Information for Professionals

PACT is a treatment method with a tool kit consisting of the PACT treatment manual, videos and other training and intervention materials. Step-by-step goals are identified following the six steps of the PACT manual. For a summary of thee evidence base for PACT  please click here. Please feel free to view and share the PACT professional flyer click here

 

  1. What is PACT?
    1. PACT global training is supported by our Social Enterprise CIC IMPACT (Interaction Methods of Paediatric Autism Communication Therapy) with the mission of maximum reach of PACT intervention, for the benefit of children with autism (and their parents/ carers), to improve communication skill and quality of life, driven by parental advocacy.
    2. IMPACT CIC addresses the worldwide treatment gap for children with autism, taking intervention from specialist centres/ hospitals into the child’s community and environment through UK wide and global PACT (Paediatric Autism Communication Therapy) training. For a summary of PACT research please click here
    3. PACT is a relatively low intensity adult/carer-led video feedback intervention improving the social communication skills of children (aged 2-10 years) on the autistic spectrum with a range of language difficulties, from children who use a limited range of sentences, to those who use few or no words.
    4. PACT addresses the enduring difficulties with social communication and repetitive behaviours found in autism in young children. It is a treatment method with a tool kit consisting of the PACT treatment manual, training materials, videos and other intervention materials. Step-by-step goals are identified following the six steps of the PACT manual.
    5. PACT helps adults/carers to interact in different ways to more effectively improve the communication skills of children who have different communication resulting from their autism. The PACT intervention identifies the child’s individual profile and adult/carer’s existing skills, building and extending communication techniques. PACT does not aim to ‘teach adult/carer skills’ or ‘cure’ autism; instead PACT is a method of building the highest level of individual skills. The PACT intervention encourages and empowers adult/carers to help them feel confident and competent in maximising their support of their child with autism – enabling adult/carer’s to develop their own skills and ultimately become advocates for their child.
    6. Professional training is available in order to certify professionals in the use of PACT in clinical practice.
    7. IMPACT aims to maximise the reach of PACT through our global ‘train the trainer’ programme, where we gain user feedback and measures of social worth.
  2. The need for PACT
    1. One of the best predictors of an autistic person’s life chances is their language and communication ability at a young age.1
    2. Currently one in four autistic people speak few or no words throughout their life.2
    3. Language and communication skills have a significant impact on an autistic person’s ability to convey their mental and physical health needs and are recognised as a key factor underlying behaviour that challenges.3,4,5 These skills are likely to affect an autistic person’s mental and physical health outcomes, their likelihood of social exclusion, their educational attainment and chances of finding employment.6,7,8,9
    4. Adult/carer-led video therapies are distinct from other interventions for autistic children. Existing interventions can help prepare children on the autism spectrum for social situations and teach educational skills. However, PACT is the only well-evidenced therapy that has the potential to improve a child’s social communication skills in a sustained way as they develop and therefore alter their longer-term trajectory in life.
    5. Autistic people and their families identified effective interventions to develop communication and language skills as their second highest priority for autism research during an extensive priority setting partnership led by Autistica in 2016.10
    6. PACT is the only social communication intervention of this type in the UK to have been rigorously tested in a Randomised Control Trial (RCT). Trials into PACT were funded by the Medical Research Council and the (then) Department for Children, Schools and Families (now the Department for Education).
    7. The RCT was completed in 2010 involving 152 autistic children, aged from two years to four years and 11 months. A follow-up study was completed in 2016, when the children were aged between 7 and 11 years old, showing that the improvements had persisted six years after PACT was delivered. The results of both studies were published in The Lancet.11,12
  3. The evidence for PACT
    1. PACT is the first autism intervention rigorously tested to show sustained impact on reduction in autism symptoms.12 PACT has proven significant sustained reduction in the difficulties in social, communication and repetitive behaviours/ restricted interests over 6 years after the intervention was delivered.
    2. PACT has also been adapted for use in low and middle-income countries. In 2016, an RCT was completed on 65 autistic children, aged two to nine years, in India and Pakistan, with similar improvements in their communication ability.13
    3. A play-based pilot intervention trial called JASPER, was completed with 61 minimally verbal autistic children aged five to eight years. The study found significant increases in the children’s use of spontaneous language and new words following parent-led play sessions.14
    4. A follow-up study published in 2018 found that children’s communication ability still improved when adults applied most but not all of the techniques from the therapy.15
    5. PACT was recently added to the recommended curriculum for the Children and Young People’s Improving Access to Psychological Treatment (IAPT) programme, overseen by NHS England and Health Education England.16
    6. The National Institute for Health Research (NIHR) featured PACT in its NIHR Signals programme, which summarises the most important research for decision makers.17
    7. NICE Clinical Guideline 170 Autism spectrum disorder in under 19s: support and management was published in 2013 before the latest evidence about PACT became available. However, in section 1.3 the guidelines recommend that play-based social-communication interventions, which use video-interaction feedback, are considered for supporting pre-school and school-aged children.18
    8. Autistica, a UK’s autism research charity and the largest independent funder of autism research in Europe promoted PACT in World Autism Month (2018).
  4. How does PACT work?
    1. PACT involves collaborative video feedback and analysis between therapists and adults/carers. By working with adults/carers rather than directly with the child (the traditional approach), therapists empower adults in recognising and enhancing key skills proven to lead to better child social communication outcomes.
    2. Adults/carers identify step by step goals following the six steps of the PACT manual.
    3. Adults/carers undertake 30 minutes daily motivational play based practice. PACT is then generalised in everyday natural interactions of the child, reducing the barrier to transition of skills into the child’s real world.
    4. Adults/carers receive 1 ½ – 2 hour sessions alternate weeks for 6 months (a total of 12 sessions) and optional monthly maintenance sessions for 6 months (a total of 18 sessions).
  5. What are the Benefits of PACT?
    1. PACT implementation has been successfully tested in local services, working within existing organisational frameworks and community services e.g. NHS community clinics/ centres, family/ school/ social care centres and within the child’s home.
    2. Our PACT ‘train the trainer’ programme has been successfully implemented in the UK and internationally, extending the capacity for individual centres to become centres of excellence developing PACT training in their own context with updates and support from IMPACT.
    3. PACT was awarded the “Outstanding Innovation Award” as the most ‘innovative and potentially transformational solutions to social issues’ and “Making A Difference Award” for social responsibility (2018) for ‘outstanding benefit to society through research’.
    4. The PACT programme is relatively low cost and effectively modeled to NHS clinical practice.
    5. IMPACT monitors quality standards through annual updates, conferences, implementation trials and user feedback.
    6. IMPACT supports bid and grant applications to extend implementation trials, research and social worth measures.
    7. Training on the PACT model has been undertaken in the UK, France, Italy, Spain, Canada, Australia , USA and Hong Kong with further requests for training and international grant applications.
    8. In addition to the UK based trials, PACT is the first autism evidence based intervention to be successfully replicated in Low and Middle income Countries (LMIC) demonstrating its potential for incorporation into existing world health provision delivered in communities, with a focus on culturally appropriate, feasible and scalable delivery.
  6. Who can train in PACT?
    1. PACT Level 1 introductory/ awareness e-learning is suitable for service leads and professionals from health, education and social care. click here
    2. PACT Level 2 certified training is suitable for professionals (speech and language therapists, clinical/ educational psychologists, psychiatrists, specialist teachers, therapists, social workers and specialist nurses) who have experience of working with families of children with autism between the ages of 2-10 years.
    3. PACT is now available for accredited clinical training; for training enquiries, please complete the online PACT training registration form or email:  info@pacttraining.co.uk
  7. Becoming a PACT Accredited Trainer
    1. A PACT ‘Train the Trainer’ package is available for organisations to become accredited PACT trainers in their local area, supported by our social enterprise CIC IMPACT.
    2. To become a PACT Accredited Trainer, professionals must first complete Level 1 and Level 2 PACT training, and progress to becoming a PACT Champion. This requires implementing PACT with a minimum of 5 cases.
    3. To become a PACT Trainer, the PACT Champion will co-deliver a PACT training course with an IMPACT senior trainer.
    4. UK PACT Associate. UK PACT Associates will receive PACT training materials including PACT training video clips. PACT Associates receive validated trainee applications who have completed and submitted online PACT registration. An Associate fee is paid for local PACT training courses in a specific area.
    5. International Franchise/ License. Our international Franchise/ License comes complete with PACT training materials, a recommended pricing structure and discounted rates to reflect our social enterprise mission and goals. International PACT trainers develop their own PACT training video clips in their language, including:
      • 6 video clips illustrating each of the 6 PACT stages
      • 3 therapist feedback video clips
      • 1 PACT whole session video
      • 4-6 PACT case studies, illustrating video clips of a PACT case progressing through the stages of PACT

      A Senior IMPACT Trainer will review and approve the training video clips prior to the training course.

    6. An IMPACT Franchise/ License allows international PACT trainers to advertise PACT training courses in their local area and incurs a 5% of turnover paid to IMPACT (plus an optional 1% premium to subsidise less advantaged areas, countries and charities).
    7. IMPACT Franchise/ Licenses are renewable every 3 years, with the franchisee submitting feedback and data on PACT training, further PACT videos for fidelity rating and information on quality control standards.
    8. IMPACT asks PACT Associates/ Franchisees to provide data to measure social worth of PACT training (how many trainees implement PACT, number of children benefitting, parent/carer feedback and how PACT is delivered in local services).
  8. PACT Research
    • PACT Research PACT centres of excellence that have received full PACT certification are encouraged to undertake PACT implementation trials to test the acceptability, feasibility and adaptation of PACT in their cultural context. IMPACT senior leads provide research support, including advising on methods, measures/ assessment and outcomes, depending on individual requirements. please contact IMPACT to discuss your project/ trial.
  9. How To Apply For Subsidies And Discounted Rates

    A range of discounted rates and subsidies are available:

    • Developing countries – training supported through grant applications and charity/donations.
    • Charities – up to 20% discount supported through our premium contributions.
    • Public sector discounts – up to 20% discounts on live 2-day face-to-face training and post course group supervision and fidelity.
    • Group discounts – 15% discount for groups of 15-24 delegates; 50% discount for post course group PACT supervision through lead champions.

    Organisations may provide information on the application form to check their eligibility for appropriate discounted rates. Individual quotations are provided with the appropriate discount, where applicable.

  10. Frequently Asked Questions
    • What equipment do I need for PACT? Materials and equipment required include a video camera (e.g. camcorder or pad), memory card, screen for video play back (e.g. laptop), secure video storage (e.g. encrypted external hard drive) and a range of toys. The list of suggested toys is contained in the PACT manual.
    • How do you deliver PACT in a low resource setting? In low resource settings play may include available everyday or household items, e.g. cooking utensils, large boxes, food, fabric, a ball, bubbles. The child’s motivation is considered when selecting suitable play material.
    • What if the child is not motivated by toys? For children who are not motivated by toys, interaction is included in PACT e.g. songs, music, rhymes, actions, interaction games.
    • Can trainees practice PACT with more than 2 families and chose 2 cases to submit 2 videos for fidelity rating? Trainees may choose to practice with more than 2 families. The IMPACT senior trainer will view two case videos (including the parent-child play, therapist’s feedback session with the parent, setting home goals and a copy of the written home programme). The senior trainer provides supervision and feedback once one video has been viewed, the trainee continues to practice, and then submits the second case video for fidelity rating. Once trainees pass the fidelity, they receive a PACT certificate. The trainee may be asked to submit a further case video if they do not pass fidelity initially.
    • What is the timescale for completing the follow up course? This depends on how quickly the trainee can find the practice cases. If parents have agreed to practice sessions prior to the professional attending the 2 day PACT course, the practice usually takes 3 months. Where trainees need time to identify practice cases and may require more practice, post-course fidelity may extend to 12 months. It is recommended post course work commences within 1 month of completing the 2-day live PACT training.
    • Are the PACT post course supervision sessions individual with each trainee or in a group setting? Post course supervision is usually delivered individually where the senior lead PACT views and rates individual trainee videos. In some circumstances, where we offer the ‘train the trainer’ programme, the lead champion may deliver local group supervision with a group of 4-5 PACT trainees. Lead champions submit 1 post course video for senior IMPACT review to check consistency of fidelity rating.
    • Are the follow up sessions face to face or online after submitting the video recordings? Trainees send the case video using a secure web link or on an encrypted memory stick for senior trainer review. Feedback and supervision is provided by email. For centres becoming PACT centres of excellence, a local PACT lead champion may review post course videos.
    • Are the PACT sessions carried out at the family home or in a centre? The original PACT was delivered in clinic centres. In some cases, depending on family circumstances, PACT may be delivered in the home. PACT practitioners are advised to consider home factors that assist the PACT sessions e.g. an appropriate space/ room, considering creating a quiet, calm setting, managing distractions (e.g. TV, video, radio off).
    • If I train to become an accredited PACT user, can I then be a supervisor for colleagues who have completed the 2 day training and provide post course supervision to my colleagues? A professional wishing to become a PACT lead champion attends all levels of PACT training and post course supervision from a senior IMPACT trainer. Once certified, the lead champion may supervise the other trainees who completed the PACT pre-course work and live 2-day PACT face-to-face training.
    • Once the lead champions have practiced PACT with at least 5 families and worked through the PACT stages, they may become PACT trainer themselves by co-training on a live 2-date PACT course with a senior trainer from IMPACT.
    • I understand that some experience in working with children with autism is needed to be able to train in PACT implementation. Would an experienced and capable band 6 professional be able to implement PACT after accessing the training or do you feel a higher level of clinical experience is necessary? A minimum of 5 years general clinical experience including 2 years experience of working with children with autism and their families is required to be eligible for accredited PACT training. Professionals below band 6 may complete the PACT introduction e-learning course.
    • Are you looking for NHS SLT departments that are keen to use PACT with the aim to pilot PACT and carry out implementation trials in their community services? If yes, what support would you be able to offer? We have a number of implementation trials to test PACT in different communities, countries, cultures. We support local communities piloting and delivering local implementation trials by gaining feedback from users and parents (e.g. measuring changes in parent self-efficacy, family life questionnaire, parental values and aspirations) to inform help inform local service delivery and feedback social values to our IMPACT social enterprise.
    • Several UK based PACT services have gained NHS funding based on quality measures of this kind.
    • Why do trainees need to complete the PACT post course work? PACT requires practice in implementing the clinical skills e.g. using cascading probes in therapist feedback, developing therapeutic alliance with parents/ carers, observation skills and video analysis, selecting video clips, setting social communication goals and measuring progress through the stages. Training in such clinical skills is progressive from the 2 day live training course through supervised post-course clinical practice to gain fidelity in PACT.
  11. References
    1. Magiati I, et al (2014). Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: a systematic review of longitudinal follow-up studies in adulthood. Clin Psychol Rev. 2014 Feb;34(1):73-86
    2. Wallace S, Parr J, and Hardy A. (2013). One in a Hundred: putting families at the heart of autism research. London: Autistica.
    3. NICE (2015). NG11 Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges.
    4. Chiang H (2008). Expressive communication of children with autism: the use of challenging behaviour. J Intellect Disabil Res.52(11):966-72.
    5. McClintock K, et al (2003). Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study. J Intellect Disabil Res. 2003 Sep;47(6):405-16.
    6. Pickard H, et al (2017). Are Social and Communication Difficulties a Risk Factor for the Development of Social Anxiety? J Am Acad Child Adolesc Psychiatry. 56(4):344-351.
    7. Paul R and Cohen D (1984). Outcomes of severe disorders of language acquisition. J Autism Dev Disord.14(4):405-21.
    8. Howlin P, et al (2014). Cognitive and language skills in adults with autism: a 40-year follow-up. J Child Psychol Psychiatry.55(1):49-58.
    9. Howlin P, et al (2005). An 8 year follow-up of a specialist supported employment service for high-ability adults with autism or Asperger syndrome. Autism. Vol 9 (5): 533-549.
    10. Autistica and the James Lind Alliance (2016). Your questions: shaping future autism research.
    11. Green J, et al. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial. Lancet; 375: 2152.60.
    12. Pickles A, et al. (2016). Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. Lancet [Online].
    13. Rahman A, et al. (2016). Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial. The Lancet Psychiatry, Vol 3(2), 128 – 136.
    14. Kasari C, et al. (2014). Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial. J Am Acad Child Adolesc Psychiatry. 53(6):635-46.
    15. Shire S, et al. (2018). Brief Report: Caregiver Strategy Implementation-Advancing Spoken Communication in Children Who are Minimally Verbal. J Autism Dev Disord [Epub].
    16. NHS England (2017). Children and Young People’s Improving Access to Psychological Therapies Programme Learning Collaboratives and Training Offer [webpage].
    17. NIHR (2017). NIHR Signal: Parent-focused therapy has some long-term benefits for children.
    18. NICE (2013). CG170 Autism spectrum disorder in under 19s: support and management.