ISWO and Ministry of Health have been considered as the ASD services providers while the Iranian Special Education Organization (ISEO) is responsible for educational services. Almost 90% of healthcare services for individuals with ASD are provided through governmental services [17]. These services are recently improved to cover a bigger group of this population [18]. ISWO provides clinical and vocational training services to preschoolers with physical and intellectual disabilities and individuals with severe forms of developmental disabilities who are considered by educational services as not being able to benefit special or mainstream schools. While a group of financially able parents pay for parts of the services or the extra needed support, the government pays for most of the individuals' expenses. A group of individuals with developmental disabilities who are registered in mainstream schools also attend these centers after graduation from their schools because of the available services such as vocational or another type of special training or rehabilitation. Families contribute to these costs.

From an electronic and telecommunication services perspective and in terms of numbers, Iran ranked first in the Middle Eastern area concerning satisfactory Internet infrastructures and 43 million users [19], similar to other countries, widespread use of smartphones, social media [20], and computers throughout the country daycare centers was able to provide some aspects of online parental supports through video conference to deliver some types of educational services and providing consults and instructions [21].

Although other studies logically stress the crucial rule of different organizational characteristics and processes for providing the support and resources for preparing therapists and practitioners to implement new models of practices, at the COVID-19 imposed situation, it seemed that the only possible way to survive was shortcutting all the previously mentioned factors such as funding the time and cost of consistent and qualified supervision, organizational support for evidence-based practice [22], and starting the training with the minimal necessary factors. One of the most important factors for successful dissemination of the online courses and application of telecommunication for children with ASD was that their parents who were already reluctant in being engaged in direct service provisions for their children were asked the closed daily caregiving centers for a practical solution and have different queries regarding pieces of advice for keeping them active and fruitful for their children with ASD at home. The most important element in the successful dissemination of these newly developing models is to consider training facilities for parents according to their needs [23].

The ISWO decided to provide online services to parents through their daycare centers during the 3-month lockdown in time of pandemic COVID-19. Staying active and being able to service provision for parents who were urgently needed to assist with their continuous caregiving was one of the aims. Assisting parents and

extending their abilities to become active participants in service providing made the different types of training facilities a must for them. This is a difficult aim to attain because of the lack of highly trained professionals in different filed of services for individuals with ASD.

Hence, the most important advantage for children with ASD was the emphasis on the implementation of different strategies in their natural environment, where they spend most of the time, and where strategies can be applied over different available opportunities.

Caregiving centers and parents were not well prepared for the shift of services, but the most practical solution for a potential group of nearly 10,000 children who were registered in these centers and 14,000 staff members who were working in different units of these centers based on ISWO's report. They were all in danger of being negatively impacted due to the unpredictable serious healththreatening situation, which forced them to keep distancing for an unclear period. Telecommunication was an accessible solution. Care-providing centers already used different social media platforms to contact parents. The contacts were on their way and in a passive form of sharing various information.

During the lockdown, parents can use mobile-based technology, to keep in contact with the professional caregiving centers, while interacting with their child under the remote supervision and coaching of the professionals. The information that is provided is interactively based on the need of the individuals, which is filtered by supervisors who are assisting key persons who in turn act under the supervision of a senior consultant in ISWO on ASD research and training courses. Parents receive guidance to be able to provide services for their children at their home using functional daily activities. This approach can save money and time to both caregivers and parents while offering relief to ISWO as the main service provider for individuals with developmental disabilities. To understand the applicability of online services for parent training under the supervision of the caregiving center during the COVID-19 lockdown in an area with limited caregiving centers and professional services for individuals with ASD.

This chapter reports findings of a study that set out to examine the ease with which online training can be implemented in the home setting through the continuous supervision from the daycare centers and the needed levels of engagement that parents need to perceive to find the service satisfactory through their self-rating reports and caregiving centers' judgment.

For the present reported finding, an online model was developed. In this model daily training sessions, for parents, are administered by the caregiving centers, with direct daily remotely supervision and coaching by a professional senior consultant in the field of ASD considered. It was decided to provide information for parents through online sources, which cover different areas of caregiving with the main focus on play as a modality to facilitate communication and to understand behavioral challenges and the way they could be managed and considering functional daily living skills using different types of play, exercises, and tasks. For each part, there were separate tutorial video clips along with written and oral information and rubrics that parents might find useful. (See the following link)

سامانه-غربالگری-تشخیص-و-مداخالت-در-اختالل-طیف-اتیسم *http://www.behzisti.ir/news/12221/*

The main aim for developing an online parental training under the supervision of the daycare centers was to act with parents of children with ASD based on the following finding reports from Schmidt and Taylor [24]: (a) freeing up time from

#### *Online Training for Parents of Individuals with Autism Spectrum Disorders during COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.102949*

other clinical work for training; (b) access to reading materials; (c) high-quality supervision and comprehensive training; (d) peer-learning working groups; and (e) program evaluation support adoption of empirically supported interventions. All these items are considered as factors that identified to be critical for therapists and practitioners to adopt a model for intervention into practical usage. Parsons et al., [6] in a review suggest that compared with the texts and written information, video-based parental training intervention was reported to be more effective. Furthermore, answering parental questions by professional and coaching provision based on a daily or weekly schedule compared with a self-directed program proved to be more effective in the following areas: (1) intervention appropriateness, (2) program completion, (3) parent intervention fidelity, (4) parent engagement, and (5) parent's positive perception of their child condition.

To understand the daycare service providers' ideas about the possible parental information needs, five 1-hour online group sessions are held. The focus group consisted of the head of the 50 selected active daycare centers based on their experience and ISWO's criteria. The final output of the session was to recruit active and eager centers and to answer the following questions:


This study aims to determine the uptake by daycare centers and parents in an online course and understand the reason for any negative attitudes and possible dropouts of the parents. The impacts of online parental training on the center staff, their reactions to the program and monitoring the work undertaken by parents and center staff are focused as well.
