Supported Employment

The Challenge of Producing Good Outcomes

Those few who did complete the vocational evaluation had a high job placement rate, perhaps because they were higher functioning, while those with more challenging characteristics were filtered and left out. This is supported by the 2015 report published by the A.J. Drexel Autism Institute that young adults with autism had lower employment rates and higher rates of complete social isolation than people with other disabilities.

While the intent and mission of VR agencies is good, employment outcomes are not.  Most VR counselors do not have a good understanding of autism, focusing instead on best practice strategies and supports, and repeatedly labeling the employment seeker “unemployable.”

The difference between Employment Industry Standards and Autism Best Practice, Research Based Support Standards

It is important for individuals and families to advocate for the specific strategies that support communication, socialization, emotional regulation, sensory processing and other needs to minimize barriers or potential problems as an employee.

Families are typically more knowledgeable of the autism-specific support needs of their son or daughter. It is essential that everyone involved understands the difference between employment industry support standards and autism best practices, research-based supports and strategies. To be clear, both are essential to the employment needs of a worker with autism.

Autism Best Practice, Research Based Support Standards (Educational Interventions)

TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) is one of the most widely used educational intervention programs for children and adults with ASD. This educational/teaching strategy has been in use since the 1970s. TEACCH supports individuals with autism across the spectrum and across their lifespan.

Structure: the environment should be highly structured, with specific activities occurring only in specific places.

Marking: the work spaces should be clearly marked physically, including colorful marking on the floor, specific arrangement of furniture, and other concrete and visual clues.

Visual Communication: staff should use picture-based schedules and work systems to outline the activities for the children.

Routine: there should be a clear and regular sequence of activities. The routine should be listed on the schedules.

Sensory distractions should be minimized to improve concentration.

Individualized: specific activities and supports should be based on a child’s interests, skills, and needs

Picture Exchange Communication System (PECS) [1]: PECS-type communication systems are proving to be a useful supplement, even for people with adequate verbal skills. For example, the widely-known Walgreens project features a PECS-based communications system (Emmett, 2009).

Social Stories™ [2] are narrative descriptions of social situations that help the person with ASD understand particular situations or activities which might be confusing to them. Some vocational rehabilitation practitioners have found social stories to be a useful technique. They can be used to help clients understand the initial VR interview, the VR process, the vocational evaluation process, etc. In the workplace, they can be used by job coaches to help clients understand the social aspects of work and the work day (Emmett, 2009). [3]

[1] http://www.pecsusa.com/pecs.php

[2] http://carolgraysocialstories.com/social-stories/

[3] http://jamesemmett.com/about

Case Studies

Brock is a non-verbal young man who experiences autism and lived most of his life in a residential habilitation center (RHCs are state-operated residential settings that provide 24-hour supervision, and medical/nursing services for clients who meet Medicaid eligibility and need active treatment services). [1]

In 2004 the State of WA DDA introduced the “Working Age Adult Policy” with the involvement of many statewide stakeholders. This policy stated that all people, regardless of the significance of their disability, needed to be on a pathway to employment. The DDA gave counties a two-year roll out timeline to implement the policy with their county employment contractors. It was a concept that many in the field (contractors and parents alike) felt did not apply to “all”. That is where my work, support and training on autism support strategies and technical assistance came into play for Brock.

When I met Brock in 2006, he was working in a sheltered workshop (SW) sorting materials that came from Boeing. Brock was sitting at a station with his back to the wall behind a barricade of tables in front of him. When I asked the SW staff why he was seated that way, they indicated that it kept him from running away from his work.

I met with the Executive Director of the workshop and asked her what supports she felt Brock would need to get into paid employment. She indicated that she was at a loss. For the past few years the only way she knew how to support and maintain him was to follow a behavior support plan that was developed by a psychologist from the Residential Habilitation Center which usually ended with Brock engaging in a number of self-injurious behaviors.

What I saw that day was a physically strong and capable young man with crystal blue eyes who clearly had no functional way to communicate. He was contained in a warehouse area subdued by a barricade and supported by staff who knew nothing about autism. Within the first month of meeting Brock, I introduced him to the first visual system that illustrated his daily schedule at the sheltered workshop. Brock went from daily episodes of self-injurious behaviors to “zero”!

The visual support strategies (TEACCH) and other ASD supports cleared the negative impression of who Brock was. In addition, when the sheltered workshop started their individual employment program, staff was learning about job development and marketing. Between these two efforts, and understanding the need for both employment industry support standards autism best practice, and research-based supports, Brock succeeded in getting a paid job. See YouTube link below for more information:

Rosalyn is a non-verbal young woman who experiences autism and was having significant behavioral issues in social settings including school, stores, banks, etc. I had the opportunity to work with and support Rosalyn’s (at the time) new living concept “Companion Home”, and her provider Amber. Amber was open and excited to learn ways to help Rosalyn. With Amber’s support, Rosalyn progressed in leaps and bounds toward functional communication, social skills, sensory supports, and so much more.

I started working with her employment agency’s job coach training her on visual communication systems, sensory supports, and social skills. This job coach listened well to her interests and skills, and was able to customize a job at a private physical therapy clinic. Rosalyn was trained through visual supports on how to wash laundry that therapist used with their patients, fold and restock them in exam rooms. The proposal to the prospective employer demonstrated how Rosalyn’s laundry washing skills could save their business money, freeing up physical therapist time being used to launder towels and patient gowns back to providing patient care. The proposal was accepted and Rosalyn was hired.

I worked with the employer designing visual work systems and low-tech folding jigs that created independence and autonomy throughout Rosalyn’s work day. Rosalyn has worked for this employer for more than four years, has learned to do more, and has increased her work schedule.

Abraham is a “functionally” non-verbal young man. Although Abraham could verbalize words, he could not communication his wants or needs. When I met him, he was living in a residential habilitation center for adults with autism. He was assigned two support staff to assist him throughout his day because of self-injurious behaviors (SIB) and aggression toward others. Because of his SIB, he was ordered to wear a crash helmet to keep him from causing serious injury to his head.

I was able to observe Abraham in his public school environment, which was a self-contained classroom located in a modular unit outside the school building. Abraham was an impressive young man with incredible number aptitude and good computer skills, but was often relegated into janitorial work (i.e. mopping and cleaning the toilet). Abraham was also very observant and could see anything environmental that was broken or out of place; light bulbs, cracked tiles, welcome mats misaligned to name a few. He a unique interest in RVs, specifically Class-A RVs, but any would do.

Abraham was one of my participants in a travel training I provided the RHCs staff.  With the use of visual supports and social stories, Abraham was able to wait for the para-transit bus, travel to a local retail store, purchase a pre-selected item, walk to a fast food restaurant, and travel back to the RHC without SIB or aggression. It was a great experience for Abraham and his staff to see the use of functional visual supports and implementation of visual social stories that he responded to in a positive way. It was through this structured opportunity that his staff could see a different person—a young man with talents and skills—not a constant behavioral challenge.

Although Abraham had challenges with his first supported employment agency, his family helped him select a new agency. I provided training to that agency and helped them implement ASD support strategies that enabled Abraham’s ability to access his community. With my overall knowledge of Abraham and the support strategies he needed, I developed a visual resume and presented a customized employment proposal to a local RV Center. The proposal came about after visiting the center and identifying several tasks that Abraham could complete with excitement. The proposal was accepted and Abraham was hired to detail new and old RVs. Abraham has worked detailing RVs for over two years.

[1] https://www.dshs.wa.gov/dda/consumers-and-families/residential-services