News and Knowledge

It is expected that the number of autistic youths transitioning from school-based services will increase by 123% in this decade. Current estimates indicate that about half of adults who receive services through developmental disability agencies spend their days in adult day programs, so it is important that those programs lead to positive outcomes for the adults they serve, particularly when it comes to vocational skill building and related resources.

A major drawback to achieving those positive outcomes is the lack of training for day program staff when it comes to best practices to support autistic adults. Although systematic reviews have identified evidence-based practices for autistic individuals, including practices effective for behavior change, social skills development, and vocational skills instruction, the majority of the research has been focused on children.

In 2019, OAR awarded a research grant to Jessica Suhrheinrich, Ph.D., for an 18-month study examining the feasibility of an established professional development model and evidence-based practice resources to train day program staff in the use of evidence-based practices to better support autistic adults. Dr. Suhrheinrich is an assistant professor in the Special Education Department at San Diego State University and an investigator with the Child and Adolescent Services Research Center.

The goals of her study were to:

1. Evaluate consumer, staff, and organizational characteristics and needs. Dr. Suhrheinrich and her research team used a survey and focus groups to gather information from autistic adults, their family members, day program administrators and staff, California Developmental Disability Services (DDS) representatives, and California Autism Professional Training and Information Network (CAPTAIN) members.
2. Adapt National Professional Development Center on Autism Spectrum Disorder (NPDC) assessment and training resources to support training implementation. The model and its resources are associated with increases in overall program quality, use, and fidelity of evidence-based practices and individual student progress.
3. Assess the effectiveness of the adapted model and resources in partnership with the California Department of Developmental Disability Services and CAPTAIN.

Methodology

Due to COVID restrictions that closed day programs during the period of the study, Dr. Suhrheinrich recruited three community care facilities and their staff to participate in the study.

The team developed an online survey to ask about the needs of autistic adults living in group homes. They also conducted focus groups with group home administrators to discuss barriers to training staff and suggestions for adaptation of the training program. A total of 88 individuals completed the survey, including 13 direct care staff, 73 facility administrators, and two parents. Fifty-two respondents reported behavior as their top need with 26 respondents noting antecedent-based interventions as their preferred evidence-based intervention.

In the focus groups, group home administrators reported staff knowledge as a main barrier to trainings and suggested several adaptations including scenario-based trainings, ongoing supervision, and interactive trainings.

With that feedback, the research team developed two skills packages, adapted from NPDC resources, using evidence-based visual supports and prompting practices for use with autistic adults. These skills packages were hosted on an interactive platform that allowed users to view the video presentation and digitally complete activities and answer content questions. Additionally, pre- and post-tests were embedded into the presentation to assess knowledge. Learners also received feedback to increase long-term retention, tripling learning efficacy over standard video presentations.

The adapted training resources were then used with staff at the community care facilities. A CAPTAIN leader employed by Alta California Regional Center provided a half-day interactive didactic training workshop. Working with a center administrator and staff members, the trainer developed goals for each participating client. Each facility received a start-up kit to prepare visual supports. Additionally, staff participated in weekly coaching sessions with the trainer to discuss goal progress and implementation of evidence-based practices.

Outcomes

For Providers/Agencies: The trainer reported a high level of engagement in the training, with 62.5% of participants extremely engaged and 37.5% very engaged. In pre-tests, the average score for correct answers about prompting was 35% and 65% correct for visual supports. Those scores improved after the training with an average score of 65% for prompting and 76% for visual supports. When asked how they felt about implementing each evidence-based practice, the majority indicated they felt competent to a “slight extent” (57.1%) in implementing prompting and to a “moderate extent” for visual supports.

All of the participants found both evidence-based practices and the training program to be accessible, fitting, easy to use, and applicable for their setting.

All three sites were assessed for overall quality including site structure, organization and use of visual cues and schedules. Results indicated improvement for all sites.

For Clients: The majority of goals for the 13 clients targeted self-help skills (66.7%) such as preparing meals, laundry, morning routines, and showering. Social skills (16.7%) such as staying on topic and engaging in leisure activities (16.7%) were also targeted. By the end of the training program, all clients but one had reached their expected level of progress and almost half (46.1%) had exceeded their expected level of progress.

Findings

Study findings indicated that the majority of the adult participants improved their self-help and social skills. These skills will improve their quality of life by increasing their independence as well as ability to engage in the community. Staff felt more knowledgeable and competent in implementing evidence-based practices. Additionally, based on testimonials from participants, staff noted that the practices could reduce their workload by encouraging clients to be more independent.

Next Steps

Dr. Suhrheinrich plans to submit a manuscript to a professional peer-reviewed journal, likely either Autism in Adulthood or Behavior Analysis in Practice. Because the findings are promising, she also noted that ongoing funding could allow for implementation of the training across a larger sample as well as with other agencies, like day programs. Additional research could also examine whether the improvements last over time.

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.