OARacle Newsletter

Research has shown that autistic adults have poorer quality-of-life outcomes than their neurotypical peers, including lower employment rates and educational achievements. A key way to improve outcomes for this growing population is to implement research-informed transition planning, which addresses core impairments in skills needed for autonomous and independent living, including self-knowledge, self-determination, and self-regulation.

In 2021, OAR awarded an applied research grant to Susan White, Ph.D., for her study, Improving Outcomes in Autism: Community Implementation of Stepped Transition in Education Program. Dr. White is a professor and director of the Center for Youth Development and Intervention at the University of Alabama. Her study tested the effectiveness of Stepped Transition in Education Program for Students with ASD (STEPS), which is designed to help autistic transition-age youth prepare for independence.

In a prior trial, Dr. White and her research team found that STEPS participants demonstrated significant improvement in transition readiness, predicted by self-determination, while participants receiving transition services as usual did not. STEPS was also highly acceptable to families, feasible to implement with fidelity, and resulted in significantly increased readiness for transition.

The OAR-funded study sought to test the impact of community-implemented STEPS on independence and readiness for adult transition in a sample of autistic teens and young adults. The study’s goals were to: 

• Test feasibility and effectiveness of the program
• Assess factors that influence implementation, consistent with the Consolidated Framework for Implementation Research

Methodology

In the first phase, the research team called together an implementation workgroup comprised of an autistic young adult, two parents, five administrators at agencies serving autistic individuals, three school system administrators, one university support services representative, and four mental health providers. The team asked for their thoughts and experiences about how to make the program sustainable in community settings.

The second phase was an open trial of STEPS in the community, which included assessments at eligibility, baseline, midpoint, endpoint, and follow-up six months after the trial ended. Participants included 24 autistic adolescents and young adults (ages 16 to 29) and their caregivers. The sample was predominantly male and white, although participants reported variability in their household incomes.

Trained counselors delivered the STEPS program in 12 sessions over 14 weeks at participating community agencies. The weekly sessions involved didactic and experiential learning of self-knowledge, self-determination, and self-regulation skills, with practices geared toward client-identified goals. Throughout the intervention, the counselors checked in by Zoom or phone as needed to remind participants about practices and planned activities related to program goals, such as joining a new group, and to provide encouragement.

Outcomes

Results supported the acceptability of STEPS delivered in the community. Only two of the 24 participants dropped out, both before attending any sessions. The program also received moderate-to-high satisfaction ratings. Participants reported increased transition readiness at the end compared to their baselines. Caregivers also reported significant increased transition readiness for their young adult by the end of the program.

Dr. White and her research team found strong evidence for both acceptability to consumers and feasibility of delivery, based on the clinically significant improvements as noted above. Caregiver and family engagement in the program seemed to help with implementation and impact.

This study was one of the first community trials to evaluate a research-supported transition program for autistic adolescents and young adults. The results suggest that further research in this area is warranted, to facilitate the community implementation of effective programming that is acceptable to consumers.

Practical Findings

For autistic people and their parents, the most relevant findings are: 

• Previous participants found STEPS helpful and not too time-consuming. 
• Autistic people felt more prepared for the transition to adulthood and experienced some changes in their employment and education activities after participating in STEPS. 
• Autistic people were more self-determined and had higher self-efficacy after participating in STEPS.

Therapists and other non-family caregivers who support autistic people during the transition to adulthood noted that:  

• STEPS was easy to implement by therapists and a good fit for their autistic clients. 
• STEPS clients experienced positive changes in their readiness for the transition to adulthood, self-determination, and self-efficacy.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.