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Autism spectrum disorders (ASD) encompass a group of neurodevelopmental disorders whose defining features include deficits in social communication across multiple contexts and restrictive, repetitive patterns of behavior, interest, or activities (APA 2000, 2011). ASD is an increasingly prevalent (1 in 68) and costly condition in American society. Only 6-10% of adults with ASD obtain competitive employment (Cedurland, Hagberg, Billstedt, Gillberg, & Gillberg, 2008; Taylor & Seltzer, 2011; Wilczynski, Tramell, & Clarke, 2013). To have a meaningful impact on competitive employment rates for adults with ASD, vocational services must improve both employment matching and employment customization. The customized employment process provides the framework for the Achieving Competitive Customized Employment through Specialized Services (ACCESS) intervention that is to be tested. This process has demonstrated potential to improve employment matching in adults with ASD; however, the model has not been experimentally tested (Heath, Ward, & Reed, 2013). Additionally, the employment customization component of the process has yet to be applied to adults with ASD and must be adapted to address specific challenges that this population face in gaining and, ultimately, maintaining competitive employment outcomes. The ACCESS intervention promises to improve functional outcomes by improving both employment matching and customization for job seekers with ASD. The goal of this R34 application is to refine and test an intervention that can be utilized by community-based Vocational Rehabilitation (VR) service practitioners to improve competitive employment outcomes for adults (age 22+) diagnosed with ASD. The primary aims of this application are to: 1) refine training, treatment and study protocols to test the ACCESS intervention; 2) examine the feasibility and acceptability of ACCESS in an iterative open trial; and 3) examine the feasibility, acceptability and preliminary effects of ACCESS relative to usual care in a randomized controlled pilot trial of 30 adults with ASD. After iteratively improving training, treatment, and study protocols, the research team expects to gather convincing evidence of the feasibility and effectiveness of the ACCESS intervention to support a larger randomized controlled trial delivered by certified VR practitioners to adults with ASD. This research study has the potential to dramatically shift current practice paradigms by informing research and policy decisions and by customizing employment placement strategies to address the specific support needs of adult job seekers with ASD using the platform of an intervention already reimbursed by VR. Given early evidence regarding the promise of customized interventions, ACCESS has the potential to yield far-reaching benefits for this population and the stakeholders who support them.
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