Community-Based Transition Support Programming for Autistic Emerging Adults

Becoming an independent adult is a critical life transition, characterized by new roles and responsibilities in employment, relationships, and education. For adolescents with Autism Spectrum Disorder (ASD), this transition is marked by unique challenges including unemployment/underemployment, social isolation, and difficulties living independently. Despite growing evidence of the utility of programs that prepare autistic individuals for adulthood, these programs are rarely adopted into routine clinical practice. The current study uses an implementation science approach to refine and test an existing, evidence-based transition support program, the Stepped Transition to Employment and Postsecondary Success program (STEPS) for community implementation. In Phase 1, qualitative feedback was sought from stakeholders (total n = 45; i.e., autistic adults, caregivers, and professionals involved in the adult transition process) on several barriers and facilitators to implementation of STEPS in the community. In Phase 2, STEPS was piloted with 12 autistic individuals aged 16-35 in a local community agency to examine program feasibility, acceptability, and initial clinical impact. Results supported feasibility of STEPS implementation, evidenced by 93% of treatment objectives being delivered as intended by the STEPS therapist and moderately strong therapeutic alliance (average rating = 3.29, possible range = 0-5) established with clients. Results also supported acceptability, evidenced by low attrition (91.67% retention rate), high session attendance (96.27% sessions attended as scheduled), high homework completion (84.10% homework completion), and high participant- and caregiver-reported program satisfaction (average ratings of >4 across all items, possible range 1-5). Results also partially support the clinical impact of STEPS, evidenced by clinically significant change and reliable improvement in participants' transition readiness, as well as secondary measures of adult functioning, self-knowledge, self-determination, and self-regulation. In Phase 3, participants from Phase 2 completed exit interviews to provide final input on STEPS content, which was used to prepare STEPS for community implementation. Findings informed future community implementation of STEPS, and produced a fully scalable, stakeholder-informed program that was developed to address implementation challenges and ready for community deployment. Future research could utilize innovative implementation approaches (i.e., hybrid effectiveness-implementation trials) to test strategies that might promote adoption and long-term sustainability of STEPS in communities.