A pilot trial of the Individualized Placement and Support model in autistic adults in the community

University Of California At Davis, Davis CA

Investigators

Abstract

ABSTRACT Over half a million autistic young adults will graduate from high school over the next ten years. As they enter early adulthood and no longer receive funded services through the education system, they will become increasingly disengaged from expected adult roles including getting and staying employed. Based on current statistics, about 40% of these adults will be placed in state-funded day programs or sheltered workshops where they will not work in actual paid employment. Most of the remaining 60% will remain chronically unemployed, underemployed or employed in non-competitive jobs that don’t match their skills or interests. Although engaging in meaningful work is one of the most important determinants of mental health, physical health, and quality of life in all adults the autism services field lacks an empirically validated supported employment model that can be scaled up and financially sustained in community settings and that promotes competitive integrated employment (CIE) as an endpoint. In this R34 application we address this urgent problem by continuing and advancing our current pilot study funded by the California Department of Developmental Services (DDS; Grant A22-334). In this pilot, we are implementing the Individualized Placement and Support (IPS) model of supported employment – a person-centered model with a strong evidence base of 28 randomized clinical trials (RCTs). Thus far, using the core un-adapted IPS model, we have achieved CIE rates of 41%. Notably, we have observed potentially mutable issues related to improving agency selection and training. We also propose that increasing positive parent engagement, and helping consumers improve work- related social cognition, may serve as mediators of intervention success and potentially improve model outcomes. In Aim 1 of this R34 application, draw upon our experience in the DDS pilot, where we identified challenges to agency selection and training, and conduct iterative focus groups with the DDS pilot consumers, parents/carers, vocational support professionals (VSPs), employers and members of a community academic partnership panel (C/APP) to investigate these and additional barriers and facilitators of IPS success. We will then integrate this information to create a consumer support toolbox (CST) to be used to improve IPS model fit. We also field test the CST used with IPS – together they are referred to as IPS-AUT-- in 5 consumers. In Aim 2, we conduct a 12-month Hybrid Type1 trial of IPS-AUT where we examine acceptability, feasibility and preliminary effect sizes for employment outcomes as well as IPS fidelity. We hope to achieve at least 75% acceptability and feasibility and to achieve at least 50% CIE. In Aim 3, we preliminarily investigate signals of effect for proposed mediator (target) variables including parent/carer engagement and work-related social cognition. The goal of this project is to prepare us to successfully compete for an adequately powered R01- funded effectiveness trial of IPS-AUT in community settings. Our goal is to address the need to competitively employ the large population of able autistic persons, and in so doing, to improve their mental health outcomes.