Greater Manchester

Paediatric Autism Communication Therapy (PACT)

An intervention to enhance social communication with young children with autism spectrum disorder - this project has now completed.

Paediatric Autism Communication Therapy (PACT) is an evidence-based intervention in which therapists work with parent/carers to enhance social communication with their young child with autism spectrum disorder (ASD).

PACT is the first autism intervention to have shown long-term reduction in autism symptom severity: in a large clinical trial, the group of children receiving PACT pre-school, when compared to usual care, showed improvements in social communication and a reduction in level of restricted and repetitive behaviours that were sustained into middle childhood, six years after the end of treatment.

PACT is a partnership between professionals and the parent/carer – enhancing the knowledge and skills of those who know the child best, while working with professionals who have specialist knowledge and skills in autism. The therapist uses specific video feedback techniques to help parents recognise, respond to and enhance their child’s communication. They also work to support and empower parents to embed these communication techniques into daily family life. In this way, children are supported to develop their interaction and communication skills in their natural environment, which is one of the most effective ways of ensuring enduring improvements in social communication skills

Health Innovation Manchester has worked with the Greater Manchester Health and Social Care (GMHSC) Partnership and the PACT team at The University of Manchester to undertake a barriers and enablers capture to help feed into learning of progress being made with adoption and also capture information which could aid wider spread and adoption.

HInM captured relevant information through varying data collection sources such as interviews and online surveys, both within the GM system and nationally to inform the report. From these responses, overarching themes emerged:

  • Supporting the workforce: PACT professionals require the full support of their managers and executives, backed with funding and backfill and with established peer support networks. The workforce also needs to be supported with funding to complete their training, the autonomy to manage their own diaries and with adequate resource of trained professionals within their locality to manage the workload.
  • Family-centred, evidenced-based approach: The robust evidence base gives greater confidence in the intervention, resulting in increased engagement, both with families and managers and executives. The culture and approach were endorsed by the majority of practitioners. The impact of COVID-19 on everyday life meant some families were not ready to engage. It was also suggested that further consideration was needed about how PACT could be adapted to be culturally relevant in different contexts.
  • Alignment with the wider system: Analysis indicated that PACT should be embedded as part of the wider system and that awareness of the intervention and its benefits could be increased. Policy levers and incentives could be utilised to support embedding the intervention, and thought is needed about how PACT fits within the pathway of a locality. There was also a suggestion that further consideration is needed around how to prioritise families that will benefit most from the intervention.
  • Putting in place practical process to ensure effective delivery: Practical processes include information governance, administration and recruitment, but also aspects such as marketing to make sure PACT is ready for the next stage of growth. Further consideration also needs to be given to ensuring the intervention is financially sustainable, including processes to gain funding and securing backfill.

Parent comment: “I understand more about my child and what she needs to communicate better with me, to relax demands on her in general routines (we have used PACT in more than just “our time”)” and my child is able to share attention with me when PACT techniques are used.”

HInM also produced a PACT implementation pack, bringing together key resources as a reference guide.

Find out more about PACT


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