Lawer, L., Brusilovskiy, E., Salzer, M.S., & Mandell, D.S.  (2008). Use of vocational rehabilitative services among adults with autism. JADD, DOI on Paper.

• comparison of individuals with ASD vs. others in vocational rehab
  • studies - 15% achieve independence; 20% community-based (Howlin, 2004)
  • voc rehab- one of the few formal systems
    • maximize employment outcomes
      • assessment and Dx
      • counseling
      • job search assistance
      • AT
      • training
  • employment  - competitive and non-competitive
    • sheltered employment - not considered a positive outcome
• ASD - different vocational needs - difficult to address through traditional means - makes employment difficult
  • services are often less than optimal - very little literature with small samples and qualitiative methods
  • Schaller & Young (2005) - get this one!
• Research question - would individuals with autism be more likely to be refused services and therefore be more expensive to the system?
• Data from OSEP services age 18-65 that had cases closed - 382,221 subjects
  • coded for why cases were closed
    • competitive employment
    • total amount state spent on services
• 4 categories of impairment
  • ASD - 1, 707
  • MR - 30,728
  • SLD - 33, 155
  • Other - 316,471
• also looked at
  • number of months in services
  • cost of the service
  • whether on-the-job supports are used
• Results
  • ASD - more white males
    • 89% between 18 and 34 - similar to SLD, higher than MR
    • 80% high school or lower
    • 64% not completed HS or SPED
    • Other impairement - most had high school or higher
  • 4.3% - too severe to be served - much more likely for ASD
    • older, female, less than HS, previous clase closure = higher probability of closure
    • Blacks less likely to have a case closure
  • service costs highest for individuals with ASD and MR
• Employment
  • ASD more likely to be employed at closure
  • no difference from MR or SLD
  • older white males less likely to be employed
  • ASD and MR - more likeley to need job supports (57%)
    • ASD - more likely to have competitive employment with supports
• Discussion
  • consisten - ASD more likely to receive, more expensive services (although not much different from MR)
  • employment rates no different, but with more supports
    • coach, followup, etc...
  • study limitations
    • no confirmation of Dx
    • no comorbis discussions
    • may have other funding sources - could have affected response
    • no data on the effectiveness of services
    • possible that voca rehab increases cognition?
    • couls also be that VR is not seen as an option by parents
      • how do kids with ASD get in the system?
      • what are the barriers?
      • how can we reduce costs (cost-effectiveness)?