Vocational Rehabilitation and Autistic Adults

13 Nov

I recently saw a paper in the Online First section of Journal of Autism and Developmental Disorders called “Use of Vocational Rehabilitative Services Among Adults with Autism“. I knew I had to read it. It comes from one of my favorite research groups, that of Prof. David Mandell. I’ve been carrying this paper around in my pocket for a month now. It is folded, tattered and filled with highlight marks.

The reason for the delay: how to condense this paper into a meaningful blog post without essentially copying the entire paper? As it stands, this will be a series of excerpts. The reason for blogging it: papers on issues directly related to adults with autism are few. This one looks at what I consider to be a very important question: training to get employment for adults with autism.

One other note: I will skip over the data analysis section. This will be a long post already, and I want to concentrate on the discussion of the results. But, rest assured, they did their due diligence and analyzed the data thoroughly.

So, even though this may not be the best presentation of the study, if I don’t do it now, it may never get done.

Here’s the abstract:

This study examined the experiences of individuals with autism spectrum disorders (ASD) in the US Vocational Rehabilitation System (VRS). Subjects included all 382,221 adults ages 18–65 served by this system whose cases were closed in 2005; 1,707 were diagnosed with ASD. Adults with ASD were more likely than adults with other impairments to be denied services because they were considered too severely disabled. Among those served, adults with ASD received the most expensive set of services. They and adults with MR were most likely to be competitively employed at case closure. Post hoc analyses suggest that their employment was highly associated with on-the-job supports. The results suggest the importance of the VRS in serving adults with ASD.

If you are interested, here is the first page (for free).

The paper points out that adults with ASD require considerable supports, with possibly only 15% achieving independence, and another 20% “functioning well in the presence of community based support.” This points out the great need for studies such as this one. We need a better understanding in order to improve the situation for the estimated 65% who are not independent or “functioning well”.

In the United States, the vocational rehabilitation system falls under the Department of Education, and helps with assessments, diagnosis, counseling, job search assistance, assistive technology and on-the-job training.

The outcomes include “Competitive employment”, which involves integrated settings (with supports as needed) and wages at or above the minimum required by law. Alternatively, Non-competitive employment can be paid below the minimum wage, and can include sheltered employment.

Results were compared for people with ASD, Mental Retardation, Specific Learning Disability (SLD) and Other Impairment Cause (OIC).

Individuals with ASD’s have “markedly different vocational needs than individuals with other developmental disabilities”. And “the small body of research in this area suggests that services provided through vocational rehabilitation programs are less than optimal for individuals with ASD.”

The authors stress, repeatedly, the value of employment. The concluding paragraph starts with the statement, “Work is among the most valued social roles in our society. Many individuals with ASD can achieve successful employment outcomes, despite questions about access and cost-effectiveness.” The value of employment is also spelled out in an earlier section:

Our findings are also important in light of research indicating that supported
employment through vocational rehabilitation programs may improve cognitive performance of adults with ASD (Garcia-Villamisar and Hughes 2007) and generally improves quality of life (Garcia-Villamisar et al. 2002).

They found that at the end of VR training, 42.2% of those with ASD were competitively employed, whith 2.1% employed in a sheltered setting. The remaining (55.7%) were not employed. These results are better than those for the other groups. The numbers for those competitively employed were, 39.4% (mental retardation), 37.5% (SLD) and 35.1% (OIC).

They found that 4.3% of individuals with ASD had cases closed for having a disability “too severe to benefit from services”. Compare this to 2% for those with mental retardation, 0.4% for those with SLD, and 2.2% for those in other categories. So, people with ASD were more likeley to be denied services for this reason. They state that this “hints at the possibility” that “some people with ASD’s may never explore the use of VR services because they (or their families) do not see it as a viable option or are discouraged from seeking services.” This could affect the numbers found for those achieving competitive employment.

The costs were compared:

VR expenditures were much higher for individuals with ASD than for those with other impairments except people with MR. This difference may be due to the additional needs of people with ASD (Muller et al. 2003). Alternatively, the VR system may not be structured to provide services to individuals with ASD in the most cost-efficient manner (Hillier et al. 2007). Both potential explanations beg for additional research on the most cost-effective strategies for achieving competitive employment.

The median costs? $2,380 (ASD), $2,160 (mental retardation), $1,108 (SLD), $1,280 (OIC).

So, yes, the numbers were higher for the ASD group. But even $2,160 per person to me sounds like a pretty darned good investment to get a sizable fraction of a group employed.

The authors noted:

VR expenditures were much higher for individuals with ASD than for those with other impairments except people with MR. This difference may be due to the additional needs of people with ASD (Muller et al. 2003). Alternatively, the VR system may not be structured to provide services to individuals with ASD in the most cost-efficient manner (Hillier et al. 2007). Both potential explanations beg for additional research on the most cost-effective strategies for achieving competitive employment.

There is a lot more valuable information in this paper. One thing that is missing is who funded the research. I’d love to hear that this is the sort of research NIH is sponsoring, and will continue to sponsor through the IACC process.

I’ve already quoted part of the conclusion. I think it worth quoting it in whole here:

Work is among the most valued social roles in our society. Many individuals with ASD can achieve successful employment outcomes, despite questions about access and cost-effectiveness. Individuals with autism and their families should seek out supports and employment; other support providers should emphasize employment as a possible social role; and policymakers should continue to examine ways in which they can enhance the variety and accessibility of supports for adults with autism, including vocational services, in order to ensure that they have opportunities to live and contribute in their communities.

ResearchBlogging.org
Lindsay Lawer, Eugene Brusilovskiy, Mark S. Salzer, David S. Mandell (2008). Use of Vocational Rehabilitative Services Among Adults with Autism Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-008-0649-4

8 Responses to “Vocational Rehabilitation and Autistic Adults”

  1. Paulene Angela November 13, 2008 at 16:28 #

    I’m shocked at the low investment costs, what is the world waiting for?

    Very interesting, thanks for this post Kev.

  2. Socrates November 13, 2008 at 20:50 #

    In the UK we have a very limited HFA employment service run by the National Autistic Society – “Prospects”

    http://www.autism.org.uk/prospects

    The cold, hard truth about unemployment amongst HFA’s in the UK:

    “They are clearly a disadvantaged group, excluded both by a lack of understanding of their disability and the fact that only 15% are at present in full-time employment.”

    I believe Prospects success rate was around 80% – And a study into its cost-effectiveness said that it was “cost neutral”.

    “A positive, independent professional evaluation was carried out on the pilot of Prospects London from 1995 to 1997, which elicited and took account of substantial input from clients. This evaluation demonstrated the effectiveness of the Prospects model and highlighted the need to extend the service to reach more people. A further evaluation last year found: 98% of clients surveyed felt their registration with Prospects had been helpful; 85% were satisfied with their jobs; 97% liked their employment support worker; and 75% felt they could not have coped at work without their employment support worker.”

    We also have a smaller, local scheme called “Reboot” which refurbishes and recycles computer equipment:

    http://www.red2green.org/_reboot

  3. Paulene Angela November 13, 2008 at 21:16 #

    I’m not based in the UK now, however I remember many years ago my friend was a branch manager for http://www.remploy.co.uk/. I had a quick look at their site

    Quote:
    You’ll have the support of a Remploy Employment Advisor. Be it job search advice, training and development or work placements, we’ll work with you to identify positions that best match what you want from a job.

    Each and every year we help thousands of disabled people and people with a health condition achieve their employment goals and enjoy the benefits of working.

    Last year we supported over 6,600 people to find sustainable employment, in a wide range of roles with many of the UK’s top employers. From retail and administration roles, to contact centre jobs, warehousing & logistics, and catering, we’ll help you make the most of your ability.
    Unquote
    Are they only geared for high functioning persons? I’ve not scanned the whole site.
    Kind Regards,

  4. Schwartz November 14, 2008 at 03:15 #

    The median costs? $2,380 (ASD), $2,160 (mental retardation), $1,108 (SLD), $1,280 (OIC).

    So, yes, the numbers were higher for the ASD group. But even $2,160 per person to me sounds like a pretty darned good investment to get a sizable fraction of a group employed.

    I agree wholeheartedly!

  5. Afraa awad January 13, 2009 at 10:15 #

    thanks , that is very intersted . But we need to know more about the test that it should be used for assessing vocational training for an autistic adult. if any ?

  6. ALADDIN_1978 September 25, 2009 at 23:45 #

    Prospects is only available in London. If a person lives outside London, it is only possible to work in London if the salary is high enough. The service is very limited, outside London. Prospects have no links to organisations for employment. If a person is neuro-diverse, then Prospects cannot help you because a lot of their jobs are in administration, so a person who also has dyspraxia cannot work in administration.

    Prospects are the best of a bad bunch. Remploy, RBLI , Workstep , Disability Employment Advisor and the Employment service are very bad. The government should act a.s.ap with investment.

    Graduates who have an ASD are generally placed in roles beneath their capabilities. I think Prospects, only help a very small number of people (5%-15% approximately).

    It should be expanded and replaced with a neuro-diverse organisation such as key4learning.

Trackbacks/Pingbacks

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    […] individuals with ASD.” The authors stress, repeatedly, the value of … … Read more: Vocational Rehabilitation and Autistic Adults « Left Brain Right Brain ← Veterans Retraining Assistance Program (VRAP) and GI Bill for […]

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