From Challenges to Change: A PhD Journey into Healthcare Pathways for Families

Madhusudan Pokharel, a first-year student at the University of Manchester’s School of Health Sciences, won first place in Kohlrabi's recent PhD Thesis Competition for research on scalable, caregiver-led interventions aimed at improving children’s mental health in low-resource settings. The study demonstrates that empowering parents, guardians, and community health workers with structured, culturally adapted tools can significantly improve emotional regulation, behaviour, and caregiver-child interactions—without reliance on mental health specialists.

Pursuing a PhD is more than an academic achievement—it is a deeply personal endeavour rooted in a commitment to addressing gaps in autism care in Nepal. Many families face significant challenges in accessing diagnosis and intervention, often travelling long distances with limited resources. Growing up in a working-class household fostered a deep understanding of these barriers and continues to motivate efforts to develop inclusive and sustainable solutions for families in need.

My research focuses on engaging caregivers in the care of their autistic children through evidence-based interventions. Specifically, I am studying the implementation of caregiver-mediated approaches such as the WHO Caregiver Skills Training (CST), which equips parents with practical strategies to support their children’s development through everyday activities. The training aims to strengthen parent-child relationships, enhance developmental outcomes, and ensure accessibility, affordability, and cultural relevance in low-resource settings.

Through this work, I aim to address immediate needs while contributing to broader systemic change by improving autism care pathways in low- and middle-income countries (LMICs). The task-sharing cascade model underpinning my research empowers non-specialists to train caregivers, making autism interventions more scalable and inclusive. By collaborating with local governments, this approach also informs sustainable improvements across health and education systems.

A key component of this work is the NAMASTE initiative (Neurodevelopment and Autism in South Asia: Treatment and Evidence), which focuses on early detection and support for children with developmental delays. Female community health volunteers (FCHVs) play a vital role in this initiative, conducting culturally adapted screenings and guiding families toward programmes such as PASS Plus, CST, or other appropriate interventions. This approach bridges the gap in areas where specialist services are unavailable, providing timely, community-based support.

This PhD journey has been transformative, blending academic rigour with meaningful community engagement. Working remotely with research teams in Nepal and supervisors at the University of Manchester has allowed me to stay connected to both the global and local aspects of my work. Witnessing the impact—such as a parent sharing how these approaches improved their bond with their child—has been deeply rewarding and motivates me to continue this vital work.

As I progress, my goal is to further integrate caregiver-mediated strategies into autism care frameworks, fostering greater inclusivity and equity for families. By bridging research and practice, I aim to contribute to a future where every child and caregiver has access to the support they need to thrive.

💬 Judge's feedback: “I strongly believe in the importance of empowering caregivers as mental health providers. Having a caregiver can be a blessing, and we need to alleviate the mental burden on family members. In today’s fast-paced society where everyone is busy, it’s crucial to have trained professionals providing mental health care services—but we don’t have enough. This research aims to fill that gap.”

Madhusudan is a first-year PhD student at the University of Manchester’s School of Health Sciences, whose research is funded by the National Institute for Health and Care Research (NIHR). You can find Madhusudan on LinkedIn.