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Policy PointsEmployment is a key social determinant of health and well‐being for the estimated 5.4 million autistic adults in the United States—just as it is for citizens without disabilities. Evaluation and monitoring of publicly funded employment services is paramount given the dramatic increases in adults with autism who need job supports.Vocational Rehabilitation agencies appeared to be absorbing short‐term employment needs of autistic people, but Medicaid was severely lacking—and losing ground—in serving those who need longer‐term employment services.Across both Vocational Rehabilitation and Medicaid, we estimated that only 1.1% of working‐age autistic adults who potentially need employment services are actually receiving them—leaving an estimated 1.98 million autistic individuals without the employment services that are associated with achievement of well‐being. Context: Employment is a key social determinant of health. As such, high rates of unemployment, underemployment, and poverty across the rapidly growing autistic population are concerning. A web of publicly funded services exists to support the employment, and associated health and well‐being, of United States citizens with autism and other intellectual and developmental disabilities, namely through Vocational Rehabilitation (VR) and Medicaid home‐ and community‐based services (HCBS) waivers. Given an absence of overarching surveillance of employment services, this study aimed to characterize the distribution of autistic service users across Medicaid versus VR, understand the types of employment services utilized within these programs and expenditures, and assess overall capacity to provide employment services as needs continue to increase. Methods: This study examined the distribution of employment services among autistic people compared with those with intellectual disability using 2008–2016 data from the Centers for Medicare & Medicaid Services and the Rehabilitation Services Administration. Estimated need for employment services among autistic individuals was compared with capacity derived from VR service counts and a review of HCBS waivers. Findings: The number of autistic people served through VR tripled during the study years, whereas those served through Medicaid only increased slightly. VR spending increased by 384% over the study years, whereas Medicaid costs decreased by 29%. Across VR and Medicaid, we estimated that only 1.1% of working‐age autistic adults who needed employment services received them. Conclusions: Although VR appeared to be absorbing short‐term employment needs of autistic individuals, Medicaid was severely lacking—and losing ground—in serving those who needed longer‐term employment services. VR far outpaced Medicaid in both the number of autistic people served and total expenditures across the study years. However, an estimated 1.98 million autistic adults did not receive employment services that could be critical to improving their health and well‐being. [ABSTRACT FROM AUTHOR]

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Few funding sources have explicitly supported systems‐wide research to identify mechanisms for improving access, service delivery, outcomes and wellbeing for autistic transition‐age youth and young adults. We aimed to integrate findings from research produced through a five‐year federal Autism Transition Research Project (ATRP) cooperative agreement. This capstone review sought to: (1) map the body of scientific evidence that emerged from this federal award, and (2) identify remaining evidence gaps to inform future autism transition services research. We used scoping review methods to assess 31 ATRP‐funded published scientific studies. We charted study characteristics, topical domains, socio‐ecological levels of variables, focus on equity, and inclusion of autistic participants. We evaluated how these topics were addressed across studies to identify continued gaps in the evidence base. Compared to prior published reviews and research agendas, we found improvements in characterization of study participants, broader examination of socio‐ecological correlates, and examination of multiple outcome domains. However, we also identified continued deficits in inclusion of autistic study participants, use of multisectoral data, and research with a strong focus on equity. Our recommended priorities for autism transition services research to facilitate healthy life outcomes and wellbeing included: continued analysis of population‐level data and improved data infrastructure; development of service delivery methods and interventions that target marginalized groups; expanded research to inform improvements in the performance and coordination of complex service ecosystems that interface with autistic youth; and bolstering the roles of autistic research participants. Lay Summary: There is little federal funding available for researching services, outcomes and wellbeing of autistic transition‐age youth and young adults. We reviewed 31 published studies produced through a historic federal investment in autism transitions research by the U.S. Health Resources and Services Administration. We discuss findings of these studies, gaps in research, and priorities for autism transition services research to facilitate healthy life outcomes and wellbeing for autistic youth and adults. [ABSTRACT FROM AUTHOR]

This paper used Social Security Administration program data from 2005 to 2019 to examine national- and state-level changes in the number of new adult supplemental security income (SSI) awardees on the autism spectrum relative to awardees with intellectual disability and other mental health disorders. We identified three main findings: the number of autistic awards increased between 2005 and 2019 when awards for all other mental health disorders declined; roughly nine out of every 10 autistic adult awardees were between ages 18–25 years; there was variation in the growth of autistic awards across states. These findings support the need to consider geographic and age differences in SSI program participation among autistic adults and determine the underlying causes. [ABSTRACT FROM AUTHOR]

Most published autism research, and the funding that supports it, remains focused on basic and clinical science. However, the public health impact of autism drives a compelling argument for utilizing a public health approach to autism research. Fundamental to the public health perspective is a focus on health determinants to improve quality of life and to reduce the potential for adverse outcomes across the general population, including in vulnerable subgroups. While the public health research process can be conceptualized as a linear, 3‐stage path consisting of discovery – testing – translation/dissemination/implementation, in this paper we propose an integrated, cyclical research framework to advance autism public health objectives in a more comprehensive manner. This involves discovery of primary, secondary and tertiary determinants of health in autism; and use of this evidence base to develop and test detection, intervention, and dissemination strategies and the means to implement them in 'real world' settings. The proposed framework serves to facilitate identification of knowledge gaps, translational barriers, and shortfalls in implementation; guides an iterative research cycle; facilitates purposeful integration of stakeholders and interdisciplinary researchers; and may yield more efficient achievement of improved health and well‐being among persons on the autism spectrum at the population‐level. Lay Summary: Scientists need better ways to identify and address gaps in autism research, conduct research with stakeholders, and use findings to improve the lives of autistic people. We recommend an approach, based in public health science, to guide research in ways that might impact lives more quickly. [ABSTRACT FROM AUTHOR]

U.S. policy interventions encourage earlier provision of Vocational Rehabilitation (VR) services to support students and youth with disabilities such as autism spectrum disorder (ASD) during the transition from school to work. We analyzed Rehabilitation Services Administration (RSA-911) data using multivariable logistic regression to determine the association of VR services receipt with employment outcomes for students ages 16–21, same-age non-student youth and young adults with ASD. Students with autism received job-related services (job search, job placement, and on-the-job supports) at rates significantly below comparison groups, even though odds of successful employment at VR exit were significantly higher if they received these services. Findings suggest that rates of employment among students with autism might be improved with intentional delivery of job-related services. [ABSTRACT FROM AUTHOR]

This study used nationally representative data to describe the prevalence and correlates of work experiences among high school students with autism who received special education. Four in tenstudents with autism experienced any type of work (community-based, school-sponsored, paid or unpaid) within a given year-significantly fewer than peers with and without disabilities. Rates of paid work among students with autism were comparable to students with intellectual disability (ID)but half the rate of non-special education peers. Among youth with autism, significant correlates of having work experiences included being white, parent participation in transition planning, and functional skills including navigation. Fostering a variety of early work experiences should be a key goal of disability employment policy at federal and state levels. [ABSTRACT FROM AUTHOR]

Employment outcomes for transition-age youth with autism spectrum disorder (TAY-ASD) following Vocational Rehabilitation (VR) services declined between 2002 and 2011; although a few states showed significant progress. We examined inter-state variation in VR service use and outcomes among TAY-ASD in 2014–2016, finding significant differences in the percentage of TAY-ASD who received VR services, entered VR services during secondary school, had timely development of an employment plan, and were employed at VR exit. Inter-state differences remained significant after adjusting for the influence of individual-level demographics and state-level unemployment and fiscal capacity, suggesting other factors influence variation. Future research should monitor whether changes in the VR program, via the 2014 Workforce Innovation and Opportunity Act, move the needle on VR outcomes for TAY-ASD. [ABSTRACT FROM AUTHOR]

Transition-age youth with autism (TAY-ASD) experience poor employment outcomes and gaps in services that could assist them in securing jobs. Vocational rehabilitation (VR) is a source of public assistance for people with disabilities seeking employment and TAY-ASD are a growing segment of VR service users. Postsecondary education (PSE) is essential for building vocational skills, contributing to employment satisfaction and better wages. VR provides services to support PSE success. Fewer TAY-ASD received PSE training from VR (18%) than TAY with other disabilities (32%), but more than TAY with an intellectual disability (15%). TAY-ASD who received PSE training were more likely to exit VR with a job. The importance of PSE to employment should be considered in TAY-ASD who seek employment supports. [ABSTRACT FROM AUTHOR]

Objective: This study used Social Security Administration program data to identify population-level trends in Supplemental Security Income (SSI) program participation and payments to adult recipients with autism spectrum disorder (ASD) relative to recipients with intellectual disability and other mental disorders.Methods: The authors examined SSI program data from 2005 to 2015. Variables included caseload size, number of new adult awardees per year, total annual SSI payments per disability group, and average annual SSI payment per recipient.Results: Adults with ASD represented a growing share of the total first-time SSI awards given to adults with mental disorders, with percentages increasing from 1.3% in 2005 to 5.0% in 2015. In 2015, 158,105 adults with ASD received SSI benefits, a 326.8% increase since 2005. Federal SSI payments to adults with ASD increased by 383.2% during the same period (totaling roughly $1.0 billion in 2015). The annual average payment for adults with ASD was $6,527.40 in 2015.Conclusions: The purpose of the SSI program is to reduce the extent of poverty by providing monthly payments to eligible individuals with disabilities. The authors found that a large and growing number of adults with autism receive SSI benefits. This finding underscores the importance of future research related to the economic security of adults on the autism spectrum. [ABSTRACT FROM AUTHOR]

Purpose Of Review: We review original research about services for adults on the autism spectrum published from January 2013 through December 2018. The main aim is to characterize the topical and methodological aspects of research about services. We review research on services related to employment, living in the community, and social participation. We compare our results with those from a similar review published in 2012 to assess progress and identify where new directions in research about services for adults with autism are needed.Recent Findings: We found the evidence base about services for adults on the autism spectrum remains very small and highly variable in aims and methods. There is wide variability in methods used to define sampling frames and recruit participants. Most studies focus on employment. Almost no studies examine the overall ecosystem of services serving autistic adults. Few studies use a conceptual framework for understanding access to, or improvement of, services. The small size of the extant research coupled with inconsistent quality prevents the accumulation of new knowledge in ways that would significantly inform the improvement of systems of care for the growing population of adults on the autism spectrum. [ABSTRACT FROM AUTHOR]

BACKGROUND: The problem of persistently low rates of employment and earnings for people with autism is well established. In the U.S., the 2014 Workforce Innovation and Opportunity Act (WIOA) updated the legal framework for the federal Vocational Rehabilitation (VR) program which assists people with disabilities to find and maintain employment. OBJECTIVE: This study examined whether and how the needs of transition-age youth and adults with autism are addressed in state WIOA plans. METHODS: We analyzed WIOA documents for all states plus the District of Columbia using content analysis. RESULTS: Of the 51 state plans, 44 contained references to autism, and 19 explicitly identified autism as a disability group that is underserved by the state VR agency. Even among states that clearly defined autism as underserved, only 10 provided comprehensive plans which defined goals and strategies to address the vocational needs of this group. We discuss major themes related to VR service delivery for people with autism identified within the state plans. CONCLUSIONS: This study identifies state policy aimed at facilitating employment for people with autism and contributes to efforts to discover why individuals with autism in some states have better employment outcomes than in others. [ABSTRACT FROM AUTHOR]

Almost half of young American children live in low-income families, many with unmet needs that negatively impact health and life outcomes. Understanding which needs, proactively addressed, would most improve their lives would allow maternal and child health practitioners and social service providers to generate collaborative solutions with the potential to affect health in childhood and throughout the life course. 2-1-1 referral helplines respond to over 16 million inquiries annually, including millions of low-income parents seeking resources. Because 2-1-1 staff members understand the availability of community resources, we conducted an online survey to determine which solutions staff believed held most potential to improve the lives of children in low-income families. Information and referral specialists, resource managers, and call center directors (N = 471) from 44 states, Puerto Rico, and Canada ranked the needs of 2-1-1 callers with children based on which needs, if addressed, would help families most. Childcare (32%), parenting (29%), and child health/health care (23%) were rated most important. Across all childcare dimensions (e.g. quality affordable care, special needs care), over half of the respondents rated community resources inadequate. Findings will help practitioners develop screeners for needs assessment, prioritize resource referrals, and advocate for community resource development. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tremendous state-level variation exists in the Vocational Rehabilitation (VR) service experiences of transition-age youth with autism spectrum disorder (TAY-ASD). Individual-level factors alone have not adequately explained differences in VR service utilization and employment outcomes for these youth, and the socio-demographic and economic state-level factors examined to date are largely non-modifiable. OBJECTIVE: This study aimed to identify and prioritize modifiable state-level policies and practices that may affect VR service utilization and outcomes of TAY-ASD. METHODS: We used a modified, two-round Delphi approach with 12 subject matter experts within this mixed methods study. RESULTS: Twenty-three factors of VR service use and outcomes were rated in the top half of importance scores – most of which were also in the top half of modifiability scores. These factors were organized into five themes regarding capacity, efficient and effective VR processes, innovation, inter-agency efforts, and staff training and competency. All participants agreed that these themes captured the main types of factors that might be driving state-level variability in VR outcomes. CONCLUSIONS: This study identified key themes and modifiable factors for investigation within next-step research. Studying these themes and factors may enable researchers to learn from what is working in some states to enhance employment outcomes for TAY-ASD. [ABSTRACT FROM AUTHOR]

BACKGROUND: With evidence pointing to particularly poor employment outcomes for young adults with ASD, it is important to understand their employment experiences in order to develop effective interventions that address their needs. OBJECTIVE: We compared the job search experience, job duration and job loss of young adults with Autism Spectrum Disorder (ASD) and their peers with four other types of disabilities. METHODS: The study analyzed wave 5 data collected in 2009 from youth or their parents who were included in the National Longitudinal Transition Study-2 (NLTS2), a nationally representative sample of youth who received special education services in high school. RESULTS: Among 21 to 25 year olds with ASD, fewer than 30% were looking for a paid job at the time of the interview and approximately 22% found a job on their own, the lowest rates among the five disability groups included in the analyses. It took them an average of 14 months to find a job, longer than the other disability groups. Young adults with ASD held a job for an average of 24 months, longer than youth in two of the other disability categories. The main reason young adults with ASD became unemployed is because their temporary job ended. Those who were older, were from higher-income households, had better conversational or functional skills, or attended postsecondary schools had more positive employment experiences. CONCLUSIONS: Young adults with ASD experienced considerable difficulty obtaining long-term employment and more research is needed to determine strategies for improving their employment outcomes. [ABSTRACT FROM AUTHOR]

This study examined the prevalence and correlates of three living arrangements (with a parent or guardian, independently or with a roommate, or in a supervised setting) among a nationally representative sample of postsecondary young adults with an autism spectrum disorder. We assessed living arrangements since leaving high school. Compared with young adults with other disability types (learning disabilities, intellectual disabilities, or emotional disturbances), those with an autism spectrum disorder were more likely to have lived with a parent or guardian and least likely ever to have lived independently since leaving high school. Members of the autism spectrum disorder group were less likely to have ever lived elsewhere and more likely to live under supervision since leaving high school compared to persons with emotional disturbances and learning disabilities. Group differences persisted after controlling for functional ability and demographic characteristics. Correlates of residential independence included being White, having better conversation ability and functional skills, and having a higher household income. Further research is needed to investigate how these residential trends relate to the quality of life among families and young adults. [ABSTRACT FROM PUBLISHER]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The original version of this article unfortunately contained mistakes in Table 1 values. Some of the values in "TAY-ASD who received services" were incorrect. The corrected Table 1 is given below. [ABSTRACT FROM AUTHOR]

The article presents the authors' opinion on research on employment support for adults with autism spectrum disorders (ASDs). They argue for the need for systems to measure outcomes of employment services for people with ASDs in order to learn from prior efforts, and the highlight an approach based on public health methods.