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Taking flight: improving outcomes of transition age youth on the autism spectrum

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Taking flight: improving outcomes of transition age youth on the autism spectrum

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Taking Flight: Improving Outcomes of Transition Age Youth on the Autism Spectrum
Capstone Project Proposal
Laura Kohley, LCSW, MBA
University of Southern California
Suzanne Dworak-Peck School of Social Work
DSW Program
Ronald Manderscheid, PhD
August 2023
i
Table of Contents
Acknowledgments ii
Executive Summary iii
Abstract viii
Positionality Statement ix
Problem of Practice and Literature Review 1
Conceptual Framework 8
Project Description 10
Methodology 17
Implementation Plan 21
Conclusions and Implications 25
References 29
Appendices 38

ii
Acknowledgments
First, I would like to thank Dr. Ronald Manderscheid, Primary Professor, and Capstone
Advisor for all his support and feedback. Cassandra Faturoso, MBA, LCSW, Senior Lecturer of
Social Work at USC, has been a sounding board and mentor throughout this journey. Most
importantly, I want to acknowledge and thank my family who has supported me throughout my
time completing the Doctoral Program at the University of Southern California (USC) Suzanne
Dworak-Peck School of Social Work. They were there during the most stressful times as well as
cheering me on as I completed each course. Thank you to Marc Bonaguide, Clinical Director,
and my external design partner. His positive attitude and forward thinking helped to keep me
moving in the right direction. Special thanks to my classmates, specifically my classmate
collaborator, Ilene Candreva, MSW, BCBA. Every student in Cohort 13 has pushed and
supported each other to see things through to completion. We have been a team and a family
over the last three years.

iii
Executive Summary
Problem of Practice
An estimated 50,000 to 80,000 youth on the autism spectrum turn eighteen each year with
only 4–11% of autistic young adults competitively employed and only 34% transitioning into
post-secondary education. Research indicates that three-quarters of transition-age youth on the
autism spectrum (TAY AS) had at least one co-occurring mental health disorder(s), which is
further impacted by their experience of higher levels of disconnection and/or lack of a sense of
inclusivity (A.J. Drexel Autism Institute, 2021; Baker-Ericzén, et al, 2022; Kohley, 2022b; Roux
et al, 2015). This population is growing annually which also guarantees an increase in the need
for services and support throughout their lives and most critically during their transition into
adulthood (Baker-Ericzén, et al., 2022; Kohley, 2022b). A central problem is the lack of human-
centered services addressing lifelong needs in an evidence-based manner, with a focus on
strengths as opposed to the current model of deficit-driven support. As awareness continues to
grow, there is an urgency to address service needs to support successful outcomes for this
population and disrupt societal bias and structural barriers to services. TAY AS do not need to be
“cured”, instead they need to be accepted for who they are, and environmental changes must
occur to expand the universal acceptance of neurodiversity. The neurodiverse population has its
place in this world, and it is the right of these individuals to be respected for who they are and
acknowledged for what they have to offer.
Proposed Innovation and the Grand Challenge
The primary goals of The Grand Challenge to Ensure the Healthy Development of All
Youth are to reduce the prevalence of behavioral health problems in the population of young
people from birth to age 24 by 20% and to reduce racial, socioeconomic, and other disparities in
iv
behavioral health problems by 20% (Grand Challenge for Social Work, 2018). The
proposed innovation, Taking Flight, originates from research gathered from peer-reviewed
articles, stakeholder interviews, podcasts, TED talks, online surveys, focus groups, and real-life
observations. These findings highlight the gap in services for the autistic population as they enter
adulthood. A need for increased awareness of the lifelong experiences of this marginalized
population including health disparities, inequities, and social exclusion was also revealed. Taking
Flight is designed to target the behavioral health problems of TAY AS as they enter adulthood
and to address the disparities and inequities of the healthcare system that has underserved this
population. Taking Flight is innovative in that it increases the availability of evidence-based
treatment to meet the specific needs of this population and their caregivers as they exit the safe
and inclusive community of the residential and day therapeutic environment of the Glenholme
School. The school serves children ranging in age from 11 to 21 and then has a transition
program serving individuals beyond the age of 21. The population includes individuals on the
autism spectrum, other mental health diagnoses, and learning differences.
This innovation incorporates the voices of those most impacted and empowers them to
make self-identified and measurable life goals according to the 8 Dimensions of Wellness and
associated services (SAMHSA, 2018). Each individual served has the opportunity to consider the
complexities of family dynamics and healthy support systems. Taking Flight addresses the Grand
Challenge of Ensuring the Healthy Development of Youth to promote positive lifelong
outcomes.
Design Thinking Methodology
Exploration of design criteria helped to guide the process and implementation of design
thinking methodology and tools. Interviews and observations of TAY AS, parent/caregiver
v
interviews and focus groups, provider interviews and focus groups, advocacy group member
interviews, peer-reviewed literature, and several other sources were used to come up with the
design goal (must), the user perception (what the innovation could potentially do), physical &
functional attributes (what the innovation should do and/or include) and identify constraints and
what the innovations should not do. Stakeholder influence and interest were also given attention
as the logic model (see Appendix B) was developed to look at the inputs (what is needed),
activities (what is done), and outcomes (short and long-term) of creating the innovation, Taking
Flight. This helped to focus the innovation to be human-centered and strengths-based providing a
clear conceptual framework in support of the theory of change.
Innovation Theory of Change
Taking Flight intentionally moves away from the medical model of disability which
approaches autism as a disability rooted within the individual, seeking a cure. The innovation
embraces the social model of disability which focuses on an environment that does not meet the
needs of the individual (Pellicano & Houting, 2022). The innovation focuses on the self-
determination theory of change to embrace human-centered design capitalizing on the
individual’s strengths and considering environmental factors impacting outcomes. TAY AS are
asked to complete a self-assessment as it relates to the 8 Dimensions of Wellness (SAMHSA,
2016) and consider associated services to create a transition plan that will support their goals and
dreams for their future. This is a new way of thinking and a strong example of what it looks like
when moving away from the medical model as it relates to this population and beyond.
The innovation has realistic and progressive goals and objectives to better meet and
support the autistic population as they age. The proposed innovation engages the most important
stakeholders and gives voice and volume to what it is that they want and do not want. Change
vi
must happen to address these individuals’ pervasive negative outcomes as they become adults
and engage with their community. The Taking Flight Transition Plan puts in motion the
individual’s desired personal outcomes and provides the road map to the team of providers so
that they are better equipped to provide a high standard of care.
Project Significance
The innovation, Taking Flight, addresses TAY AS and their current experience of poorer
outcomes in areas of employment, postsecondary education access and completion, mental
health, and social inclusion. This will contribute to the Grand Challenge (GC) of Ensuring the
Healthy Development of Youth by increasing service access to this growing population of TAY
AS. It further aligns with the GC as it not only supports and serves this population but will add to
the critical and growing research that is needed to further inform policy influencers and makers.
At the federal level, there is greater awareness of the lifelong needs of this population but there is
not enough outcome data to demonstrate which services need to be the focus of further
investment. As Taking Flight becomes more visible it will demonstrate the outcomes desired for
this population, resulting in a higher quality of life across the lifespan.
Project Implementation and Future Steps
Taking Flight has begun to demonstrate the positive impact that it can have on the
individuals served. The pilot and implementation have been successful thus far in initiating the
first steps toward creating and implementing individualized Transition Plans that have realistic
and measurable goals to assist each individual in their journey to their chosen community. With
implementation underway, quarterly reviews will begin to generate data that will be presented to
vii
all stakeholders and more specifically get additional attention from the Devereux Foundation to
expand the program to other Devereux locations.
Post-satisfaction surveys will be launched as the TAY AS youth leave the program and
further follow their self-identified plans. These surveys will serve as a measure of success that
can be publicized and will result in publishable research to add to the ongoing need for
knowledge, understanding, and acceptance of this population. The ultimate goal is to reach the
public outside of the Devereux Foundation and gain traction with needed policies to create an
environment that is inclusive and accepting of TAY AS and all the strengths and talents they
have to offer.

viii

Abstract
This paper introduces a solution to address the needs of transition-age youth on the autism
spectrum (TAY AS) who are preparing to graduate/exit a therapeutic residential and educational
setting. The number of individuals diagnosed with autism is on the rise, resulting in an increased
need for services and support. Described within this paper are concerning outcomes for this
population. The proposed solution, Taking Flight, originates from research gathered from
multiple sources and real-life observations. These findings highlight the gap in services for the
autistic population as they enter adulthood. It reveals an increasing awareness of the lifelong
experiences of this marginalized population including health disparities, inequities, and social
exclusion. There is a need for scalable evidence-based practices and a standard of care that will
satisfy the needs of this population by integrating their individually defined goals. Additionally,
the importance of increased understanding and inclusion of neurodiversity by moving away from
the medical model is critical. Taking Flight is an innovative design utilizing social-relational
evidence-based treatment to meet the needs of this population and their caregivers as they exit a
supported environment that provided a safe and inclusive community for neurodiverse
individuals. The methodology described within defines how human-centered strengths-based
design improves the outcomes of this population. Taking Flight is hypothesized to increase TAY
AS experience of success, acceptance, and understanding. Individual goals developed according
to the 8 Dimensions of Wellness and their support team will address the Grand Challenge of
Ensuring the Healthy Development of Youth will ensure lifelong success.
Keywords: transition-age youth outcomes, autism spectrum outcomes, services and
supports for transition-age youth on the autism spectrum

ix
Positionality
I am a 50-year-old white female living in Sandy Hook, CT. I hold a master’s degree in
social work (MSW) and a master’s degree in business administration (MBA) and have been
working in the field for more than 20 years. I recognize my position as a privileged white female
and my access to resources that are not available to everyone. To bring a more comprehensive
view to my proposed project, I make every effort to be humble and mindful of my privilege and
seek to actively listen to those with unique lived experiences (i.e., transition-age youth on the
autism spectrum, caregivers, providers, community members, etc.). With this knowledge, I
devote a substantial amount of time to collecting data from stakeholders who are impacted by
this proposed project. I understand that there are significant disparities in society that impact at-
risk populations. My values are driven by my desire to improve the quality of care which will
positively impact the lifelong outcomes of everyone served. The human-centered and strengths-
based design of care keeps my focus on the individual and their identified support system,
community, and life goals. I am committed to this project and understand that it will take time to
see the actual impact of this proposed service model.
1
The Problem of Practice and Literature Review
Transition-age youth (TAY) on the autism spectrum (AS) experience poorer outcomes in
areas of employment, postsecondary education access and completion, mental health, and social
inclusion. There are between 50,000 to 80,000 youth on the autism spectrum turning eighteen
each year. Factors impacting their outcomes include disorder-related social, communicative,
sensory, and executive functioning impairments. As the population of individuals diagnosed with
autism continues to increase annually, so will the need for services and support throughout their
lifespan and most importantly during their transition into adulthood (Baker-Ericzén, et al., 2022;
Kohley, 2022). The Grand Challenge to Ensure the Healthy Development of Youth suggests that
prevention efforts be further enhanced by examining the structural source of behavioral health
outcomes and consider not just the individual, but also the broader context of the environmental
factors impacting behavioral health long-term (Barth, et al., 2022; Maiden & Weiss, 2023). TAY
AS are having difficulty finding appropriately trained providers and services, resulting in
observed health disparities (Hume et al., 2021; Ishler et al., 2021; Jackson et al., 2018; Kohley,
2022; Roux et al., 2015). Health disparities remain in place in a society that has engrained bias
toward this population and which does not acknowledge them as human capital (Heasman &
Gillespie, 2019; Kohley, 2022b). A person on the autism spectrum
1
may potentially require
support not just in childhood but throughout their life. The challenges these individuals face are

1
The language that is used to describe this population conveys, shapes, and perpetuates ideologies and
therefore it is recommended that a less offensive reference would be to use a “person on” the autism spectrum in
place of “person with” (person-first language) or “autistic person” (identify-first language) (Botha & Williams,
2021).
2
intensified by the likelihood of having at least one co-occurring mental health condition, and
nearly half have at least two co-occurring disorders (A.J. Drexel Autism Institute, 2021; Kohley,
2021). Less than 8% of young adults with a learning disability, emotional disturbance, or speech
and language impairment felt disconnected compared to 37% of those on the autism spectrum. In
addition, TAY AS who were from lower-income households had double the rate of
disconnection than those from higher-income households. Nearly half as many white young
adults ever experienced disconnection compared to those who were Hispanic or Black (Roux et
al., 2015; Kohley 2021). Disparities are glaring in literature based on race, ethnicity, and socio-
economic status across education, employment, living arrangements, social participation, health,
safety and risk, and family well-being domains. This wealth of data suggests that low-income
youth on the spectrum are less likely to benefit from opportunities and services (including
transition-related services and activities) after high school than their white and higher-income
peers. The long-term impacts result in outcomes of increased poverty levels, unemployment, and
limited postsecondary education attendance and completion. The lack of research describing
underlying mechanisms that lead to these disparities negatively impacts the development and
advancement of interventions and/or policies that would reduce these differences and lead to
more equitable access to services (Eilenberg et al., 2019; Kohley, 2021).
Racial disparities exist in the age of diagnosis and prevalence. Diagnosticians diagnose
white non-Hispanic and higher socioeconomic status children earlier than other racial and lower
socioeconomic status groups. These factors are known to be linked to decreased awareness of
services and greater structural barriers to accessing appropriate care (Eilenberg et al., 2019;
Kohley, 2021; Lai & Weiss, 2017; Shattuck et al., 2011; Taylor & Henninger, 2015). Findings
note that AS providers in lower-SES urban areas must deliver services to more than twice the
3
number of clients than providers located in higher-SES urban areas, which puts into question the
quality of care and services that they are able to provide under these circumstances. There are
fewer geographically proximal AS service providers near urban socioeconomically
disadvantaged neighborhoods and less populated rural areas. This illustrates that the inequitable
availability of services is a factor underlying poorer functional and health outcomes in adults
from marginalized groups (Drahota et al., 2020; Kohley, 2021, Lai & Weiss, 2017).
Hume et al. (2021) found that authors reported race and ethnicity in 17.9% of previous
literature dated 1990 – 2011 with an increase to 30% in sources dated 2012 – 2017, and such
findings are just beginning to uncover these disparities. Socioeconomic status has also been
missing from much of the research as has gender identity and sexuality. The intersectionality of
the problems the TAY AS face will be magnified as research begins to uncover additional and
more engrained disparities. Research and practice have seen progress in diagnosing individuals
earlier but have not yet addressed autism as a lifelong difference that requires additional
research, dissemination, and implementation of evidence-based practice (EBP) for the evolving
needs of individuals as they enter adulthood (Kim et al, 2022; Mulvale, et al., 2019; Turcotte, et
al., 2016; Kohley, 2022b).
The increased prevalence of autism has both intensified the demand for effective services
and uncovered the need for society to better understand and accept the neurodiverse population
(Kohley, 2021; Roux et al., 2015; Baker-Ericzén, et al., 2022). Without supportive services, over
66% of TAY AS are not transitioning into postsecondary education or employment after leaving
high school. Up to 80% of adult individuals on the autism spectrum are unemployed, which is
higher than those seen in any other disability, and 70% are without higher education even
multiple years after high school graduation (Baker-Ericzén, et al., 2022; Kohley, 2021; Shattuck
4
et al., 2012). Additional findings indicate that the number involved with the vocational
rehabilitation (VR) system has doubled every five years since 2000 but employment rates have
not changed despite its use. Though seen to be beneficial, researchers have found qualified VR
services to be scarce, limiting any potential impact on employment rates for this population
(Baker-Ericzén, et al., 2022; CDC, 2020; Kaya et al., 2016; Kohley, 2021). TAY AS are filled
with uncertainty as they think about obtaining paid employment, attending college, connecting
socially, and living as a self-sustained/independent happy adult. These are young adults
transitioning from their childhood security of family and educational services and support to
adulthood, when the expectations of independence and self-sustainment are the norm. Ultimately
TAY AS must receive ongoing services provided by adequately trained professionals to nurture
and cultivate the human capital within this population (A.J. Drexel Autism Institute, 2021; CDC,
2020; Kohley, 2022b; Roux et al., 2015).
McGrawth’s 2018 documentary, Autism and Me, elicits the voices of TAY who describe
the challenges they face in obtaining employment and furthering their education because they are
confronted with a society that is trying to “fix” the issue instead of focusing on what they as
individuals can do. They describe feeling deprived of the basic human right to be included.
Individuals on the autism spectrum are neurologically divergent, yet methods for studying their
social behavior are based on neurotypical definitions of being social. This often results in autistic
behavior being defined as a deficit, rather than a difference (Heasman & Gillespie, 2019; Kapp et
al., 2013; Kohley, 2022b; Langan, 2011). In a Ted Talk by Jac Den Houting (2019), she
indicated that TAY AS are disabled by the environment because of the historical and engrained
medical model making it the individual’s problem instead of society's failure to accept autism as
5
a difference without any negative connotations. The effort an individual on the spectrum requires
to conform to neurotypical norms has significantly impacted this population.
Research has documented “autistic burnout” (i.e., chronic exhaustion, loss of skills, and
reduced tolerance to stimulus) because of prolonged attempts to mask autistic traits especially as
life stressors accumulate such as transitioning to adulthood, increased expectations (i.e., family,
society, and school/work), and disability management (Kohley, 2022b; Mantzales, et al., 2022;
Raymaker, et al., 2020). The lack of acceptance and understanding further impedes the ability to
develop and expand appropriate services and supports to ensure future success. There is no
standard of care required in the implementation of services (i.e., enforcing EBPs as the standard
of care) and no structure to uphold and enforce such a standard (L. Shea, personal
communication, May 31, 2022). For a better understanding of what is important to stakeholders,
how they can contribute to this project, barriers they may create, and strategies to engage
stakeholders please see Appendix A (Kohley, 2022b).
Compounding these challenges, the social and mental health difficulties of TAY AS may
worsen as they age, due to increasingly complex social and academic demands, growing self-
awareness of difficulties, and numerous other adversities, such as bullying, victimization, and
inconsistent or inadequate support and transition services (A.J. Drexel Autism Institute, 2021b;
Heasman, 2017; Kerns et al., 2019; Kohley, 2022b). TAY AS have far higher rates of
disconnection than their peers with other disabilities. Professional observations and lived
experiences made by this doctoral student repeatedly note that students preparing to exit high
school are anxious, fearful that they will not have romantic relationships/friendships, and
concerned that they will be unable to manage schoolwork or hold a real job. Frequently heard
statements include: “I don’t think they like me,” “I don’t know if what I am saying sounds
6
weird,” or “I just don’t fit in” (confirmed by professional experience, 2022). In a focus group on
April 19, 2023, licensed and unlicensed professionals serving TAY AS unanimously expressed
concern about the vulnerability of this population and the risk of being taken advantage of (e.g.,
stolen identities and internet scams). They are fearful of what will happen to them once they
leave the residential environment without the appropriate services and support.
These young adults have indicated that they feel most supported by their families but less
than half of them felt that they could manage adult responsibilities, that life was interesting, or
that they could make friends easily. Caregiver-directed and/or initiated services for these young
adults were consistently observed, reflecting the importance of embedding family support into
the service system (Kohley, 2022b; Lai & Weiss, 2017; Roux et al., 2015). On June 17, 2022, a
focus group of parents and caregivers described their fears and efforts to help their adult children
be as independent as possible. They did not want their child(ren) to be reliant on them for the rest
of their lives but did not know where to go for services to help with executive functioning,
independent living skills, financial support, and/or employment. Additionally, the parents and
caregivers expressed frustration with the eligibility process to receive services, often
experiencing denial at least once and then not knowing how to proceed or where to seek further
guidance.
Consideration of broader historical and contextual factors is key in interpreting these
findings. Autism has shown a series of changing views from the 1960s, when society blamed
parenting and used terms such as “refrigerator mother”, to the 1990s when some characterized
autism as a disease and/or epidemic resulting from vaccinations. In the 2000s a shift in thinking
began to turn away from blaming parenting and using the disease model and moved towards
acceptance of autistic diversity (Heasman & Gillespie, 2019; Kohley, 2022b; Langan, 2011).
7
Autism and neurodiversity awareness is associated with viewing autism as being positively
diverse and not requiring a cure, suggesting underlying differences between the medical model
that has been embedded in the structure and system of care and the neurodiversity movement
(Kapp et al., 2013; Kohley, 2022b; Novak, 2015).
In looking at more recent contextual considerations, the present-day impact of more than
two years of the COVID pandemic has exacerbated the challenges faced by TAY AS in their
daily lives. Research has demonstrated that employment instability predicted an increase in
depressive symptoms among young adults on the autism spectrum. COVID intensified the
difficulties faced by TAY AS when attempting to obtain and maintain employment (Heasman &
Gillespie, 2019; Taylor et al., 2022). Kaku et al. (2021) highlighted individuals who described
their difficulty moving from in-person to online work which further supported the risk of
depressive symptoms. Challenges to keep up with work and training goals while working from
home made it hard to connect with supervisors and mentors. Overall, the pandemic made
participants feel more isolated while they struggled to cope with their emotional responses.
However, resiliency in this population was noted as participants identified one positive aspect of
working online to the degree that it allowed them to join meetings worldwide and beyond their
usual communities (Kaku et al., 2021; Kohley 2022b).
Professional observation and interactions have revealed the repetitive use of the term
“COVID Kid.” TAY AS students enrolling in a therapeutic educational and boarding
environment often presented with referral behaviors including resistance to engage in online
schooling, electronics addiction, developmentally significant regression, and perceived parental
inability to manage behaviors of concern. The pandemic has also negatively impacted their
8
comfort level with in-person versus online interactions reducing their real-life community and
social connections (Focus group, June 17, 2022; Confirmed by professional experience, 2022).
Despite the evident need for more robust support for this population, data suggest that
this is still lacking. According to the Individuals with Disabilities Education Act (IDEA), federal
law requires students who received special education services to have a transition plan that
supports achieving postsecondary education, employment, and independent living upon leaving
high school. Transition planning is typically inadequate because resource availability is limited
and/or involves long waitlists (Autism Speaks, 2021, Kohley, 2022b; Roux et al., 2015; Taylor &
Henninger, 2015; U.S. Department of Education [USDEA], 2021). The cost of supporting this
population and the need to address diversity, equity, and inclusion makes it imperative to
continue the work toward positively impacting the lifelong outcomes of TAY AS.
Conceptual Framework
The Taking Flight Logic Model (see Appendix B) describes its human-centered design
and provides greater detail as to what is needed to implement Taking Flight (inputs), the program
description and what is offered (outputs/activities), who will be reached (outputs/activities) and
short- to long-term desired outcomes (Kohley, 2022c). The inputs include personnel (licensed
clinicians with 3-5 years of experience working with the autistic population, case managers,
direct support professionals/vocational coaches, volunteers, and/or peer mentors), fixed
operations, and space. Outputs and activities include the services, curriculums, treatment plan
design, and those that will be served (i.e., TAY AS and parents/caregivers). The purpose of this
project is to increase the implementation and availability of evidence-based services to improve
the outcomes of the autism population (more specifically those youth exiting/graduating from the
Devereux Glenholme School, an intensive therapeutic environment) in the areas of post-
9
secondary education, mental health, and social inclusion, fostering a sense of belonging. The
vision and mission are embedded within the outcomes described. The voices of parents and
students are recognized as they continue to identify the need for support in their adult life.
Parents/caregivers have expressed concern that community providers do not understand the
needs of their adult children or the level of support from which they are coming. Leaving such an
intensively therapeutic environment and re-entering the community with little to no support can
be overwhelming for most of these youth. Professional observations made by this doctoral
student and colleagues repeatedly note that students preparing for adult living are anxious, and/or
feel confused about how to engage in romantic relationships/friendships, and/or will not be able
to manage college or hold a real job. Other participating TAY AS present as deeply uncertain
about what they want or what is expected of them, and they simply become withdrawn and make
comments such as, “I don’t know,” “I don’t care,” or “I don’t want to do anything” (Kohley,
2022c).
The gap in services when children become adults has been documented and discussed
extensively. The proposed solution of human-centered transitional support for TAY AS provides
continuity of care as these young adults enter their home community. Licensed clinicians and
professionals who are experts in this field will provide the stability of a continued therapeutic
relationship with strengths-based, person-centered, and solution-focused services. Clinicians
and/or case managers clearly understand the therapeutic environment these individuals are
leaving, and the life domains in which they require support and growth. They will collaborate in
the execution of a transition plan including self-identified goals and objectives (Kohley, 2022c).
To address ingrained assumptions amongst employers, educators, and the public there has
been a movement away from the medical model to a social model (acknowledging diversity and
10
inclusion) (Mantzalas, et al., 2022; Novak, 2015; Kohley, 2022a). The proposed solution will
continue this movement by adhering to transformative social innovation. This builds on the self-
determination theory, in which empowerment is conceptualized in terms of the fulfillment of
basic psychological needs, such as autonomy and having a sense of community and belonging of
the TAY AS population (Pel, et al., 2020; Kohley, 2022c). Individual, community, and
organizational partnerships are imperative to mutual engagement, authenticity, empowerment,
and the ability to accept and work with differences. Autonomy, community connections, and
acceptance of this population will be achieved through the implementation of strength-based and
humanistic evidence-based practices with the highest standard of care (Kohley, 2022c).
TAY AS are vulnerable to risk in the community, thus providing needed support when
they are faced with increasing demands in the different domains of life will positively impact the
rates of economic independence, life expectancy, and mortality in adulthood (Eilenberg et al.,
2019; Ford, 2020; Kohley, 2021; Kohley, 2022a; Mulvale et al., 2019). Social innovation and
self-determination theory will help to establish a standard definition of transition success to
support quantifiable indicators to promote successful readiness, planning, monitoring, and
transfer of care/transfer completion rates, and transition policy (Cleverly, et al., 2018; Kohley,
2022a; Kohley, 2022c).
Project Description
The proposed solution, Taking Flight, is a service being offered to transition-age youth
(TAY) on the autism spectrum (AS) who are moving on after graduation to reduced support from
the therapeutic boarding school (Devereux Glenholme School) as they prepare to enter
adulthood. There is an identified need for scalable evidence-based practices and a standard of
11
care to satisfy the needs of TAY AS by focusing on their individually defined transition (future)
goals. Additionally, increased understanding and inclusion of the neurodiverse population will be
achieved by moving away from the medical model that focuses on impairments and functional
deficits (Pellicano & Houting, 2022). The essential services are provided both in a residential and
a day program format including current licensed and trained professionals to provide
employment support and preparation, vocational training, mental health support, and life and
social skills training (Baker-Ericzén et al, 2022; Ishler et al., 2021; Kaya et al., 2016; Kohley,
2022a; Kohley, 2022c). The program already employs experts in the autism field and more
specifically has been working with individuals transitioning from children to adult services to
support the needs of this growing population. Taking Flight’s transition plan aligns with the
individual’s goals for adulthood and is the flight path for TAY AS as they prepare to enter their
home community.
The 8 Dimensions of Wellness and associated services help to solidify this population’s
thoughts about goals for their adult lives. The 8 dimensions include emotional, spiritual,
physical, social, financial, occupational, intellectual, and environmental well-being (SAMHSA,
2016). TAY AS will also consider family dynamics and ways that they can identify and maintain
any significant others who are part of their support system. The interconnected dimensions and
particularly emotional well-being are essential given that the medical model, which focuses on
impairments and functional deficits, to a social model which focuses on individual strengths and
considers environmental factors of the TAY AS accessing this program are likely to have a
comorbid diagnosis (i.e., depression, anxiety, obsessive-compulsive disorder, other mood
disorders, and learning disabilities).
Theory of Change
12
Taking Flight is an intentional move away from the medical model which focuses on
impairments and functional deficits to a social model which focuses on individual strengths and
looks at the environmental factors. This model will drive the implementation of services and
support through the lens of the self-determination theory of change (Pellicano & Houting, 2022;
Pel, et al., 2020). The parents and caregivers of these youth will also receive support to ensure
they remain a positive part of the youth’s life while attending to their own self-care and life
satisfaction. This innovative model becomes the stepping-stone to successful outcomes tailored
specifically for TAY AS exiting a therapeutic residential and/or day program. See Appendix C
for a visualization of the theory of change. The support will produce positive outcomes for this
population in the areas of post-secondary education, employment, mental well-being, and social
inclusion. Implementation has begun to demonstrate the ways in which the transition plan is
changing stakeholders’ determination of future planning and realistic goals. The primary focus is
on the self-determination of TAY AS, reflecting a shift in thinking that will help to better
identify and increase access to appropriate care and ultimately disrupt the problem. All aspects of
services provided rely upon knowledge and fidelity of evidence-based care, collaboration with an
integrated team approach based on shared goals, dedication, learning, and knowledge by
continuing to review and revise the innovation to advance services. The proposed solution
demonstrates that TAY AS will be better prepared and supported to navigate post-secondary
college and career opportunities to bridge the gap between child and adult services.
Solution Landscape
Historical attempts to address and support this population include the Americans with
Disabilities Act (ADA), which became law in 1990. The ADA is a civil rights law that prohibits
discrimination against individuals with disabilities in all areas of life, including jobs, schools,
13
transportation, and all public and private places that are open to the public. The purpose of the
law is to make sure that people with disabilities have the same rights and opportunities as all
other Americans. Further, the Americans with Disabilities Act Amendments Act (ADAAA) of
2009 made changes to the definition of disability that applied to all areas of the ADA to help
strengthen the act. Several Supreme Court decisions over time have weakened the protections of
the Act by requiring very narrow interpretations of disability. Researchers have found that the
ADA has not been successful in increasing the employment of people with disabilities, although
there is disagreement as to why this has been the case (ADNN, 2022; Brandeis Now, 2015;
Kohley 2022b).
Only 2% of federally funded research on autism (AS) has been dedicated to the needs of
AS adults (U.S. Department of Health & Human Services, 2017; Kohley, 2022b). There are not
enough meaningful outcome measures to enable the development and evaluation of effective
models to increase coordinated, comprehensive, and individualized services for TAY AS.
Research fails to account for the heterogeneity of the AS population transitioning to adulthood
and their caregivers. This work is necessary for federal agencies and external stakeholders to
address the need for integration of funding sources, surveillance, outcomes research, and
transition services (U.S. Department of Health & Human Services, 2017; Kohley, 2022b). In
addition, the Autism Collaboration, Accountability, Research, Education, and Support Act of
2019 (Autism CARES Act) restated the purpose of federal activities across the lifespan of
individuals on the autism spectrum and other developmental disabilities specifically for this
reason (U.S. Department of Health & Human Services, 2019; Kohley, 2022b).
State-specific agencies such as the Connecticut (CT) Department of Developmental
Services (DDS) provide transitional services for high school graduates who meet the eligibility
14
criteria, including a documented intellectual disability (Full-Scale IQ of 69 or less), or a
diagnosis of autism spectrum disorder or Prader Willi syndrome (Connecticut Department of
Developmental Services, 2020; Kohley, 2020; Kohley, 2022b). Additionally, the CT Department
of Mental Health and Addictions Services (DMHAS) attempts to address the needs of this
population as it relates to mental health stability. Both DDS & DMHAS are state agencies meant
to address the needs of specific populations, but families and children who do not meet the
necessary diagnostic criteria or severity level for eligibility will not have access to the essential
services (CT DMHAS, 2020; Kohley, 2020; Kohley, 2022b).
Taking Flight is an opportunity to increase positive outcomes for TAY AS and their
families/caregivers. It aligns with the needed outcome measures to further federal policy as it
addresses life-long needs and fills the gaps left by state agencies. This is an undertaking that will
require time to demonstrate outcomes via continued research and stakeholder engagement, which
will help to better understand TAY AS to improve their lived experiences as it relates to the 8
Dimensions of Wellness (SAMHSA, 2016).
Prototype Description
Taking Flight is an innovative design utilizing social-relational evidence-based treatment
to meet the needs of the autistic population as they exit an intensive residential and day-
supported environment. There are 13 Grand Challenges for Social Work and Society. Taking
Flight addresses the Grand Challenge of Ensuring the Healthy Development of Youth. The
prototype includes a manual that defines the stages of implementation, staff responsibilities,
guidelines for staff during implementation, templates for each component, and follow-up rating
15
scales for TAY AS and their parents/caregivers. The outcome data will inform scalability and
sustainability.
The innovation, Taking Flight, provides clear and replicable guidelines for
implementation within a residential setting and beyond. This program aims to create a realistic
and attainable Transition Plan related to the 8 Dimensions of Wellness (SAMHSA, 2016)
focusing on strengths-based and person-centered approaches. TAY AS will engage in Making
Action Plans (MAPs) that will incorporate a newly structured Transition Plan. TAY AS will
have the opportunity to explore the 8 Dimensions of Wellness before completing the Transition
Plan. They will be encouraged to consider family dynamics as well as the importance of making
connections with a trusted support system. This will be measured by having TAY AS and their
parents/caregivers complete the Family Adaptability and Cohesion Evaluation Scale (FACES IV
Survey) (Olsen et al., 2004). The Taking Flight Transition Plan outcomes will be measured with
quantifiable goals and objectives that are assigned specific time frames for review and
completion. Follow-up will occur after leaving the program to measure the success and
satisfaction of both parents and TAY AS at predetermined intervals.
The length of the service is determined by the student’s current age and position in the
residential or day program and the time needed to solidify transfer of care needs within their
identified home community. The initial surveys for family members and TAY AS are part of the
pre-transition steps. Optimally, 12 to 24 months would provide the initial data required to
demonstrate success. The preliminary data are primarily qualitative. The prototype is in the
beginning phase of implementation and currently, seven students have completed the Self-
Assessment: 8 Dimensions of Wellness and Associated Services Survey. They also completed
the FACES IV survey to consider family dynamics and their decision to include this in the
16
Transition Plan. Of the seven, only one student chose to include a family goal in their Transition
Plan. Parents have completed the Satisfaction Survey (n = 3) and FACES IV (n = 7) to provide
feedback from the parent’s perspective and compare the differences/similarities in responses to
the FACES IV survey. Focus groups with the staff implementing the prototype have produced
several revisions and enhancements to the prototype. TAY AS have been open to these exercises,
expressing how helpful it was to see the dimensions written out. Here is a link to the Taking
Flight Manual (high-fidelity prototype) (see Appendix D).
Likelihood of Success
The success of this program will meet the goal of demonstrating proof of concept. As the
innovation remains on target, additional planning with the Clinical Director, Program Director,
and Devereux Foundation will occur to consider the feasibility of expanding Taking Flight to
other programs (i.e., short-term residential settings) within the Foundation. If the program proves
to be profitable and repeatedly demonstrates successful outcomes, buy-in from multiple
stakeholders will likely help to support external marketing. Appendix E demonstrates the
projected stakeholder movement intended by the implementation of this prototype (Kohley,
2022).
Increased interest in the prototype will produce opportunities to provide training at other
Devereux Foundation locations and in different communities. For example, presenting to school
districts, other therapeutic boarding schools, and short-term transition programs will determine if
there is interest in implementing this program within their setting(s) or establishing a partnership
and/or shared resources. If interest exists, the manual for Taking Flight will be sold as a package
with a predetermined number of hours of training to ensure fidelity (Kohley, 2022c).
17
Methodology
Human-Centered Design
The initial tools of design thinking that were implemented were empathy and exploration
(Liedtka & Ogilvie, 2011). To demonstrate this, a deeper understanding of the target population
(TAY AS) was developed. The voices of TAY AS were sought out as well as those of varying
stakeholders. The methodology for the program development incorporates the 8 Dimensions of
Wellness including occupational wellness, emotional wellness, social wellness, physical
wellness, financial wellness, spiritual wellness, intellectual wellness, and environmental wellness
(SAMHSA, 2016). This framework and standardized practice are captured within a manual (the
high-fidelity prototype) that defines the implementation of human-centered and strengths-based
best practices.
Design Criteria
The design criteria helped to guide the development of Taking Flight (See Appendix
F). The goal of capturing a greater understanding of this population’s goals and aspirations in
life is accomplished through the implementation of this program as it identifies the positive
attributes of TAY AS. The design incorporates the need for support systems that can remain a
positive presence and help to enhance a sense of inclusivity. The design acknowledges the
growing population and the need for environmental changes to increase successful life-long
outcomes. The design strives to support goals such as employment, post-secondary education,
and independence. In addition, the design criteria incorporate the 8 Dimensions of Wellness to
further enhance TAY AS’s understanding of their environment and help them to define the areas
that they are striving to achieve (i.e., mental well-being). Ultimately, the goal of the design is to
18
gain attention and move towards structural and environmental change to better serve and
accommodate this population throughout their lifetime.
Market Analysis
State agencies offer services to this population if they meet strict qualifying criteria while
other public and private agencies continue to rely on and utilize treatment modalities that focus
on autism as a disability and attempt to improve outcomes by reinforcing neurotypical behavioral
and social norms and expectations. Additionally, there are advocacy groups that provide
resources for individuals and/or caregivers but the primary focus is on children under the age of
18. Services and support for TAY AS are limited at best.
This innovation differs from its competitors in that it is attached to a therapeutic boarding
school which proactively identifies the opportunity to engage in transitional support and the
Taking Flight program is readily available. Other sought-after agencies and resources tend to be
a more reactive attempt to address identified needs that TAY AS and their families often
encounter. In comparison to other transition services and support, Taking Flight focuses on the
dimensions of wellness and helps the individual during the self-determination process of
establishing goals that are clearer and more well-defined. It focuses on the strengths and abilities
of the individual instead of focusing on deficits. Taking Flight features autism as being part of a
diverse population allowing for the heterogeneity of the population rather than assuming that the
TAY AS population is all the same. It focuses on the environment and what is needed to ensure a
successful transition to the individual’s chosen community. For a more in-depth example of
competitive market analysis see Appendix G.

19
Financial Plan and Implementation Strategies
The budget for the start-up year includes a small allocation of a licensed clinician’s hours
(already employed at Glenholme) to initiate piloting, implementation, and manual review with
current employees of the transition program. As the Taking Flight model becomes more scalable
the number of required employees (licensed and unlicensed) will need to be reexamined. Piloting
and implementation have demonstrated no other additional cost to engage TAY AS in this
process. Costs associated with the distribution of pre-and post-surveys, as well as ongoing
outcomes review, must be considered. Piloting and implementation have identified areas for
revisions and further clarification within the text of the manual. This has been addressed and
reviewed during focus groups with staff and TAY AS. Once enough data has been gathered
(estimated time of 12 to 24 months), a quarterly review of this data with the Devereux
Foundation will be appropriate to demonstrate effectiveness. Pursuit of a National Provider
Identification (NPI) number will be needed to seek reimbursement for services after the
Individualized Education Plan (IEP) has ended. Privately funded (paid by parents or scholarship
dollars when available) individuals will continue to receive these services with the understanding
that clinicians may not hold the necessary licensure for their state.
Methods for Assessment
Program impact will be measured by online surveys and telephone/video conferences
with TAY AS who have entered their chosen community as well as their parent and/or
caregivers. This will provide quantifiable data pertaining to post-secondary education attendance
and competition as well as employment for this population. It will also provide feedback about
how helpful (or unhelpful) Taking Flight was for TAY AS and their parents/caregivers as they
20
prepared for their transition and the extent to which they attribute their success to the program.
Social change will be a longer-term goal as it will require sufficient data, continued collaboration
with necessary stakeholders, and expansion and sustainment of the program in Connecticut and
other locations within the Devereux Foundation and eventually outside of the Foundation in
varying communities to increase equitable access.
Stakeholder Involvement & Communication Products
Taking Flight will continue the effort to engage stakeholders including TAY AS,
parents/caregivers, providers, funders (local educational authorities, Devereux Foundation, and
seek any potential grant opportunities), advocacy groups, etc. This will be completed in the form
of mailings, social media, surveys, focus groups, and community outreach. Infographics such as
Appendix H demonstrate the current state of TAY AS and their futures, which will be sent to
potential collaborators as a call to action. Additionally, there will be a one-page flyer that can be
handed out that describes the program and has contact information to be given to potential
stakeholders (see Appendix I).
Appendix J delineates a communication plan, the audiences that will be reached, the
goals of each type of communication, the timeframes, and schedule, the format that will be
utilized to engage the audience, and the individual who is going to be responsible for each.
Communication will include weekly Leadership Team Meetings, where there is an opportunity
to share with Glenholme Program Directors, Supervisors, and designated department
representatives (non-supervisory). The initial meeting to introduce Taking Flight has already
occurred. Other examples include focus groups for parents/caregivers (quarterly) and TAY AS
(quarterly), website, and YouTube Channel communication to further advertise and provide
video footage of what is happening in the program.
21
Implementation Plan
As described in Taking Flight’s manual, there are three phases to the program including
pre-transition, transition, and post-transition. There are cohort comparisons depending on the
time frame for program implementation/completion. The Pre-Transition phase includes pre- &
post-family satisfaction surveys, Self-Assessment: 8 Dimensions of Wellness (a self-assessment
survey), and Services Related to the 8 Dimensions of Wellness. Additionally, the Family
Adaptability and Cohesion Evaluation Scale (FACES IV) will be utilized to establish baseline
data and qualitative information about family dynamics and functioning (Olson, et al., 2004;
Olson, 2019). During the Transition phase, the Taking Flight Transition Plan is developed,
incorporating measurable goals and objectives reflecting the individual’s desires and aspirations
which are then set in motion. The Post-Transition phase begins with a final request for the
completion of the surveys mentioned above and outreach by the Social Worker to complete a
successful transition of care within their home community. Once this is complete the graduate
and caregivers will receive post-transition satisfaction surveys at the following time markers six
months, twelve months, two years, and five years.
Explore, Preparation, Implementation, and Sustainment (EPIS) Framework
Taking Flight utilizes EPIS to incorporate promising characteristics and strengths of this
framework and encourages future use including more precise operationalization of factors,
increased depth and breadth of application, development of aligned measures, and broadening of
user networks (Moullin et al., 2019). Important factors of this framework include close
considerations of the main challenges and facilitators of each of these phases both through the
lens of inner and outer context (see Appendix K). The culture and leadership of the organization
are key factors in the process and there has been observed potential to capitalize on the
22
organization’s desire to improve upon best practices and embrace diversity, equity, and
inclusion. TAY AS are vital collaborators to determine what it is that they need and how they
experience the external world so that they experience the quality of life to which all human
beings are entitled to. In order to have a sufficiently strong impact on society and the healthcare
structure, the future success of this population needs to be seen as human rights. Taking Flight
considers the continual loop of exploration, preparation, implementation, and sustainment in that
it continues to engage stakeholders and welcomes differing opinions in the field and from
external stakeholders.
Budget Consideration
Taking Flight, part of a larger not-for-profit organization seeks to improve the outcomes
of TAY AS with a human-centered and individualized Transition Plan to Ensure Healthy
Development of Youth within this population. The program expansion is supported by the
following, responsible financial plan.
To summarize, the plan for the start-up and first year of operation requires $2.6 million.
General details are outlined below:
Start-up Year 1 Operation
July 1, 2023 – July 1, 2024 -
June 30, 2024, June 30, 2025
Revenue $1,604,164.00 $2,960,714.00
Expenses
Personnel $872,934.96 $1,255,369.00
Other Expenses $207,540.00 $240,710.78
Total Expenses $1,080,474.96 $1,496,079.78
Surplus/(Deficit) $523,689.04 $1,464,634.22
23

Appendix L contains the line-item budget required for the implementation of this
program. Taking Flight requires a partial full-time equivalent to implement the innovation during
the start-up year. These licensed clinician hours will be applied directly to the program to ensure
fidelity of implementation. This is estimated at eight hours per month for the first year which
annualizes at $3,692.16 with added employee benefits at 28% totaling $1,033.80. There is
already a line item for training and professional development with added dollars to support the
implementation of Taking Flight (approximately 50% of the $10,000 listed). Monthly, quarterly,
and annual reporting to complete a comparison of the projected budget versus the actual will
provide the metrics needed to assess feasibility and sustainability. There will be a semi-annual
budget review with an open invitation to stakeholders that are involved in the program, those
impacted by it, and external stakeholders.
Stakeholders invited will include internal (leadership, clinical staff, and direct support
professionals) and external stakeholders (individuals receiving services, community members,
family members, and providers with similar interests) to ensure that the budget is being
interpreted accurately and limit any bias a particular stakeholder may hold. There is a need to
differentiate and be aware of the changes that may be required when considering the start-up
year versus the first full year of operation after that. An extensive review of this will further
define the first year’s budget after the start-up year.
Challenges & Strategies
Staff readiness has already been identified as a potential challenge and efforts to address
this have included focus groups to engage them in the process, planning, and
24
development/refinement of the innovation. Strategically identifying and preparing champions
(Brownson et al., 2017; Leeman et al., 2017; Kohley, 2022) who can provide education and
endorsement of Taking Flight is also necessary to promote more robust awareness within the
organization. The champions can provide education to staff regarding differences between the
prescribed treatment (traditional medical model) and the current innovation, which is tailored to
the self-identified strengths, needs, and goals that the TAY have along with their chosen support
network (innovative social model) (Kohley, 2022). It is possible that staff turnover may occur,
which is not uncommon when there is a culture shift. Preparing for that as a possibility will be
important so that it does not impede the implementation of Taking Flight. Fortunately, that has
not been the case during the piloting phase, which is directly attributed to the proactive and
productive focus groups.
Accessibility is a limitation that the program faces (somewhat rural and away from most
public transportation) along with funding and/or local educational authority agreement to the
placement of the TAY AS in the program. Establishing a National Provider Identification (NPI)
number to address the need for expansion in the potential revenue stream has proven to be a
challenge and is an ongoing body of work within the Devereux Foundation. An unexpected but
welcomed culture shift has begun with new leadership in place, which is positively impacting the
staff and creating the ability for the innovation to move forward. Strong leadership behaviors
including being an active communicator, following up on commitments, collaborating with
others to find the best solutions, anticipating others’ needs, being respectful, and having a can-do
attitude have been more present following this shift (Greenleaf, 2002; Kohley 2022).
Ethical Consideration and Applying Design Justice Principles
25
The Taking Flight innovation factors in diversity, equity, and inclusion as key
components to improving the outcomes of TAY AS. Innovation development and refinement
incorporate feedback to identify and address any negative impact this could have on TAY AS,
the population’s support system, and the community and will be ongoing. Taking Flight will
include TAY AS and parents/caregivers in the ongoing review of its impact and outcomes.
Additionally, they will be invited to be a part of the quality improvement team to address the
principles of design justice as it relates to considering those directly impacted and whether there
is an increased level of empowerment. It is understood that there is a continued need to capture
missing voices, identify areas for improvement, and identify when and how fidelity has been
upheld or challenged. This innovation brings to the solution landscape a clearer understanding of
neurodiversity and its difference from neurotypical norms and biases. Further addressing the
disconnect in mutual understanding has made empathy, perspective-taking, and social perception
difficult for the TAY AS, the community, and service providers (Heasman et al., 2019; Kohley,
2022a). Prioritizing the ways in which this program affects the community and increases
accountability (by reviewing outcome data and being transparent), accessibility (engaging the
Devereux Foundation to expand to their other locations), and collaborations are required.
Conclusion and Implications
Taking Flight is innovative in that it introduces a “step-down” approach from the
therapeutic boarding environment (24/7 support and care) and combines it with the SAMHSA
(2016) 8 Dimensions of Wellness to guarantee a person-centered design validating the voices of
the most important stakeholders (i.e., TAY AS and their parents/caregivers). This model moves
away from a deficit-driven medical model to a social model which considers the environment as
an important factor to this population’s success and/or identifies barriers that require further
26
work. Taking Flight increases the opportunity to capitalize on the strengths and skills that make
the TAY AS population valuable and recognized as worthy, talented humans with much to offer.
Taking Flight’s Transition Plan will increase the individuals’ ability to generalize learned
skills to a community setting with needed support and coaching to increase their level of success
in the areas of post-secondary education, employment, mental and behavioral health, social
inclusion, and autonomy. The use of evidence-based mental and behavioral health treatment
modalities (i.e., individual therapy, cognitive behavioral therapy, solution-focused family
therapy, group therapy, and trauma-informed practices) will address comorbidities such as
anxiety, depression, obsessive-compulsive disorder, and other mood disorders which impact
between 30-54% of autistic individuals entering adulthood (Rydzewska, et al., 2018). In
addition, vocational skills training and executive functioning coaching will add to the
multidisciplinary approach, confirming expected outcomes to impress upon funders, local
educational authorities, and the Devereux Foundation the value of investing in this innovation.
The required supporting data regarding the success of this innovation will be measured
through quantitative and qualitative measures pre-transition, during the transition, and post-
transaction with a plan to further follow up with these individuals once they are integrated into
their chosen communities. An ongoing review of the results will guide and inform policymakers
and influencers to consider and develop a standard of care that should be adhered to in order to
best meet the lifelong needs of this population. Providers, researchers, policymakers, and funders
need to think in terms of differences and not rely on assumptions that existing services intended
to meet the needs of neurotypical TAY will also meet the needs of individuals on the autism
spectrum. The recent pilot program has yielded data that indicates that specialized services, such
as Taking Flight, are more effective than most existing generic services. For example, one
27
student’s action plan written prior to beginning Taking Flight, contained goals that had no
concrete steps for connecting with their home community providers/resources. After becoming
part of Taking Flight, the individual’s transition plan included observable and measurable goals
and objectives that directly addressed this need. In addition, it identified the evidenced-based
interventions (i.e., cognitive behavior therapy) that would best support their needs and highlight
their strengths.
Community awareness will grow beyond the services provided and improve inclusivity
and belonging, measured by self-report through post-transition satisfaction surveys for TAY AS
and their caregivers. This will continue the examination of the structural source of behavioral
health outcomes and the broader context of the environmental factors impacting behavioral
health (Barth, et al., 2022) that will contribute to the efforts of the Grand Challenge to Ensure the
Healthy Development of Youth. The holistic approach of Taking Flight aims to change the
preconceived notions of providers and the community to see these youth as valuable. Success
rates will be measured by an increase in competitive employment and individual satisfaction
reports. An ongoing review of quality of care and appropriateness will be completed by the
identified quality improvement team.
As awareness and understanding have continued to grow it has been brought to light that
so much more needs to be done to address the challenges that exist for the autism population
throughout their lifespan. This may also open avenues to grant funding that could enhance
Taking Flight’s support to TAY AS. This is consistent with policy and research
recommendations for increased evidence-based interventions, manualized treatment to increase
the fidelity of promising support programs, professional development, and training to work with
28
this population (Baker-Ericzén et al., 2022; Kerns et al., 2019; Kim et al., 2022: Kohley, 2022b,
Kohley, 2022c).
There is a concrete plan for advancing the next steps which include the continuation of
implementation and needed refinement(s) of each component of Taking Flight to produce
outcome data that will drive the future growth of this program in Connecticut and beyond. The
continuation of stakeholder engagement during each step is vital to identify any potential bias
toward or about the model and ensure that education for both this doctoral student and those
involved remains open to diversity, equity, and inclusion. The impact of Taking Flight’s
outcomes will be highlighted as engagement continues to happen through education and applying
new knowledge to address the effort to Ensure the Healthy Development of Youth (Grand
Challenges of Social Work, 2018; Kohley, 2022a). Taking Flight has a clearly defined
communication plan (see Appendix J) for further implementation and ensures the bold step
forward in collaborating with the most important stakeholders (i.e., TAY AS and their
parents/caregivers) to address this wicked problem.
The communication plan will incorporate the one-page handout (see Appendix I) which
will market Taking Flight to surrounding districts in addition to the expected expansion within
the Devereux Foundation. Should the district be interested in utilizing this model that focuses on
the 8 Dimensions of wellness then feasibility would be discussed. Determining the number of
individuals that would benefit from Taking Flight within their district will be the first step and
then considerations for resources needed to ensure fidelity of program implementation. A plan
would be drafted to determine training needs (cost of) along with the cost of the manual itself
would be offered to support the external district in its effort to better serve transition-age youth
as they leave high school and ensure their successful transition to adulthood and beyond.
29
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38
Appendix A
Stakeholder Analysis Matrix
Stakeholder
Name
Impact
How much
does the
project
impact
them? (Low,
Medium,
High)
Influence
How much
influence do
they have
over the
project?
(Low,
Medium,
High)
What is
important to the
stakeholder?
How could the
stakeholder
contribute to the
project?
How could the
stakeholder block
the project?
Strategy for engaging the
stakeholder
Transition-age
youth on the
autism
spectrum (18 -
26 years)
High High Relationships,
independence,
success as an adult,
decision-maker
Provide valuable
input as to what is
helpful, supportive,
and preferred.
Lack of trust limiting
willingness to
engage.
Incorporate in the design thinking
and development process and
demonstrate a willingness and
desire to hear their feedback.
Quarterly check-ins.
Parents /
Caregivers
High Medium Their children’s
success and
optimal level of
independence,
feelings supported
as parents and able
to live their own
lives as well.
Provide valuable
input from a parent’s
perspective as to
what would be
helpful to them in
their effort to
support their child
and give
observations of what
has worked for their
child.
Establishing
unrealistic
expectations of their
child and not
allowing their child
to have a voice about
what it is that they
want (i.e., a parent
knows best).
Additional focus groups in
different communities, expand
semi-structured interviews to
increase data, information, and
feedback meetings every 3-6
months
39
Stakeholder
Name
Impact
How much
does the
project
impact
them? (Low,
Medium,
High)
Influence
How much
influence do
they have
over the
project?
(Low,
Medium,
High)
What is
important to the
stakeholder?
How could the
stakeholder
contribute to the
project?
How could the
stakeholder block
the project?
Strategy for engaging the
stakeholder
Providers Medium High Providing services
and support that
benefit the
population that
they serve with
measurable
outcomes.
Implement evidence-
based practices that
have seen positive
results in working
with this population.
Provide outcomes
data to further
influence
policymakers and
funders.
Culture may hold
current practices in
place without
consideration of
change.
Having
informational/educational
meetings and training related to
the evolving needs of this
population throughout their
lifetime.
Funders Low Medium Does the mission of
the project align
with the funders?
Does it meet the
needs of the
intended
recipients,
efficiently provided
and outcomes data
available?
Provide financial
resources to fund the
project supporting
feasibility and
sustainment.
Decide that the
mission does not
align and not agree
to fund the project.
Provide a concise concept note
and a short version of the
proposal for their review. Engage
in conversation about the mission
and how it aligns and provide
indicators that would
demonstrate the alignment.
40
Stakeholder
Name
Impact
How much
does the
project
impact
them? (Low,
Medium,
High)
Influence
How much
influence do
they have
over the
project?
(Low,
Medium,
High)
What is
important to the
stakeholder?
How could the
stakeholder
contribute to the
project?
How could the
stakeholder block
the project?
Strategy for engaging the
stakeholder
Policy Makers
/ Influencers
Low High The extent to which
there will be a
positive impact on
the population at
large. If it will
serve the purpose
of enhancing their
reputation within
the community.
Create an
infrastructure within
the federal policies
that will serve and
protect this
population.
Lack of interest or
investment could
result in a continued
misperception about
this population.
Engage in community
forums/meetings, and special
education boards to facilitate
conversations regarding this age
group.
Employers Medium Low Making money and
sustaining a
profitable business.
Meeting the needs
of the customers.
Provide
opportunities for
competitive
employment to this
population.
Deny education
opportunities and re-
evaluate their
awareness of this
population’s skill
set/strength.
Seek out quarterly vendor
meetings to provide education and
answer questions. Going into the
community and talking to
employers, those responsible for
hiring, and recruiting employers
that have awareness to join the
effort.
41

Stakeholder
Name
Impact
How much
does the
project
impact
them? (Low,
Medium,
High)
Influence
How much
influence do
they have
over the
project?
(Low,
Medium,
High)
What is
important to the
stakeholder?
How could the
stakeholder
contribute to the
project?
How could the
stakeholder block
the project?
Strategy for engaging the
stakeholder
Advocacy
Groups
Medium Medium Gaining leverage
and impacting
policy makers and
providing
resources and
support to the
population,
caregivers,
providers, etc.
They could promote
the project online
and get the message
out through the
larger network that
they have
nationwide.
If they don’t see the
project as a priority
over other efforts,
they are currently
invested in could
delay engagement
and support.
Join local sectors of advocacy
groups. Invite them to be part of
the process.
Educators /
Academia
Low Low Social cause, grant
seeking, research,
and education.
Shared resources as
it relates to research
and large data sets.
Pilot programs of
similar missions may
be willing to partner.
If the missions do not
align, they may not
welcome an
opportunity to
partner, reducing the
potential for resource
sharing.
Engage educators that are
already doing research in the area
related to this population and
start the conversation.
Uniformed
Community
Medium Low Their happiness
and well-being.
Increase public
awareness and
inclusivity.
Preconceived biases
and a lack of
inclusiveness remain.
Make it worthwhile to engage in
open community forums (i.e.,
food).
42
Appendix B
Taking Flight Logic Model
The purpose of this project is to increase the availability and implementation of evidence-based/supported, strengths-based, and human-centered services to improve the
outcome of the autism population in the areas of post-secondary education, employment, mental health & social inclusion.
The project is innovative because it fills the documented gap in services (children to adult services) for individuals transitioning from the intensive structure of a therapeutic
boarding and educational environment on an outpatient basis, as a supported step-down and re-entry into the community.
INPUTS ACTIVITIES OUTCOMES
What we invest What we do Whom we reach
Short-term
results
Intermediate
results
Long-term results
Funding
Licensed Clinical
Social Workers
(Implementers).
Case Managers /
Vocational Coaches
(implementers).
Volunteers/Peer
mentors
(support/team
members)
Time
Research findings
Materials
Technology
Partners
Space
Survey TAY AS and caregivers
with a satisfaction survey, 8
Dimensions of Wellness and
associated services, and FACES IV
Manual guiding services.
Parent/Caregiver Support &
education.
Person-Centered Transition Plan
with quarterly reviews of progress/
need for revisions &/or referrals.
Peer Mentors to provide coaching &
social skills modeling.
Virtual access for TAY AS that are
not local to Connecticut once they
return to their home community.
Individual, group, and family
therapy.
Focus groups.
Follow up at designated intervals
post-transition.
Transition-age youth on
the autism spectrum
exiting a therapeutic
environment (15-20
individuals annually at the
CT location)
Family
members/caregivers
Devereux Foundation (18
states – potential
expansion).
Agencies and community-
based organizations
Other residential schools.
Decision-makers
Clinical professionals
Increased awareness
Identify biases &
challenge thinking.
Increase support.
Ongoing review of
stakeholder
feedback.
Decision-making to
move forward with
this innovation and
expansion beyond
the pilot to sister
locations of the
foundation (i.e.,
New York).
Determining the
scope of the project.
Change in attitudes &
beliefs.
Treatment outcomes
review (individual &
caregiver/parent) of
the pilot program at
the school.
Plan of action -
Broadening the
implementation of
the project
/scalability &
sustainability.
Ongoing review of
stakeholder feedback.

Transition-age youth gaining
independent & supported
living, experiencing social
inclusion, financial
stability/savings (impact from
intervention).
Upscaling from the pilot site
once outcomes are reviewed
(Foundation & other
community collaborators).
Policy initiatives/recognition of
benefits to the autism
population and society.
demonstrate cost savings in the
long term.
Ongoing review of stakeholder
feedback.
Interstate-Compact
Assumptions
Societal norms and beliefs about autism and the public and providers’ misconceptions.
External Factors
Culture/Community, finances, and demographics

43
Appendix C
Theory of Change

44

Appendix D
High Fidelity Prototype

High-Fidelity Prototype & Description
Laura Kohley, LCSW, MBA
University of Southern California
Suzanne Dworak-Peck School of Social Work
SOWK 725C: Preparatory Scholarship for Capstone
Ronald Manderscheid, PhD
May 2023

45

Table of Contents

Introduction Page 2 - 3
Step 1: Pre-Transition Page 3 - 7
Step 2: Transition Page 7 - 9
Step 3: Post- Transition Page 9 - 10
Staff Responsibilities Page 10 - 13
Example of Initial MAPs Page 13 - 15
Example of MAPs Review with Addition of Transition Plan Page 15 - 19
Plans for Sustainability and Expansion Page 20
Links to Required Forms Page 21
Links to Pilot Data Analysis Page 22
References Page 23

46

Introduction

Taking Flight is an innovative design utilizing social-relational evidence-based treatment
to meet the needs of the autistic population as they exit an intensive 24/7 supported environment.
There are 13 Grand Challenges for Social Work and Society (more information can be found on
this website: https://grandchallengesforsocialwork.org/). Taking Flight addresses the Grand
Challenge of Ensuring the Healthy Development of Youth. The prototype includes this manual
that defines the stages of implementation, staff responsibilities, guidelines for staff during
implementation, templates for each component, and follow-up rating scales for transition-age
Youth on the autism spectrum (TAY AS) and their parents/caregivers. Outcome data will inform
scalability and sustainability.
This high-fidelity prototype provides clear and replicable guidelines for implementation
within a residential setting and beyond. This program aims to create a realistic and attainable
Transition Plan related to the 8 Dimensions of Wellness (SAMHSA, 2016) focusing on
strengths-based and person-centered approaches. TAY AS will engage in Making Action Plans
(MAPs) that will incorporate a newly structured Transition Plan. They will have the opportunity
to explore the 8 Dimensions of Wellness before completing the Transition Plan. Students will be
encouraged to consider family dynamics and the importance of making connections with a
trusted support system. This will be measured by having TAY AS and their parents/caregivers
complete the Family Adaptability and Cohesion Evaluation Scale (FACES IV Survey) (Olsen et
al., 2004). Outcomes will be measured with quantifiable goals and objectives with defined time
frames. Follow-up will occur after leaving the program to measure the success and satisfaction of
both parents and TAY AS at predetermined intervals.

47

The length of the service is determined by the student’s current age and position in the
residential program and transfer of care needs. The initial surveys for family members and TAY
AS are part of the pre-transition steps. Optimally, 12 - 24 months would provide the initial data
required to demonstrate success.
Step 1: Pre-Transition
1. Define cohort comparisons: students leaving in 6 months or less, students leaving in 12
months, or students leaving in more than 12 months. The cohorts will be made up of
students ranging in age from 18 - 22 years of age. These individuals are on the autism
spectrum and may also have comorbid disorders.
2. Review the manual for Taking Flight. Directors, social workers, special education
teachers, case managers, and direct care staff read the manual. All staff are given the
opportunity to ask questions or provide feedback about the content. Hyperlinks for forms
and surveys are embedded within the manual as well as listed on the Links to Required
Forms page followed by Links to Pilot Data Analysis.
3. Fact Sheets providing guidance and directions to introducing the 8 Dimensions of
Wellness, directions to introducing Services Relevant to the 8 Dimensions of Wellness ,
and directions to introducing the FACES IV Survey are available for the
staff/teacher/social worker prior to introducing the surveys to students.
4. Complete/attend weekly staff meetings with Taking Flight as a standing agenda item.
Provide on-going staff training during this meeting. Weekly staff meetings are facilitated
by the Program Director and Clinical Director. A sub-agenda item to Taking Flight is a
questions and answers period. Document meeting minutes to capture staff feedback,

48

perspectives, and understanding.
5. Social worker(s):
a. Establish a means of distributing surveys to identified audiences (i.e.,
parents/caregivers). Online platforms can include but are not limited to Survey
Monkey or Google Forms depending on available resources within the program.
b. Create hyperlinks to be added to the email template to be sent to parents.
c. To note, it may be required to send out reminder emails to engage
parents/caregivers to encourage completion. Reforward original email with links
and/or call parents/caregivers to offer support if they are facing challenges.
d. Establish a means of data analysis.
6. Parents/Caregivers are asked to complete the Family Adaptability and Cohesion
Evaluation Scale (FACES IV) FACES IV Survey (Olson, 2019; Olson, et al, 2004) &
Family Satisfaction Survey to establish baseline data.
a. The purpose of completing these surveys is explained in the email template and
provides additional resources for caregivers to learn more. The Licensed Social
Worker(s), Clinical Director and Program Director utilize the email template (if
not in person) to instruct parents/caregivers how to access the online surveys.
b. The Family Satisfaction Survey gathers the voices of the caregivers as it relates to
their experiences with services and providers or lack of over the last 2 (+) years.
c. The FACES IV Survey will provide a better understanding of the similarities
and/or differences in how family members perceive relationships and dynamics.
Information from FACES IV Survey results informs the treatment team to support
the student as they identify areas for growth and wellness within the family

49

system (if applicable).
7. Students complete the FACES IV Survey, The Personal-Assessment 8 Dimensions of
Wellness and the Services Relevant to the 8 Dimensions of Wellness Survey.
Week 1
o Students complete the FACES IV Survey in a classroom environment with a
special education teacher and/or social worker to support and answer any
questions they may have. Instructions will be read aloud to students in the room.
o The students will be told that their caregivers will also receive the questionnaire
and be asked to complete it.
o Students can share their own answers if they choose to or can be kept confidential
as part of their health record if they are their own guardian or share decision
making with their caregiver.
o Students will have at least 60 minutes each day to complete the survey (answering
20-22 of the 66 questions). If more time is needed or additional accommodations
are needed, they will be provided on an individual basis.
Week 2
o Students complete the Personal Assessment 8 Dimensions of Wellness and the
Services Relevant to the 8 Dimensions of Wellness Survey in a classroom
environment with a special education teacher and/or social worker.
▪ Introduced with a clear explanation of its purpose and what the students
gain from participating. The special educator and/or social worker
explains that the survey is meant to focus on the student as an individual.

50

It will provide students with concrete information and definitions of the 8
Dimensions of Wellness. Encourage students to consider all aspects of
their lives that they may not necessarily think of independently. Each of
these dimensions is something that could be beneficial to focus on.
▪ Results from these surveys assist in collaboratively developing the
Transition Plan to replace a prescriptive model of treatment (i.e., provider
focused treatment goals related to observed areas for growth).
o The special education teacher and/or social worker explains that their answers
will become a part of the quarterly Making Action Plans (MAPs) meeting as it
will enhance future planning and ensure that it is in the individuals’ words.
8. The Clinical Director and Program Director create/edit a calendar for MAPs meetings
adding new students as needed. An example of a MAPs meeting is provided after all the
steps are described. The calendar is distributed to case managers, special educators, staff
& social workers for coordination and attendance.
The MAPs process is a meeting that includes the student, Clinical Director and/or
Program Director, Social Worker, Case Manager, and anyone that the student would like to be
part of the meeting (i.e., trusted adult, peer mentor, and/or parent/caregiver). The MAPs meeting
collects information from the chosen team members and the student defines who they are, who
they consider to be part of their circle, their likes, and dislikes. The MAPs gather information
about the students’ self-identified strengths, challenges, dreams, and fears. The student speaks
about where they see themselves in one month, six months, one year and five years. The student
is supported and asked to create action steps to work towards their goals while in the program

51

and to identify who they want to support them. This is reviewed quarterly to determine progress,
barriers, revisions, and next steps.
Initial piloting data for each of the surveys listed in the table of contents is provided at the
end of the manual for review.
Step 2: Transition
1. The data collected from the FACES IV Survey provides insight into family dynamics and
potential areas for support. This potentially leads to the development of family support
groups and educational seminars to better understand their neurodiverse child. All
educational seminars will be created and approved by the Clinical Director and Program
Director. If appropriate, outside providers with unique expertise can facilitate these
seminars.
2. Combine the quarterly MAPs process with the self-identified areas within the 8
Dimensions of Wellness as a need and/or want to develop the Transition Plan . Also,
incorporate family as a component of care currently and after if chosen.
a. If there is a delay of more than 2 weeks after the student completes the surveys,
an additional MAPs meeting must be added to the calendar to incorporate the
Transition Plan; from then on adherence to the MAPs schedule already developed
will continue.
3. Once the MAPs meetings are completed to incorporate the Transition Plan with
measurable goals and objectives, tasks are assigned to students, case manager(s), social
worker(s), and or director(s) to partner with the student to meet the identified objectives.
4. The social worker creates a physical or electronic binder to follow progress with a clearly

52

defined table of contents.
5. Students meet with their case manager every other week (or predetermined frequency
depending on the student's needs) for up to 60 minutes to work on all aspects of their
short-term action steps and steps related to their Transition Plan. This will also potentially
happen in the moment when an opportunity arises during the course of any given day
with direct care staff, case managers, clinicians and/or teachers.
6. Students meet with their assigned social worker for at least 60 minutes weekly for
individual therapy and support to work on their self-defined goals.
7. Parents/Caregivers receive bi-weekly updates by phone and/or email from the social
worker regarding their student(s)’ progress. The extent of detail provided will be
determined by guardianship status and student preference.
8. Parents/Caregivers are offered 60 minutes per month for parent coaching, education and
support provided by the Clinical Director and/or Social Worker.
9. Family Therapy is provided upon request by students & parent/caregiver. This can be
completed by the assigned social worker, but if a conflict is noted they can be referred to
an independent contractor or family identified provider.
10. Quarterly MAPs review meetings are completed to produce a Transition Plan Progress
Report.
Piloting Data Notation
During the piloting of a MAPs meeting review and incorporation of the Transition Plan,
it was noted that the student didn’t clearly understand some of their choices on the Services
Relevant to the 8 Dimensions of Wellness survey. This created a need to add an additional task

53

of reviewing this tool after each MAPs meeting to either further define, add, or clarify services.
For example, the service “peer mentoring” was chosen. The student thought it meant they wanted
to volunteer time to mentor younger children.
Step 3: Post-transition
1. Students complete the FACES IV Survey & the Personal-Assessment: 8 Dimensions of
Wellness Survey upon discharge.
2. Parents/caregivers complete the FACES IV Survey & Family Satisfaction Survey.
3. Social worker(s) document coordination and transfer of care to the students’ home
communities upon discharge.
4. Social worker(s) provide telehealth support and check-ins to each cohort and their
caregivers once they have exited the program. Note, this may mean getting involved in
the pursuit of the interstate licensure compact (currently pending in Utah, Missouri,
Kentucky & South Carolina).
a. These will initially be provided every other week for 30-minute sessions (can be
extended as needed) for the first 2 months or until a complete transfer of care
related to hometown community support has been done. This is provided at no
additional cost to the student/family. If a Connecticut resident, Telehealth can
continue for up to 6 months if the National Provider Identification number has
been established and services are reimbursable through insurance.
b. Until an interstate compact has been established, those residing outside of
Connecticut will receive the same first 2 months of support as defined in the
previous bullet at no additional cost. If there is a need for continued Telehealth

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appointments, support will be extended without additional cost until an
appropriate transfer of care is complete (i.e., waiting lists for the appropriately
trained provider). This is reviewed through the budgetary process to determine
sustainability by the Devereux Foundation.
5. Social Worker(s) follow up in 6 months, 12 months, 2 years, and 5 years to complete
Post-Transition Satisfaction Surveys for parents/caregivers and graduates.
6. Social Worker(s) review outcomes survey data received from students and
parents/caregivers and compile reports to be shared with all stakeholders (Devereux
Foundation representatives, transition age youth, parents/caregivers, staff and any
community collaborators).
7. Social Worker(s) review the pre and post data from the FACES IV Surveys, Family
Satisfaction Survey and the Personal-Assessment 8 Dimensions of Wellness Survey to be
presented to stakeholders.
8. A budget is developed annually with monthly operations review and degree of meeting
targeted budgetary goals.
9. A stakeholder meeting is held with the Board of Directors (Devereux Foundation
Representative), providers, the Taking Flight team, community collaborators, family
members and transition age youth on an annual basis to review benefits and determine
sustainability.

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Responsibilities
Case Manager(s):
o Participate in the Taking Flight Training and weekly staff meetings.
o Attend supervision with the Director bi-weekly.
o Meet with students every other week to review progress on MAPs action steps
and Transition Plan (including efforts toward post-transition needs such as
research in the student’s area for identified wellness supports).
o Send a brief email summary to the Clinical Director, Program Director, special
educators, social workers, and parents/caregivers (if needed/wanted) after each
meeting.
o Help students manage, organize and act on any incoming mail as necessary.
o Assist students in keeping important documents organized and filed appropriately.
o Job coaching, job development, money management and budgeting skills training.
o Communicate any important updates or concerns to the student’s social worker.
o Participate in the student’s quarterly MAPs & Transition Plan review meetings.
o Document progress, need for revisions, and/or barriers.
Social Worker(s):
o Participate in the Taking Flight Training and weekly staff meetings.
o Attend supervision with the Director bi-weekly.
o Provide the identified services per the students MAPs and Transition Plan (i.e.,
Psychotherapy, Social Skills Groups, Sibling Support, and Family Resources (i.e.,
parent seminars, parent coaching, parent support groups). If services are requested

56

beyond the social worker(s) expertise then in consultation with the Program &
Clinical Director an independent contractor(s) would be sourced, contacted for
interest, and collaboration.
o Complete any revisions needed to the current Services Relevant to the 8
Dimensions of Wellness Survey.
o Interface with community providers within the students’ home community to start
to identify potential supports and services that the Student is interested in
accessing once at home, in college or employed and living independently (transfer
of care).
o Provide Family Therapy as appropriate and requested by students or engage
independent contractors or Student/Family identified providers for additional
hours to separate individual and family therapy.
o Attend MAPs meetings and generate a Progress Report in collaboration with Case
Managers and input from the Program and Clinical Director(s).
o Maintain a physical binder (or electronic record of all MAPs meetings, signed
Transition Plans and Progress Reports).
o Collaborate with Case Managers in their effort to work on short and long-term
goals and objectives.
o Post-transition, social worker(s) provide Telehealth check-ins with students and
parents/caregivers as requested or at least at the interval of review related to
outcomes listed below.
o Provide Post-Transition Satisfaction Surveys to parents/caregivers
and graduates. Follow-up if no response. Compare data over time (6

57

months, 12 months, 2 years, and 5 years).
Administration: (Clinical Director(s) & Program Director)
o Identify Nutritional Therapy support (local and in student
communities) and work to establish a partnership or independent
contractor agreement if approved through the budget process.
o Research housing, financial, and budgeting resources within the
students’ hometown communities.
o Establish relationships with neighboring transition programs to
collaborate on best practices.
o Review data collection and outcomes to continue to enhance best
practices.
o Initiate peer mentoring by reaching out to alumni or community
groups that have established peer mentors to invite them to partner
with this program to provide additional support/modeling to the
students as they prepare to integrate into their hometown
communities.
o Provide supervision and support to social workers and case
managers bi-weekly in addition to the weekly staff meeting.
o Create and present projected budgetary needs to the Devereux
Foundation for approval.
o Facilitate annual Stakeholder meetings.

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Example MAPs & MAPS with added Transition Plan
To illustrate the Taking Flight program, here is an example of an initial MAPs meeting
without the Transition Plan. Then there is an example of a MAPs review with the creation of the
Transition Plan. A blank template of the Transition Plan can be found in the Links Section.
The week prior to the scheduled MAPs review, the student completed the Services
Relevant to the 8 Dimensions of Wellness Survey.
MAPS
Student: XXXXX XXXXX MAPs Facilitator: Staff Member
Date of MAPs Meeting: 12/28/22
Who Am I? Who’s in My
Circle?
Likes Dislikes
Person who has goals
Reserved but
outgoing.
Being able to take care
of himself.
Good sense of humor
Has a wide range of
interests?
Animals generally
Reasonable
Mom
Brother
Staff

Animals
Pop culture
Hanging out solo
or with others

People not doing
chores.
Doesn’t like it
when people are
mean.
Math

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Strengths Challenges Dreams Fears
Empathetic
Flexible
Understanding
Good with dogs
Sense of humor
Willing to try / do things
Slow to trust new
people.
Math
Can be distracted
Live
independently

Deep water
Clowns

Where I see myself…
In one month In six months In one years In five years…
Internship

Starting an online
course
Still at internship

Working toward
getting your own
place
Maintain
Internship or get
a part time job.
Educated
Canines Assisting
with Disabilities
(ECAD)

Completed
undergrad.
Obtaining a job
Own apartment

My Goals/Action Steps
Will pay for phone bill.
example includes save money, budget for bills, transfer the phone bill from parents.
Exercise at the YMCA 3 to 5 times per week
Apply to college & register for a college course.

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MAPs Review Meeting
Student: Student
Date: 3/23/23
Individuals in Attendance: Student, Clinical Directors, Case Manager, & Social Worker

Summary
The student and his team reviewed results from their last MAPs and progress made on
action steps. The team also reviewed the results with the student his assessment of the 8
Dimensions of Wellness and corresponding information regarding areas he felt he needed more
support and/or opportunity for growth.
The team discussed Student’s goals around fitness. The student indicated that he was
only going to the YMCA once every other week now and that he was finding himself too tired to
go more regularly. The team agreed that his existing goal of three times per week may have
been a difficult place to start for Student and he agreed to begin going consistently once a week
as well as taking a walk from Glenridge once a week and building from there.
The team next discussed Student’s thoughts regarding college and Student indicated he
was still looking forward to auditing a class this summer. The Clinical Director will assist the
student in setting this up.
One of Student’s highest rated areas of need within the 8 Dimensions of Wellness was
Physical Wellness as it relates to better nutrition. This student will be working on becoming
more comfortable preparing meals on his own while also practicing how to make meals more
balanced nutritionally.

61

The team discussed that while Student was largely doing well at his internships, his time
management and use of his cell phone still required further attention, however all parties agreed
that Student’s plan should, and will, include a move to a more independent internship once he
showed more consistency in these areas. This student would like to work with animals.
Another area of concern Student indicated revolved around money management, and it
was agreed that Student should be developing and using his own budget.
In the social realm of wellness, Student indicated that he has enjoyed peer mentoring
(being a mentor for younger children) in the past and was also looking forward to starting a
Dungeons & Dragons group.
Short-term New or Revised Action Steps
1. This student will go to the YMCA at least once per week in addition to taking at least one
walk from Glenridge.
2. The Case Manager and student will look at summer class offerings at Northwestern and
choose his class.
3. This student will practice, and become comfortable with, preparing three meals on his
own.
4. This student will work with his team to plan for more nutritious meals and snacks.
5. This student will start to use the self-report form at his internship and share regularly with
his Case Manager.
6. This student will create a budget with the Case Manager.
7. The Clinical Director will investigate opportunities to volunteer with youth.
8. The Case Manager will assist this student in getting his Dungeons & Dragons group
started.

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Taking Flight Transition Plan
Goal #1: This student will develop the skills and knowledge necessary to live independently
upon returning home as evidenced by a mastery of objectives.
Objective 1: With moderate support from the case manager and/or social worker, this
student will have a conversation with parents to discuss preferred housing options by 4/30/2023.
Objective 2: Upon completion of objective 1, with moderate support from the case
manager, local listings of apartments in that area and possible roommate listings will be
reviewed to determine housing cost over the course of the next 6-8 months.
Objective 3: With moderate case manager support, this student will identify budgeting
and money management support services within the hometown once objective 2 is complete. If
there is a waitlist, apply for service to be added to the list.

Goal #2: This student will complete the necessary research to determine an appropriate course
of post-secondary study and education.
Objective 1: Once the preferred housing area is determined, with moderate case manager
support colleges within that area which are accessible by public transportation will be identified
over the course of the next 6 months.
Objective 2: Once 2-3 schools are identified, with moderate case manager support, this
student will review the application process, consider cost of courses, and resources/finances
needed (parent support or financial aid).
Objective 3: With moderate case manager support, this student will complete
applications to be submitted at the appropriate time.

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Goal #3: This student will complete the steps necessary to find and obtain independent
employment upon returning home.
Objective 1: With moderate case manager support, Student will look in his hometown to
find employment opportunities that fall within his areas of interest. The Case Manager will
assist this student in determining job availability and monitor over time as discharge approaches
to submit resumes and applications within a time frame to be determined during the next
quarterly review.

I have been given the opportunity to participate in the development of goals and objectives.

Name Relationship Signature Date
Individual _________________________ __________

Team Member _________________________ __________

Team Member _________________________ __________

Social worker ________________________ __________

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Plans for Sustainability and Expansion
As piloting continues, the goal is to demonstrate proof of concept. If this remains on
target, additional planning with the Clinical Director, Program Director, and Devereux
Foundation will occur to look at the feasibility of expanding Taking Flight to other programs
(i.e., short-term residential settings) within the foundation and across states. If the program
proves profitable and demonstrates successful outcomes for the individuals served, buy-in will
be more likely to support marketing and provide training at other potential locations and in
different communities. For example, presenting to school districts, other therapeutic boarding
schools, and short-term transition programs to see if there is interest in implementing this
program within their setting(s) or establishing some type of partnership and/or shared resources.
If there is, the manual for Taking Flight could be sold as a package with a predetermined number
of hours of training to ensure fidelity.

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Links to Required Forms (Forms are also on the pages that follow this page)

Binder Table of Contents Template
Email Template to Parents/Caregivers
directions to introducing the FACES IV Survey
FACES IV
Family Satisfaction Survey
directions to introducing the 8 Dimensions of Wellness
Personal-Assessment 8 Dimensions of Wellness
directions to introducing Services Relevant to the 8 Dimensions of Wellness
Services Relevant to the 8 Dimensions of Wellness Survey
MAPs Template
Transition Plan Template
Transition Plan Progress Report Template
Post-Transition Satisfaction Survey: Parent/Caregiver
Post-Transition Satisfaction Survey: Graduate

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Table of Contents

Cohort:___________
(Cohort 1 (exiting 3-6 months), Cohort 2 (exiting 6-12 months), Cohort 3 (exiting 12 months +)
Initial MAPs Page
Maps with Transition Plan Page
Progress Report Quarter 1 Page
Progress Report Quarter 2 Page
Progress Report Quarter 3 Page
Progress Report Quarter 4 Page

67

Email Template to Parents/Caregivers

Good Afternoon,

You are receiving this email because your student/transition-age youth (18-26) is at
different phases of preparing for the next steps in their lives after high school. There is a
considerable gap in services and support for this population as they apply for and enter
college, employment, and independent living which can negatively impact lifelong
outcomes.

There are 13 Grand Challenges of Social Work, and these surveys will help to inform
the process and content of creating the Taking Flight Transition Plan for your adult child.
This program enhancement is an effort to address the Grand Challenge of Social Work,
Ensuring the Healthy Development of Youth. If you are interested in learning more
about the Grand Challenges of Social Work, please click on this link
https://grandchallengesforsocialwork.org/

https://usc.qualtrics.com/jfe/form/SV_41InNcSnHwdfjyC - Family Satisfaction Survey

https://usc.qualtrics.com/jfe/form/SV_3WrUr6q0TJEXzJc - FACES IV Survey

Your answers are valuable to identify needed individualized support for your transition-
age youth and their support system/caregivers.

Your student/transition-age youth will also be completing the FACES IV survey. If you
are comfortable sharing your results with them, please indicate on the survey when
prompted. Your student/transition-age youth will be asked if they would like to share
their answers and if you would like to see them. Please indicate your interest by
responding to this email.

I appreciate your time and please reach out with any questions.

Best Regards,

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Fact Sheet: Training and directions to introducing the FACES IV Survey

1. Understanding the FACES IV Survey. FACES IV is one of the latest versions of a family
self-report measurement tool designed to assess family cohesion and family flexibility
(Olson, 2019). Students, caregivers, and siblings can complete this survey to get a better
understanding of how each member perceives their relationships.
2. The survey has 62 statements and might be challenging to complete in 1 sitting
depending on the individual's stamina and ability to maintain attention for an extended
period. With that consideration, please ask the students to respond to 20 - 22
statements per class. This will mean the survey will be completed over the course of 3
days. This survey should not be given on the same day as the 8 Dimensions of Wellness
and Related Services.
3. Explain to the student that their caregivers and/or siblings will also be given the
opportunity to complete the survey.
4. If students, ask to see their caregivers’ results permission will need to be given by the
caregiver to do so. This will be explained in the email to caregivers requesting
completion.
5. Students should be asked if they are comfortable sharing their answers with their
caregivers. If a student says no, then it will be explained to the caregiver (that they
would prefer not to share). This will also be explained in the email to caregivers
requesting completion.

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Name Date

FACES IV: Questionnaire
Directions to Family Members
All family members over the age of 12 can complete FACES IV.
Family members should complete the instrument independently, not consulting or discussing their
responses until they have been completed.
Circle the corresponding number as it relates to the scales defined below.

Using the 5-point Likert scale provided below, please indicate the degree to which you agree
or disagree with each statement about yourself.
1 2 3 4 5
Strongly
Disagree
Generally,
Disagree
Undecided Generally,
Agree
Strongly
Agree
Items Rating
1. Family members are involved in each other’s lives. 1 2 3 4 5
2. Our family tries new ways of dealing with problems. 1 2 3 4 5
3. We get along better with people outside our family than inside. 1 2 3 4 5
4. We spend too much time together. 1 2 3 4 5
5. There are strict consequences for breaking the rules in our
family.
1 2 3 4 5
6. We never seem to get organized in our family. 1 2 3 4 5
7. Family members feel very close to each other. 1 2 3 4 5
8. Parents equally share leadership in our family. 1 2 3 4 5
9. Family members seem to avoid contact with each other when at
home.
1 2 3 4 5
10. Family members feel pressured to spend most free time
together.
1 2 3 4 5
11. There are clear consequences when a family member does
something wrong.
1 2 3 4 5
12. It is hard to know who the leader is in our family. 1 2 3 4 5
13. Family members are supportive of each other during difficult
times.
1 2 3 4 5
14. Discipline is fair in our family. 1 2 3 4 5
15. Family members know very little about the friends of other
family members.
1 2 3 4 5
16. Family members are too dependent on each other. 1 2 3 4 5
17. Our family has a rule for almost every possible situation. 1 2 3 4 5
18. Things do not get done in our family. 1 2 3 4 5
19. Family members consult other family members on important
decisions
1 2 3 4 5

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Items Rating
19. My family is able to adjust to change when necessary. 1 2 3 4 5
20. Family members are on their own when there is a problem to be
solved.
1 2 3 4 5
21. Family members have little need for friends outside the family. 1 2 3 4 5
22. Our family is highly organized. 1 2 3 4 5
23. It is unclear who is responsible for things (chores, activities in
our family.
1 2 3 4 5
24. Family members like to spend some of their free time with each
other.

25. We shift household responsibilities from person to person. 1 2 3 4 5
26. Our family seldom does things together. 1 2 3 4 5
27. We feel too connected to each other 1 2 3 4 5
28. Our family becomes frustrated when there is a change in plan or
directions.
1 2 3 4 5
29. There is no leadership in our family. 1 2 3 4 5
30. Although family members have individual interests, they will
participate in family activities.
1 2 3 4 5
31. We have clear rules and roles in our family. 1 2 3 4 5
32. Family members depend on each other. 1 2 3 4 5
33. We resent family members doing things outside the family. 1 2 3 4 5
34. It is important to follow the rules in our family. 1 2 3 4 5
35. Our family has a hard time keeping track of who does various
household tasks.
1 2 3 4 5
36. Our family has a good balance of separateness and closeness. 1 2 3 4 5
37. When family problems arise, we compromise. 1 2 3 4 5
38. Family members mainly operate independently. 1 2 3 4 5
39. Family members feel guilty if they want to spend time away
from the family.
1 2 3 4 5
40. Once a decision is made, it is difficult to modify the decision. 1 2 3 4 5
41. Our family feels hectic and disorganized. 1 2 3 4 5
42. Family members are satisfied with how they communicate with
each other.
1 2 3 4 5
43. Family members are good listeners. 1 2 3 4 5
44. Family members express affection to each other. 1 2 3 4 5
45. Family members are able to ask each other for what they want 1 2 3 4 5
46. Family members can calmly discuss problems with each other. 1 2 3 4 5
47. Family members discuss their ideas and beliefs with each other. 1 2 3 4 5
48. When family members ask questions of each other, they get
honest answers.
1 2 3 4 5
49. Family members try to understand each other’s feelings. 1 2 3 4 5
50. When angry, family members seldom say negative things about
each other.
1 2 3 4 5

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1 2 3 4 5
Strongly
Disagree
Generally,
Disagree
Undecided Generally,
Agree
Strongly
Agree

Items Rating
51. Family members express their true feelings to each other. 1 2 3 4 5
52. Family members express their true feelings to each other. 1 2 3 4 5
Items Rating
53. The degree of closeness between family members. 1 2 3 4 5
54. Your family’s ability to cope with stress. 1 2 3 4 5
55. Your family’s ability to cope with stress. 1 2 3 4 5
56. Your family’s ability to share positive experiences. 1 2 3 4 5
57. The quality of communication between family members. 1 2 3 4 5
58. Your family’s ability to solve conflicts. 1 2 3 4 5
59. The amount of time you spend together as a family. 1 2 3 4 5
60. The way problems are discussed. 1 2 3 4 5
61. The fairness of criticism in your family. 1 2 3 4 5
62. Family member’s concern for each other. 1 2 3 4 5
Thank you for Your Cooperation!

72

Family Satisfaction Survey
Please take a few moments to complete this satisfaction survey. Results will be used to
aid Taking Flight Devereux Behavioral Health to continue improving specialized autism
services for individuals with ASDs and their families.

Please check the specialized autism spectrum disorder (ASD) services you used
within the last 2 years that have been helpful.

Assessment

Nutrition Therapy

Autism Training

Occupational Therapy (OT)

ABA Consultation & Treatment

OT: Social Skills Motor Group

Registered Behavior Technician

Parent Training

Community Inclusion

Respite

Cognitive Behavior Therapy

Social Skills Groups

Dialectical Behavior Therapy

Curriculum-based Social Skills

Psychotherapy

Speech- Language Pathology (SLP)

Pre-employment Services

SLP: Social Skills

Prevocational Services

Speech Implementer

Intensive Follow-along

Augmentative-Alternative
Communication Assessment

Career Planning

Therapeutic Camp

Job Development

Transition Planning

Supported Employment

Telehealth

Family Resource Services

Other: (specify)

Independent Living Skills

Music Therapy

Please Circle Yes or No for Questions 2-5:
Were you able to choose from a variety of specialized ASD services? Yes No

Were you able to choose who provided the specialized ASD services? Yes No

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Were the specialized ASD services that were available the services you needed? Yes No

Were you satisfied with the quality of specialized ASD services you received? Yes No

County of Residence:

Age of individual with ASD:
8. Please check the services you currently need that you do not have access to?

Assessment

Couples/Family Therapy

Community Inclusion

Parent Training

Cognitive Behavior Therapy

Personal Care Assistance

Dialectical Behavior Therapy

Peer Mentoring

Psychotherapy

Social Skills Groups

Pre-employment Services

Post-secondary Education Support

Prevocational Services

Sibling Support

Intensive Follow-along

Service Coordination

Career Planning

Transition Planning

Job Development

Telehealth

Supported Employment

Curriculum-based Social Skills

Family Resource Services

Other: (specify)

Independent Living Skills

9. Do you, caregiver(s), have a support system? Yes No

10. Would you like support and education related to caring for and/or maintaining
a positive relationship with your adult child? Yes No

Additional Comments:

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Optional Questions:

Do you want to be contacted for more information and/or your input/experience(s)?

If you would like to be contacted, please provide contact information:
Name:

Address:

City, State & Zip Code:

Telephone Number:

Email Address:

75

Fact Sheet: Training and directions to introducing the 8 Dimensions of
Wellness

1. Understanding the 8 Dimensions of Wellness. This was adapted by the Substance Abuse
and Mental Health Services Administration (SAMHSA) to promote wellness. This is also
very applicable to students that are on the autism spectrum (with or without comorbid
disorders) as they are faced with the challenges of adulthood. Staff/Special
Educators/Clinicians will support individuals to consider the 8 Dimensions of Wellness
defined here.
2. What are they:
a. Emotional Wellness - Considering the individual’s ability to cope effectively with
life and create/maintain satisfying relationships.
b. Financial Wellness - Considering the individual’s ability, understanding, and
satisfaction with their current and future financial situations.
c. Social Wellness - Considering the individual’s ability to develop a sense of
connection, and belonging, and if they have a well-developed support system.
Looking at what might improve this and ensure the individual’s safety within the
community.
d. Spiritual Wellness - Considering the individual’s ability and interest in expanding
their sense of purpose and meaning and whether they know where to go if they
do have an interest. (i.e., Is there an interest in being part of a religious
community or attending religious services? etc.).
e. Occupational Wellness - Considering the individual’s satisfaction with their
employment or challenges faced when attempting to gain employment.
f. Physical Wellness - Considering the individual’s interest and understanding of
healthy physical activity, diet, sleep, and nutrition. This can include thoughts
about body image and health risks.
g. Intellectual Wellness - Considering the individual’s awareness of their own
creative abilities and finding ways to utilize and expand those areas of
knowledge and skills.
h. Environmental Wellness - Considering the individual’s surroundings and
environment as to whether it supports well-being and their interest in being
involved in creating an environment that promotes health.

3. Staff will explain this to students: It is important to introduce the 8 Dimensions of
Wellness to help them define all the contributing factors to their success and happiness
as they enter adulthood. Defining each, as described above, prior to completing the
survey and allowing for questions is the next step.
4. Staff will explain to the students that this will help to enhance their future planning and
make actionable steps towards their personal goals. Staff will support them as they
think about aspects of their lives that they might not have considered prior to learning
more about the different dimensions of wellness.

76

5. Staff will explain to the students that this will be incorporated into their initial Making
Action Plans (MAPs) and/or MAPs Review.
6. Further explaining to the students that they will be working with their team regularly
and at least semi-annually with the full team to determine quantifiable progress, the
need for revisions, and/or continued work on the active plan.

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The 8 Dimensions of
Wellness

78

Personal Assessment: 8 Dimensions of Wellness
Directions: Review each statement and put a check mark in the box of how often you feel that statement applies to you.

Emotional
Rarely,
if ever
Some-
times
Most of
the time
Always
I can recognize my feelings and express them in a non-
confrontational way.

I can express all ranges of feelings (i.e., hurt, sadness, fear,
anger, joy, etc.) and manage emotion-related behaviors in a
healthy way.

I accept responsibility for my own actions.

I find healthy ways to cope with stress (e.g., exercise,
meditation, social support, self-care activities, etc.)

I feel good about myself and believe others like me for who I am.

I am flexible and able to adapt/adjust to life’s changes in a positive
way.

I can ask for assistance when I need it, either from friends and family,
or professionals.

I maintain a balance of work, friends, family, school, and other
obligations.

I do not let my emotions get the better of me. I think before I act.

I have a healthy relationship with social media.

Emotional Wellness is important to me.

I enjoyed thinking about this and planning for my future needs.

Spiritual
Rarely,
if ever
Some-
times
Most of
the time
Always
I take time to think about what is important in life – who I
am, what I value, where I find meaning, where I’m going.

I make time for relaxation during the day.

I feel and practice gratitude for good things in life.

79

I can name my own personal values and describe my beliefs about
life.

My values guide my decisions and actions.

I am tolerant and accepting of the view of others.

I am active in communities or causes I care about.

I have a strong sense of hope and optimism in my life.

Spiritual Wellness is important to me.

I enjoyed thinking about this and planning for my future needs.

Physical
Rarely,
if ever
Some-
times
Most of
the time
Always
I get 7-9 hours of sleep each night and feel rested in the morning.

I exercise or am physically active regularly in ways that work for my
body.

I stay hydrated and drink water throughout the day.

I seek advice from health care professionals if I have a
health concern I cannot solve on my own.

I do not engage in harmful use of drugs (over the counter,
prescription and illicit).

I abstain from drinking alcohol or drink responsibly and
moderately if I do choose to drink.

I protect my skin from sun damage by using sunscreen with SPF 30+,
wearing hats and/or avoiding tanning booths and sun lamps.

I maintain healthy eating patterns that include fruits and vegetables.

I protect myself from STIs and unplanned pregnancy by
abstaining from sexual behaviors or using proper
protection.

I practice body positivity, thinking positive thoughts about my body
and self-image

Physical Wellness is important to me.

80

I enjoyed thinking about this and planning for my future needs.

Social
Rarely, if
ever
Some-
times
Most of
the time
Always
I participate in social activities and enjoy being with people who are
different from me.

I strive to maintain a network of supportive friends, family and
social contacts.

I am accepting of diverse identities of others (race, ethnicity,
religion, gender, ability, sexual orientation, etc.)

I can set, communicate and enforce boundaries.

I have someone I can talk to about my feelings and struggles.

I plan time with my family and friends.

I contribute equally in my relationships.

I am a compassionate person who tries to help others and see good
in them.

I work to create balance and peace within my interpersonal
relationships, community and the world.

I choose partners/friends who respect my values, needs, and
choices.

Social Wellness is important to me.

I enjoyed thinking about this and planning for my future needs.

Financial
Rarely,
if ever
Some-
times
Most of
the time
Always
I am able to set and stick to a budget each month, so I don’t run out
of money.

I know my total amount of debt and interest rates.

I pay my credit cards, tuition/fees, and other bills on time.

81

I know about the different sources of financial aid that I am
eligible for and apply when I am able.

I save in accordance with my needs and life goals.

I keep my financial information safe by using secure passwords,
PINs, and dual authentication.

I feel good about my current and future financial situation.

I check my bank statements/accounts each month.

I ask for help from resources or professionals about my financial
situation and/or financial aid.

Financial wellness is important to me.
I enjoyed thinking about this and planning for my future needs.

Occupational
Rarely, if
ever
Some-
times
Most
of the
time
Always
I can balance work, play, school and other aspects of my life.

I take advantage of opportunities to learn new skills that can
enhance my future employment opportunities.

I know what skills are necessary for the occupations I am interested
in.

I strive to develop good work habits (dependability, initiative, etc.).

I work effectively with others.

I have confidence in my job search skills (resume writing,
interviewing, cover letters, networking, etc.).

I have explored different career options.

I manage my time effectively.

I have participated in internships or volunteer work.

Occupational Wellness is important to me.

I enjoyed thinking about this and planning for my future needs.

82

Intellectual
Rarely, if
ever
Some-
times
Most of
the time
Always
I am eager to learn.

I feel fulfilled in my academic program.

I seek personal growth by learning new skills.

I look for ways to use my creative, cognitive, and critical thinking
skills.

I am open to new ideas.

I learn about different topics that interest me from books,
magazines, newspapers, and the internet.

I stay informed about social, political, and other current issues.

I critically consider the source of information I am consuming and if
it is reliable.

I know about available campus resources to help me study.

I am comfortable reaching out to my professor/TA for help or
attending office hours.

Intellectual Wellness is important to me.
I enjoyed thinking about this and planning for my future needs.

Environmental
Rarely, if
ever
Some-
times
Most of
the time
Always
I spend time outdoors enjoying nature.

I reduce, reuse and recycle products.

I try to lessen my environmental impact.

I walk, bike, use public transportation or carpool when possible.

I am concerned about impacts on my local, national and world
climate.

I have a safe space to call my own.

I feel comfortable in the space I occupy.

I feel content in my environments (class, home, work, etc.).

I participate in events that help my community (food drives,
fundraisers, etc.).

83

I contribute to making my community a safer and healthier place.

Environmental Wellness is important to me.

I enjoyed thinking about this and planning for my future needs.

84

Personal Wellness Reflection

Which dimensions are you doing your best in and/or finding the most success in?

What are you doing to achieve more success in these dimensions and what can you do to maintain
this success?

Come up with at least two action steps per dimension you want to maintain your success in.

Which dimension(s) could you use support or intentional improvement in?

What are some things you can do to enhance your responses in these dimensions?

Come up with at least two action steps per dimension you are looking to enhance your responses in.

85

Fact Sheet: Training and directions to introducing Services
Relevant to the 8 Dimensions of Wellness

Staff will explain any of the following services as students make their decisions about
whether they have an interest and would like to pursue it.

Emotional Dimension

Assessment - learning about what your needs are by seeking a professional to assess one’s
emotional wellness.

Cognitive Behavioral Therapy - a type of psychotherapy in which negative patterns of thought
about oneself and their surroundings are challenged to alter unwanted behavior patterns or treat
mood disorders such as depression and anxiety.

Dialectical Behavior Therapy - a modified type of cognitive behavioral therapy. It teaches
individuals how to live in the moment, develop healthy ways to cope with stress, regulate their
emotions, and improve their relationships with others.

Psychotherapy - an approach for treating mental health issues by talking with a licensed mental
health provider. Can be described as talk therapy, counseling, psychosocial therapy or, simply,
therapy.

Intensive Follow-along - Case management to assist in finding resources and understanding
human rights and healthcare benefits.

Mindfulness - Practicing in-the-moment awareness of your thoughts, feelings, bodily sensations,
and surrounding environment without judgment.

Couples/Family Therapy - A form of therapy that addresses the behaviors of all family members
and the way these behaviors affect not only individual family members but also relationships
between members and the family as a whole.

Telehealth - Services provided by video conference.

Spiritual Dimension

Spirituality Counseling - a method of healing that considers an individual's beliefs and values, and
in which there is typically a longing for meaning larger than the individual self.

Local Religious Support Services - Faith-based support from the individual's identified religion.

Psychotherapy - a faith-based approach for treating mental health issues by talking with a licensed
mental health provider. Can be described as talk therapy, counseling, psychosocial therapy or,
simply, therapy.

Intensive Follow-along - Case management to assist in finding resources as it relates to the
spiritual dimension.

86

Physical Dimension

Nutritional Therapy - helps to maximize one’s health potential through individually formulated
nutritional and lifestyle changes.

Intensive Follow-along - Case management to assist in finding resources as it relates to the
physical dimension.

Telehealth - Services provided by video conference.

Community Resources for physical fitness - Local fitness centers, physical fitness trainers, and
classes.

Community Resources for primary health care and Related - Establishing a primary care
physician.

Social Dimension

Social Skills Group - Social skills training that helps an individual improve and understand social
behavior. The goal of social skills groups is to teach people about verbal and nonverbal behaviors
that are involved in typical social interactions.

Peer Mentoring - Spending time with a person who has lived through a similar experience for
guidance and modeling.

Personal Care Assistance - Support with daily living skills.

Service Coordination - Case management to assist in finding resources as it relates to the social
dimension.

Telehealth - Services provided by video conference.

Curriculum-based Social Skills - Individual and/or classroom social skills training that helps an
individual improve and understand social behavior. The goal of social skills groups is to teach people
about verbal and nonverbal behaviors that are involved in typical social interactions.

Community Inclusion Resources - Local groups that identify as being similar to establish and be
part of an accepting community.

Volunteering - giving time to your community (i.e., spending time with children - Big Brother/Sister)

Financial Dimension

Budgeting & Money Management - Supported the development of a budget that aligns with income and
expenses.

Community Resources for financial planning - Local financial advisors.

87

Occupational Dimension

Pre-employment Services - Skill development in preparation for employment.

Prevocational Services - Provide learning and work experience, including volunteer work, where
the individual can develop general, non-job-task-specific strengths and skills that contribute to
employability.

Intensive Follow-along - Case management to assist in finding resources as it relates to the
occupational dimension.

Career Planning - Looking at strengths and interests to determine job options that would result in
successful employment.

Job Development - Finding a position that matches the individual’s skill set and preparing to
interview for employment.

Supported Employment - Job coaching.

Telehealth - Services provided by video conference.

Intellectual Dimension

Family Resource Services - State agencies and advocacy groups providing resources to support
caregivers.

Executive Functioning Coaching - Specialized professional that teaches individuals how to
organize, plan, prioritize, manage time, maintain focus, self-assess, and study efficiently.

Transition Planning - Creating a plan that will lead to the individual’s identified future goals.

Intensive Follow-along - Case management to assist in finding resources as it relates to the
intellectual dimension.

Telehealth - Services provided by video conference.

Environmental Dimension

Community Inclusion - local groups that promote Diversity, Equity, Inclusivity & Belonging.

Independent Living Skills - Support with daily living skills.

Family Resource Services - State agencies and advocacy groups provide resources to support
caregivers.

Housing - Determining a plan for housing after transitioning within the community.

88

Telehealth - Services provided by video conference.

Sibling Support - Outpatient clinics offering sibling support.

Intensive Follow-along - Case management to assist in finding resources as it relates to the
environmental dimension.

Parent Training - Outpatient clinics offering parent training, state agencies, and advocacy groups
providing resources to support caregivers.

89

Name

Services Relevant to the 8 Dimensions of Wellness
Please take a few moments to review services associated with the 8 Dimensions of
Wellness and select any that you might want more information about as you plan for
your transition after graduation. Results will be used to inform the Taking Flight
Transition Plan to continue improving specialized services for individuals who are
neurodivergent and their families.

Please check the specialized services as they relate to the emotional dimension.

Service Interest
Assessment

Cognitive Behavior Therapy

Dialectical Behavior Therapy

Psychotherapy

Intensive Follow-along

Mindfulness

Couples/Family Therapy

Telehealth

Please check the specialized services as they relate to the spiritual dimension.

Service Interest
Spirituality Counseling (looking for support from your religion
for advice or combination with psychotherapy in the pursuit of
healing or well-being)

Local Religious Support Services

Psychotherapy

Intensive Follow-along

90

3. Please check the specialized services as they relate to the physical dimension.

Service Interest
Nutritional Therapy

Intensive Follow-along

Telehealth

Community Resources for physical fitness

Community Resources for primary health care and
related

4. Please check the specialized services as they relate to the social dimension.

Service Interest
Social Skills Group

Peer Mentoring (spending time with a person who has lived
through a similar experience for guidance and modeling).

Personal Care Assistance

Service Coordination

Telehealth

Curriculum-based Social Skills

Community Inclusion Resources

Volunteering (i.e., working with children in your community)

5. Please check the specialized services as they relate to the financial dimension.

Service Interest

91

Budgeting & Money Management Coaching

Community Resources for financial planning

Other:

92

6. Please check the specialized services as they relate to the occupational dimension.

Service Interest
Pre-employment Services

Prevocational Services

Intensive Follow-along

Career Planning

Job Development

Supported Employment

Telehealth

Other:

7. Please check the specialized services as they relate to the intellectual dimension.

Service Interest
Family Resource Services

Executive Functioning Coaching

Transition Planning

Intensive Follow-along

Telehealth

Other:

93

8. Please check the specialized services as they relate to the environmental dimension.

Service Interest
Community Inclusion

Independent Living Skills

Family Resource Services

Housing

Telehealth

Sibling Support

Intensive Follow-along

Parent Training

Additional Comments:

________________________________________________________________________________
________________________________________________________________________________
_____________________________________________________________________________

Version 5.2023

94

MAPS
Student: MAPs Facilitator:
Date of MAPs Meeting:
Who Am I? Who’s in My
Circle?
Likes Dislikes

Strengths Challenges Dreams Fears

Where I see myself…
In one month In six months In one years In five years…

My Goals/Action Steps

95

Taking Flight: Transition Plan
Measurable goals and objectives as they relate to the Personal Assessment of 8 Dimensions of
Wellness and the active MAPs process.

Name:
Treatment Plan Effective Dates:
Date of Plan:

Goal #1:

Measurable Objective(s): with clear review dates

Goal #2:

Measurable Objective(s): with clear review dates

Goal #3 (Family related, if applicable):

Measurable Objective(s): with clear review dates

Goal #4 (Post-transition):

Measurable Objective(s): with clear review dates

96

I have been given the opportunity to participate in the development of goals and objectives.

Name Relationship Signature Date

Individual _________________________ __________

Team Member _________________________ __________

Team Member _________________________ __________

Social worker ________________________ __________

97

Transition Plan Progress Report
Progress towards measurable goals and objectives as it relates to the Personal Assessment of 8
Dimensions of Wellness and the active MAPs process.

Name:
Treatment Plan Effective Dates:
Date of Review:

Goal #1:

Progress towards Objective(s):

Goal #2:

Progress towards Objective(s):

Goal #3 (Family related, if applicable):

Progress towards Objective(s):

Goal #4 (Post-transition):

Progress towards Objective(s):

98

I have been given the opportunity to participate in the review of goals and objectives.

Name Relationship Signature Date

Individual _________________________ __________

Team Member _________________________ __________

Team Member _________________________ __________

Social worker ________________________ __________

99

Post-Transition Satisfaction Survey: Graduate

Name: _________________________
Date: _________________
Directions: Please circle your choice or write in answers.

1. How would you rate your satisfaction with the services and support that you have received?

Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

2. Did the Taking Flight Transition Plan support your needs and goals? Yes No
3. Are you still receiving support from Taking Flight or have community resources within your vicinity
been accessible?
____________________________________________________________________________________
4. How successful would you rate your completion of goals and objectives that you worked toward?
Very Successful Successful Somewhat Not Successful Very Unsuccessful

5. How satisfied are you with your financial independence?
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

6. How satisfied are you with your family relationships?
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

7. What is your level of stress as it relates to daily living?
Very High High Neutral Low Very Low

100

8. Are you in college? Yes No
9. Full-time or Part-time Student (circle one)

10. Are you employed? Yes No

11. Full-time or Part-time Employment (circle one)

12. Do you have a sense of community? Yes No

13. Are you in a relationship? Yes No

14. How satisfied are you with the relationship?
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

15. How satisfied are you with the number of friends that you have?
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

16. Would you recommend Taking Flight transition
planning for others? Yes No

Why? Or why not? __________________________________________________________________

Additional Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

101

Post-Transition Satisfaction Survey: Parent/Caregiver

Name: _________________________
Date: _________________
Directions: Please circle your choice or write in answers.

1. How would you rate your satisfaction with the services and support that you as a caregiver
have received?

Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

2. Did the Taking Flight Transition Plan support the needs of your child? Yes No
3. Are you still receiving support from Taking Flight or have community resources within your vicinity
been accessible?
____________________________________________________________________________________
4. Would you rate your child’s success with their identified goals?
Very Successful Successful Somewhat Not Successful Very Unsuccessful

5. How satisfied are you with your child’s financial independence?
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

6. How satisfied are you with your family relationships?
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied

7. What is your level of stress as it relates to your child on the autism spectrum?
Very High High Neutral Low Very Low

102

8. Would you recommend Taking Flight to other parents with transition age youth on the autism
spectrum? Yes No

Why? Or why not? __________________________________________________________________

Additional Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

103

Links to Pilot Data Analysis (Actual data are on the following pages)
FACES IV Review of caregiver (N = 7) and student (N =7) Answers and Comparison
Family Satisfaction Survey Pilot Data
Services Relevant to the 8 Dimensions of Wellness Pilot Data Review

104

FACES IV Review of caregiver (N = 7) and student (N =7) Answers and Comparison
Percentages may vary at times if not all questions were answered completely.
Student Parent/Caregiver
1. Family members are
involved in each other’s
lives.
Strongly Agree 57%
Generally Agree 28%
Undecided 14%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 60%
Generally Agree 40%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%
2. Our family tries new
ways of dealing with
problems.
Strongly Agree 28%
Generally Agree 42%
Undecided 14%
Generally Disagree 14%
Strongly Disagree 0%
Strongly Agree 20%
Generally Agree 40%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 0%
3. We get along better with
people outside our family
than inside.
Strongly Agree 0%
Generally Agree 42%
Undecided 28%
Generally Disagree 14%
Strongly Disagree 14%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 60%
Strongly Disagree 40%
4. We spend too much time
together.
Strongly Agree 0%
Generally Agree 0%
Undecided 28%
Generally Disagree 42%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 0%
Undecided 20%
Generally Disagree 40%
Strongly Disagree 40%
5. There are strict
consequences for breaking
the rules in our family.
Strongly Agree 14%
Generally Agree 28%
Undecided 14%
Generally Disagree 28%
Strongly Disagree 14%
Strongly Agree 0%
Generally Agree 0%
Undecided 20%
Generally Disagree 40%
Strongly Disagree 40%
6. We never seem to get
organized in our family.
Strongly Agree 0%
Generally Agree 0%
Undecided 42%
Generally Disagree 28%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 20%
Undecided 20%
Generally Disagree 20%
Strongly Disagree 40%
7. Family members feel
very close to each other.
Strongly Agree 42%
Generally Agree 28%
Undecided 14%
Generally Disagree 14%
Strongly Disagree 0%
Strongly Agree 20%
Generally Agree 80%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%
8. Parents equally share Strongly Agree 28% Strongly Agree 0%
105

leadership in our family. Generally Agree 28%
Undecided 42%
Generally Disagree 0%
Strongly Disagree 0%
Generally Agree 60%
Undecided 20%
Generally Disagree 0%
Strongly Disagree 20%
9. Family members seem to
avoid contact with each
other when at home.
Strongly Agree 0%
Generally Agree 0%
Undecided 14%
Generally Disagree 57%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 20%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 40%
10. Family members feel
pressured to spend most free
time together.
Strongly Agree 0%
Generally Agree 28%
Undecided 42%
Generally Disagree 14%
Strongly Disagree 14%
Strongly Agree 0%
Generally Agree 40%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 40%
11. There are clear
consequences when a
family member does
something wrong.
Strongly Agree 0%
Generally Agree 28%
Undecided 28%
Generally Disagree 42%
Strongly Disagree 0%
Strongly Agree 0%
Generally Agree 60%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 0%
12. It is hard to know who
the leader is in our family.
Strongly Agree 14%
Generally Agree 0%
Undecided 42%
Generally Disagree 28%
Strongly Disagree 14%
Strongly Agree 0%
Generally Agree 20%
Undecided 20%
Generally Disagree 60%
Strongly Disagree 0%
13. Family members are
supportive of each other
during difficult times.
Strongly Agree 42%
Generally Agree 28%
Undecided 28%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 60%
Generally Agree 20%
Undecided 20%
Generally Disagree 0%
Strongly Disagree 0%
14. Discipline is fair in our
family.
Strongly Agree 14%
Generally Agree 42%
Undecided 42%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 40%
Generally Agree 20%
Undecided 20%
Generally Disagree 20%
Strongly Disagree 0%
15. Family members know
very little about the friends
of other family members.
Strongly Agree 14%
Generally Agree 0%
Undecided 28%
Generally Disagree 42%
Strongly Disagree 14%
Strongly Agree 20%
Generally Agree 0%
Undecided 20%
Generally Disagree 40%
Strongly Disagree 20%
106

16. Family members are too
dependent on each other.
Strongly Agree 0%
Generally Agree 0%
Undecided 42%
Generally Disagree 28%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 20%
Undecided 0%
Generally Disagree 60%
Strongly Disagree 20%
17. Our family has a rule for
almost every possible
situation.
Strongly Agree 0%
Generally Agree 0%
Undecided 57%
Generally Disagree 0%
Strongly Disagree 42%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 60%
18. Things do not get done
in our family.
Strongly Agree 0%
Generally Agree 28%
Undecided 28%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 60%
Generally Agree 40%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%

Student Parent/Caregiver
19. Family members consult
other family members on
important decisions.
Strongly Agree 28%
Generally Agree 28%
Undecided 14%
Generally Disagree 28%
Strongly Disagree 0%
Strongly Agree 40%
Generally Agree 40%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 0%
20. My family is able to
adjust to change when
necessary.
Strongly Agree 42%
Generally Agree 28%
Undecided 28%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 60%
Generally Agree 40%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%
21. Family members are on
their own when there is a
problem to be solved.
Strongly Agree 14%
Generally Agree 14%
Undecided 42%
Generally Disagree 28%
Strongly Disagree 0%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 60%
22. Family members have
little need for friends
outside the family.
Strongly Agree 0%
Generally Agree 14%
Undecided 42%
Generally Disagree 0%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 60%
Strongly Disagree 40%
23. Our family is highly
organized.
Strongly Agree 0%
Generally Agree 0%
Undecided 83%
Strongly Agree 0%
Generally Agree 40%
Undecided 0%
107

Generally Disagree 17%
Strongly Disagree 0%
Generally Disagree 60%
Strongly Disagree 0%
24. It is unclear who is
responsible for things
(chores, activities) in our
family.
Strongly Agree 0%
Generally Agree 0%
Undecided 42%
Generally Disagree 42%
Strongly Disagree 14%
Strongly Agree 0%
Generally Agree 40%
Undecided 20%
Generally Disagree 40%
Strongly Disagree 0%
25. Family members like to
spend some of their free
time with each other.
Strongly Agree 28%
Generally Agree 42%
Undecided 28%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 20%
Generally Agree 60%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 0%
26. We shift household
responsibilities from person
to person.
Strongly Agree 14%
Generally Agree 28%
Undecided 57%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 40%
Generally Agree 0%
Undecided 20%
Generally Disagree 40%
Strongly Disagree 0%
27. Our family seldom does
things together.
Strongly Agree 0%
Generally Agree 0%
Undecided 28%
Generally Disagree 42%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 60%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 20%
28. We feel too connected to
each other.
Strongly Agree 0%
Generally Agree 0%
Undecided 14%
Generally Disagree 42%
Strongly Disagree 42%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 60%
Strongly Disagree 40%
29. Our family becomes
frustrated when there is a
change in plans or routines.
Strongly Agree 0%
Generally Agree 0%
Undecided 57%
Generally Disagree 14%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 40%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 20%
30. There is no leadership in
our family.
Strongly Agree 0%
Generally Agree 0%
Undecided 28%
Generally Disagree 42%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 100%
31. Although family
members have individual
interests, they still
Strongly Agree 14%
Generally Agree 42%
Strongly Agree 40%
Generally Agree 60%
108

participate in family
activities.
Undecided 28%
Generally Disagree 14%
Strongly Disagree 0%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%
32. We have clear rules and
roles in our family.
Strongly Agree 14%
Generally Agree 28%
Undecided 28%
Generally Disagree 28%
Strongly Disagree 0%
Strongly Agree 0%
Generally Agree 40%
Undecided 20%
Generally Disagree 20%
Strongly Disagree 20%
33. Family members seldom
depend on each other.
Strongly Agree 0%
Generally Agree 0%
Undecided 57%
Generally Disagree 14%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 60%
34. We resent family
members doing things
outside the family.
Strongly Agree 0%
Generally Agree 14%
Undecided 28%
Generally Disagree 28%
Strongly Disagree 28%
Strongly Agree 0%
Generally Agree 0%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 60%
35. It is important to follow
the rules in our family.
Strongly Agree 17%
Generally Agree 17%
Undecided 50%
Generally Disagree 17%
Strongly Disagree 0%
Strongly Agree 0%
Generally Agree 40%
Undecided 0%
Generally Disagree 40%
Strongly Disagree 20%
36. Our family has a hard
time keeping track of who
does various household
tasks.
Strongly Agree 14%
Generally Agree 14%
Undecided 42%
Generally Disagree 0%
Strongly Disagree 28%
Strongly Agree 20%
Generally Agree 20%
Undecided 20%
Generally Disagree 20%
Strongly Disagree 20%
37. Our family has a good
balance of separateness and
closeness.
Strongly Agree 14%
Generally Agree 57%
Undecided 28%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 0%
Generally Agree 100%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%
38. When family problems
arise, we compromise.
Strongly Agree 14%
Generally Agree 42%
Undecided 14%
Generally Disagree 28%
Strongly Disagree 0%
Strongly Agree 20%
Generally Agree 20%
Undecided 20%
Generally Disagree 20%
Strongly Disagree 20%
39. Family members mainly
operate independently.
Strongly Agree 0% Strongly Agree 0%
109

Generally Agree 14%
Undecided 42%
Generally Disagree 28%
Strongly Disagree 14%
Generally Agree 60%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 20%
40. Family members feel
guilty if they want to spend
time away from the family.
Strongly Agree 14%
Generally Agree 14%
Undecided 42%
Generally Disagree 14%
Strongly Disagree 14%
Strongly Agree 0%
Generally Agree 20%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 60%
41. Once a decision is made,
it is very difficult to modify
that decision.
Strongly Agree 14%
Generally Agree 0%
Undecided 28%
Generally Disagree 42%
Strongly Disagree 14%
Strongly Agree 20%
Generally Agree 0%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 80%
42. Our family feels hectic
and disorganized.
Strongly Agree 0%
Generally Agree 14%
Undecided 57%
Generally Disagree 14%
Strongly Disagree 14%
Strongly Agree 0%
Generally Agree 20%
Undecided 20%
Generally Disagree 0%
Strongly Disagree 60%
43. Family members are
satisfied with how they
communicate with each
other.
Strongly Agree 14%
Generally Agree 14%
Undecided 57%
Generally Disagree 14%
Strongly Disagree 0%
Strongly Agree 0%
Generally Agree 80%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 20%
44. Family members are
very good listeners.
Strongly Agree 14%
Generally Agree 28%
Undecided 42%
Generally Disagree 0%
Strongly Disagree 14%
Strongly Agree 20%
Generally Agree 60%
Undecided 20%
Generally Disagree 0%
Strongly Disagree 0%

45. Family members express
affection to each other.
Strongly Agree 17%
Generally Agree 50%
Undecided 17%
Generally Disagree 0%
Strongly Disagree 17%
Strongly Agree 60%
Generally Agree 40%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%
46. Family members are able
to ask each other for what
they want.
Strongly Agree 33%
Generally Agree 17%
Undecided 50%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 40%
Generally Agree 40%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 0%
110

47. Family members can
calmly discuss problems
with each other.
Strongly Agree 17%
Generally Agree 50%
Undecided 33%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 20%
Generally Agree 40%
Undecided 0%
Generally Disagree 20%
Strongly Disagree 20%
48. Family members discuss
their ideas and beliefs with
each other.
Strongly Agree 33%
Generally Agree 0%
Undecided 50%
Generally Disagree 17%
Strongly Disagree 0%
Strongly Agree 40%
Generally Agree 20%
Undecided 20%
Generally Disagree 20%
Strongly Disagree 0%
49. When family members
ask questions of each other,
they get honest answers.
Strongly Agree 17%
Generally Agree 50%
Undecided 33%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 60%
Generally Agree 40%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 0%
50. Family members try to
understand each other’s
feelings.
Strongly Agree 17%
Generally Agree 33%
Undecided 33%
Generally Disagree 17%
Strongly Disagree 0%
Strongly Agree 20%
Generally Agree 60%
Undecided 0%
Generally Disagree 0%
Strongly Disagree 20%
51. When angry, family
members seldom say
negative things about each
other.
Strongly Agree 0%
Generally Agree 17%
Undecided 33%
Generally Disagree 33%
Strongly Disagree 17%
Strongly Agree 0%
Generally Agree 60%
Undecided 20%
Generally Disagree 20%
Strongly Disagree 0%
52. Family members express
their true feelings to each
other.
Strongly Agree 33%
Generally Agree 33%
Undecided 33%
Generally Disagree 0%
Strongly Disagree 0%
Strongly Agree 60%
Generally Agree 20%
Undecided 20%
Generally Disagree 0%
Strongly Disagree 0%

111

Student Parent/Caregiver
53. The degree of closeness
between family members.
Extremely Satisfied 17%
Very Satisfied 33%
Generally Satisfied 33%
Somewhat Dissatisfied
0%
Very Dissatisfied 17%
Extremely Satisfied 20%
Very Satisfied 40%
Generally Satisfied 20%
Somewhat Dissatisfied
20%
Very Dissatisfied 0%
54. Your family’s ability to
cope with stress.
Extremely Satisfied 33%
Very Satisfied 0%
Generally Satisfied 33%
Somewhat Dissatisfied
17%
Very Dissatisfied 0%
Extremely Satisfied 20%
Very Satisfied 20%
Generally Satisfied 20%
Somewhat Dissatisfied
20%
Very Dissatisfied 20%
55. Your family’s ability to be
flexible.
Extremely Satisfied 17%
Very Satisfied 33%
Generally Satisfied 17%
Somewhat Dissatisfied
33%
Very Dissatisfied 0%
Extremely Satisfied 60%
Very Satisfied 0%
Generally Satisfied 40%
Somewhat Dissatisfied
0%
Very Dissatisfied 0%
56. Your family’s ability to
share positive experiences.
Extremely Satisfied 50%
Very Satisfied 33%
Generally Satisfied 17%
Somewhat Dissatisfied
0%
Very Dissatisfied 0%
Extremely Satisfied 20%
Very Satisfied 60%
Generally Satisfied 20%
Somewhat Dissatisfied
0%
Very Dissatisfied 0%
57. The quality of
communication between
family members.
Extremely Satisfied 17%
Very Satisfied 17%
Generally Satisfied 66%
Somewhat Dissatisfied
0%
Very Dissatisfied 0%
Extremely Satisfied 0%
Very Satisfied 20%
Generally Satisfied 40%
Somewhat Dissatisfied
40%
Very Dissatisfied 0%
58. Your family’s ability to
solve conflicts
Extremely Satisfied 33%
Very Satisfied 0%
Generally Satisfied 66%
Somewhat Dissatisfied
0%
Very Dissatisfied 0%
Extremely Satisfied 20%
Very Satisfied 20%
Generally Satisfied 40%
Somewhat Dissatisfied
20%
Very Dissatisfied 0%
59. The amount of time you
spend together as a family.
Extremely Satisfied 17%
Very Satisfied 17%
Generally Satisfied 50%
Somewhat Dissatisfied
17%
Extremely Satisfied 0%
Very Satisfied 20%
Generally Satisfied 20%
Somewhat Dissatisfied
60%
112

Very Dissatisfied 0% Very Dissatisfied 0%
60. The way problems are
discussed.
Extremely Satisfied 17%
Very Satisfied 0%
Generally Satisfied 50%
Somewhat Dissatisfied
33%
Very Dissatisfied 0%
Extremely Satisfied 0%
Very Satisfied 20%
Generally Satisfied 20%
Somewhat Dissatisfied
40%
Very Dissatisfied 20%
61. The fairness of criticism
in your family.
Extremely Satisfied 17%
Very Satisfied 17%
Generally Satisfied 33%
Somewhat Dissatisfied
17%
Very Dissatisfied 17%
Extremely Satisfied 0%
Very Satisfied 20%
Generally Satisfied 60%
Somewhat Dissatisfied
0%
Very Dissatisfied 20%
62. Family member’s concern
for each other.
Extremely Satisfied 33%
Very Satisfied 17%
Generally Satisfied 50%
Somewhat Dissatisfied
0%
Very Dissatisfied 0%
Extremely Satisfied 40%
Very Satisfied 60%
Generally Satisfied 0%
Somewhat Dissatisfied
0%
Very Dissatisfied 0%
113

Family Satisfaction Survey
Please list the specialized autism spectrum disorder (ASD) services
you used within the last 2 years that have been helpful.

1. I have no idea of what services were offered or used other than a brief social skills
group and some horseback riding.

2. Transition program, social worker support, life skills preparation, residential placement

Were you able to choose from a variety of specialized ASD
services?
2

0
Yes No

Choice Count

Were you able to choose who provided the specialized ASD
services?
2

0
Yes No

Choice Count

114

Were the specialized ASD services that were available the services you needed?
2

0

Choice Count

Were you satisfied with the quality of specialized ASD services you received?
1

0

Yes No

Yes No Somewhat
115

Please provide services you currently need that you do not have
access to:

3. Executive functioning services; Social skills; physical education, yoga, and movement;
team sports; job training and internships

4. physical health component integrated into the behavioral programming.

Additional Comments
Additional Comments

As far as I know the only ASD services that my son had access to was a temporary social skills
group and horseback riding. The latter was good, the former not so much. And no one has ever
spoken to me in 3 years about specialized ASD services either required, useful or offered.

116

Services Relevant to the 8 Dimensions of Wellness (Sample Size = 7)
Data review revealed the current top 10 Services being requested by the current sample.
1. Budgeting & Money Management Coaching
2. Nutritional Therapy
3. Social Skills Group
4. Peer Mentoring
5. Housing
6. Sibling Support
7. Telehealth (emotional, occupational, intellectual, physical, social)
8. Community Resources for financial planning
9. Job Development
10. Family Resource Services
This list is just a frame of reference to better understand what students are
currently saying that they want and/or need.

117

References
Olson, D. H. (2019). Faces iv (pp. 997-1004). Springer International Publishing.
Olson, D. H., Gorall, D. M., & Tiesel, J. W. (2004). Faces IV package. Minneapolis, MN: Life
Innovations, 39, 12-13. http://35.192.68.109/documents/FACES%20IV.pdf
Substance Abuse and Mental Health Services Administration (SAMHSA). (2016). Creating a
healthier life: A step-by-step guide to wellness.
https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4958.pdf

118

Appendix E
Stakeholder Influence & Interest Map

Keep Interested/Meet Their Needs!

1. Providers

2. Funders

3. Policy Makers

4. Employers

(Aim to move into the right-hand box)

Key Players

1. Youth transitioning into adulthood
who are on the autism spectrum.

2. Parents/Caregivers
3. Devereux Foundation

Least important

1. Uniformed/seemingly unimpacted
communities.

(Aim to move into the right-hand box)
Show Consideration

1. Advocacy Groups

2. Educators/Academia

Power/influence of
stakeholders
Interest of Stakeholders
119

Appendix F
Design Criteria

CRITERIA
Design Goal:
(MUST)

• There is a need for increased awareness of the autistic
population and an acknowledgment of their positive
attributes.
• Inclusivity and community education are greatly
needed to accept this diverse population and dispel the
misperception that autism equals disabled.

• Programmatic support must address the personal
aspirations and goals of the transition-aged youth on
the autism spectrum (TAY AS).

• There is a need for parent/caregiver support.

• Increase awareness through increased information
output (i.e., post infographics on social
media/professional platforms).
• Implement EBP that is scalable & supports the personal
aspirations and goals of TAY AS according to the 8
Dimensions of Wellness (SAMHSA, 2016).
• Ease of access to support.
User Perception:
(COULD)

• Increase TAY AS sense of belonging within their
community.
• Enhance support to include TAY AS in the community.
• Acceptance of this growing population.
• Include the voices of this population to enhance their
experience of the community and environment that
they live in.
Physical Attributes &
Functional Attributes:
(SHOULD)
• Increase employment rates amongst TAY AS

• Reduce depression, anxiety, and other mental and
behavioral health concerns.

120

• Local and federal government engagement and support.
• Employment opportunities, strengths-focused job
searching?

• EBP as a standard of care

• Federal support and infrastructure, funding, and
monitoring.

Constraints: (and
W ON’T )

• Constraint of providing services across state lines
without the interstate compact being active.

• Time needed to impact change.

• It won’t perpetuate a lack of government support.

• It won’t worsen outcomes/reduce awareness of this
population.

121

Appendix G
COMPETITIVE MARKET ANALYSIS
Taking Flight
State Agencies:
CT Autism Waiver
The Kennedy Collective
(example provider)
Autism Speaks Autism Services and
Resources Connecticut
Direct Competitors Indirect Competitors
Company Profile
Company
Highlights
website website website website
Key Competitive
Advantage
Familiarity with population Multiple services are provided
to individuals with disabilities.
Branding Provides services for
children, teens, and into
adulthood.
Target Market
Market
Information
ASD individuals in the state of
CT
Trumbull, CT, and
surrounding areas.
Individuals on the autism
spectrum.
Individuals on the autism
spectrum who are seeking
social opportunities.
Market Share State-specific services and
support to individuals on the
autism spectrum.
Local to Trumbull CT,
recognized by the Connecticut
State Department of Education
(CSDE) and Bureau of Special
Education (BSE)
Recognized nationally. Wallingford & Hartford CT.
Marketing Strategy No advertisement. Must be
sought out.
No advertisement, expects
people to look for them.
The website provides
links to educational
material and resources.
The website provides links to
become a member depending
on age group.
Products & Services
Product
Information
Clinical Behavioral Supports,
Social Skills Group, Job
Coaching
Life Skills Coach
Community Mentor, Respite,
Assistive Technology,
Interpreter
Non-Medical Transportation,
Nutrition
Specialized Driving Assessment,
Live-in Companion
Work Skills Development
Training, Vocational Skills
Evaluation, Job Training &
Coaching Supports
Independent Life Skills
Training, Community
Independence Training
Travel Training, Behavioral
Services
Workplace Readiness
Training, Peer Mentoring
Training
Materials and connections
can be made through the
website.
Branded materials are
available to purchase to
increase awareness.
Virtual social opportunities
Friday - Sunday.
Social Skills Groups.
Networking groups for
parents, grandparents, and
caregivers of children/adults
with autism spectrum
disorders (ASD). Trained
Parent Advisors facilitate all
Networking groups and
provide education and
support to the individuals in
the group.
Pricing Capped at $50,000 per
participant per year.
Negotiated with Local
Educational Authority
Free Membership fees, products,
and services have an
additional cost.
Distribution Channels Applied for. Individuals and families
advocating for services.
Online Online
122

State Agencies:
CT Autism Waiver
The Kennedy Collective
(example provider)
Autism Speaks Autism Services and
Resources Connecticut
Strengths
SWOTT
Information
CT Government opportunity to
speak to policy change.
Recognized by the
Connecticut State Department
of Education (CSDE) and
Bureau of Special Education
(BSE)
Visibility and potentially
attract
contributors/funding
resources.
The ruling year was 1998.
Well known in those
communities. Potential for
expansion.
Weaknesses Capped resources and long
waitlists because it is not
deemed an entitlement.
Limited by LEA funding until
22, private pay, grant, and gift
reliance.
Not all positive feedback
and seen as only using a
portion of their funding
for what they claim.
Currently not serving outside
of these communities.
Opportunities Demonstrate positive outcomes
for those individuals served to
increase financial support.
Demonstrate positive
outcomes to increase
awareness.
Influencer, able to get the
audience needed for
federal policy change and
implementation.
Continue outreach to broaden
audience and visibility.
Threats Funding limitations, the growing
ASD population is greater than
the providers/services available.
Reliance on LEA, grants, and
gifts to sustain the
organization.
Reputation puts them at
risk of losing the
following of the
population that they are
advocating for.
Services primarily focus on
the area of social skills and
don’t consider other aspects
of an individual’s life and
what their goals might be.
Trends The limited and slow movement
to make a change. CT can say
they have the waiver.
Passive outreach. The
webpage is available through
search engines.
Material and resources are
prescriptive.
Focused on social
opportunities and parent
networking.
123

Appendix H
Infographic demonstrating the current state of TAY AS

124

Appendix I
One-Page Handout

125

Appendix J
Communication Plan
COMMUNICATION AUDIENCE GOALS SCHEDULE FORMAT Responsible Party
Leadership Team
Meeting
Program Directors,
Supervisors, and
department
representatives
Introduce Taking Flight to
the set audience, and
request thoughts and
feedback. Determine the
level of support.
This is a weekly
meeting, and the initial
introduction has been
completed. Updates
will be provided as the
pilot continues.
Verbal presentation,
review of any outcomes
data, sharing of the
piloted plans so that they
can review the difference
that Taking Flight is
making.
Laura Kohley, LCSW
Transition Team
Meeting
Program Director,
Clinical Director,
Social Worker,
V ocational Specialists,
Direct Care Staff &
Case Managers.
Introduce Taking Flight to
the set audience, and
request thoughts and
feedback. Determine the
level of support.
Monthly attendance of
this meeting to ensure
fidelity and adherence
to the manualized
materials.
Verbal presentation,
questions, and answers.
During the initial
meeting, a markup on the
manual itself was
requested. This has been
completed and
incorporated.
Clinical Director & Laura
Kohley, LCSW
Email/Phone
Communication with
Parents/Caregivers
Parent/Caregivers and
TAY AS (as
applicable).
Engagement in the
completion of surveys
and follow-up on goals
identified by the TAY AS
as part of their Transition
Plan.
Bi-weekly Written communication
and phone calls/video
conferences.
Transition Program Team
(Case Managers, Social
Workers, Clinical and/or
Program Director)
Focus Groups Parent/Caregivers Get feedback on the new
Transition Plan and
establish a potential
support network for
parents.
Quarterly Video Conference,
educational materials as
requested/needed
Social Workers, Case
Managers, and Directors.
Focus Groups TAY AS, Invite
graduates, and TAY AS
community members
Shared experiences of
goal setting and
establishing a potential
social support network.

Quarterly (and at
request).
Video Conference, open
forum for discussion.
Social Workers
Community Outreach Local School Districts,
Community Mental
Health Centers, etc.

Introduce the program
and meet potential
collaborators.
Monthly Email communication
and flyers about the
program
Program Director
126

COMMUNICATION AUDIENCE GOALS SCHEDULE FORMAT Responsible Party
Website Community beyond
local scope of
outreach.
Introduce the program
and advertisement.
One-time development
and ongoing web-based
maintenance.
Add into the program
description to inform the
public of the benefits.
Devereux Foundation &
Web-design
YouTube Channel Glenholme community
and invited members
Video footage of the
program in action.
Semi-annually Virtual platform. Glenholme Development
Department
Budget Review Glenholme
Leadership, external
stakeholders, and
representatives from
the Devereux
Foundation.
Review the projected
budget including Taking
Flight with the actual
budget to demonstrate
feasibility.
Monthly (internal),
quarterly (larger group),
and annually.
Video conference with
PowerPoint presentation
for visual representation.
Clinical Director &
Program Director.
National Meeting Devereux Board
Members & National
Team (Foundation
Leadership
Present outcomes data
and performance review
to encourage the
Foundation to expand to
other locations.
Upon completion of
data analysis (12-24
months from now).
Video Conference and
PowerPoint presentation.
Invite guest speakers
(TAY AS who have
completed the program)
Laura Kohley, Clinical
Director, and Program
Director.

127

Appendix K
Summary of Facilitators and Barriers of the EPIS Model
EXPLORATION Inner Context Outer Context
Main Challenge Perceived need for change. For
example, programmatically, transition
planning for Glenholme has been
skill/deficit-focused with less
emphasis on future planning for their
return to home communities.

Funding Source (Local Educational
Authorities (LEA), Private Funders,
Insurance, Grants)
Main Facilitator Values/Goals: The organization
implemented the “Servant Leadership”
model which is a philosophy and a set
of values and practices that enrich the
lives of individuals, build better
organizations, and create a more just
and caring world (Greenleaf, 2002;
Kohley 2022).
Consumer Organizations and advocacy
groups that are speaking out about the
needs of this TAY AS and their
lifelong needs.

PREPARATION Inner Context Outer Context
Main Challenge Training needs have been identified
resulting in the development of a
manual to support these needs.
Finding experienced staff.
Definition of evidence: Utilizing a
recognized model of care for the 8
Dimensions of Wellness (SAMHSA,
2016), and tailoring transition plans to
incorporate the appropriate EBPs.

Main Facilitator Championing adoption (Leadership)

Organizational Linkages: Seeking out
similar environments to partner and
potentially share resources.
IMPLEMENTATION Inner Context Outer Context
Main Challenge Readiness for Change is being
addressed by ongoing focus groups to
incorporate staff perspectives and
suggestions/differing opinions being
heard.

Funding without a projected budget is
difficult to determine the level of being
a barrier.

Main Facilitator Priorities/goals: Quality improvement
and program review are valued in the
organization.

Effective Leadership Practices. A
leadership team of champions is ready
to adopt this model.

SUSTAINMENT Inner Context Outer Context
128

Main Challenge Being able to ensure that there is a
fidelity support system to track and
ensure the program is implemented
with fidelity and is sustained.
Funding will become more challenging
should the individual require services
beyond LEA funding.

Main Facilitator Leadership: Staff and family members
have described Glenholme’s
leadership as transformational.
Valuing multiple perspectives by
continuing to incorporate the voices of
the stakeholders impacted by this
program.

129

Appendix L
Projected Budget
Devereux: Taking Flight
July 1, 2023 - June 30, 2024 (Start-up)
Category Comments

REVENUE
Contracts, private pay, and
fees from government
agencies - Residential
Fees $ 1,142,704.00
IEP funding, DDS,
OPWDD, Private Pay
(average $142,838.00 per
year with a minimum of 8
individuals)
Contracts, private pay, and
fees from government
agencies - Day Fees $ 448,960.00
Same funding sources
(average $99, 768.00 per
year with a minimum of 4.5
day attending individuals).
Donations $ 10,000.00
Estimated donations from
families.
Fee-for-service / Private
Insurance $ -
Not possible until NPI is
established for CT
residents/Interstate
Compact
Special Events Revenue $ 5,000.00 Attempt at fundraising
Special events costs of
direct benefits to donors $ (2,500.00)
money used to create a
fundraising event
Total REVENUE $ 1,604,164.00

EXPENSES

Personnel Exp
Wages/Salaries
Salaries & Wages (11.71
FTEs) $ 688,128.00
This is not broken out by
position but by the total
annual budget.
Taking Flight additional
partial FTE $ 3,692.16
LCSW 8 hours per month
at $38.46/hour
Sub-Total $ 691,820.16
Benefits (calculated at
.28) $ 180,081.00
Benefits include Insurance,
time off, sick time, 403B
with contributions, etc.
130

Taking Flight additional
partial FTE Benefits $ 1,033.80
Benefits include Insurance,
time off, sick time, 403B
with contributions, etc.
Total Personnel Exp. $ 872,934.96

Other Operating Exp
Purchased Services $ 49,626.00
Include fees paid to a
contracted psychiatrist and
salaries/stipends paid to
students for their
internships.
Occupancy $ 52,548.00
Includes electricity, home
heating oil fuel, cell phone,
building repairs,
maintenance, rent for office
space, and trash removal.
Supplies $ 3,000.00 Office Supplies
Depreciation &
Amortization $ 52,548.00
Depreciation and paying
the Foundation a portion to
pay back the purchase of
the residential location
Insurance $ 23,563.00
Auto insurance, general &
professional liability,
property insurance
Various other Expenses $ 16,255.00
Vehicle repairs, marketing
costs, and student
recreation costs.
Training & Professional
Development $ 10,000.00
Any license continuing
education, specialized
professional development,
etc. Added expense to
original budget to satisfy
any needs upon introducing
Taking Flight.
Total Other Op Exp $ 207,540.00

Total EXPENSES $ 1,080,474.96

SURPLUS/DEFICIT $ 523,689.04

131

Devereux: Taking Flight
July 1, 2024 - June 30, 2025 (First Year)
Category Comments

REVENUE
Contracts, private pay
and fees from
government agencies -
Residential Fees $ 2,142,570.00
IEP funding, DDS,
OPWDD, Private Pay
(average $142,838.00 per
year with a minimum of 15
individuals)
Day Fees $ 798,144.00
Same funding sources
(average $99, 768.00 per
year with a minimum of 8-
day attending individuals).
Donations $ 15,000.00
Estimated donations from
families.
fee-for service / Private
Insurance $ -
Not possible until NPI
established for CT
residents
Special Events
Revenue $ 10,000.00 Attempt at fundraising
Special events costs of
direct benefits to
donors $ (5,000.00)
money used to create
fundraising event
Total REVENUE $ 2,960,714.00

EXPENSES

Personnel Exp
Wages/Salaries
Salaries & Wages
(16.71 FTEs) $ 983,128.00
This is not broken out by
position but total annual
budget.
Taking Flight (1 FTE) $ 72,000.00 LCSW $34.61/hour
Sub-Total $ 1,055,128.00
Benefits ( calculated
at .28) $ 180,081.00
Benefits include
Insurance, time off, sick
time, 403B with
contributions, etc.
Taking Flight FTE
Benefits $ 20,160.00
Benefits include
Insurance, time off, sick
time, 403B with
contributions, etc.
Total Pers. Exp $ 1,255,369.00

Other Operating Exp
132

Purchased Services
(3% increase) $ 51,114.78
Include fees paid to a
contracted psychiatrist
and salaries/stipends paid
to students for their
internships.
Occupancy $ 62,548.00
Includes electricity, home
heating oil fuel, cell
phone, building repairs,
maintenance, rent for
office space, and trash
removal.
Supplies $ 4,000.00 Office supplies
Depreciation &
Amortization $ 62,548.00
Depreciation and paying
Foundation a portion to
pay back purchase of the
residential location
Insurance $ 26,000.00
Auto insurance, general &
professional liability,
property insurance
Various other
Expenses $ 22,500.00
Vehicle repairs, marketing
costs, student recreation
costs.
Training & Professional
Development $ 12,000.00
Any license continuing
education, specialized
professional development,
etc. Added expense to
original budget to satisfy
any needs upon
introducing Taking Flight.
Total Other Op Exp $ 240,710.78

Total EXPENSES $ 1,496,079.78

SURPLUS/DEFICIT $ 1,464,634.22

Abstract (if available)

Abstract This paper introduces a solution to address the needs of transition-age youth on the autism spectrum (TAY AS) who are preparing to graduate/exit a therapeutic residential and educational setting. The number of individuals diagnosed with autism is on the rise, resulting in an increased need for services and support. Described within this paper are concerning outcomes for this population. The proposed solution, Taking Flight, originates from research gathered from multiple sources and real-life observations. These findings highlight the gap in services for the autistic population as they enter adulthood. It reveals an increasing awareness of the lifelong experiences of this marginalized population including health disparities, inequities, and social exclusion. There is a need for scalable evidence-based practices and a standard of care that will satisfy the needs of this population by integrating their individually defined goals. Additionally, the importance of increased understanding and inclusion of neurodiversity by moving away from the medical model is critical. Taking Flight is an innovative design utilizing social-relational evidence-based treatment to meet the needs of this population and their caregivers as they exit a supported environment that provided a safe and inclusive community for neurodiverse individuals. The methodology described within defines how human-centered strengths-based design improves the outcomes of this population. Taking Flight is hypothesized to increase TAY AS experience of success, acceptance, and understanding. Individual goals developed according to the 8 Dimensions of Wellness and their support team will address the Grand Challenge of Ensuring the Healthy Development of Youth will ensure lifelong success.

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University of Southern California Dissertations and Theses

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Asset Metadata

Creator Kohley, Laura Lynn (author)

Core Title Taking flight: improving outcomes of transition age youth on the autism spectrum

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2023-08

Publication Date 08/01/2023

Defense Date 08/01/2023

Publisher University of Southern California. Libraries (digital)

Tag autism spectrum outcomes,OAI-PMH Harvest,services and supports for transition-age youth on the autism spectrum,transition-age youth outcomes

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Manderscheid, Ronald (committee chair), Bonaguide, Marc (committee member), Fatouros, Cassandra (committee member)

Creator Email kohley@usc.edu,lkohley27@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113291851

Unique identifier UC113291851

Identifier etd-KohleyLaur-12175.pdf (filename)

Legacy Identifier etd-KohleyLaur-12175

Document Type Capstone project

Rights Kohley, Laura Lynn

Internet Media Type application/pdf

Type texts

Source 20230802-usctheses-batch-1077 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA

Repository Email cisadmin@lib.usc.edu