The Development and Evaluation of a Cross-Context Employment Program for Autistic Adolescents

Abstract

Vocational programs typically focus on building the skills of autistic youth. However, there is growing recognition that the supportive environment (or ecosystem) around an individual plays an important role in finding and maintaining work. Programs at the ecosystem-level can be established by coordinating support before high school ends. Cocreation of a vocational program by support providers can facilitate an integrated effort to prepare autistic youth for employment. In this study, we describe and evaluate the Job-Train Program (JTP), a vocational program for autistic high school students codesigned with educators and a community-based social services agency. A school board, community-based social services agency, and academics partnered to cocreate JTP. JTP combined skill teaching and paid supported employment on a university campus. This pilot study evaluated JTP using qualitative and quantitative data. Twelve autistic youth were recruited, aged 15–18 years (10 males, 2 females) with an average intelligence quotient of 101.9 (standard deviation = 14.4), from the Wechsler Abbreviated Scale of Intelligence-2. Youth and parents completed self-report measures (pre–post), including the primary outcome, Canadian Occupational Performance Measure (COPM). Post-JTP, interviews, focus groups, and surveys collected additional information from youth (n = 11), parents (n = 10), job coaches (n = 5), and employers (n = 8). Youth COPM scores indicated significant improvements in self-perceived ratings of skill performance (z = −2.5, p = 0.01) and satisfaction (z = −2.6, p = 0.01). Qualitative data corroborated COPM results noting youth skill improvements in self-esteem, independence, communication, and understanding work. Findings demonstrated a promising vocational training model for autistic high school students informing the development of integrated service pathways to support preparation for employment.

Community brief

Why was this program developed?

When autistic young people leave school, they can experience difficulties in getting a job. We need to test whether job training might be helpful for autistic young people when they are leaving school. Current support focuses mostly on developing educational skills, but it is important that we think about the strengths and abilities of the individual within their environment. In this study, we worked with educators from schools and a community service agency (who support autistic adults) to develop a job training support program for autistic youth.

What does this program do?

We designed the 13-week Job-Train Program (JTP) to provide training and paid work experience, develop work abilities, and increase support around the autistic youth. Participants took part in weekly group sessions about work skills, and they did 8 weeks of paid work, supported by a job coach on a university campus.

How did researchers evaluate the program?

Twelve autistic high school students (age 15–18) took part, and eight university departments hosted work experiences. We used several approaches to see if the program was helping and to identify areas where we could improve the program in the future. Ten parents and 11 autistic youth completed the Canadian Occupational Performance Measure (COPM) before and after the program, so we could see if there were any changes in work-related skills. We also completed interviews with youth, focus groups with parents, and surveys with job coaches to gather feedback.

What were the early findings?

Scores on the COPM questionnaire showed that the young people rated themselves as more skilled and they were more satisfied with their skills after the program. Parent ratings showed a similar pattern. When we spoke to youth, parents, and job coaches, they mentioned improvements in responsibility and independence. Eight employers in university departments gained awareness of autistic youth as employees and all were willing to be part of the program again. Parents suggested that having more training of advocacy skills would help youth with gaining work in the future.

What were the weaknesses of this project?

We did not assess how well the job coaches did in delivering the program or exactly how they made accommodations within the work experience jobs. Autistic individuals and their parents were not included in program development.

What are the next steps?

We now plan to include autistic youth and their parents in further refining the program. We also plan to follow up with the youth who took part, to see how they are doing in the long term. We also will improve the support provided by job coaches.

How will this work help autistic adults now or in future?

The JTP approach may help autistic youth as they go into employment and could provide high-quality support for the transition to adulthood. We also show that university campuses could be great places for autistic youth to gain experience, so in the future hope that universities and schools work together more to help support autistic youth.

Introduction

Difficulties in employment for autistic youth begin in the adolescent years where low employment rates at high school exit have long reaching impact. Prospective research over 10 years has found lower success in educational and employment outcomes following high school completion, suggesting that the decline in level of independence and engagement at school exit for autistic individuals continues into adulthood.¹ Poor employment outcomes among autistic adults have been described as negatively related to lower quality of life.^2,3 On the contrary, employment for autistic individuals, when attained, is correlated with several positive outcomes such as economic independence and improvements in self-esteem, quality of life, cognitive abilities, and social integration.^4–7

For individuals with any disability, including autistic individuals, holding a paid job in the community during high school is one of best predictors of postsecondary employment in the years after graduation.^8–10 However, already by high school, employment is less common for autistic students. In a large U.S. longitudinal study, autistic youth had among the lowest paid-work experience in high school compared with other youth with an Individualized Education Plan.¹¹ Recent research examining the correlates of employment for autistic high school students highlighted the importance of parent support in transition planning, daily living skills, and early work experiences, to enhance employment success.¹²

Vocational training programs for autistic youth exist, but research mainly comprised small-scale studies that lack careful measurement and involve only one domain or context.¹³ Emerging evidence-based vocational interventions for high school students typically focus on the transition from high school into employment and postsecondary school rather than paid work during high school. Two major evidence-based programs are available for autistic youth during high school. The first, JobTIPS program, is an internet-based multimedia employment training program effective in improving interview responses and covers areas related to career interests, finding/keeping a job, and other job-related topics.¹⁴ The second employment program in the United States, “Project SEARCH plus Autism Spectrum Disorder Supports” (PS-ASD),¹⁵ involves complete immersion of autistic youth in workplaces across three unpaid internships during the final year of high school.

A recently completed multisite randomized trial of PS-ASD found a significant positive effect of the program.¹⁶ PS-ASD's success illustrates that carefully designed vocational interventions can have a substantial impact on employment outcomes. However, the program requires full workplace immersion for the last year of high school and depends on high levels of resource-intensive support from local business, which is not easily replicated.⁵ In addition, both PS-ASD and JobTIPS lack early paid work experiences and are situated only within an educational context.

For transition-aged youth across disabilities there is a significant need for information exchange and coordination between service systems (health, education, and social services) to support the development of social roles, including employment.^17,18 However, the collaborative development and delivery of vocational interventions have received little attention in the autism research literature to date. Vocational programs that address school-work transitions earlier in high school and through intersecting supports in different service contexts may better develop vocational pathways and increase the likelihood of sustained future employment.^13,19

As such, this study had two aims. The first was to work with high school educators and a community-based social services agency (providing person-centered services to support autistic individuals and their families, including adult-based social and employment programs, as well as independent living) to codesign a paid vocational training program for autistic youth that emphasized contextual supports. The second aim was to pilot the resulting 13-week Job-Train Program (JTP), evaluate its impact on youth, families, and employers, and examine the degree to which the program succeeded in integrating supports to promote the development of youth job skills.

Emerging Practice

Recent reviews of the autism employment literature highlight several research gaps that include the following: the need to examine socioecological components impacting vocational outcomes; and a need to focus on the importance of collaboration between contexts (home, school, and community) to create sustainable and effective programs for autistic individuals.^20,21

Socioecological factors

Typically, vocational intervention efforts aim at remediating difficulties for autistic youth without considering contextual factors such as education supports and employer attitudes toward autistic people that can impact employment success. Secondary school education supports and practices influence employment outcomes for autistic students.²² Curriculum and instructional practices that do not focus specifically on job procurement contribute to difficulty obtaining employment.²³

Participation in transition planning during secondary school predicts employment among disabled students in general.²⁴ Among autistic youth leaving high school, career counseling during high school, and school contact with postsecondary vocational training programs or potential employers were associated with employment participation.²⁵ Teacher expectations also play an important role, specifically in relation to providing access to rigorous learning opportunities for students' college and career prospects.²⁶ Other school practices such as promoting career awareness, connecting to early work experiences, and involvement in work experiences all predict positive employment outcomes for autistic students.²⁶

Employer attitudes toward disabled people are also an important factor^20,27,28 as employer accommodations can promote improvements in job-person fit and facilitate sustainable work.²⁹ Thus, it is essential to determine processes that facilitate a sustainable, positive work environment for autistic individuals while still meeting employer needs to meet operational objectives.

Collaboration between support contexts: the ecosystem

A recent integrated vocational model by Nicholas et al.³⁰ emphasizes the role played by the “ecosystem” surrounding an autistic individual in improving vocational opportunities and outcomes. This model conceptualizes employment of autistic people as being closely linked to broader community resources, family support, policy, and work-place capacity building (by employers and coworkers). This approach expands the focus of intervention beyond the autistic individual, to strengthening and integrating the full range of supports around them. The components of the model include individualized support (i.e., job-skill preparation), family support (i.e., augmenting family role), community/workplace capacity (i.e., employer, workplace, and mental health support), and structural program issues (i.e., service availability/coordination).

The ecosystem approach is appealing, but its implementation requires some mechanism to orchestrate the operation of disconnected silos of support, in service of the common goal of improving work skills for autistic youth. The establishment of community partnerships between supports for the individual is one way to develop vocational programs that more effectively integrate the knowledge and capacities of intersecting services.

Development of the Job-Train Program

The principles of the ecosystem model³⁰ guided the development of our JTP. However, the process of developing, implementing, and disseminating results from JTP drew on the experience and curricula of community stakeholders outside of an academic team.³¹ The community–academic partnership involved in this work included stakeholders across contexts that can have an impact on student employment outcomes. Study partners included a community-based social services agency, local high school board, and the university-based autism research team, which included academics and clinicians (i.e., psychiatry, speech-language therapy, psychology, and occupational therapy). The community social services agency has a long history of providing specialized services, learning opportunities, and supports to autistic children, youth, adults, and their families focusing on the development of social, recreational, vocational, and independent living skills.

The school board (both primary and secondary) offered supplemental content and supportive learning environments for autistic children and youth in traditional learning settings, culminating in the transition to adulthood planning. The team met regularly to develop the program, including establishing program goals that intersect across contexts and developing autism-focused program curriculum, implementation, and evaluation outcomes. Chairs for two committees were established for curriculum development and implementation, and evaluation outcomes. Curriculum development and implementation chairs were two school board speech-language therapists and the director of autism services in a community organization, each with more than 25 years of experience working with autistic youth. Chairs for the outcome evaluation committee were academics with 20 years of experience in research and clinical practice in the areas of autism and employment. Dissemination of the results of this work involved all partners in the writing and editing of all knowledge translation activities, including this article.

Description of JTP

The JTP goals included the following: (a) development of job-related skills; (b) preparation for, and successful completion of, supported short-term work experience; (c) establishment of a youth work profile of strengths, interests and support needs; and (d) acquainting employers with autistic youth. The 13-week JTP had two main components (100 hours)—weekly skills training in a socially interactive group (Job Club) and experiential learning in a job-coach supported, paid work placement on a university campus. The program began with weekly 3-hour Job Club sessions to teach work-related skills using small-group role play and large-group discussion within an interactive curriculum. Take-home activities at session end promoted conversation between youth and parents about work.

Sessions focused broadly on roles at work with an emphasis on self-determination through youth setting their own work-related goals. More specifically, session topics covered employer/workplace expectations, professionalism, asking for help, receiving feedback, what to do at break time, identifying and managing stress, problem solving, disclosure of diagnosis, and self-advocacy. Participants also received health and safety training, in an extra full day session of training required by the host university. An “adulting” approach was taken in that youth were expected to undertake primary responsibility for their work obligations with parents acting as supports rather than initiating and ensuring completion of work prerequisite tasks.

Work experience consisted of part-time job placement within various departments on one Canadian university campus 2-half days per week over the final 8 weeks. Participants earned a $31.25 stipend per 4-hour shift, paid biweekly to emulate paycheque timing. Job coaches and curriculum developers matched students to available jobs, taking into consideration the following information: observed work samples from the TEAACH Transition Assessment Profile-Second Edition³²; identified goals from school and employment contexts using the Canadian Occupational Performance Measure (COPM)³³; job coach knowledge of student strengths observed within Job Club sessions; and student preferences of job descriptions and/or work environments (e.g., indoor vs. outdoor).

Job coaches completed modules on autism and supported employment before beginning the program. Job coaches had two roles within the JTP—they taught the Job Club curriculum and provided one-to-one support during work placements, adjusting support intensity over time. Support during work placements also including liaising with department managers or direct reports to ensure student work was appropriately supported. Their dual role facilitated generalization of taught concepts to the workplace and ensured job experiences informed problem solving and group discussion within Job Club sessions. Coaches emailed parents once weekly to share the progress. At program end, coaches completed employment profiles documenting student skills, strengths, and support needs. Youth received a copy of their employment profile. One was sent to their school for placement in their student record to promote success in upcoming cooperative education experiences and contribute to transition planning.

Evaluation Methods

Participants

The school and community agency recruited and prescreened 12 youth (10 males) with a formal diagnosis of autism, with a mean age of 16.5 (standard deviation [SD] = 0.7). Primary inclusion criteria were a diagnosis of autism, absence of aggressive behavior, ability to manage the curriculum, and sufficient independence in self-care to participate in the group. Five participants had co-occurring conditions including attention-deficit/hyperactivity disorder, dyslexia, developmental coordination disorder, and generalized anxiety disorder based on parent-completed questionnaires. The mean composite full-scale intelligence quotient scores for youth on the two-subtest form of the Wechsler Abbreviated Scale of Intelligence-Second Edition³⁴ was 101.9 (SD = 14.4), which falls in the “average” range.

The six coaches included four child and youth workers and two occupational therapy trainees. Five had 3–10 years of experience working with autistic youth and adults. One had several years of experience supporting disabled individuals. Eight university departments within one Canadian postsecondary institution provided jobs in lawn maintenance (Building Services), housekeeping at school residences, research offices (CanChild Centre for Childhood Disability Research, Offord Centre for Child Studies, and Department of Paediatrics), library services (Health Science Library), cleaning, and setting up classrooms (School of Rehabilitation Science). Within each department, one central contact person was identified (i.e., the employer). All university employers reviewed a school board video before a meeting with the team recruiting for job placements. This led to a better understanding of the nature of learning differences in autistic individuals and the supports provided through JTP.

The Hamilton Integrated Research Ethics Board, a jointly constituted board of St. Joseph's Healthcare Hamilton, Hamilton Health Sciences, and McMaster University's Faculty of Health Sciences, provided research ethics approval. Autistic youth and their parents provided written informed consent.

Evaluation

Quantitative and qualitative data were collected as part of a formative assessment to evaluate and explain outcomes and understand how the program might be modified in the future. Quantitative measures were collected using a pre–post design. Qualitative data were collected postprogram to examine the perspectives on program delivery and variables impacting skill acquisition. The primary quantitative measure was the COPM,³³ completed separately by youth and parents with student occupational therapists, with the support of lead author (B.D.R.). Parents independently completed the Child Behaviour Problems Checklist school-age version (CBCL/6–18),³⁵ which was compared pre–post to examine any changes in mental health state while involved in the program (stability of scores or a decrease in scores was ideal).

The COPM³³ is an individualized semistructured interview assessment, measuring an individual's change in self-perceived performance for specific tasks. For this study, the COPM was used to help youth identify employment-related goals in the areas of self-care (in preparation for work), productivity (in a job or workplace), and leisure (in relation to social aspects of work). Participants determined tasks they struggled with but wanted to accomplish and used a 10-point Likert scale to rate both performance (1 = not able to do it; 10 = able to do it extremely well) and satisfaction with performance (1 = very unsatisfied; 10 = completely satisfied). Average scores across the three domains on initial and follow-up assessments are compared for performance and for satisfaction, with a change score of two or more considered clinically significant.³³

Two trained student occupational therapists, supervised by the lead investigator (B.D.R.), administered the COPM. The reliability, validity, and responsiveness of the COPM are satisfactory to excellent.³⁶ Specific psychometric properties include internal consistencies of 0.56 for performance and 0.71 for satisfaction, and test–retest reliability of 0.80.³³ The COPM, completed by youth and parents, has been used in other studies of autistic youth and their parents.^30,37,38

Qualitative data were collected from youth, parents, job coaches, and employers approximately 2 weeks postprogram using varied data collection methods. A 90-minute focus group with all parents captured parental impressions. Semistructured interviews consisting of closed and open-ended questions assessed youth perspectives. Job coaches conducted youth interviews to facilitate participant comfort through a familiar person while also enabling clarification of statements given a shared knowledge of job context. Interviews were audio-taped and transcribed. The investigator who facilitated job placements conducted the employer semistructured interviews. Job coach perspectives were captured through surveys incorporating open-ended questions and several items using a 5-point Likert scale.

Data analysis

Quantitative analyses utilized descriptive statistics (mean and SD), Wilcoxon signed-rank test (COPM), and independent t-tests (CBCL).

Qualitative data were derived from a verbatim transcription of audio-recorded student interviews, employer interviews, and the parent focus group, as well as from surveys exploring job coach perspectives. Codes were derived directly from the four data sets (youth and employer interviews, parent focus group, job coach surveys) using conventional qualitative content analysis methods³⁹ to closely interpret the opinions of all participants.⁴⁰ Transcript analyses included 11 youth interviews (one interview was lost due to a corrupted data file), 8 employer interviews, and the parent focus group (including 10 parents, 2 were unable to participate). Job coach perspectives (n = 5) were captured through surveys.

Two researchers (E.F. and L.C.) completed analysis and coding. They coded the raw data independently, and then convened several meetings to reach a consensus on the final codes, thereby enhancing the trustworthiness of analysis through triangulation. The lead investigator (B.D.R.) adjudicated codes that could not be agreed upon. Member checking was attempted, in which final codes were distributed to the participants to increase rigour of the study results, but youth participants did not respond to the request.

Reflection of team's analytical lens

The lead author (B.D.R.) is an associate professor and occupational therapist with an interest and research emphasis on improving community participation and engagement of all neurodivergent individuals across the life course. The team's perspective embraced diversity with a focus on person centeredness in terms of understanding the employment strengths and abilities of autistic youth to develop individual job profiles to help them achieve their full potential. The team believed in the collaborative transition approach that involved the perspective of multiple service contexts (community social services, education, and interdisciplinary clinical roles) and a supportive ecosystem that can help to better facilitate earlier and more coordinated transition into future employment.

Results and Lessons Learned

This study took a collaborative approach to developing a vocational training program across contexts for autistic youth, which developed skills as well as enhanced and integrated the supports around the individual within their work roles. The resulting JTP was implemented and demonstrated changes in youth skills, which mapped onto the curriculum goals. There was some evidence of collaboration among various supports. Lessons learned are grouped into the following categories: (i) community-university process of collaboration (ii) feasibility of JTP; (iii) youth outcomes; and (iv) integration of supports.

Community-university process of collaboration

The academic partners collaborated with educators and a community organization, by collectively developing, implementing, and disseminating the vocational training program.³¹

Development

All partners worked together to identify the critical need for early “paid” employment experience that was paired with direct instruction of work skills and supported by multiple settings/contexts. A process to share information with parents and the school was considered important. The university campus was determined an ideal environment for this initiative due to its inclusive work environment and diverse job opportunities. Partners cowrote a successful research grant for this study, and collectively contributed expertise to the design, analytical plan, and writing of the proposal.

Implementation

Throughout the collaborative partnership, the team did the following: engaged in regular consensus meetings to promote colearning; involved all partners in the iterative process across research steps; and grounded the JTP on addressing employment needs from an ecological perspective. The school board and community partner led the curriculum development. School partners had knowledge of what students learned from high school to build on within the JTP. The research team also included clinicians who were available to provide mental health support, if needed, throughout the duration of the program. The community social service agency with its extensive experience supporting autistic adults contributed resources and best practices for teaching work-related daily living skills. The community social service agency also hired, trained, and supervised job coaches.

University research partners led the evaluation for descriptive and outcome measurement, data collection, data analyses, and to generate employment profiles of participants. Academics also used university networks to identify departments amenable to hosting the youth.

Dissemination

All partners were involved in analyzing and disseminating findings and knowledge gained from this research for community programming and academic purposes. Dissemination materials included a final report for the granting agency, summaries of findings shared with all the partner agencies involved, reviewing final reports for all the individuals involved in the program to be shared with school partners, and cowriting of this article as seen in the coauthorship team.

Feasibility of JTP

Feasibility of implementing an ecosystem-based program was established. The partnership resulted in the jointly designed JTP model and its attendant curriculum. The feasibility of implementing the JTP model was also demonstrated. A paid employment program was established on a university campus. Twelve participants and their families completed the study. Embedding work placements into the campus setting was manageable and effective. Eight university departments hosted autistic youth. All indicated they would participate in the JTP again. Feedback about the campus setting was positive from youth, families, and coaches. Employers noted that the less hectic summer term afforded more flexibility for the participating departments to accommodate JTP youth. Parents and youth expressed a desire for future work opportunities outside of the university setting, which suggests a natural progression for this program in the future.

Youth outcomes

To ensure the development and implementation of evidence-based services, there is a need for measurement feedback loops in vocational research to learn from experience in ways that help improve future performance.²¹ In keeping with this idea, the current study combined multiple quantitative and qualitative measures to evaluate program impact.

Youth and parents independently generated goal areas related to school and work experiences. Participants established 1–5 goals for each COPM that were averaged for each participant. Youth goals covered areas such as the need for specific skill development in school and/or work contexts, such as better initiation of communication/conversation, but also described challenges in learning new tasks, such as anxiety in learning/completing new tasks. Youth had also identified goals related to advocating for themselves within different contexts (e.g., advocating for self in the context of being bullied, and when gaming with peers). Other goals were related to appropriateness of behaviors within the school and work contexts, such as gauging appropriateness of humor and in how to respond when others break the rules.

For parent goal areas, participants commonly identified goal areas for their youth that were related to independence skills (e.g., independently getting themselves up in the morning, and organizing and completing tasks). Parents also highlighted the importance of age-appropriate behaviors within the school and work contexts, such as the use of technology and when to put it away.

The primary quantitative individual outcome measure, the COPM, was sensitive enough to detect a significant positive change in the youth's perceived skill levels and skill satisfaction with a parallel trend in parent ratings. Pre–post change in youth COPM ratings was not clinically significant (i.e., an improvement of 2 points on the Likert scale), but there was also a statistically significant difference with an increase in self-perceived average skill performance levels (Z = −2.5, p = 0.01) and average skill satisfaction (Z = −2.6, p = 0.01). See Table 1 for results of primary outcomes.

Table 1.

Pre–Post Job-Train Program Scores and Mean Change for Parent and Youth Primary Outcomes

Measure	n	Pre-JTP (T1), mean (SD)	Post-JTP (T2), mean (SD)	Change scores (T1–T2), mean (SD)	Scores	p	ES
CBCL (T-score internalizing)	9	13.3 (9)	11.1 (6.7)	2.2 (6.1)	t = 1.1 (df = 8)	0.31	0.2
CBCL (T-score externalizing)	9	3.1 (3.1)	2.7 (2.4)	0.44 (2.5)	t = 0.5 (df = 8)	0.61	0.1
COPM (youth)
Average performance	11	5.5 (1.2)	7.2 (1.5)	−1.7 (1.9)	Z = −2.5	0.01*	1.4
Average satisfaction	11	5.8 (1.6)	7.5 (1.6)	−1.7 (1.8)	Z = −2.6	0.01*	1.0
COPM (parent)
Average performance	8	3.6 (1.3)	6.3 (1.6)	−2.6 (1.9)	Z = −2.5	0.01*	2.0
Average satisfaction	8	2.9 (1.3)	6.3 (2.4)	−3.3 (2.1)	Z = −2.4	0.02*	2.6

Note: ES formula was δ_χ/SD baseline. Z scores (Asymp. Sig. 2-tailed based on negative ranks).

^* Statistically significant p-values.

CBCL, Child Behaviour Problems Checklist; COPM, Canadian Occupational Performance Measure; ES, effect size; JTP, Job-Train Program; SD, standard deviation.

Change in COPM performance scores can be conceptualized as a measure of goal attainment.³⁶ Parent COPM results showed the same trend but achieved clinical and statistically significance differences pre- and post-JTP for COPM goal performance and satisfaction ratings. Additional support for skill improvement comes from the job coach survey. When asked if youth acquired new work-related skills, four of five responded “strongly agree” or “agree,” while the fifth coach provided a neutral response to skill improvement. In Table 1, youth CBCL scores also demonstrated either a minimal change or a decrease postprogram.

Qualitative data corroborated COPM results with multiple informants (job coaches, parents, employers), noting changes in self-esteem, independence, and social communication skills, all of which may contribute to goal attainment.

Self-esteem

The parent group, employers, and job coaches all noted positive changes in youth. One parent described the JTP as an opportunity that helped him “fit in” with school peers in their network who had summer jobs, which contributed to a sense of belonging. Another parent relayed that her son secured a part-time job at a community restaurant stating—“G…is a dishwasher and helps replenish the buffet…Having the ‘housekeeping’ duties on a resume really helped. G really enjoyed his summer job and it helped give him a much-needed self-esteem boost.” Employers also noted JTP participants' improved confidence. One employer stated, “…at this age to think of yourself as employable… this (the JTP experience) is very strong evidence that one can do it… building their own confidence.”

Independence

Increased independence (part of curriculum focus) was also consistently noted across qualitative data sources. One youth commented “I think that I've matured over the summer. I've grown as a person”; another said “I'd say I gained a lot more independence.” Another parent stated, “I saw my child become more independent, take on more responsibility and be excited to get up and go to work.” When asked to identify the most important work-related skill youth gained from JTP, a job coach stated: “Independence-whether that be learning to navigate bus routes to get to work or being able to complete a task completely independently and gaining the confidence and awareness of how capable and talented they are.”

Social communication skills

Improvement of work-related social communication skills within a work context was another program goal—as it would be for any young adult starting to learn about the work environment. Positive change was noted. One survey question asked if coaches saw social growth in youth. All five job coaches responded “strongly agree” or “agree.” Written responses on job coach surveys included comments such as: “I felt very proud of my students when I observed them actively working on their goals and stepping out of their comfort zones (speaking to coworkers, exchanging contact info, etc.) without any prompting from me.”

Youth interview responses also shared this theme. One youth said: “Socially, I learned about the environment of the work, that and how to appropriately respond and ask for help when needed.” Another participant commented on greeting, having learned “that I could just walk in and say hi- basically stop by first thing in the morning and say hello to everybody and get along with my job.”

Understanding the world of work

Another goal of JTP was to develop a positive, realistic understanding of work. Comments from youth interviews showed gains in this area. One youth remarked “It was able to give me good experience for what I can expect from a job.” Another participant said: “I kind of like the fact that you got to explore on yourself and see how you'd fit in a certain type of job.” One participant stated that it will help him in the future because of having learned—how to get a job; what I do to relax myself, and what are people expecting when I have a job. The strength-based focus of the program was evident in youth descriptions. For example, one person said the program had the effect of “sharpening my already good organization skills.” Several respondents stated that they enjoyed the work they were doing and particularly noted the benefits of paid employment.

Integrating supports in JTP

JTP aimed to enhance the ecosystem of supports surrounding the autistic individual (as operationalized by Nicholas et al.)³⁰ to promote workplace success. Several positive cross-context effects emerged within each of the four components of the model.

Tailored individual supports

The establishment of a peer group within the Job Club enriched youth support networks. Many participants stated that it was valuable and positive to connect with other autistic people. One participant stated: “I enjoyed most about Job Club was the social situations that happened as was just chatting to other people as well.” The curriculum focused on students themselves undertaking primary responsibility for work roles, with parents taking less of a directive role. This was a delicate balance, but the synchronized timing of increasing supports around youth through coaches and peers while encouraging goal setting and monitoring may have contributed to a sense of independence.

Family support

JTP integrated family support through take-home activities that required youth to share information about JTP work experiences and to ask parents about their own work. This was meant to help youth tap into parent experience and support and help parents to appreciate youth employment-related growth. During the focus group, many parents did describe upward revisions in their perception of youth capabilities as epitomized by the comment: “I learned my son was far more independent that I thought he was.” It is not clear what accounted for this change in perception and if it would translate into higher parent expectations postprogram. Paychecks precipitated budgeting skill instruction by parents. The need to get to work drove instruction on transportation skills (i.e., taking the city bus).

During the focus group, families also suggested adding a parent training component to help them advocate for their children with employers and service systems so that they could better assist youth to find jobs in the community. Parent motivation for employment advocacy skills could be conceptualized as a potential strengthening of supports for youth,¹ one motivated by the JTP. In the future, parent advocacy training could be offered in tandem with the JTP.

Workplace capacity

Employer education about the strengths, abilities, and learning styles of autistic youth in combination with first-hand experience of youth themselves enhanced workplace capacity. Employers had no previous experience employing autistic people, although all had prior experience of disabled employees. Employers stated that JTP increased their awareness of the strengths and needs of autistic individuals. For example, all employers during the exit interviews noted the importance of the youth/workplace mentor match, stating that youth were most successful when paired with skillful immediate supervisors and coworkers who were able to support, teach, and challenge them appropriately.

As one supervisor expressed: “…make sure whoever they work with is positive, because sometimes you could put them with people who make things worse. Matching is important for their success and the success of the operation…you just make sure you match them with somebody who is going to be a mentor to them, who is also not afraid to tell them what to do, and how to do it, and if they're not working out, how to get them back on the right track.” Employers said more information on youth skills and abilities preplacement would assist with mentor matching and assigning tasks that were a good fit. Employers commented that JTP prompted a closer analysis of workplace training and communication to optimize the workplace for autistic individuals. Campus employers expressed interest in future participation in the program, which may increase the probability of hiring autistic youth and adults in the future.⁸

Job coaches were also a major contribution to workplace capacity. Coaches also developed accommodations and promoted skill transfer between Job club sessions and the workplace. Employers valued job coach presence, stating that coaches benefited participants, ensured work quality standards were met, and decreased the need for additional staff resources to supervise youth. Employers also found coaches helped to ensure students understood expectations, and that instructions were sufficiently detailed. Job coaches were often a deciding factor for employers who hosted a student. Some employers commented that coach communication regarding skills taught in Job Club was helpful as they could then reinforce those skills if observed, or to add opportunities to practice them. A number of employers noted that less and less job coach support was needed over time.

School supports

The job coach-generated work profile outlining student skills, strengths, and helpful supports was sent to all students and their schools. The study did not evaluate whether this was a useful tool to support cooperative education experiences and transition planning.

Discussion

This study utilized a collaborative approach to program development to enable academics, educators, and a community social service agency to generate an ecosystem-oriented vocational training program for autistic youth. This work utilized a partnership with educators and a community organization through collaborative development, implementation, and dissemination of the research project. We worked with various stakeholders providing support for autistic youth across various contexts of the supportive ecosystem—school and community. In addition, the parents (or home context) were engaged within JTP to ensure a family-centered approach, which continues to be a main source of support for youth at this stage in their life and into adulthood.⁴¹

Collaboration within this work focused on developing and connecting the supports within the ecosystem of autistic youth to create consistency across contexts to ensure that paid summer employment experiences supported autistic high school students. The impact of environments on the development of individuals with neurodevelopmental disabilities has been described in the literature as having an impact on adult roles across the life span.⁴² The JTP study aimed to begin to address this by creating an opportunity for paid early work experiences on a university campus in well-supported environments coupled with direct instruction of job-related skills over the summer. Youth skill improvement and goal attainment were indicated by positive changes in COPM scores for work performance and satisfaction. University departments were amenable employers who provided positive work experiences.

There was some evidence of the JTP resulting in improved coordination between supports in a way that supported youth learning. Furthermore, the program provided opportunities for autistic youth to develop relationships with other autistic people, something that was valued and an identified need in this population.⁴³ Evidence for this type of codesigned program has demonstrated effectiveness in outcomes related to children and adolescents with neurodevelopmental disabilities increasing friendships, recreational participation, self-esteem, and quality of life.⁴⁴ Successful outcomes in the JTP were demonstrated in similar areas from the qualitative data from job coaches, employers, parents, and youth, indicating positive changes in areas of self-esteem, workplace communication, and independence. Identified strengths and abilities were reported in employment profiles that were individualized for autistic youth post-JTP to assist with identifying future employment opportunities and the environmental supports to enable success.

It is important to bear in mind the limitations of this study when interpreting findings.

We did not involve autistic youth and their parents at the outset of program development based on the focus of establishing a collaboration between stakeholders providing services across contexts. This work aimed to first bring together the environmental contexts to identify a coordinated effort to support autistic youth in paid summer employment. Future research should integrate the autistic voice through collaboration with autistic youth and adults who can provide their insights on the best ways to be supported within the work, home, and education contexts.

A second limitation was that youth responses to postprogram interviews may have been influenced by a (potential) perceived power differential as job coaches completed these interviews. Future research will explore having noncoach interviewers and consider having autistic interviewers involved as per recent evidence.⁴⁵ In relation to evaluation of supports, employer interview results did not capture natural supports in their work environments, such as helpful coworkers, which may have contributed to a more supportive work setting for youth (but not documented), and there were no measures of fidelity to account for consistency of supports provided by job coaches. Novel measures and processes to better evaluate the supports provided in the work environments, as well as identify the training needs of these environments, will be important to develop in future research.

The final limitation in this work was that there was no follow-up to ascertain later employment outcomes following the JTP and the utility of the individualized employment profiles from the school perspective was not assessed. Collecting information on future employment of success on subsequent cooperative education placements (i.e., work experience through school) could be explored in a longer follow-up study measuring both vocational and educational outcomes.

Future work will aim to recruit a larger and more diverse sample of autistic youth and to explore the replicate of JTP at other universities, include job placements within the broader community, and add parent education to support family employment advocacy efforts. Assessment of youth perspectives may be enhanced in future work by independent (and potentially autistic) interviewers and by redesigning interviews to incorporate techniques recommended by the Academic Autism Spectrum Partnership in Research and Education (e.g., providing written questions in advance and using multiple passes to attain full elaboration).⁴⁵ Program development could be enhanced by inviting autistic youth to collaborate on design for the next iteration of JTP.

As society improves in how it better supports neurodivergent people in the workplace, cross-context models (similar to JTP) may facilitate earlier entry of autistic youth into the workforce and enable society to more fully benefit from their skills and talents. The JTP model could be part of a process to support vocational pathways for autistic youth and might be offered early in high school with the aim of promoting paid employment coupled with strong transition supports. The use of a university for the provision of work experience enhances replicability and scalability since postsecondary institutions are located in many communities. As universities are nested within communities, programs such as JTP can begin to establish a greater number of autistic youth with early work experience in preparation for employment in the communities they live.

The focus on providing better work supports through the JTP can also provide best practices for employers in the community and improved job coaching capacity to assist them with providing a more supportive work environment.

Authorship Confirmation Statement

B.D.R.: Lead investigator in designing, implementing, overseeing data collection, and analysis of data, and was responsible for creating the first draft of the article and refining drafts for submission. I.O.C.: Provided support in designing, implementing, data collection and analysis, as well as in writing and refining the article for submission. S.G.: Provided support in the design and guidance on implementation and analyses, as well as providing feedback on article drafts for submission. R.B., S.H., and A.D.F.: Provided support in the design, implementation, and data collection, as well as providing feedback on article drafts for submission. G.B.H.: Provided support in the design and guidance on analyses, as well as providing feedback on article drafts for submission. L.C., R.S., and E.F.: Provided support in qualitative data analysis, as well as providing feedback on article drafts for submission. T.B.: Provided support in the study design and implementation, as well as providing feedback on article drafts for submission.

All authors have reviewed and approved of the article before submission. The article has been submitted solely to this journal and not published elsewhere in whole or in part, except as an abstract. The article is not being simultaneously submitted elsewhere.

Author Disclosure Statement

The authors have no conflicts of interest to disclose.

Funding Information

Funding for this study was provided by a Family Services Community Grant from Autism Speaks Canada (Grant number: FSCG-2015-10). Funding support was also provided to Dr. Di Rezze by the Hamilton Health Sciences Research Early Career Awards in 2018 and 2019.