Employment policy and autism: Analysis of state Workforce Innovation and Opportunity Act (WIOA) implementation plans

1.1.Vocational services and autism

The employment support needs of people with ASD merit special attention because of the social-cognitive, behavioral, and communication impairments associated with ASD (Hendricks, 2010; Müller, Schuler, Burton, & Yates, 2003; Richards, 2012), in addition to the frequent co-occurrence of health and mental health diagnoses (Croen et al., 2015). These issues contribute to a complex array of employment challenges mixed with potential strengths in memory, focus, and in-depth knowledge of special interest areas (Hurlbutt & Chalmers, 2004; Müller et al., 2003; Richards, 2012). Ongoing access to job coaching or mental health supports after a job is obtained may be necessary to meet the unique needs of this population, but VR does not typically provide these services (U.S. Government Accountability Office, November 17, 2016). Vocational interventions for ASD have traditionally focused on modifying individuals’ impairments versus modifying policies, practices or work environments, and have thus yielded little evidence of improvement in actual employment rates (Scott et al., 2018).

The context surrounding vocational service delivery has also shifted in recent years. Rates of employment within the general population declined dramatically during and following the Great Recession, making employment opportunities scarce for people with disabilities (Livermore & Honeycutt, 2015). A simultaneous shift to a knowledge-based economy required workers with more postsecondary training (Bird, Foster, & Ganzglass, 2014), while job creation shifted toward the service sector where many jobs revolve around a core need to successfully interact and communicate with others. These changes pose unique challenges for adults on the spectrum who tend to have social impairments (American Psychiatric Association, 2013) and low rates of postsecondary education (Shattuck, Narendorf, et al., 2012; Wei, Yu, Shattuck, McCracken, & Blackorby, 2013).

Some consensus regarding priorities for improving employment services for individuals with ASD is emerging. The federal Interagency Autism Coordinating Committee (IACC) Strategic Plan recommended “expanding current models of job finding and development services, long-term intensive services and supports, and long-term but minimal supports (e.g., a few hours/month),” (IACC, October 2017) along with better training of employment support providers. Other federal panels have called for development of more direct support providers with competency to serve those with autism (U.S. Government Accountability Office, November 17, 2016).

1.2.WIOA and Vocational Rehabilitation

As of 2017, each state has a unique, federally approved plan for implementing the 2014 Workforce Innovation and Opportunity Act (WIOA) legislation which updated the legal framework for the VR program. WIOA seeks to “increase access to and opportunities for the employment, education, training, and support services that individuals, particularly those with barriers to employment, need to succeed in the labor market,” and to “promote improvement in the structure and delivery of services” (U.S. Department of Labor, March 4, 2016). Major changes within WIOA included limitations on subminimum wages and a new requirement that states spend 15% of their VR funds on pre-employment transition services (Pre-ETS) for students with disabilities.

Each state WIOA plan summarizes rehabilitation needs within the state and identifies populations which have been unserved or underserved by VR, including youth and students with disabilities and their need for transition services and Pre-ETS (34 CFR §361.29). Underserved groups are those who have not traditionally received equal access to and benefits from rehabilitation services (e.g., racial and ethnic minorities), but may also include specific disability groups (The VR Needs Assessment Guide, November 30, 2009). By design, state WIOA plans should specify strategies for outreach to underserved groups, methods to expand and improve services, and details regarding how the state will support innovation and expansion (I&E) services and overcome barriers related to access. Per WIOA state plan instructions, “While discussion of strategies for every target population is not expected, States must address as many as are applicable to their State’s population and look beyond strategies for the general population.” Youth and adults with ASD are an example of a group that may require tailored strategies to improve their employment outcomes. In fact, the IACC Strategic Plan (October 2017) pointed to the need to study autism-related state initiatives emerging from WIOA. To our knowledge, the content of state WIOA plans has not been systematically analyzed to understand whether and how states are specifically attempting to address the needs of youth and adults on the autism spectrum.

1.3.Purpose of this study

We analyzed state WIOA plans with the following aims: (1) Characterize the prevalence and types of autism-specific references across state WIOA plans, and the degree to which youth and adults with autism are identified as an underserved group, (2) Describe the goals, strategies and programs states propose to improve VR services for youth and adults with autism.

3.1.Autism-specific VR services

Twelve plans (24%) described autism-specific services and programs (Table 2). Some of these programs were limited to specific locales, and several were pilot programs. In contrast, Virginia’s program was “designed to be planned and delivered as part of a coordinated continuum of services model” for VR consumers with autism. Some states focused on modifying and expanding existing services to better meet the needs of those with autism including job placement (AL, KY, MO, NC), workplace modifications (MO), job coaching (VA), and specialized training for STEM careers to better serve the autism group (WI). Maryland reported progress on adding Driver’s Education services for individuals with autism.

Thirteen states described a current need for additional service options specific to the needs of individuals with autism (CT, GA, IL, MD, NH, NY, TX) or long-term supported employment services for those with autism (CA, MN, MO, NC, NE, WI). Maryland listed “social support group, social skills training, and ADHD organizational training” as examples of needed services. New York was developing VR service options for “social speech and communication skill development.”

Two state plans explicitly discussed using assistive technology (AT) services to meet the employment needs of VR service users with autism. Missouri described AT as including “assessment and recommendations for accommodations, assistive devices and assistive technology necessary to improve the quality of work and/or increase work productivity.” Virginia provided loaner devices, coaching supports and webinars focused on AT, and included AT experts within their high-intensity comprehensive autism service pilot projects.

In regard to funding autism-related services, Nebraska used a Grants Management staff position to develop and implement innovative partnerships, including expansion of autism services and “development of a braided milestone funding payment system” to fund supported employment via a collaboration of VR, Health and Human Services, and the Division of Behavioral Health. Other states planned to use I&E funds for specific current or future activities related including: training VR business service teams and providing a summer transition program (KY), expanding provision of services for autism (MD), funding lifespan services for individuals with autism delivered in partnership with a non-profit organization (SC), expanding Project SEARCH sites for TAY-ASD and to hire Autism SMEs (VA).

3.2.Services for transition-age youth with autism

Thirty state plans (59%) referenced TAY-ASD. Five states reported delivering training activities regarding serving students and youth on the spectrum (AR, OK, SC, TX, VA), and two others reported a need for such trainings (KS, MI). Michigan stated, “Concern was expressed at all levels about the job readiness preparation this group will have as they exit school, the preparedness of the adult vocational rehabilitation agency staff to provide services, and the availability of supported employment services for this population.” While not specific to autism, New Jersey also noted that “while many high schools take advantage of the [VR] counselor’s expertise in vocational rehabilitation, others prefer not to include [VR] on a regular basis.”

Of the 16 autism-specific services and programs listed in Table 2, nine (56%) were directed at students or youth. Of these, Project SEARCH was the most prevalent transition program mentioned by name. At least two states discussed supports for students with autism seeking post-secondary education (MD, CA). Maryland designated VR staff to work collaboratively with community college Disability Support Services staff to provide supports including “one-on-one personal services, such as those required by students with autism spectrum disorders who could benefit from in-class assistance to maintain focus and attention or be reminded of classroom behaviors.” Three states indicated a need for supported employment services for TAY-ASD (DC, LA, NE).

Kentucky was the only state that documented use of Pre-ETS for TAY-ASD, identifying the need to expand services and “coordinate with the Autism Council/Office of Autism to discuss and address the issues of students with Autism.” Kentucky planned to support a summer program to facilitate transition into higher education. Other states discussed Pre-ETS in sections of the plans that referenced autism (ND, NE, NY, SC, TX), but it was unclear whether they planned to tailor Pre-ETS activities to meet the needs of students with autism.

3.3.Engaging and educating employers

Nine states referenced building relationships with employers to better meet the needs of the autism population (GA, KY, NC, NH, NY, TN, TX, VA, WA). Activities included educating employers on providing autism-friendly, culturally competent work environments; and educating employers on the benefits of hiring people with autism. New York stated it is important for “businesses to understand how this disability impacts on social roles as well as job task function.” Kentucky’s VR agency provided autism training to Kentucky Career Center Business Service Teams who would then train employers. Georgia also mentioned use of the VR Business Division to develop employment opportunities with local employers for underserved populations like autism, and to “provide a variety of employer supports and services.” Virginia and Washington developed specific business partnerships with the information technology industry.

3.4.Building capacity

Most state efforts to build capacity to serve people with autism involved training and technical assistance activities and creation of autism-specific services. Additionally, Alabama appointed a staff person in the VR state office “to develop and enhance the agency’s autism program.” Texas appointed a board-certified behavior analyst to serve as the State Program Specialist for Autism “to implement multiple strategies to enhance services” including an extensive training infrastructure for increasing staff competency. Texas also built capacity for job placement by identifying CRPs who had autism expertise and asking each to “develop at least one partnership with a business that has an autism-friendly work environment.” Several states aimed to increase the capacity of CRPs (GA, LA, MD, NE, ND, RI) and/or competency of CRPs (AL, KS, MD, MI, MO, TX) to provide services to people with autism. In 2015, Texas implemented premium payments for CRPs “to reward providers who maintain training and skills necessary to work with specific populations,” including autism. To earn the premium the CRP must show proof of specialized certification or licensure such as an Autism Specialization Certificate from the University at North Texas.

3.5.Barriers to improving employment outcomes

Twelve states named barriers to improving employment outcomes and/or providing VR services for those with autism (DC, DE, ME, MD, MI, MN, MO, NE, NC, SC, TN, TX). Barriers included: lack of staff training and expertise to serve those with autism (n = 3), inadequate resources for supporting individuals with multiple or complex disabilities (e.g., visual impairment and autism) (n = 3), lack of availability of supported employment for this population (n = 2), a lack of service providers to meet increasing demands (n = 2), and need for education of employers about hiring and accommodating people with autism (n = 2). Two states noted that individuals with autism who did not have ID did not qualify for long-term supported employment services through the state Developmental Disability (DD) agency via a Medicaid waiver. Tennessee also noted that “cultural competence in understanding various cultures and disabilities on the part of employers and some staff” is a barrier to reaching out to underserved groups including those with autism.

4.1.State-level innovations in VR services for ASD

As states have increased their efforts to improve employment for youth with disabilities, they are essentially becoming incubators for employment innovation. Researchers define innovation in the public sector as the implementation of a significant change to services and goods, operational processes, organizational methods, or the way an organization communicates with users, that has been implemented to better the outcomes of service users, which is new to the organization even if the innovation was developed by others (Arundel, Bloch, & Ferguson, 2016; Bloch & Bugge, 2013).

Six types of innovation in WIOA plans emerged: 1) comprehensive service models, such as Virginia’s pilot project which combined technical assistance, supported employment, community support services, and therapeutic behavior services; 2) extension of longer-term vocational services via Medicaid waivers, such as the Pathways program in Delaware; 3) activities that focus on improving work environments – largely through a focus on supporting employers, such as Kentucky’s training of its business teams; 4) reorganization of work staff by specialization, such as Texas’ use of autism experts to train and support other staff; 5) novel funding models, such as Texas’ enhanced reimbursement to autism providers and Georgia’s attempts to develop a “braided milestone funding payment system”; and 6) a focus on developing standards of practice, such as Texas’ attempts to define trainings required for providers. The first three are examples of improvements to services, while the last three are examples of organizational and process innovations. However, we found no innovations that focused on communication about the availability of VR services for individuals with autism or methods to influence uptake of VR services in this population.

Innovation is somewhat context dependent; what is innovative in one state might not be innovative in another and, therefore, might not be mentioned in a state plan. Further, it is highly possible that vocational innovation is occurring in states beyond what is evident in WIOA plans. For example, there is emerging evidence of successful use of Individual Placement and Support services, an evidence-based supported employment model for people with mental illness (McLaren, Lichtenstein, Lynch, Becker, & Drake, 2017), for assisting young adults with ASD and co-occurring psychiatric disorders to achieve competitive employment. South Carolina is currently piloting this model (https://scdmh.net/individual-placement-and-support-ips/); although it was not mentioned in their state WIOA plan. Likewise, Maryland’s Seamless Transition Collaborative (MSTC) has evidence of success in serving students with autism and other disabilities (Luecking, Fabian, Contreary, Honeycutt, & Luecking, 2017), but is not mentioned in the state plan. As implementation of WIOA advances and more public funding is spent on Pre-ETS, states should develop mechanisms for identifying and evaluating vocational service innovations so that we can better learn from what is working – or not working - at the community level to improve employment outcomes for people with autism (Shattuck & Roux, 2014).

4.2.Addressing the needs of transition-age youth with autism

Our finding of frequent references to the vocational needs of TAY-ASD in state WIOA plans is supported by the finding that TAY-ASD currently comprise nearly 40% of all closed VR cases of youth with ID/DD (Roux, Rast, & Shattuck, 2018), and that 11.8% of state VR agencies had at least one transition-specific program that targeted TAY-ASD in 2015 (Swankoski, Rosenbluth, & Sevak, 2016). Nevertheless, while many autism-specific services identified in the WIOA plans did target youth, plans contained almost no information regarding how Pre-ETS might be tailored to meet the needs of TAY-ASD. State progress in implementing Pre-ETS remains in an early stage and has been fraught with challenges and insufficient technical assistance (National Council on Disability, December 20, 2017). However, the almost complete lack of discussion of use of Pre-ETS to meet the needs of underserved TAY-ASD is surprising given recent calls for VR to provide more opportunities and support for integrating education and employment (Office of Disability Employment Policy, September 16, 2014).

4.3.Identified gaps in WIOA plan content

Over half of all state plans identified an autism-specific training need and/or currently had a plan in place for providing training needed to better serve those with autism. Autism specialists typically delivered trainings, but the qualifications of these individuals were often not specified. Limited educational requirements for VR counselors may leave them underqualified to deliver counseling, while in-service training quality and topics vary from state to state (McClanahan & Sligar, 2015). Guided practice and supervision are also important components of effective training for implementation of interventions (Beidas & Kendall, 2010), but the extent of active versus passive learning opportunities was unclear in state plans.

Several states discussed the heterogeneity of vocational needs across the autism spectrum, but the breadth of proposed goals and strategies did not appear to reflect a variety of needs. For example, few plans addressed the vocational challenges posed by co-occurring mental health conditions. Harmuth and colleagues (2018) noted co-occurring conditions are rarely addressed in the employment literature concerning adults with ASD, an insight which appears to carry over into planning for delivery of VR services. There were more references in the WIOA plans to the VR needs of those with co-occurring visual impairment and autism than co-occurring mental health issues which are vastly higher in prevalence.

Only one state plan addressed cultural competence in regard to serving the autism population. This is problematic given known disparities in services and outcomes for people with autism from marginalized groups (Shattuck, Narendorf, et al., 2012; Shattuck, Wagner, Narendorf, Sterzing, & Hensley, 2011). No outreach strategies were tailored to reaching African American, Hispanic, or low-income TAY or adults with autism. This mirrors a review of services and programs for adults with autism which found that services research was deficient in its consideration of the heterogeneity of the autism population (Shattuck, Roux, et al., 2012).

There was also a need for increased emphasis on developing relationships with employers via a ‘dual-customer approach’ which views the employer as an equal target of VR intervention efforts (Haines et al., 2018). This approach is vital for building capacity, as the ability to provide job opportunities to match the range of skills and interests inherent in the autism spectrum is contingent upon having a wide variety of job opportunities available via partnerships with community employers.

Finally, there was little evidence in state plans regarding use of AT for those with autism, despite evidence that positive employment outcomes for people with autism can be promoted through the use of AT including iPad use for prompting and virtual reality simulations for interview training (Gentry, Kriner, Sima, McDonough, & Wehman, 2015; Smith et al., 2015). AT can increase vocational independence/self-management, but the purpose/use of AT specific to autism needs was often not clarified in the plans. However, further research is needed to determine which employment-related AT interventions are most effective and to inform how AT is best utilized within the VR service system.

4.4.Limitations and future direction

An inherent limitation of document analysis is potential for insufficient detail within documents which were not written for research purposes (Bowen, 2009). We may not have captured the full range of activities directed toward VR service users with autism. This analysis focused on autism-specific references, while goals and strategies in some state plans may have been directed toward broader groups of persons with ID/DD that included autism but did not provide autism-specific adaptations or focus. The limited scope of the study did not allow us to verify findings by interviewing states. Nor did we inquire as to how decisions were made regarding plan contents. Despite these limitations, we reduced bias by securing a complete set of documents representing all states and triangulating findings when possible.

A recent study identified 13 states with above-average performance across indicators of VR services for TAY-ASD prior to WIOA implementation (Roux, Rast, Nye-Lengerman, et al., 2018). Future studies should continue to monitor state VR performance post-WIOA while gathering more complete contextual information about whether and how states are implementing autism-focused goals and strategies which may be contributing to better outcomes for TAY-ASD in some states. There is a corresponding need for study of local implementation of state employment policy (Butterworth, Christensen, & Flippo, 2017), and study of the complex interplay between the local economics, physical environment (e.g., population density) and employment policy for people with disabilities, since state and local policies may have differential effects on subpopulations of people with disabilities (Sevak, O’Neill, Houtenville, & Brucker, 2018).