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The program to improve the employment prospects of autistic adults

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The program to improve the employment prospects of autistic adults

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Content The Progam to Improve the Employment Prospects of Autistic Adults: Capstone Project Proposal Ilene Allinger Candreva, DSW, BCBA University of Southern California Suzanne Dworak-Peck School of Social Work DSW 725C: Preparatory Scholarship for Capstone Ronald Manderscheid, PhD August 4, 2023 Table of Contents Acknowledgements .......................................................................................................................... i Executive Summary ........................................................................................................................ ii Abstract .......................................................................................................................................... vi Positionality Statement ................................................................................................................. vii Problem of Practice and Literature Review .................................................................................... 1 Conceptual Framework ................................................................................................................... 8 Proposed Solution/Project Description ......................................................................................... 10 Methodology ................................................................................................................................. 17 Implementation Plan ..................................................................................................................... 21 Conclusions and Implications ....................................................................................................... 25 References ..................................................................................................................................... 29 Appendix A: Problem Landscape ................................................................................................. 41 Appendix B: Stakeholder Analysis ............................................................................................... 50 Appendix C: Logic Model ............................................................................................................ 54 Appendix D: Employment Specialist Job Description ................................................................. 55 Appendix E: HCBS Final Rule ..................................................................................................... 58 Appendix F: Solution Landscape .................................................................................................. 60 Appendix G: Prototype Materials ................................................................................................. 71 Appendix H: Pilot Program Data and Graphs ............................................................................. 106 Appendix I: Theory of Change ................................................................................................... 109 Appendix J: Design Criteria ........................................................................................................ 112 Appendix K: Competitive Analysis ............................................................................................ 114 Appendix L: Budgets .................................................................................................................. 115 Appendix M: The Lanterman Act ............................................................................................... 117 Appendix N: Internal Communication Materials ....................................................................... 118 Appendix O: Communication Plan ............................................................................................. 127 Appendix P: EPIS Framework .................................................................................................... 128 Appendix Q: Implementation Timeline ...................................................................................... 132 i Acknowledgements I am indebted to my team of Capstone advisors: Dr. Ron Manderscheid, Cassandra Fatorous, and Suad Bisgono. Ron encouraged me to think bigger and broader and convinced me to go beyond my skill set and comfort zone. Cassandra’s expertise and encouragement is found not only throughout this paper, but in my entire DSW career. Saud generously donated her time to help me with this project and she inspires me with her daily work. Without you three, I never would have become Dr. Ilene Allinger Candreva. I am so grateful to my parents, Dr. Norman L. and Dr. Janet W. Allinger, who expected the best from me and showed me that having a doctorate was possible. There are 65 years between my doctorate and my mother’s in organic chemistry. We Allinger women persevere. I could not have undertaken this journey without the tireless, loving support of husband, Philip J. Candreva, who has never said no to any crazy idea that I have had. I am indebted to the academic tutoring and supportive shoves from both my older boys, Chris and Andy. And to my youngest Liviu – you were the one who set me on this particular journey. I must acknowledge Kanka Gus and Evil Aunt Ellen, who cheered me on and assured me that I was not too old to do this. I honor two amazing women with my work – Laura Cole Rossidivito and Adele Castillo – who encouraged me ever onward and upward. Sweet memories and thanks to the two sister-friends that I lost during this journey, Sarah Oliver Knorr and Laura Rust; your absence is felt as strongly as was your presence. I want to thank my classmates as you made the unbearable bearable. Laura K., Raine, Emiley – I could not have done it without you! Lastly, I also want to give a very special thanks to my work colleagues and other friends who listened to me, read my papers, and served as a source of practical knowledge – you all know who you are. ii The Project to Improve the Employment Prospects of Autistic Adults: Capstone Project Proposal Executive Summary Problem of Practice Depending on which source is used, the unemployment rate of autistic adults ranges between 35% and 84%; in fact, among all disability groups, autistic individuals have the lowest rate of employment (Baker-Ericzen et al., 2022; CDC, n.d.-b; Fong et al., 2021; Wojciechowski, 2019). Given that autistic individuals with high support needs, low verbal skills, and/or intellectual disability are often excluded from research and employment programs, it is likely that this particular groups of autistic adults has an even lower employment rate (Almalky, 2020; Baker-Ericzen et al., 2022; Fong et al., 2021). Individuals who are employed tend to be under- employed (employed beneath their education or experience), earn lower wages than others in comparable jobs, work fewer hours than their colleagues, and have a shorter average tenure than neurotypical peers (Rogge & Janssen, 2019; Roux et al., 2015; Scott et al., 2017). Research has repeatedly demonstrated a correlation between unemployment and poor physical and mental health for autistic adults (Almalky, 2020; Forde et al., 2021; Gotham et al., 2015; Hirvikoski et al., 2016; Howlin & Magiati, 2017; Nicolaidis et al., 2013; Wanberg, 2012). Unemployment negatively impacts income, living conditions, socialization, and education (Almalky, 2020; ANCOR, 2022; Magiati & Howlin, 2019; Roux, et al., 2015; Turcotte et al., 2016). Employment is an essential part of adulthood and the deleterious effects of its absence reverberate across the autistic adult’s entire life (Almalky, 2020; ANCOR, 2022; Chen et al., 2015; Gotham et al., 2015; Khayatzadeh-Mahani et al., 2020). iii Proposed Innovation and Relation to Grand Challenges The Grand Challenge to Achieve Equality and Justice cites stigma as the root cause of social injustices and calls for new interventions to directly address this barrier (Barth et al., 2022; Bent-Goodley et al., 2019; Goldbach et al., 2015; Link et al., 2014). The Program to Improve the Employment Prospects of Autistic Adults (PIEPAA) is a proactive form of community education, which directly addresses stigma through fact-filled presentations given to existing community, civic, professional, and governmental groups filled with potential employees. By utilizing the evidence-based practices from medical-based stigma reduction programs, PIEPAA supports sustainable behavior changes that increase autistic adults’ access to employment (Bauer & Gerwurtz, 2022; Chan et al., 2010; Delman et al., 2017; Godin & Kok, 1996; Griffin et al., 2011; LEAD Center, 2015; Nickels, 2021; SEDL, 2017). Project Methodology Interviews with multiple stakeholders and extensive research (peer reviewed materials and gray literature) repeatedly demonstrated the lack of proactive and deliberate demand-side interventions to address the high rates of unemployment among autistic adults. This data informed the creation of PIEPAA, which was then field tested with multiple focus groups. Their feedback was incorporated, and the result is PIEPAA, a simple and sustainable vehicle for empowering individuals to change their community’s employment rates. Project Theory of Change PIEPAA is attempting to reduce and/or eliminate what has been identified as a major barrier to the employment of autistic adults: stigma, particularly in the form of low expectations and prejudice against autistic adults with high support needs, limited verbal skills, and/or intellectual disability (Almalky, 2020; Baker-Ericzen et al., 2022; Fong et al., 2021; Goldbach et iv al., 2015; Link et al., 2014). By presenting a strong business case for hiring autistic adults and dispelling myths associated with autism, PIEPAA reshapes the attitudes of those attending the presentation. Local community leaders (as demonstrated in the success story video) and other group members (as demonstrated by the invitation to present PIEPAA) are seen as approving of hiring autistic adults. An attainable behavior change option is then presented, as well as offers of the support necessary to successfully make that change. To help move intention to action, incentives to increase the appeal of such a novel behavior are described. These elements combine to impact the demand-side of employment and result in increased hiring of autistic adults. PIEPAA codifies an ad hoc process (employer education) that is typically found in its evidence- based approaches and programs. The goal of increasing the employment rates of autistic adults is attainable if sufficient time is allotted for PIEPAA’s full impact to be felt. Project Significance PIEPAA is likely to be widely welcomed, accepted, and implemented as a simple, portable way to address the underlying cause of unemployment among autistic adults: stigma in the form of discrimination, low expectations, and ableism. As this bias is eliminated, the employment rate will improve, and as it does, so will the overall quality of life for autistic adults (Ayers et al., 2018; Bishop-Fitzpatrick, et al., 2018; Khayatzadeh-Mahani et al., 2020). Current community education programs do not incorporate the best practices of proven approaches to reducing stigma nor do they support (or in some cases even ask for) the necessary behavior change on the part of employers. PIEPAA has the potential to open doors to employment and in doing so, to create access to more opportunities and greater equality for autistic adults. v Project Implementation and Future Steps Working in partnership with the Employment Specialists (ES) of California’s Regional Centers (RC), PIEPAA will be implemented in at least three different geographic regions of California in the early fall. The opportunity to incorporate PIEPAA will be extended to the remaining RCs at their October ES Roundtable, with individual follow-ups occurring immediately after this presentation. The ES is an existing funded position within all RCs, and they are mandated by law to provide community outreach and education; consequently, PIEPAA’s expenses are already included within the RCs’ annual budgets. Its implementation merely requires a reallocation of existing funding and a specific focus of staff outreach time. Data gathered by the ESs during their presentations will inform and update PIEPAA as appropriate; it will also be incorporated into proposals submitted to national conferences within the social work, disability justice, and vocational rehabilitation fields. As partnerships are formed across disciplines, opportunities for implementing PIEPAA nationally will be utilized to expand its reach across the entire country. vi Abstract This paper proposes a novel intervention (the Program to Improve Employment Prospects for Autistic Adults or PIEPAA) to address the high unemployment rates of autistic adults with high support needs (HSN), low verbal skills (LVS), and/or intellectual disability (ID). This unemployment results in a lower economic status, poor physical and mental health, loss of autonomy, and many other negative outcomes. Multiple, ineffective solutions currently exist in the form of employment models and federal and state policies. The Grand Challenge to Achieve Equality and Justice cites stigma as the root cause of social injustices and calls for new interventions to directly address this barrier. PIEPAA is a demand-side intervention that does this by increasing employers’ knowledge of autistic workers and reducing the associated stigma. Utilizing the Theory of Planned Behavior, the intervention addresses its key components (attitude, subjective norms, perceived behavior control) with regards to hiring autistic people. Evidence-based practices from medical-based stigma reduction programs form the basis of fact- filled and strengths-based presentations for existing community groups, highlighting the successful employment of local HSN, LVS and/or ID autistic adults, and asking for attainable behavior changes. The methodology of creating PIEPAA is detailed, including the use of human- centered design and input from multiple stakeholder groups. The paper concludes by discussing the strong feasibility of the proposed project, its scalability beyond the local setting, and the implications to the wicked problem of unemployment among autistic adults. Key words: autism, employment, stigma, intervention, demand-side, employers vii Positionality Statement I am an older, well-educated woman of European descent who was born and raised in the United States. As a doctoral student, I have ready access to the resources necessary to conduct my research. I acknowledge the privilege that I have in being able to easily obtain the varied supports and resources throughout my community. I seek to remain mindful of the fact that not everyone can access such necessities in the manner that I can. I strive to be aware of the biases (both implicit and explicit) that I have as a baby boomer, an intellectual, and a white person through reflection and introspection. As I am neurotypical, I actively seek to incorporate neurodiverse voices into my work through interview, collaboration, and the printed word. I acknowledge that each person has their own lived experience and I work to remain humble, mindful of my privilege, and teachable as I seek to collaborate with the many stakeholders impacted by my capstone project. I hold fast to the ideal that diversity enriches my community and believe that it is fear and ignorance that keeps others from including individuals who differ from themselves. I trust that education to address myths and misconceptions about autistic individuals will increase employment opportunities within their communities; my capstone project is designed to address these deficits within my community so as to create a more inclusive space for autistic individuals. 1 The Project to Improve the Employment Prospects of Autistic Adults: Capstone Project Proposal Problem of Practice and Literature Review The American Academy of Social Work and Social Welfare (AASWSW) introduced its initial 12 Grand Challenges (GC) of Social Work in 2016; Eliminate Racism was added as an additional GC in June 2020. The intent of all of the GCs is to “chart an agenda for social innovation in the 21 st century” (Sherradan et al., 2014). One of these GCs, Achieve Equal Opportunity and Justice, seeks to ensure that all marginalized groups experience “full social, civic, economic, and political integration” (AASWSW, 2018, para. 2). It accomplishes this by “addressing racial and social injustices, deconstructing stereotypes, dismantling inequality, and exposing unfair practices” (AASWSW, 2018, para. 2). Several authors have suggested that the Grand Challenge to Achieve Equal Opportunity and Justice encompasses many of the other challenges (e.g., Bishop-Fitzpatrick et al., 2018; Goldbach et al., 2015). For example, the lack of equal access to healthcare and education hinders the healthy development of children, results in a health gap, supports economic inequality, and contributes to homelessness. Systematic injustice reflects racism, and thus, the need for smart decarceration. In short, the Grand Challenge to Achieve Equal Opportunity and Justice can be seen as foundational to many of the other challenges (Bishop-Fitzpatrick et al., 2018; Goldbach et al., 2015). Despite the universal importance of this Grand Challenge, there is no mention of autism in its working papers; indeed, there is no mention of autism (and relatively few mentions of any disabled population) within any of the Grand Challenges (e.g., Barth et al., 2022; Bent-Goodley et al., 2019; Maiden & Weiss, 2023). Yet, individuals (adults and children) on the autism spectrum lack access to equal opportunity and justice across all areas of life. For example, this 2 group has experienced great social injustices, such as being utilized as subjects in medical experimentation, confined to asylums, and forced to undergo sterilization (Srikanth, 2022; Weiser, 2021). Individuals on the spectrum are often isolated at schools and workplaces as well as in the community (Amaral et al., 2019; Bishop-Franklin et al., 2018). Autistic 1 individuals experience economic injustice: systematic exclusion from workplaces, low rates of employment, high rates of poverty, increased medical expenses, and impacted parental employment (Bishop- Franklin et al., 2018; Forde et al., 2021; Winson et al., 2018). Clearly, the Grand Challenge to Achieve Equal Opportunity and Justice is directly relevant to this marginalized community. Autism is a neurological developmental disability with an estimated prevalence of 2.21% of the American d results in individual differences in the areas of communication, social interaction, and leisure activities (CDC, n.d.-b). Autism is a heterogeneous disability, meaning that each person’s individual experience of autism and the resulting need for services and support can vary widely (CDC, n.d.-a). However, regardless of where on the autism spectrum a person falls, each autistic individual faces multiple barriers to employment, resulting in extremely low employment rates and an accompanying poor quality of life. Autistic individuals with high support needs (HSN), low verbal skills (LVS) and/or intellectual disabilities (ID) are often excluded from employment programs, making their employment rate almost nonexistent (Almalky, 2020; Baker-Ericzen et al., 2022). Despite the numerous laws and policies, employment approaches, intervention programs, and academic research aimed at correcting this problem, autistic individuals remain unemployed at an alarming rate (Baker-Ericzen et al., 2022; Bishop-Fitzpatrick et al., 2018; Praslova, 2021). 1 There is no universally accepted language to describe autism spectrum disorder among autistic people, their families, and professionals (Kenny et al., 2016). However, there is a growing movement among the Autistic community to use identity-first language (“autistic adult”) rather than person-first language (“adult with autism”) (Botha et al., 2021). 3 An estimated 7.3 million American adults are on the autism spectrum (CDC, n.d.-b). Compared to the general public’s current rate of unemployment (3.7%), the rate for adults on the autism spectrum ranges between 22.1% and 84%, with less than 16% maintaining full-time employment (Baker-Ericzen et al., 2022; CDC, n.d.-b; United States Bureau of Labor Statistics, n.d.; Wojciechowski, 2019). This means that only 1.1 million adults on the autism spectrum are employed full-time, leaving roughly another 6.2 million autistic adults employed part-time or not at all. Autistic individuals are employed at the lowest rate among all individuals with disabilities (Fong et al., 2021). When autistic individuals do find employment, they are often employed at positions below their qualifications or skill level (under-employed) and the jobs held typically offer reduced hours at lower wages than for neurotypical co-workers (Rogge & Janssen, 2019; Roux et al., 2015; Scott et al., 2017). These jobs, often entry level or part-time positions, usually come with only limited (if any) benefits as well, making private insurance unavailable to most autistic adults (Rogge & Janssen, 2019; Roux, et al., 2015; Scott, et al., 2017). The impact of this high rate of unemployment can be considered from three perspectives: individual, employer, and societal. On the individual level, the effects of poor employment outcomes are felt across all areas of an autistic adult’s life. Most obviously, unemployment has a profound impact on whether or not an individual lives below the poverty line: unemployed adults with cognitive disabilities such as autism are 200% more likely to live below poverty line than employed disabled individuals and experience greater dependence on family support and governmental assistance (Rogge & Janssen, 2019; Winson et al., 2018). This lower socio-economic status then places the autistic adult at greater risk for poorer physical health outcomes (Hirvikoski et al., 2016; Nicolaidis et al., 2013). Almalky (2020) found that, although the mechanisms are poorly understood, employment is strongly correlated with 4 better physical health in autistic adults. Unemployed autistic individuals are found to have greater incidence of comorbid diagnosis of physical health problems such as diabetes, hypertension and obesity than employed autistics (Forde et al., 2021). Autistic adults who are unemployed are also at greater risk for premature death and a heightened risk for suicide (Hirvikoski et al., 2016; Nicolaidis et al., 2013; Wanberg, 2012). Being unemployed has a negative impact on the autistic adult’s mental health and social relationships (Howlin & Magiati, 2017; Roux, et al., 2015; Turcotte et al., 2016). As Nico B., an autistic self-advocate stated, “If I don’t have any economic value, what’s my purpose in life?” (Boskovic, 2022). This sense of insignificance, prevalent among autistic individuals who are unemployed, may help to explain why they are more likely to experience anxiety and depression than those who are employed (Magiati & Howlin, 2019). In turn, this increase in mental health issues is thought to play a role in the comparatively high number of pharmacological interventions used with autistic adults (Magiati & Howlin, 2019). Autistic individuals with a co- occurring mental health diagnosis also struggle to find treatment; this is due, in part, to their unemployment and the resulting lack of access to private insurances (Howlin & Magiati, 2017). Doug B., another autistic self-advocate, expanded on this barrier by saying, “Medicaid sucks. It doesn’t cover a lot of things that private insurances do, which I couldn’t get…without a job” (personal communication, June 2, 2022). Employment has been found to enhance interpersonal relationships and to forge strong connections through shared interests (Almalky, 2020; ANCOR, 2022). Autistic individuals who are employed benefit from stronger social networks and greater community inclusion (ANCOR, 2022; Chen et al., 2015; Khayatzadeh-Mahani et al., 2020). These benefits are hypothesized to arise from two sources. First, the employed autistic person spends more time in the community 5 (workplace, related settings, etc.) and with other people (colleagues, employers, customers, etc.); this sheer volume of time allows for the development of stronger relationships and networks (ANCOR, 2022; Khayatzadeh-Mahani et al., 2020). Second, employed autistic individuals are seen as contributing to society rather than burdening it. This results in a decrease in social stigma, which enhances social value and connections (Almalky, 2020; Chen et al., 2015). Unemployment and the resulting lack of income also limits autistic adults’ independence. In fact, only about 7% of adults on the autism spectrum live independently; the remaining 93% live in group homes or with extended family (Gotham et al., 2015). Ayers et al. (2018) and Almalky (2020) both found that employed autistic individuals experience greater autonomy and independence than did unemployed autistic adults. This manifested itself not only in living arrangements but in improved self-advocacy and decision-making skills as well as a greater sense of personal and financial empowerment. In sum, across all of life’s domains, unemployed individuals on the autism spectrum experience a lower quality of life than employed autistic adults (Ayers et al., 2018; Bishop-Fitzpatrick, et al., 2018; Khayatzadeh-Mahani et al., 2020). “I’ve been employed and unemployed,” said Doug. B. “I like being employed a lot better” (personal communication, June 2, 2022). Many autistic adults tend to view the high rates of unemployment as being caused by discrimination or stigma. “If I could just get a chance, I could show them that I could do it. But they (employers) are so dead set against me because of my autism that I can’t even get a chance,” said Max G. (personal communication, May 10, 2023). While autistic adults have a high interest in this problem, they have limited influence to change it. Although the impact to employers is real, it does not quantify easily. For example, due to a variety of issues arising from the pandemic, employers are now experiencing an acute labor 6 shortage. Currently, for every unemployed American, there are 1.7 job openings (Richter, 2023). David H., a small business owner in Georgia, summed this up by saying “I need to hire at least, you know, 60 hours’ worth of part-time workers so that's two to three people and I can't find them… and it’s not just me, that’s all the (small business) owners in my area” (personal communication, June 13, 2022). Employers that fail to hire individuals on the autism spectrum are also missing many of the advantages associated with diversity in general and neurodiversity in particular (Goel, 2018; Hayward et al., 2019; Krzeminska et al., 2019; LEAD, 2015). Diversity of any type results in novel viewpoints, increased creativity, and a more flexible workforce (Goel, 2018; Mor Barak, 2016). Having a neurodiverse workforce has the added benefits of increased productivity, enhanced innovation, and streamlined operations (Austin & Pisano, 2017; Goel, 2018; Hayward et al., 2019; Wojciechowski, 2019). Many of the accommodations made for autistic adults (such as flexible hours, remote work, and quiet working places) typically benefit all the employers, which in turn leads to increased profits, innovative problem-solving, and improved workplace morale (Hayward et al., 2019; LEAD, 2015; Wojciechowski, 2019). In this group, some employers see autistic workers as beneficial to the work environment (Austin & Pisano, 2017; Goel, 2018; Hayward et al., 2019; Wojciechowski, 2019). Most of this stakeholder group, however, views this high rate of unemployment as justly deserved because, “autism scares me, and I don’t think a person on the spectrum could do the job. Really, couldn’t do most jobs” (Andy B., personal communication, June 9, 2022). Although this group of stakeholders have a great deal of power to create solutions, many of them are unaware of the problem or uninterested in solving it (Akin et al., 2022; Hoff & Kaplan, 2021; Pazzanese, 2021; Praslova, 2021). 7 On a societal level, poor employment outcomes among adults on the autism spectrum result in increased reliance on government funding and lost productivity, for both the autistic individual and their family (Black et al., 2019; Cakir et al., 2020; Ganz, 2007; Scott et al., 2018). Cakir et al. (2020) estimated that the annual cost for lost productivity per autistic adult is $38, 456 and that the annual lost productivity cost for the parents or caregivers of that unemployed autistic adult is $31,042. Combine this with increased governmental support and the higher medical (both physical and mental) costs associated with unemployment, and the total estimated annual cost of autism in the United States is $268 billion per year (Wright, 2015). This total is expected to rise to $1.36 trillion annually by 2030 and $5.54 trillion annually by 2060 (Blaxil et al., 2022). However, even this figure is likely to be underestimated as it does not include the impact to the autistic adult’s social life or costs associated with accommodations and respite services (Rogge & Janssen, 2019). The perspective of the larger society on this problem varies widely. For some groups, the problem is not necessarily viewed as a problem but rather, as an expected outcome for someone who “suffers from autism” (V. Torne, personal communication, November 10, 2020). Other groups view autistic adults as a solution to the labor shortage (Bergeron, 2021). These groups are scattered across the impact-to-influence spectrum and thus, their opportunities to address the problem are mixed. For a detailed description of the problem of practice and a more complete literature review, please refer to Appendix A. For diagrams mapping stakeholder groups and their relationships and their power-to-interest intersections as well as an in-depth analysis of stakeholder groups, please refer to Appendix B. 8 Conceptual Framework The proposed intervention, the Program to Improve the Employment Prospects of Autistic Adults (PIEPAA), is thoughtfully guided by a coherent conceptual framework. Trained presenters, either autistic or neurotypical, proactively contact local community, professional, service, and governmental organizations to schedule presentations at their monthly meetings (input/actions). The presentations provide actionable and accurate information to address myths, misconceptions and concerns about hiring autistic adults, particularly those with HSN, LVS, and/or ID (inputs/items). The presenters track the number of presentations given, the number of individuals attending, and the number of people requesting follow-up information or additional contacts (outputs). By directly addressing existing stigma in the presentations as well as asking for an achievable behavior change, employers’ knowledge regarding the benefits of hiring autistic adults and the support available to do so will be increased (outcome/short term). Participants will implement targeted behavior changes such as sharing newly acquired information with others, mentoring an autistic colleague, or working with human resources to hire autistic workers (outcomes/intermediate). As a result of this knowledge increase and these behavior changes, the number of employed autistic adults in the presentation area will increase (outcomes/long term). These changes are measured by pre- and post-surveys, observing employer-related contacts with the presenters and other employment professionals, and monitoring annual Regional Center data on employment rates of autistic adults. The theory that best explains the link between the intervention and the outcomes is the Theory of Planned Behavior (TBP, Godin & Kok, 1996). According to this theory, new behavior results from behavioral intentions, which in turn are influenced by attitudes, subjective norms, and perceived behavioral control (Godin & Kok, 1996). To change behavior, then, an individual 9 must have a positive attitude towards that behavior, believe that people significant to themselves think that the behavior is acceptable, and feel that the targeted behavior is possible (Ajzen, 2020). By presenting accurate information and a strong business case, PIEPAA works to reshape the employers’ negative attitude towards hiring autistic individuals into a positive one. Developing the employers’ attitude that “hiring autistic adults is good for my business,'' is a central focus of the innovation. Subjective norms are those norms in which the individual thinks that people important to them approve or disapprove of a targeted behavior (Bicchieri, 2017). By conducting these presentations within and at the request of established groups such as service clubs and professional organizations, attendees will see that leaders and respected members of the community approve the behavior of hiring autistic adults. This experience (“that community leader sitting beside me thinks hiring someone with autism is a good idea”) should directly address the need to change subjective norms prior to seeing a behavior change. The third portion of TPB requires that individuals perceive that they have actual control over the new behavior. At the end of the presentation, several attainable options for a behavior change are given to the attendees. These will range from easily accomplished (sharing the business case with a colleague) to more complex ones (hiring an autistic adult). As a result, attendees should feel that they can have control over their change to the new behavior. With attitudes shifted, subjective norms changed, and behavioral control established, the participants should develop the intention to assist in reducing the high rates of unemployment among autistic adults. Intending to change one’s behavior is not the same thing as actually changing the behavior. The move from intention to action may require additional incentives. The business case presented, which includes cost savings, increased profits, and added governmental support, 10 should be sufficient incentives for many employers to move from thought to deed. For other employers, the knowledge that they are doing something positive for themselves, the autistic adult, and their entire community may act as that necessary incentive. A survey of relevant research (e.g., Bauer & Gerwurtz, 2022; Chan et al., 2010; Delman et al., 2017; Nickels, 2021) shows that interventions that include the education of the demand-side of the employment equation are a neglected but necessary portion for increasing employment rates among autistic individuals. This education often occurs in an ad hoc manner, as a part of creating a customized or supported placement for a single, disabled individual (ANCOR, 2022; Griffin et al., 2011; LEAD Center, 2015; SEDL, 2017). Without substantial education regarding support for and benefits of hiring autistic individuals, including those with HSN, LVS, and/or ID, most employers will not hire them (Austin & Pisano, 2017). Given that this education is already a part of supported and customized employment, both evidence-based practices, demand-side education such as PIEPAA clearly aligns with the field’s best practices (ANCOR, 2022; Griffin et al., 2011; LEAD Center, 2015). Logic Model Please refer to Appendix C for PIEPAA’s Logic Model. Proposed Solution/Project Description Project Description The Program to Improve the Employment Prospects of Autistic Adults (PIEPAA) is a proactive, community outreach and education program. California’s Regional Center (RC) system is well positioned to test and implement this program: they have the connections necessary to facilitate job placement as well as a legal mandate to provide community outreach and education (Welfare and Institutions Code, Section 4648.13(A)). The Regional Centers, a 11 series of 21 non-profits located throughout California, were established by the Lanterman Act and are responsible for coordinating the delivery of services to the more than 360, 000 Californians with I/DD (California Department of Developmental Services, 2023-a). (For more information on Regional Centers, please refer to Appendix M.) Employment Specialists (ES), an existing position within the RC System, would be tasked with proactively arranging educational presentations to community, service, professional, and governmental organizations that have standing meetings. This responsibility fits nicely within the ES’s job description and supports the RC to comply with the legal mandates regarding community outreach (see Appendix D for the ES’s job description). In addition, PIEPAA presentations will provide support to fulfill requirements set forth in Medicaid’s Home & Community-Based Services (HCBS) Settings Final Rule, which mandates that autistic individuals receive services in the most integrated, community-based, and non-institutional setting possible (Center for Medicare & Medicaid Services, 2022). (See Appendix E for the HCBS Final Rule.) Other options for implementation and testing include agencies that provide supported employment programs, the Department of Rehabilitation, and local advocacy organizations. The presenters should have real-world experience in the field of employment of autistic adults as well as be connected to a source of potential autistic employees. PIEPAA works by providing information to directly address the basis for stigma against autistic adults, creating opportunities for behavior change (e.g., hiring autistic adults), and then facilitating that behavior change (e.g., forging connections among employers, employment service providers, and autistic adults). As described previously, solutions addressing the demand- side of the employment equation have long been included on an ad hoc basis within all evidence- based supply-side interventions (e.g., Bauer & Gerwurtz, 2022; Chan et al., 2010; Delman et al., 12 2017; Nickels, 2021). Thus, an intervention that specifically focuses on a demand-side intervention in a thoughtful, deliberate manner aligns well with best practices within this field. For PIEPAA’s logic model and a visual representation of its process, please refer to Appendix C. Solution Landscape To address the issue of high unemployment of autistic adults, two broad types of solutions have been attempted. Employment intervention models (e.g., non-competitive employment, supported employment, customized employment, etc.) and branded programs (e.g., Project SEARCH, TEACHH Supported Employment, Job Path, etc.) constitute the first category and grow out of the medical model of disability. This model proports that the cause of the unemployment problem lies within the autistic individual and that the solution is to cure or fix the autism (Amaral et al., 2019; Disabled World, 2022; Doyle, 2022). Therefore, this group of solutions attempts to mitigate the skill deficits (both soft and hard skills) of autistic individuals through instruction, practice, and support (ANCOR, 2022; LEAD Center, 2015; SEDL, 2017). The second broad effort of solutions reflects the social model of disability, which holds that the causes of unemployment lie within the mismatch between the autistic adult and their work environment (Beenstock et al., 2021; Disabled World, 2022; Doyle, 2022). This group includes laws (e.g., the Vocational Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990), federal policies, (e.g., the Workforce Innovation and Opportunity Act and the Home & Community-Based Services Settings Final Rule) and even a national systems- change framework (Employment First initiative). All of these solutions seek to remove the societal barriers that prevent disabled (autistic) adults from employment (Disabled World, 2022; Doyle, 2022; Harmuth, et al., 2018; Morson, 2016). For a more complete description of these solutions, please see Appendix F. 13 Despite the numerous laws and policies, employment approaches, intervention programs, and academic research aimed at correcting this wicked problem, the employment rate for autistic individuals has remained essentially unchanged for the past 30 years (Baker-Ericzen et al., 2022; Bishop-Fitzpatrick et al., 2018; Griffin et al., 2011; Praslova, 2021). These abysmal outcomes arise from the fact that none of the current solutions have a deliberate, thoughtful, and universal mechanism to address unemployment’s root cause: employer stigma in the form of low expectations of and biases against autistic individuals (Goldbach et al., 2015; Gronholm et al., 2017; Harmuth, et al., 2018). PIEPAA, however, directly and proactively addresses this barrier throughout the entire community of potential employers, and leverages the supports of federal and local legislation, the ad hoc methods utilized by branded programs, and the best practices of stigma reduction programs to do so (ANCOR, 2022; Griffin et al., 2011; Gronholm et al., 2017; Harmuth, et al., 2018; LEAD Center, 2015; SEDL, 2017). Prototype Description The prototype for PIEPAA consists of nine pieces: a detailed manual, a customizable presentation, an accompanying script, a system for tracking speaking engagements, a storyboard for creating a video of a local success story, pre- and post-presentation surveys, a sample landing page for audience members seeking more information and internal/external communication materials. Research, both academic and anecdotal, show that many prospective employers hold low expectations for and are fearful of hiring adult autistics (Akin et al., 2022; Almalky, 2020; Andy B., personal communication, June 9, 2022; Boskovic, 2022; Chen et al., 2015; Pazzanese, 2021). PIEPAA is designed to address these concerns by providing education to community members, including prospective employers, to dispel the myths and misconceptions that may prevent the hiring of autistic adults. In addition, PIEPAA deliberately establishes connections 14 between prospective employers and employment service providers to facilitate this employment. The prototype is appropriate to address this barrier because it is a proactive and educational outreach program designed to target community, service, professional, and governmental groups that influence or control the employment of all adults, including autistic adults with HSN, LVS, and/or ID. This prototype has been tested as singular elements as well as in its entirety. For example, a major component of this prototype is the proactive outreach to existing community, service, and professional groups; the presenter offers to deliver, at no cost, the informational presentation at one of their regularly scheduled meetings. Multiple community, service, professional, and governmental group representatives were contacted; all indicated that they welcomed such outreach and frequently scheduled presentations in this manner. Another component of this program is information about autism in general and autistic employees specifically. Autistic adults reviewed these sections of the prototype and found them to be accurate and respectful. Potential employers also reviewed these sections and found them to be thought-provoking and inspired several such individuals to request assistance in hiring an autistic employee. A link to the working prototype can be found here and its materials can be examined in Appendix G. Program Success and Impact to Grand Challenge An April 2023 pilot program has begun to illustrate how PIEPAA will contribute to the Grand Challenge to Achieve Equal Opportunity and Justice. Two individuals, this doctoral student and an autistic adult, gave the PIEPAA presentation to 33 people, all of whom were invited to complete the pre- and post-presentation surveys; 23 people completed both surveys (response rate of 69.6%). The Likert scale surveys measure changes aligned with the short-, mid- and long-term outcomes of the PIEPAA (knowledge, attitudes and behavior respectively). All 15 three areas demonstrated an improvement in scores, ranging from 0.90 (attitude change) to 3.84 (knowledge change). The changes in these scores illustrate the potential impact that PIEPAA has on the Grand Challenge to Achieve Equal Opportunity and Justice ((Barth et al., 2022; Bent- Goodley et al., 2019). A chart and graph illustrating these changes, as well as the raw data from the pilot project, can be in Appendix H. The pilot program also captured an increase in the predictive behavior change (“I would hire an autistic adult if they were qualified”) scores of an average of 0.48 points. Utilizing a sampling distribution method known as bootstrapping, it is possible to broadly estimate PIEPAA’s impact to employment rates of autistic adults (Ismay & Kim, 20230). On average, five employers out of every 100 trained will hire an autistic adult after attending PIEPPA. The true effect, based on the confidence interval determined through bootstrapping would be between 3.5 and 11 additional people hired per 100 employers trained. If an ES is able to present once a month, to an average of 25 employers, then they will have presented to 300 employers in a year’s time; this translates into an annual increase in hiring of between 10.5 and 30 adults within a given catchment area. To be truly effective, PIEPAA must result in this increase in employed autistic adults; the statistical analysis shows that there is every reason to expect that PIEPAA will, in fact, increase the number of employed autistic adults.. As described above, employment results in a higher quality of life for adult autistics and it is this change that will have the greatest effect to the Grand Challenge to Achieve Equal Opportunity and Justice. This long-term impact will be tracked in a global fashion by the annual data on employment collected by all RCs. ESs will be encouraged to monitor the outcomes of all potential placement referrals resulting from PIEPAA presentations to obtain a more accurate picture of its specific impact. 16 Theory of Change In addition to internal alignment with PIEPAA’s logic model (see Appendix C), PIEPAA closely aligns with its theory of change, the Theory of Planned Behavior (TPB) (see Appendix I). This theory states that new behavior results from behavioral intentions, which in turn are influenced by attitudes, subjective norms, and perceived behavioral control (Godin & Kok, 1996). To improve hiring behavior, then, the potential employer must have a positive attitude towards hiring autistic adults, believe that influential people in their community think that doing so is acceptable, and feel that the targeted behavior is possible (Ajzen, 2020; Austin & Pisano, 2017; Godin & Kok, 1996). By presenting accurate information and a strong business case, PIEPAA reshapes the employers’ negative attitude (“hiring an adult with autism will only cause problems” to a positive one (“hiring autistic adults is good for my business''). Subjective norms are impacted by the inclusion of a local employment success story, with an endorsement given by a local community leader. This shows potential employers that community leaders approve of hiring autistic adults. As these presentations are given to community, service, professional, and governmental groups, each individual attendee (potential employer) sees that respected group members agree with and support the targeted behavior change. The third portion of TPB requires that individuals perceive that they have actual control over the new behavior. As described previously, at the end of the presentation, several attainable options for a behavior change, ranging from easily accomplished to more complex are given to the attendees. Expert support, fiscal incentives, and a simple mechanism to execute the behavior change are also offered to potential employers before they leave the presentation. These factors combine to yield a high likelihood of successful behavior change, which can be measured not only through the survey 17 scores, but in the employment data captured by all Regional Centers and many California counties. Methodology Human Centered Design The principles of Design Justice guided PIEPAA’s creation and continues to inform its implementation (Design Justice Network, 2018). Just as both human-centered design and Design Justice centers the needs of the actual individuals (particularly those from marginalized communities) in the design process, PIEPAA sought input from employers and autistic adults during in its creation. The lived experience of employed and unemployed autistic adults, employment service providers, and nationally recognized experts was treated by the developer as being equal in value and the resulting product was built collaboratively with these (and many other stakeholder) groups. PIEPAA’s final prototype is a sustainable vehicle for empowering individuals to change their community’s employment rates. Design Criteria The design goal for PIEPAA is to share the qualitative and quantitative research findings regarding the business case for hiring autistic adults with as many potential employers and colleagues as possible, thus addressing a major barrier (stigma) against such employment. Eliminating this barrier to employment is critical to the mental and physical health of autistic adults and the process to do so must be highly portable, independent of internet connectivity, and utilize familiar software (Ayers et al., 2018; Bishop-Fitzpatrick, et al., 2018). PIEPAA must be low cost and simple to use, to address the current fiscal realities within the Regional Center system. For the complete design criteria, please see Appendix J. 18 Market Analysis Multiple organizations, at the local, state, and national levels, offer education about autism and employment to the general public. At the state level, the Department of Developmental Services (DDS) and the Department of Rehabilitation (DOR) both provide speakers on this topic; however, they only do so in response to a specific request. Locally, the local offices of both DOR and the RCs do similar presentations when requested. National organizations, such as Autism Speaks, Autistic Self-Advocacy Network, and the Organization of Autism Research, have educational material available on their websites. PIEPAA has four unique aspects that its competitors do not: proactive outreach to community groups, a specific request for a behavior change, support for that behavior change, and incorporation of proven stigma- reduction techniques (Gronholm et al., 2017; Harmuth, et al., 2018). For a more complete competitive analysis of the market, please see Appendix K. Financial Implementation Plan PIEPAA, as implemented by the Regional Center (RC) System, is not expected to require any form of additional funding. The RCs already fund the position of Employment Specialist (ES) at each location; one of their job duties is community education and outreach. (See Appendix D for the ES job description.) PIEPAA merely requires that the ESs are proactive in their outreach and that they target specific groups for educational presentations. The ES’s salary is included in current budgets and time is already allotted for such community outreach. There will be no additional salary costs, simply a reallocation of time. It is estimated that it will require 3% of an ES’s time to set up PIEPPA (or $2700) and 2% ($2325 annually) to maintain the program. 19 Any associated costs such as a laptop, mileage, and office supplies, should be readily absorbed by a RC’s existing budget. For more complete start up and ongoing line-item budgets, please refer to Appendix L. Assessment Plan PIEPAA will assess impact and social change in two different ways. First, a pre- and post-presentation survey will be administered at each presentation. This will capture changes in knowledge (short-term outcome) and in attitude (mid-term outcome). The survey also captures predicted behavior change (long-term outcome). However, since it only captures what behaviors might change, these results will not truly demonstrate the impact to society. That actual impact will be captured in two ways. First, all RCs are required to engage in annual data collection on ways that they uphold the Lanterman Act and related state laws and regulations (DDS, 2023-b; DDS, 2023-c) (See Appendix M for details on the Lanterman Act). This includes collecting data on the employment rate of its clients. Since that data reflects the previous fiscal year, PIEPAA’s impact on employment within a given catchment area might not be captured immediately; however, the changes will be captured within a year or two of its implementation. Second, the various county Workforce Development Boards also collect similar data; as with RC data, it reflects the previous fiscal year (California Workforce Development Board, 2023). However slowly the change might be captured, both data sets should reflect the long-term impact that PIEPAA can have on individual communities throughout the state of California. Stakeholder Inclusion PIEPAA has included such stakeholder groups as autistic adults, employers, RC employees, family members, national experts, service providers, and DOR representatives since its inception. Their fingerprints can be found throughout the project. Moving forward, the first 20 four groups (autistic adults, employers, RC employees and family members) will be involved in PIEPAA’s presentations to the community. As they will play an active role in delivering the salient information to their community, each group will have an ongoing role in shaping the presentation and its material. Communication Plan PIEPAA in and of itself is a communication plan; its primary goal is to communicate the business case for hiring autistic adults to local employers. To facilitate the presenter’s proactive outreach to community, civic, professional, and social groups, communication materials such as a phone script, flyer, and email template have been included in the prototype. In addition, a systematic way for conducting and documenting this outreach is a central part of PIEPAA; materials are provided to facilitate this within the prototype. These materials can be viewed in Appendix G. ESs will also need to communicate their new endeavor within their RC. PIEPAA’s prototype includes internal communication materials such as a possible newsletter insert and an informational presentation about PIEPAA that an ES can use to garner organizational support for PIEPAA. These materials can be viewed in Appendix N. Communication about PIEPAA must include additional stakeholder groups such as the RC Board of Directors, employment support service providers (vendors), special education teachers, and the general community. All of the external/marketing materials as well as the internal communication materials can be used to facilitate this communication. For a detailed communication plan, please refer to Appendix O. 21 Implementation Plan Implementation Plan and EPIS Framework The current implementation plan for PIEPAA is for California’s Regional Centers to host the program. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework, one of the most cited and utilized implementation frameworks, will provide the guidelines for this implementation (Aarons, et al., 2011). This model supports program implementers to consider the barriers and facilitators across all four stages of the model, for both the inner context (within the Regional Centers) and the outer context (general community). The single greatest facilitator for the implementation of PIEPAA lies within the outer context: the Lanterman Act of 1969 (A. B. 225) and its revisions in 1977 (A. B. 846). This law requires that requires that “Californians with developmental disabilities have the opportunity to make choices and lead independent, productive lives as members of their communities in the least restrictive setting possible.” (DDS, 2023-a). Across all the phases of implementation, the existence of this law indicates a socio-political climate that supports the implementation of PIEPPA; in fact, the law specifically charges RCs with providing community outreach and education. Additionally, the law mandates that the necessary funding for ESs be provided to individual RCs, and thus for PIEPAA, both now and in the future. The single greatest barrier to the successful implementation of PIEPAA is stigma, particularly in the form of low expectations for autistic adults. This barrier can be found in both the inner and outer contexts and, like the Lanterman Act, will pose challenges to PIEPAA’s implementation across all four stages. PIEPAA is designed specifically to address such stigma in the larger community and its implementation will require that the RCs wrestle with stigma’s existence within its own system (institutional stigma, Goldbach, et al., 2015; Gronholm et al., 22 2017; Harmuth, et al., 2018; Link et al., 2014). A more detailed consideration of the facilitators and barriers through the lens of the EPIS framework is in Appendix P. The single biggest expense for PIEPAA’s implementation will be the ES’s salary. Since the ES must be allowed to allocate a portion of their community outreach and education time specifically to PIEPAA’s implementation, the salary must be considered an ongoing expense. After an initial startup investment of ten hours of the ES’s time, the ES will spend approximately four hours per month on PIEPAA. This represents an estimated 3% of the ES’s time to establish and implement PIEPAA for the first year and 2% of their time to maintain the program and translates into a startup expense of $2700 in salary and an ongoing expense of roughly $2, 235 per year. Additional expenses include equipment (either purchase or maintenance), mileage, IT supports, and miscellaneous supplies with an additional anticipated cost of roughly $1,000 per year. The income to cover PIEPAA’s expenses (salary, equipment, mileage, etc.) will come from the Department of Developmental Services’ annual budget allotment to the individual RCs (Vogel, et al., 2019). DDS uses a core staffing formula to ensure that the full costs associated with staff are covered in its per staff allocation and includes salary, benefits and any additional overhead costs incurred by staff (Vogel, et al., 2019) See Appendix L for a complete line-item budget. The success of PIEPAA’s implementation within the RC system will be via a count of RCs doing at least one PIEPAA presentation within a fiscal year. This count will be conducted annually at one of the monthly state-wide ES roundtables. Currently three out of the 21 RCs have expressed interest in incorporating PIEPAA into their community outreach and education programs; the remaining 18 have not been approached with this opportunity. 23 Communication strategies for PIEPAA’s implementation include a presentation about PIEPAA at the monthly ES roundtable (tentatively scheduled for October 2023), with follow up with individual ESs and RCs as necessary. As part of PIEPAA’s implementation within a specific RC, ESs are encouraged to share the program with their supervisors and colleagues. To facilitate this, a variety of internal communication materials have been developed including an infographic, a PowerPoint presentation and a newsletter article (see Appendix N). ESs currently meet with relevant stakeholder groups (e.g., autistic adults, employers, employment service providers, families, etc.) on a routine basis (Katherine S., personal communication, May 25, 2023). To maintain their input into PIEPAA, ESs will be encouraged to share their activities related to PIEPAA and to intentionally discuss the program, its impact, and any changes with the stakeholders. Leadership Challenges The biggest challenge faced by PIEPAA will be its adoption by the ESs and RCs. Several leadership strategies will be utilized to help ensure that multiple ESs and their RCs implement PIEPPA. Two elements of Tropman and Wooten’s (2010) 7Cs Approach to Leadership are directly relevant to overcoming this challenge: collaborations and contexts. Collaborations represent the network of connections that PIEPAA’s developer has and the social capital she can call upon to achieve its goals (Tropman & Wooten, 2010). Certainly, partnerships with strategic allies (e.g., influential ESs, certain DDS employees, etc.) must continue to be developed, nurtured, and utilized. Contexts, in this situation, refers to external, structural elements that influence or could influence PIEPAA’s implementation (Tropman & Wooten, 2010). The most relevant current context for PIEPAA is the HCBS Final Rule (Center for Medicare & Medicaid Services, 2022). 24 The federal law went into full effect in March 2023; this has left many service providers scrambling to provide services within the most integrated setting possible and to ensure that their clients have full access to their communities (Center for Medicare & Medicaid Services, 2022). This current reality should be exploited to increase the appeal of PIEPAA to the ESs and their supervisors. Although three RCs have tentatively committed to implementing PIEPAA, it is possible that none of them will follow through, leaving PIEPA a program without a home. Should this happen, organizations that provide supported employment services will be targeted as potential implementers. Private and non-profit organizations (e.g., local parent groups, self-advocacy groups, etc.) and other governmental agencies (e.g., the Department of Rehabilitation, the State Council for Developmental Disabilities, etc.) are additional possible adopters. Lastly, the pilot conducted by this doctoral student demonstrated that an individual can effectively implement PIEPAA for the short-term as additional collaborative partnerships are forged. Ethical Consideration and Applying Design Justice Principles PIEPAA upholds and demonstrates many of the National Association of Social Workers’ (NASW) core values as set forth in the Code of Ethics (NASW, 2017). For example, it provides opportunities for social workers to help individuals in need and addresses the wicked problem of unemployment among autistic adults, thus demonstrating NASW’s core value of service. PIEPAA provides a vehicle for pursuing social justice as it works to change the marginalized status of autistic adults. Because autistic stakeholders were centered in the development of PIEPAA and continue to play a vital role in its implementation, it also demonstrates the importance of human relationships as essential for social change. 25 PIEPAA was designed to respect the inherent dignity and worth of autistic adults, another one of NASW’s central values (NASW, 2017). Specifically, the proposition of hiring autistic adults is presented as a positive and sound business decision. However, PIEPAA could easily be misused to present autistic adults as individuals who should be hired out of pity. To prevent this from happening, PIEPAA’s manual cautions against this type of exploitation in several places. As described in the Methodology section above, the principles of Design Justice, particularly those of stakeholder inclusion and collaborative development, guided PIEPAA’s design (Design Justice Network, 2018). These same principles, along with the principals of utilizing non-exploitative interventions and creating a more inclusive community, will continue to drive its implementation. Conclusions and Implications The proposed Program to Improve the Employment Prospects of Autistic Adults (PIEPAA) is innovative because it focuses specifically on the demand-side of the employment equation (employers). The intervention takes an existing ad hoc process, typically done on a case-by-case basis, and codifies it into a standard, scalable program proactively delivered at the group level. Further, the innovation is focused on autistic adults with HSN, LVS and/or ID, a population that is often excluded from the workplace (Almalky, 2020). Lastly, this innovation applies a proven approach to addressing health-based stigma (e.g., HIV, serious mental illness, leprosy) to a novel population and utilizes the Theory of Planned Behavior to support the necessary behavior changes (Godin & Kok, 1996; Gronholm et al., 2017; Harmuth, et al., 2018; Rao et al., 2019). PIEPAA addresses the underlying causes of the high rates of unemployment among this marginalized group: stigma, low expectations, and ableism. It supports the Regional Centers to 26 fulfill their legal mandate to provide community education and outreach and addresses the current emphasis on the implantation of the HCBS Final Rule. The components of the program were selected based on established best practices on stigma reduction; the entire program is grounded on the Theory of Planned Behavior, ensuring that the ultimate outcome (hired autistic adults) is possible as a direct result of this presentation. As simple as it is to implement, PIEPAA has the potential to impact the current wicked problem of unemployment among autistic adults. Implications for Practice Executed as designed, PIEPAA will target the largest barrier to the employment of autistic adults: stigma. This reduction in stigma will benefit autistic adults, employers, and the local economy. PIEPAA directly addresses and ultimately alleviates employers’ concerns about this potential group of employees; this change in attitude means that there are more people to fill vacant jobs. Autistic adults bring a unique set of skills and talents to the workplace. Hiring them provides the businesses with the proven benefits of diversity and inclusion, improves the quality of life for autistic adults, and creates thriving businesses that may give back to the local economy and social efforts. As PIEPAA is presented to a wide variety of community, service, professional, and governmental groups, rather than strictly limited to groups of potential employers, it has the potential to impact the beliefs and behavior of general community members. This may translate into more inclusive churches, social clubs, volunteer opportunities, sports teams, etc., thus expanding the impact of and benefits from diversity and inclusion across the community. PIEPAA is a highly portable program, rooted in the Theory of Planned Behavior. As a result, PIEPAA can be implemented in any location, with the potential to change the behavior of the general community, as well as employers. By creating competitive, inclusive employment 27 opportunities and more inclusive communities, PIEPAA has the potential to radically change individual autistic adult’s lives, and their communities, throughout the United States. Next Steps In order to implement PIEPAA, formal partnerships with as many Employment Specialists within California’s’ 21 Regional Centers as possible must be developed. PIEPAA has been tentatively invited to present at the Employment Specialist’s Roundtable in October 2023; the first step, then, is to solidify this invitation. After the presentation, individual follow-ups with each ES will be scheduled, to address any concerns that they might have or to assist with the program implementation. From there, ongoing support and assistance with troubleshooting will be offered for a duration individualized to each ES. While waiting for the October Roundtable, presentations about PIEPAA and its purposes will be scheduled with state-wide and national organizations such as the State Council on Developmental Disabilities, Association of People Supporting Employment First (APSE), TASH, Stanford Neurodiversity Program, etc. These presentations will utilize the internal communication materials found in Appendix N and focus on acquainting members of these organizations with what PIEPAA is and does. Attenders of these presentations will be offered the opportunity to invite PIEPAA to present in their community; these requests will be conveyed to an appropriate ES, based on geography. Simultaneous to these steps, PEIPAA will be submitted to a variety of professional conferences including APSE, TASH, and Disability at Work, for presentation, as a workshop or poster, at their 2024 or 2025 annual conferences. Outcome data will be collected from the ESs and used to enhance such presentations. 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(2019, October 20). Where 75% of the workers are on the autistic spectrum. BBC.com. https://www.bbc.com/worklife/article/20191018-where-75-of-workers-are-on- the-autistic-spectrum Wright, J. (2015, September 21). Over the next decade, cost of autism could escalate sharply. SpectrumNews. https://www.spectrumnews.org/news/over-next-decade-cost-of-autism- could-escalate-sharply/ 40 41 Appendix A: Problem Landscape Impact of Unemployment on Autistic Adults 2 The impact of this high rate of unemployment can be considered from three perspectives: individual, employer, and societal. On the individual level, the effects of poor employment outcomes are felt across all areas of an autistic adult’s life. Most obviously, unemployment has a profound impact on whether or not an individual lives below the poverty line: unemployed individuals with cognitive disabilities such as autism are 200% more likely to live below poverty line than employed disabled individuals and experience greater dependence on family support and governmental assistance (Rogge & Janssen, 2019; Winson et al., 2018). This lower socio-economic status then places the autistic adult at greater risk for poorer physical health outcomes (Hirvikoski et al., 2016; Nicolaidis et al., 2013). Almalky (2020) found that, although the mechanisms are poorly understood, employment is strongly correlated with better physical health in autistic adults. Unemployed autistic individuals are found to have greater incidents of comorbid diagnosis of physical health problems such as diabetes, hypertension and obesity then employed autistics (Forde et al., 2021). Autistic adults who are unemployed are also at greater risk for premature death and a heightened risk for suicide (Hirvikoski et al., 2016; Nicolaidis et al., 2013; Wanberg, 2012). “I had a massive meltdown…I mean, on the floor, clothes off, and my mom had to rush over to check on me…My mom had to find someone to come help me… just so I could keep doing life,” said Isabelle M., an autistic adult, regarding her experiences with suicidal ideation (personal communication, June 16, 2022.) 2 This Appendix is copied in its entirety from the final paper for 790b (The Problem and Solution Landscape) and can all attributed to the author of this capstone project (Candreva, 2022). 42 Being unemployed also has a negative impact on the autistic adult’s mental health and social relationships (Howlin & Magiati, 2017; Roux, et al., 2015; Turcotte et al., 2016). As Niko B., an autistic self-advocate stated, “If I don’t any economic value, what’s my purpose in life?” (Boskovic, 2022). This sense of insignificance, prevalent among autistic individuals who are unemployed, may help to explain why they are more likely to experience anxiety and depression than those who were employed (Magiati & Howlin, 2019). In turn, this increase in mental health issues is thought to play a role in the comparatively high number of pharmacological interventions used with autistic adults (Magiati & Howlin, 2019). Autistic individuals with a cooccurring mental health diagnosis also struggle to find treatment; this is due, in part, to their unemployment and the resulting lack of access to private insurances (Howlin & Magiati, 2017). Doug B., another autistic self-advocate, expanded on this barrier by saying, “Medicaid sucks. It doesn’t cover a lot of things that private insurances do, which I couldn’t get…without a job” (personal communication, June 2, 2022). Employment has been found to enhance interpersonal relationships and to forge strong connections through shared interests (Almalky, 2020; ANCOR, 2022). Autistic individuals who are employed benefit from stronger social networks and greater community inclusion (ANCOR, 2022; Chen et al., 2015; Khayatzadeh-Mahani et al., 2020). These benefits are hypothesized to arise from two sources. First, the employed autistic person spends more time in the community (workplace, related settings, etc.) and with other people (colleagues, employers, customers, etc.); this sheer volume of time allows for the development of stronger relationships and networks (ANCOR, 2022; Khayatzadeh-Mahani et al., 2020). Second, employed autistic individuals are seen as contributing to society rather than burdening it. This results in a decrease in social stigma, which enhances social value and connections (Almalky, 2020; Chen et al., 2015). 43 Unemployment and the resulting lack of income also limits autistic adults’ independence. In fact, only about 7% of adults on the autism spectrum live independently; the remaining 93% live in group homes or with extended family (Gotham et al., 2015). Ayers et al. (2018) and Almalky (2020) both found that employed autistic individuals experienced greater autonomy and independence than did unemployed autistic adults. This manifested itself in not only in living arrangements but in improved self-advocacy and decision-making skills as well as a greater sense of personal and financial empowerment. In sum, across all of life’s domains, unemployed individuals on the autism spectrum experience a lower quality of life than employed autistic adults (Ayers et al., 2018; Bishop-Fitzpatrick, et al., 2018; Khayatzadeh-Mahani et al., 2020). “I’ve been employed and unemployed,” said Doug. B. “I like being employed a lot better” (personal communication, June 2, 2022). Although the impact to employers is real, it does not quantify easily. For example, due to a variety of issues such arising from the pandemic, employers are now experiencing an acute labor shortage. Currently, for every four job openings in America, there are only three unemployed Americans (Bergeron, 2021). David H., a small business owner in Georgia, summed this up by saying “I need to hire at least, you know, 60 hours’ worth of part time workers so that's two to three people and I can't find them… and it’s not just me, that’s all the kennel owners in my area” (personal communication, June 13, 2022). To expedite the hiring process, some employers now use automated hiring software. These systems screen resumes for specific keywords, utilize chatbots to screen for pre- determined responses, administer tests for specific skills or personality traits, and analyze facial expressions and speech patterns for select responses (Bergeron, 2021). Because of the atypical communication styles of autistic adults, this software can inadvertently (or perhaps deliberately) 44 screen out autistic applicants (Akin et al, 2022). In addition, over 50% of all hiring managers refuse to hire a fully qualified person just because they are autistic (Pazzanese, 2021; Praslova, 2021). As a result of this smaller pool of ‘qualified’ applicants and the stigma associated with autism, the job may go unfilled and the business may struggle to remain afloat (Akin et al., 2022; Hoff & Kaplan, 2021; Pazzanese, 2021). Employers that fail to hire individuals on the autism spectrum are also missing many of the advantages associated with diversity in general and neurodiversity in particular (Goel, 2018; Hayward et al., 2019; Krzeminska et al., 2019; LEAD, 2015). Diversity of any type results in novel viewpoints, increased creativity, and a more flexible workforce (Goel, 2018; Mor Barak, 2016). Having a neurodiverse workforce, in particular, increases productivity, enhances innovation, and streamlines operations (Austin & Pisano, 2017; Goel, 2018; Hayward et al., 2019; Wojciechowski, 2019). Many of the accommodations made for autistic adults (such as flexible hours, remote work, and quiet working places) typically benefit all the employers, which in turn leads to increased profits, innovative problem-solving, and improved workplace morale (Hayward et al., 2019; LEAD, 2015; Wojciechowski, 2019). On a societal level, poor employment outcomes among adults on the autism spectrum lead to increased reliance on government funding and to lost productivity, for both the autistic individual and their family (Black et al., 2019; Cakir et al., 2020; Ganz, 2007; Scott, et al., 2018). Cakir et al. (2020) estimated that the annual cost for lost productivity per adult autistic is $38, 456 and that the annual lost productivity cost for the parents or caregivers of that unemployed adult autistic is $31, 042. Combine this with increased governmental support and the higher medical (both physical and mental) costs associated with unemployment, and the total estimated annual cost of autism is $268 billion per year (Wright, 2015). This total is expected to rise to 45 $1.36 trillion annually by 2030 and $5.54 trillion annually by 2060 (Blaxil et al., 2022). However, even this figure is likely to be an underestimate as it does not include the impact to the autistic adult’s social life or costs associated with accommodations and respite services (Rogge & Janssen, 2019). Indeed, researchers in Australia determined that moving 100 autistic adults from government benefits to full-time employment would save the country close to $1 million dollars in welfare payments and services each year and generate an additional $1 million Australian dollars in taxes, for a total revenue change of $2 million dollars per year (Hedley, Wilmot et al., 2017). Given that American currently has close to 6.2 million unemployed autistic adults, employing even just 1% (620, 000 adults) could result in an annual cost savings of approximately $570 million dollars (adjusting for inflation and allowing for exchange rate) (Hedley, Uljarevic et al., 2017). Theory of Causation What prevents an autistic adult from being hired? Is it that he does not make eye contact during an interview? Or that the hiring manager is disconcerted by this fact? Maybe it’s the type of questions the hiring manger asks (“Tell me where you see yourself in 3 years”) instead of the blunt answers the autistic adult gives (“I can’t see the future.”). Once hired, what prevents the autistic adult from maintaining his employment? Is it his restricted and repetitive behaviors? Or the co-workers who are bothered by them? Perhaps it’s the open floor plan with lots of noise and small talk rather than the autistic adult’s need for a quiet, focused place to work that results in difficulties. Or does the problem lie in the mismatch between the autistic adult and their work environment? The answer to these questions depends upon the lens used to frame the perspective on disabilities in general and autism specifically. 46 Three primary lenses, or models, can be used to frame the wicked problem of unemployment among adults on the autism spectrum: the medical model, the social model and the biopsychosocial model (Amaral et al., 2019; Beenstock et al., 2021; Disabled World, 2022; Doyle, 2022). The medical model has been the dominate model since the mid-1980’s and in this model, autism is viewed as a set of deficits or impairments, as an illness that needs to be cured through intensive, individualized (and often medical) interventions (Disabled World, 2022; Doyle, 2022). Researchers, and other professionals utilizing the medical model typically see the barriers to successful, competitive employment as occurring within the individual autistic adult (Amaral et al., 2019; Disabled World, 2022; Doyle, 2022). According to the medical model, the cause of high rates of unemployment among autistic adults is due to the adults themselves and the solution is relatively simple: cure autism (Bishop-Franklin et al., 2018; Doyle, 2022). Once the adult no longer has autism, they can easily find a job, get hired, and maintain that employment indefinitely. In the social model, the problems associated with the high rates of unemployment among autistic adults are seen as rooted within the larger society (Beenstock et al., 2021; Disabled World, 2022; Doyle, 2022). Researchers and other professionals utilizing the social model of disability view the barriers to employment as occurring in the workplace itself and on a societal level. Within the workplace, barriers to employment can be found within the hiring process as well as in maintaining the autistic adult’s ongoing employment. For example, several researchers found that conventional recruitment methods and standard job interviews, a focus on teamwork and social skills even when these skills are not required by the specific job, and an emphasis on conformity to scalable work processes often screen out autistic individuals during the hiring process (e.g., Austin & Pisano, 2017; Hedley, Uljarevic et al., 2017; Howlin & Magiati, 2017). 47 In addition, there is a lack of long-term and appropriate support programs specifically targeted to the unique needs of autistic adults (Beenstock et al., 2021; Bishop-Franklin et al., 2018). The vocational rehabilitation workers associated with these programs often have little to no training on the specific challenges faced by adults on the autism spectrum and thus are unprepared to provide the individualized support and training necessary for such individuals to become employed (Gerhardt, et al., 2014). Katherine S., a Regional Center Employment Specialist, described it this way: “…they (Department of Rehabilitation counselors) don’t get any specific training for Regional Center (autistic) clients…. but they have gone through a fair amount of schooling specific to rehabilitation” (personal communication, May 16, 2022). When a job placement program is successful in helping an autistic individual get hired, the support services frequently disappear after only a few months, leaving the employer with no assistance in navigating the ongoing needs and challenges of an autistic employee (Palumbo, 2020; Scott, et al., 2017). “I was very hesitant,” said Reid J., a business owner who employs autistic adults, “Very hesitant to hire someone this time around because last time, the support just disappeared and after that, it was a disaster” (personal communication, June 29, 2022). On a societal level, many of the barriers arise from the misinformation surrounding autism (e.g., autistic individuals are viewed as dangerous, rude and inflexible). “Hire someone on the spectrum?” said Andy B., a business owner who has never hired an autistic individual. “I don’t know what that means, and I’m scared of it. So no, no way.” (personal communication, June 9, 2022). This stigma both prevents the hiring of autistic individuals and decreases the length of time employed (Johnson & Joshi, 2016). Multiple researchers have also shown that the autistic employee is aware of this stigma and the resulting social isolation; this alienation also 48 often reduces the autistic’s tenure in a given position (e.g., Austin & Pisano, 2017; Harmuth, et al., 2018; Scott et al., 2017). The biopsychosocial model forms the third possible theory of causation. In this model, both the possible functional limitations of autistic individuals and the problems found within the larger society are acknowledged (Disabled World, 2022; Doyle, 2022; Harmuth, et al., 2018; Morson, 2016). Utilizing this model suggests that intervention and treatment should focus more on adjusting the fit between the autistic adult and their workplace than about treating a medical problem or righting a social wrong (Doyle, 2022). This model allows professionals to provide the therapeutic interventions required by the autistic adult (the medical model) and to work towards structural changes on the legislative, community, and workplace levels in order to improve employment outcomes for autistic adults (the social model) (Doyle, 2022; Khayatzadeh-Mahani, et al., 2020; Nicholas et al., 2019). “…it’s important for autistic adults to get vocational training and for the employer to make adjustments so it (the employment process) can be successful,” agreed Jim T., a vocational counselor (personal communication, June 9, 2022). “Without one or the other, it just doesn’t work. You gotta have both…for a successful job placement.” The 30 interviews conducted support the biopsychosocial model as the most applicable theory of causation. Isabelle M, an autistic adult, summarized it by saying, “I think the difficulties in obtaining and maintaining employment are a product of the interaction between intrinsic challenges (of autism) and societal misunderstanding” (personal communication, June 16, 2022). Over 25% of the interviews centered on the topic of Barriers to employment; every single person raised this issue during the discussion. It was the second most popular topic, following closely behind the system’s (e.g., DDS, DOR, RCs, etc.) role in the wicked problem of unemployment among autistic adults. Within the major topic of barriers, the single largest barrier 49 described were the attitudes held by everyone involved in the process of finding and maintaining employment; 28 individuals (out of 30) felt that attitudes played a significant role in the unemployment rate. Attitudes such as ableism (36% of comments), infantilism (20%), and paternalism (20%) accounted for the majority of barriers arising from society. “There is this underlying assumption,” said Darline D., a policy expert, “that individuals with disabilities are limited in what they can do” (personal communication, June 3, 2022). Still, 12 individuals felt that at least some of the barriers to employment lay within the autistic person themselves. “One of the biggest challenges is that sometimes some executive functioning skills can get in the way so people… they might not see an e-mail or lose an e-mail or sometimes it's, you know, forgetting to respond or those types of things often happen. So that’s a big barrier too,” said Reina F., a researcher on the issue of unemployment among autistic adults (personal communication, June 9, 2022). “I’m not gonna lie,” said Isabelle M., an autistic adult. “Some of the problems come straight from me – what I can do, what I can’t do” (personal communication, June 16, 2022). In sum, the interviews confirmed that biopsychosocial model was the most relevant theory of causation 50 Appendix B: Stakeholder Analysis Voc. Program Staff Adult Day Programs BAD ACTORS Autistic adults (HSN) Autistic Adults (LSN) BENEFICIARIES Regional Centers DDS DOR GATEKEEPERS Employers Colleagues RC Staff Direct Support USERS Comm. College DSSP Special Ed Teachers Family Members HIDDEN ACTORS Autistic Researchers Neurotypical Researchers Employment Workgroup EXPERTS PIEPAA 51 Stakeholder: Power-to-Interest Alignment Employment Service Providers IMPACT OF PROBLEM/PROJECT INFLUENCE ON PROBLEM/PROJECT HIGH LOW MEDIUM HIGH LOW MEDIUM Employment Specialists Regional Centers Autistic Adults Vendors Employers Adult Day Programs DDS Special Ed. Teachers Family Members DOR Vocational Training Programs 52 Stakeholder Analysis Stakeholder group Impact of project on them? Influence over project? What is important to them? How can they contribute to the project? How can they block this project? What are some strategies for engaging them? Autistic adults High Moderate Actual jobs – CIE preferred Lived experience. Success stories. Advocacy. State that they cannot do CIE. Protest against CIE. Complain of exploitation. Invite input. Include in videos. Invite to assist with presentations. Approach advocacy groups. Regional Centers Moderate High E1st, CIE, HCBS Final Rule, Lanterman’s Act – compliance Money. Time. Connection hub. Refuse to allow ESs to participate. Support individual ES to approach their bosses. Employment Specialists High High Getting autistic adults into CIE Do presentations. Advocate for program. Make connections. Not do it. Not be proactive. Conduct business as usual. Presentations to ES Roundtable. Individual meetings. Tailor presentation. Employers High Moderate Positions filled. Profit. Actual jobs. Success story videos. Not respond to requests to hire. PIEPAA itself. Directly address concerns. Family members Moderate Low Happy children. Remove opportunities to fail or be embarrassed. Connections for presentations and jobs. Advocate within RCs for program View CIE as exploitation or impossible. Protest against it. Present about PIEPAA to parent groups. Ask for their contacts. Address their concerns. DOR Low Low E1st, CIE, HCBS Final Rule, Lanterman’s Act – clients working Connections with potential employers. Ignore it. Offer their own presentations as competition. Present about PIEPAA to them at local employment workgroups. DDS Low Moderate E1st, CIE, HCBS Final Rule, Lanterman’s Act – compliance Funding. Oversight. Refuse to fund ES position or fund this portion. Support ESs to present to PIEPAA to them Employment service providers High Moderate Swift placement to obtain funding. Job placement more important than job fit. Outreach to interested employers. Refuse to utilize presentation. Fail to follow up on potential employers. Roundtable. Individual meetings. Customize presentation for them. 53 Stakeholder group Impact of project on them? Influence over project? What is important to them? How can they contribute to the project? How can they block this project? What are some strategies for engaging them? Adult day program providers Moderate Moderate Pre-vocational component. Keeping participants. Offer presentations to participants. Utilize connections. Tell families/autistic adults that this is an impossible dream. Refuse to include work component. Speaking to them in their professional meetings. ES outreach. Community colleges/V oc. training programs Low Low Job skills training. Existing connections to employers and potential groups. Limited ways to block. Mostly by ignoring it. Word of mouth. Share PIEPAA at local Business Advisory Committee meetings Special education teachers Low Moderate Successful transition to adulthood. Assure parents that work is possible. Connections for presentations and employment. Reinforce stigma and low expectations. Word of mouth. Share PIEPAA at local Business Advisory Committee meetings 54 Appendix C: Logic Model INPUTS ACTIVITIES OUTPUTS OUTCOMES What we invest What we do Who we reach What we measure Short-term results Intermediate results Long-term results ● Curriculum and/or presentation ● Pre- and post- test analysis ● Personnel, including autistic adults ● Time ● Materials ● Technology, including social media ● Partners and other contacts in this field ● Space ● Train presenters (autistic and/or neurotypical) ● Give presentations and/or workshops that: ● Incorporate best practices from health- related stigma reduction programs ● Provide actionable, accurate information to address myths, misconceptions and concerns re: hiring autistic adults ● Address subjective norms and pluralistic ignorance and ● Request behavior change within individual’s control. ● Administer pre- and post- tests ● Employers ● Service clubs ● Community and civic organizations ● Government commissions, councils, offices, etc. ● Parents ● Professional organizations ● # workshops and presentations given ● # individuals trained ● # people requesting follow- up information or contact ● Changes in pre- and post-test scores Knowledge and skill building outcomes such as: ● Increase of knowledge for employers ● Identify biases & challenge thinking of employers, employment providers, and other community members ● Create and incentivize intention to change hiring behavior Behavioral outcomes such as: ● Targeted behavior changes (e.g., information shared, contacted hiring managers, verified ADA compliance, etc.) ● Increase employment among autistic adults with HSN, LVS and/or ID Systemic and programmatic outcomes including: ● Autistic adults experience social inclusion, financial stability, etc. ● Local policy initiatives re: employment of autistic adults ● Community benefits from diversity ● Reduce structural stigma ● DEI programs expanded to include disability Assumptions External Factors ● Autistic individuals want to be employed. ● Professionals serving autistic adults will support such employment. ● Parents and loved ones believe their autistic family members can and should be employed. ● Existing employers need new employees. ● Organizations will host PIEPAA presentations. ● Culture/Community, finances, and demographics ● HCBS Final Rule put into effect in March 2023 ● Existing service codes, funding bias and reimbursement rates ● Department of Rehabilitation offering supply-side grants ● Current high demand for additional employees 55 Appendix D: Employment Specialist Job Description Sample Job Description for an Employment Specialist The Organization North Los Angeles County Regional Center “NLACRC” is a private, non-profit agency that is contracted with the State of California, Department of Developmental Services, to provide services to individuals with intellectual and developmental disabilities. NLACRC is one of the largest regional centers in California and has proudly served the San Fernando Valley, Santa Clarita Valley, and Antelope Valley since 1974. We serve individuals across the lifespan from infants and toddlers, school age children, transition-age youth, to adults and aging adults. SUPERVISION Receives supervision from the CMS Project Evaluator Manager and receives technical guidance, direction, and support from interdepartmental management staff (Community Services Director and Chief Financial Officer). THE POSITION AND JOB SUMMARY Responsible for ensuring the development and delivery of services that lead to competitive integrated employment in partnership with our community partners, staff, consumers, and their families. • Provides leadership in accordance with the Center’s Mission and core values. • Creates and assists in the implementation of processes that provides oversight of internships and employment and the achievement of employment outcomes over time. • Represents the Center and participates in community outreach, presentations, meetings and other activities. • Creates, maintains, and distributes information material, policy and procedures for use by regional center, service providers, consumers, and their families. • Develops a system to track and maintain internship and employment data in order to assist with the preparation of performance contract measures. Annually, use the data collected to prepare reports regarding internships and employment for use by the Department of Developmental Services. • Act as the liaison to local providers of employment services. Participates in the development of paid internship and employment opportunities for consumers. • Coordinates with case management staff, community services staff, and fiscal staff regarding the payment to service providers for the achievement of internships or competitive employment goals. • Develop and implement an internal and external communication strategy that promotes outreach and provides continuous education to employees, service providers, consumers and their families regarding integrated competitive employment, 56 Workforce Innovation Opportunities Act (WIOA), and internships. Provide trainings to staff, consumers and families, service providers, and community partners. • Develop benchmarks and metrics to measure success of individual programs. Use the collected information to develop reports for NLACRC. • Develop relationships with the business community to help promote job opportunities. • Performs all other assigned duties as needed Employment Standards Bachelor’s degree in rehabilitation counseling, social work or a closely related field; three years of experience working in programs providing services for individuals with developmental disabilities and two years of experience in employment recruitment or job development. Skills and Abilities • Specialized working knowledge of developmental disabilities; prior Regional Center, Department of Rehabilitation, or related agency experience preferred • Experience with employment recruitment or job development • Has experience with fostering and developing relationships within communities • Ability to perform accurately and timely in a fast-paced environment • Ability to analyze complex material and provide clear oral and/or written communication to staff and senior management • Ability to develop and foster teamwork • Ability to work effectively and collaboratively with diverse groups • Experience in training and public speaking • Experience in developing policies and procedures • Experience using and applying statutes, regulations, policies and procedures • Proven record of excellent organizational, communication and time management abilities • Intermediate computer skills, database experience preferred Essential Requirements Reliable transportation, valid CDL and acceptable driving record (or acceptable substitute) required. NLACRC Offers an Excellent Benefits Package: We offer employees a variety of health and dental plans. • Health Insurance - NLACRC pays the full cost of coverage for certain Medical plans for employee only. We also provide a generous contribution to additional plans that the employee may select for employee only or employee and dependents costs. 57 • Dental Insurance – NLACRC pays the full cost of the Dental DMO Plan for employees and eligible dependents. We also offer a Dental PPO plan with a low employee monthly contribution for employees and eligible dependents • Pre-Tax Flexible Spending Account for eligible health care expenses • Pre-Tax Dependent Care Flexible Spending Account for eligible dependent care expenses • No cost Life, Accidental Death & Disability, Long Term Disability Insurance for employees • No cost Vision plan for employees and eligible dependents • Retirement plan - NLACRC is a member of CalPERS which is a defined benefit plan that provides a monthly retirement allowance for eligible employees • NLACRC offers two (2) deferred compensation plans - 457 and 403(b) • Participate in the Public Service Loan Forgiveness program • Paid Time Off – Eligible for 3 weeks of accrued vacation in the first year, 8 hours per month sick time, education, wellness and sabbatical time • Holidays – NLACRC offers 13 paid holidays throughout the year • Most positions are offered a hybrid – remote option Professional Development Opportunities & Growth NLACRC values the professional development of staff! Variety of career paths for entry-level management positions for those seeking leadership opportunities in the social services field. Diversity, Equity, and Inclusion At NLACRC, we value and celebrate diversity! In September 2021, NLACRC launched an initiative to enhance and strengthen our commitment to diversity and belonging. Covid-19 Job Requirements Upon job offer acceptance, candidates will be required to show proof of COVID-19 vaccination. A reasonable accommodation may be requested for an exemption from the COVID-19 vaccination requirement. Compensation This position is non-exempt. Regular Salary: $25.14 - $27.07. NLACRC is an equal opportunity employer. Further, NLACRC will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. 58 Appendix E: HCBS Final Rule Home and Community-Based Services (HCBS) Final Rule FOR CONSUMERS AND FAMILIES: People with intellectual and developmental disabilities are provided many services because of the Lanterman Act. Many services people receive are paid for with state and federal money from the federal Centers for Medicare and Medicaid Services (CMS). Therefore, California must comply with what is called the Home and Community-Based Services (HCBS) Final Rule. This rule sets requirements for HCBS settings, which are places where people live or receive services. Each state has until March 2022 to help providers comply with the HCBS Final Rule. The HCBS Final Rule Applies to:  Residential and non-residential settings; including certified and licensed homes  Day programs, and other day-type services  Employment options and work programs What is the Goal of the HCBS Final Rule? To enhance the quality of services provided by:  Maximizing opportunities and choices for individuals  Promoting community integration by making sure individuals have full access to the community  Making sure individuals have the opportunity to work and spend time with other people in their community who do not have disabilities  Ensuring individual preferences are supported and rights are protected  Establishing person-centered service planning requirements, which includes a process driven and directed by the individual to identify needed services and supports The HCBS Final Rule Does NOT Apply to:  Nursing homes  Hospitals  Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)  Institutions for mental diseases (IMD) All Settings The Final Rule requires that you can:  Spend time in, and being a part of, your community  Work alongside people who do not have disabilities  Have choices regarding services and supports, and who provides them  Have control of your schedule and activities Residential Settings Provider Owned or Controlled In addition to the requirements applicable to all settings, the Final Rule requires that you have:  Choice about your roommates  Privacy in your room, including a lock on your door  Control of your schedule and activities  The ability to have visitors of your choosing, at any time  Freedom to furnish and decorate your room  A lease or other legal agreement, protecting you from eviction 59 Home and Community-Based Services (HCBS) Final Rule FOR PROVIDERS: How will your service as a provider change? If you are a service provider who provides services to multiple consumers in the same location, we have to make sure these services do not isolate individuals from the community. The Final Rule says that settings must be integrated and support full access to the community. As a provider, you may need to modify where and how your service is delivered to meet the HCBS Final Rule. Policies and program designs may need to be changed and training to your staff may be necessary to assure their understanding of the new expectations. CMS ’ HCBS Final Rule Requirements The setting: 1. Is integrated in, and supports full access of individuals receiving Medicaid HCBS to the greater community to the same degree of access as individuals not receiving Medicaid HCBS. 2. Is selected by the individual from among setting options including non-disability-specific settings and an option for a private unit in a residential setting. 3. Ensures an individual's rights of privacy, dignity and respect, as well as freedom from coercion and restraint. 4. Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to: daily activities, physical environment, and with whom to interact. 5. Facilitates individual choice regarding services and supports, and who provides them. In provider-owned or controlled residential settings: 6. The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services. 7. Each individual has privacy in their sleeping or living unit; including doors lockable by the individual, choice of a roommate if sharing a unit, and the freedom to furnish and decorate their sleeping or living units within the lease or other agreement. 8. Individuals have the freedom and support to control their own schedules and activities, and have access to food at any time. 9. Individuals are able to have visitors of their choosing at any time. 10. The setting is physically accessible to the individual. Assessing Provider Settings All providers will soon be required to complete a self- assessment survey that will help determine whether or not a setting complies with the HCBS Final Rule or if modifications are needed. For settings that require changes, there will be time to develop transition plans. Training will be provided on the self- assessment process and expectations, and additional information will be posted on the DDS webpage. Where can I find more information? To ask a question, make a comment, or get more information about the HCBS Final Rule, email HCBSregs@dds.ca.gov. For more detailed information on the HCBS Final Rule and California’s Statewide Transition Plan, please visit: http://www.dds.ca.gov/HCBS/ http://www.dhcs.ca.gov/services/ltc/Pages/HCBSSt atewideTransitionPlan.aspx https://www.medicaid.gov/medicaid/hcbs/index.ht ml 60 Appendix F: Solution Landscape Analysis of Existing Solutions 3 Current solutions for addressing the wicked problem of unemployment among autistic adults can be considered from the following perspectives: policies, approaches, and programs. Laws and Policies Impacting Employment Laws and public policies to address this issue exist at both the federal and state levels. Nationally, the first major piece of legislation passed is the Vocational Rehabilitation Act of 1973 (Public Law 93-112). Enacted by the United States Congress on September 26, 1973, this law requires affirmative action in employment by the federal government and its contractors. This law also prohibits discrimination on the basis of disability in programs conducted by federal agencies or receiving federal financial assistance as well as in the employment practices of the federal agencies and contractors. Based on the Civil Rights Act of 1964 (Public Law 88-352), Section 504 of the Vocational Rehabilitation Act established civil rights for disabled individuals and mandated that opportunities in education, employment, and other community settings be provided. Further, this same section required that reasonable accommodations (such as special workspaces or individual assistance as necessary) be provided to disabled employees. The law placed two limitations on this requirement. First, the disabled employee must be able to perform the essential functions of the job and second, the accommodations cannot cause the employer undue hardship (Wilcher, 2018). This law began the funding for vocational rehabilitation interventions such as supported employment and competitive employment. 3 This Appendix is copied in its entirety from the final paper for 790b (The Problem and Solution Landscape) and can all attributed to the author of this capstone project (Candreva, 2023). 61 The Americans with Disabilities Act of 1990 (Public Law 101-336), commonly known as ADA, extended the accomplishments of the Vocational Rehabilitation Act of 1973. It expanded the list of conditions that can be considered disabilities and, for the first time, included autism in that list. In terms of employment, the ADA specified that an employer cannot discriminate in any part of the employment process, including the job application process, on-the-job training, and the promotion of disabled employees. As with the Vocational Rehabilitation Act, the ADA mandates that an employer must provide reasonable accommodations to job applicants and employees with disabilities, under the same conditions (disabled individual can actually do the job and the accommodation does not cause undue hardship) as before. Two other pieces of federal legislation, the Workforce Innovation and Opportunity Act (WIOA) and the Home & Community-Based Services (HCBS) Settings Final Rule also play a critical role in the employment of autistic individuals. The WIOA (Public Law 113-128) was signed into law in 1998 and serves as the primary federal workforce development legislation. It established the American Job Centers (also called One-Stops), a one-stop system that supports both job seekers and employers (U.S. Department of Labor, 2020). Job seekers, including those with autism, can receive skills assessments, job training and education, and on-the-job support. The One-Stops are also authorized to address barriers such as transportation, clothing or childcare. For employers, the One-Stops help to identify job openings, recruit for those openings, host job fairs, and provide ongoing information and support (U.S. Department of Labor, 2020). The HCBS Final Rule (CMS 2249-F/2296-F) was signed into federal law in 2014 and requires that any employment, housing or community-based service receiving federal funding be conducted in the least restrictive setting possible (Center for Medicare & Medicaid Services, 2022). Specifically, it directs providers to ensure that disabled individuals, including those on the 62 autism spectrum, work in competitive, integrated settings rather than in segregated or enclave placements (see below for descriptions of these approaches). States were given until March 2023 to comply with this ruling; however, states and service providers are having difficulties in meeting this deadline and have asked for additional time (Bowers, 2022). The Employment First (E1st) initiative is not a federal policy but is a national systems- change framework predicated on the believe that all individuals, including those with autism and other significant disabilities, can and should work (Bowers, 2022). E1st establishes competitive integrated employment (CIE, see below for a complete description of this model) as the essential approach to such employment and encourages states to consider such critical issues as reimbursement rates for service providers, the phase out of sheltered workshops (see below), interagency coordination, and employer engagement (Mank & Luecking, 2017). Thus far, 20 states have passed legislation stating that employment should be the first choice for disabled individuals and prioritized over all other service options; California is an Employment First state (Mank & Luecking, 2017). California has a unique state law that addresses services to autistic individuals, including employment, informally called the Lanterman’s Act. In 1966, encouraged by the establishment of the President’s Committee on Mental Retardation, the California Department of Public Health and Mental Retardation contracted with two private agencies to provide services for individuals with developmental delays; these pilot projects were located in Los Angeles and San Francisco (Frank D. Lanterman Regional Center, 2017). Around the state, parents of individuals with developmental delays began lobbying for similar centers in their areas and in 1969, Governor Ronald Reagan signed the Lanterman Mental Retardation Services Act (AB 225), which provided for a comprehensive system to address the needs of the developmentally delayed 63 (Frank D. Lanterman Regional Center, 2017). Since that time, the Lanterman Act has undergone multiple amendments and revisions to reflect changing federal laws as well as prevailing attitudes. Throughout these changes, the intent of the act has remained essentially the same: to ensure that “Californians with developmental disabilities have the opportunity to make choices and lead independent, productive lives as members of their communities in the least restrictive setting possible” (California DDS, 2020). Approaches to Employment There are three primary approaches to employment among adult autistics: non- competitive employment, supported employment, and customized employment. Non-competitive employment, also known as a sheltered workshop or 14(c) employment, has a long history; the first such workshop was established in 1838 to provide employment for blind persons. In 1938, President Franklin Roosevelt signed the Fair Labor Standards Act, which established minimum wage, overtime pay, recordkeeping, and youth employment standards. This law also contained a little-known section called 14(c), which exempted disabled employees from the minimum wage requirement, and was intended to incentivize employers to hire wounded veterans returning from the wars. In the 1950s, however, parents of adult disabled children, with good intentions, began sheltered workshops as a way to fill their disabled children’s days and to keep them out of institutions (Carden, 2021). As of October 2020, over 1,200 employers nationwide take advantage of the 14(c) Subminimum Wage Certificate Program, allowing them to pay close to 100,000 workers an average of $2.25 per hour (Carden, 2021; Marzullo, 2020). With the implementation of the E1st initiative and the enactment of the HCSB Final Rule, however, these segregated workshops are slowly being phased out. 64 The second approach used to address unemployment among autistic adults is supported employment. Kamen (2020) outlines five principals of supported employment. First, eligibility is based on the autistic adult’s choice, and therefore, nobody can be prevented from participating in this process. Second, the goal is to find full- or part-time competitive employment that pays at least the minimum wage; the job must be open to any person who applies and is not created for an autistic individual. Third, supports are provided immediately upon request, with no requirement to complete any form of pre-vocational training (Kamen 2020). Fourth, the individual is supported during job preparation (such as resume writing or interview practice), job search, and initial onboarding. Fifth, ongoing support is provided until the autistic person and the employer agree that no such support is needed. Supported employment is considered an evidence-based practice (Becker et al., 2001; Fong et al., 2021). Supported employment may result in one of two types of placements. The first is an individual placement, in which a single autistic individual is placed into a job and is the only person responsible for all the duties of that job (Kamen, 2020). Although several autistic individuals may work at the same physical location, no more than two autistic individuals should be working at the same room at any given time (Suad B., personal communication, May 13, 2022). This type of placement usually, but not always, leads to greater integration with neurotypical colleagues (Kamen, 2020). The second type of supported employment is the enclave model, in which a group of two to eight workers function as a team, at a single worksite. Enclave participants may each work a separate job (such as clerical staff for a large office) or they may share the job duties of a single job (such as cleaning a single hotel room). They typically work within close proximity to each other and are supported by a single job coach (Ulrich, 2013). Enclave supported employment does not lend itself to integration with 65 neurotypical colleagues and often results in a form of segregation where the autistic workers are viewed as a group rather than as individuals (Carole W., personal communication, May 31, 2022; Kamen, 2020). Ideally, supported employment should represent a transitional stage between full-time support in a segregated workplace to integrated employment with only natural supports. In reality, however, this happens less than 5% of the time (Almakly, 2020). Once an autistic individual enters supported employment, “…the agency will tell you that they (the autistic employee) continue to need job coaching and support for 20% of their working hours. No matter what, you never hear ‘we’re all done’ from the vendor (service provider)” (Joyce H., personal communication, May 24, 2022). Customized employment, an evidence-based practice, is the third major model used in addressing the challenge of unemployment among autistic adults (Almakly, 2020; Fong et al., 2021; Inge et al., 2018). It contains all of the same features of supported employment (adult’s choice, integrated employment, no pre-qualifying, and continuous support from start to end) but there are two major differences. First, in supported employment, the autistic adult is fit into the available jobs but in supported employment, however, the job is tailored to fit the autistic adult (Baker-Ericzen et al., 2022). This involves a flexible process in which the autistic adult’s unique skills, and interests are identified through a process known as discovery and simultaneously, the employer’s needs and the work setting realities are delineated. The job duties are then personalized to meet the needs of both the autistic adult and the employer. In other words, the job is fit to the autistic adult rather than the other way around, as is done in supported employment (Almalky, 2020; Baker-Ericzen et al., 2022; Fong et al., 2021). Second, customized employment has no group model. Every placement is an individual placement. While the 66 activities undertaken in both supported and customized employment are basically the same, the job development process and job placement outcomes differs (Almalky, 2020; Baker-Ericzen et al., 2022; Fong et al., 2021). Typically, the autistic employee’s salary is paid by the employer in both supported and in customized employment. Employers are expected to make reasonable accommodations at their own expense; however, some funding exists to help with these modifications (Katherine S., personal communication, May 16, 2022; SEDL, 2017). Job coaching and support is paid for and supplied by a private service provider who is contracted with either a governmental agency such as DOR, DDS, or the RC system of California. An exception to this rule is the use of paid internship programs, in which the full costs of the autistic employee are covered by the governmental agency through the duration of the internship (Joyce H., personal communication, May 24, 2022; SEDL, 2017). Programs Currently, only eleven programs have been nationally recognized as an evidence-based program or an emerging/effective practices or program in addressing the wicked problem of unemployment among autistic adults (Fong et al., 2021; SEDL, 2017). While these programs could be discussed individually, it is perhaps more beneficial to explore which methods and techniques are common among these interventions as a way of developing potential solutions to this wicked problem. Each of these interventions utilize three essential components in their successful employment programs: (1) use of an employment specialist (ES) with specific training in autism; (2) specific actions to address workplace barriers; and (3) provision of repeated practice of missing skills for autistic participants (Anderson et al., 2018; Fong et al., 2021; SEDL, 2017; Wehman et al., 2017). 67 The use of an ES with extensive training and experience in the field of autism has been identified as a critical component of success (Hayward et al., 2019; Hedley, Wilmot, et al., 2017; Nicholas et al., 2019; Workforce Innovation Technical Assistance Center [WITAC], 2017). This person is instrumental through the entire employment process and assists the autistic individual as well as the employer across this process (Nicholas et al., 2018). Whether the autistic individual will work in supported or customized employment, the ES begins by working with that autistic individual to discover their talents and preferences and to develop an understanding of the type of career (not simply a job) that they wish to have (Inge et al., 2018; WITAC, 2017). Depending upon the skill and educational level of the autistic individual, the ES will either opt to guide them through the traditional employment process (application, interview, onboarding, on- the-job training, etc.) or work to create a tailored position within an appropriate business (Baker- Ericzen et al., 2022; WITAC, 2017). The ES may also work with the autistic individual on the activities of daily living (e.g., hygiene routines) and access to transportation as appropriate (Khayatzadeh-Mahani, et al., 2020). For example, in ACN Connections (one of the 11 recognized programs), the ES assists participants with completing applications, navigating interviews, and developing job-specific social skills (SEDL, 2017). In Triumph Services (another recognized program), the ES provides support in all areas of daily life (medication management, hygiene, transportation, etc.) as well as addresses employment needs (SEDL, 2017). The ES must also be skilled in working with employers. “This (job placement of an autistic individual) would absolutely not have worked had Jim (employment specialist) not been able to speak my language. He was there every step of the way and without him, I can’t imagine this working,” echoed Reid J. (personal communication, June 29, 2022). The ES must translate government regulations into understandable language and then guide the employer to apply for 68 all appropriate benefits (Doyle, 2022; Winson et al., 2018). Prior to hiring an autistic individual, the ES will work within the business to create champions for this decision, to provide any necessary diversity training for staff and to support the business to address environmental barriers to employment (LEAD, 2015; Scott et al., 2018). In Project SEARCH, for example, the ES provides general inclusion trainings to all workplace colleagues, coaches direct supervisors and managers, and assists administrators in developing appropriate accommodations (SEDL, 2017). A close and ongoing relationship between a skilled ES and the employer is critical to the placement’s success (Austin & Pisano, 2017; Nicholas et al., 2018). A second component shared among all evidence-based and emerging practices is to proactively address workplace barriers, including environmental, systemic and attitudinal barriers (Chen et al., 2015; Khayatzadeh-Mahani, et al., 2020; Nicholas et al., 2019). Environmental changes typically involve small accommodations, such as allowing autistic employees to wear headphones, work a flexible schedule or access s quiet workspace (Khayatzadeh-Mahani, et al., 2020). This type of universal support often ends up benefiting all employees and not just individuals on the autism spectrum (Nicholas et al., 2019). Systemic changes are more complicated to address, often beginning with job descriptions that state a requirement for team players with solid communication skills, even when those skills are not actually required by the position (Austin & Pisano, 2017; Khayatzadeh-Mahani, et al., 2020; Nicholas et al., 2019). The typical interview process requires a host of skills that autistic adults struggle with such as eye contact, nebulous questions (“where do you see yourself in five years?”), and general conversation skills (Austin & Pisano, 2017; Chen et al., 2015; Hedley, Uljarevic et al., 2017). Transitioning to the use of a mini-internship or extended tryout is often necessary to ensure that qualified autistic individuals are given the opportunity to demonstrate 69 their knowledge and skills (Chen et al., 2015; Hedley, Wilmot et al., 2017). Successful employment programs and practices for autistic adults guide the human resources staff to shift away from assuring compliance to scalable HR practices and policies and towards focusing on individual strengths and needs (Austin & Pisano, 2017; Chen et al., 2015; Nicholas et al., 2019). Attitudinal barriers are perhaps the most difficult to overcome. Employers and coworkers often have a lack of understanding about autism and autistic adults (Nicholas et al., 2019). This results in stereotyping and stigmatizing by potential employers and colleagues (Chen et al., 2015; Nicholas et al., 2019). “I’ll hire someone with autism,” said David H., a small business owner. “But only because I had to work with one someplace else and they gave me a bunch of training about it, so I know what to do. When that kid first got hired, I was terrified of him but the training, that training made it work" (personal communication, June 13, 2022). Programs that provide broad acceptance trainings to all employees and more specific trainings for direct supervisors have the greatest success in placing autistics into employment and in helping them to maintain that employment (Austin & Pisano, 2017; Chen et al., 2015; Hedley, Uljarevic et al., 2017). Creating a workplace culture that embraces diversity, acceptance and understanding is an essential component of successful employment programs and practices (Hayward et al., 2019; Nicholas et al., 2019). Lastly, the eleven successful employment programs and practices all work directly with autistic adults to address both hard and soft skills. Many autistics require repeated practice in order to master essential work skills and procedures (Hedley, Uljarevic, et al., 2017). For example, Project SEARCH provides extensive job skills training, both on-site and off-site, and TEACCH Supported Employment Program provides an intensive job readiness program followed by targeted coaching at the job site for as long as necessary (SEDL, 2017). “The best 70 training, you know,” said Steve Z, an employment specialist. “The best training is done on-the- job and done over and over until the person gets it. It’s not a once-and-done sort of thing” (personal communication, May 26, 2022). Soft skills involving communication, expected nonverbal behaviors, general social rules, problem-solving, and self-advocacy are explicitly taught to autistic adults as part of most successful employment programs (Bury et al., 2020; Chen et al., 2015; Fong et al., 2021). The most effective method to do this is to utilize a strengths-based approach of building on existing skills, and to target to the employer’s specific workplace culture (Austin & Pisano, 2017; Chen et al., 2015; Scott et al., 2018). For example, Job Path in upstate New York identifies areas of strength and needs for personal growth through its intake and assessment process. It then customizes existing classes and trainings to capitalize on those strengths in addressing the individual’s employment challenges (SEDL, 2017). “I’ll tell you one thing,” said Stella L., the mother of an adult autistic son. “Smarts may get Mike (her son) hired for a job but if he doesn’t get some of those niceties, those ‘hi-how-are-you’ sorts of skills down, he won’t stick around very long, that’s for sure” (personal communication, May 27, 2022). 71 Appendix G: Prototype Materials Introduction to PIEPAA Ilene Allinger Candreva, MSW, BCBA University of Southern California Suzanne Dworak-Peck School of Social Work DSW 725c: Preparatory Scholarship for Capstone Ronald Manderscheid, PhD May 29, 2023 72 PROGRAM TO IMPROVE THE EMPLOYMENT PROSPECTS OF AUTISTIC ADULTS Program Introduction INTRODUCTION TO THE PROGRAM Congratulations on choosing to implement the Program to Improve the Employment Prospects of Autistic Adults (PIEPAA) in your catchment area. You are playing a pivotal role in addressing the single strongest barrier to employment: the stigma held by general community members and prospective employers. PEIPAA provides a way to educate those groups by giving fact-filled and inspiring presentations to community, service, and professional groups that have standing meetings – groups that are typically looking for individuals such as yourself to make presentations. This type of presentation will be especially popular during April (Autism Acceptance Month) and October (National Disability Employment Awareness Month). The purpose of this program is to emphasize the strengths and benefits of hiring autistic individuals such as increased profits, enhanced productivity, and improved morale (Austin & Pisano, 2017; Baker, 2011; Bury et al., 2020). Myths regarding autism, such as autistic adults are all savants or engage in stereotypical behaviors, are directly addressed with the truth (very few autistic adults are savants, not all engage in stereotypical behaviors) (International Council on Development and Learning, 2022). Misconceptions, such as that hiring an autistic adult will increase insurance costs (it usually does not) or that they will be absent from work more frequently (they miss fewer days than neurotypical co-workers), will also be remediated (Chan et al., 2010; Gonzales, 2022). The presentation also highlights the physical and monetary support available to employers when hiring autistic adults. These elements (highlight benefits and support, reduce myths and misconceptions) combine in such a way as to make a strong business case for the inclusion of autistic adults on the payroll. The audience members will be guided to envision successful interactions with autistic adults as a way of solidifying the positive outcomes of interacting with autistic adults (Gronholm et al., 2017). Results from the piloting program can be found at the end of the manual. WHAT’S INCLUDED WITH THIS PROGRAM ● Manual ● Customizable PowerPoint presentation ● Script for the presentation ● Tracking system for speaking events ● Storyboard for video of local employment success story ● Pre- and post-presentation surveys ● Sample Landing Page for prospective employers ● External marketing and communication materials: sample flyer, phone script and email template ● Internal communication materials: PowerPoint for internal presentations, infographic, and newsletter article TO GET STARTED, click on the link the Manual and follow the steps within! 73 Ilene Allinger Candreva, MSW, BCBA University of Southern California Suzanne Dworak-Peck School of Social Work DSW 725c: Preparatory Scholarship for Capstone Ronald Manderscheid, PhD May 29, 2023 74 PROGRAM TO IMPROVE THE EMPLOYMENT PROSPECTS OF AUTISTIC ADULTS Program Manual WHAT’S INCLUDED WITH THIS PROGRAM ● Manual ● Customizable PowerPoint presentation ● Script for the presentation ● Tracking system for speaking events ● Storyboard for video of local employment success story ● Pre- and post-presentation surveys ● Sample Landing Page for prospective employers ● External marketing and communication materials: sample flyer, phone script and email template ● Internal communication materials: PowerPoint for internal presentations, infographic, and newsletter article HOW TO USE THIS PROGRAM Use the following steps to implement this program: ● 1. Review the Materials 2 ● 2. Pave the Way 2 ● 3. Secure a Co-presenter 3 ● 4. Inform Your Vendors 3 ● 5. Create a Success Story Video 3 ● 6. Copy the Surveys 4 ● 7. Customize the Materials 4 ● 8. Embed the QR Codes 4 ● 9. Build a Landing Page 4 ● 10. Track Proactive Outreach 5 ● 11. Rehearse the Presentation 6 ● 12. Confirm the Presentations 6 ● 13. Give the Presentation 6 ● 14. Follow Up the Presentation 7 ● 15. Update Supervisors and Colleagues 7 1. Review the Materials Before implementing this program, become familiar with all of the materials: read the script, go through the PowerPoint slides, take the surveys, examine the tracking system, and review the video storyboard. This familiarity will make each of the following steps easier. 75 2. Pave the Way As appropriate, discuss your plan for implementing this program with your supervisors. In this discussion, you will want to cover the time requirement (estimated four hours per month after start-up), transportation costs, necessary/available equipment or technical support and so on. There are three things that it might be helpful to know for this discussion. First, as part of their mission, Regional Centers are mandated to provide community outreach and education. This presentation provides an opportunity to engage in proactive outreach and to provide education to the community. Second, the Home and Community-Based Final Rule went into effect in March 2023. This federal law states that individuals with developmental disabilities must have access to community-based services and that these services must afford such individuals with the same degree of access as typical individuals. In doing these presentations, you are making it easier for vendors to comply with this Final Rule. Third, California is an Employment First state, which means that for day support programs funded by the Regional Centers (or any government entity), employment is the first and preferred outcome. Despite being an Employment First state for over a decade, California has made little progress in improving employment rates for disabled adults. This presentation helps to educate community members about this policy and should increase opportunities for employment among Regional Center clients. This PowerPoint presentation will help guide the conversation with your supervisor and the infographic can be used to present the urgency of this problem. Once approved, you will want to announce this new program in your next newsletter. 3. Secure a Co-Presenter According to Gronholm et al. (2017), social contact in the form of personal testimony (success stories) is a critical component of educational interventions to address stigma. Ideally, the presenter for the program should be an employed, autistic adult who will share their successful journey to employment; this provides direct social contact for the audience. If you are not autistic, you should make every effort to secure an autistic co-presenter. Co-presenters can be found by reaching out to your advisory boards or to your Board of Directors, looking internally for autistic Regional Center employees, and contacting vendors who supply employment services. 4. Inform Your Vendors Reach out to your vendors that supply employment services and let them know of your plans. Alert them to the fact that you will soon be providing them with a list of potential employers and ask them to act swiftly on these referrals. You might also consider giving this presentation for your vendors, if a suitable forum can be found. 5. Create a Success Story Video Using the storyboard as inspiration, create a video of a local employment success story. In the ideal world, you would contract with a video production company to shoot and edit the 76 video. However, for PIEPAA’s purposes, you can create a surprisingly professional quality video with your cell phone and some editing software. You can even use still photos and voice-over as a substitute for an actual video. Consider contacting your vendors that supply employment support. It is possible that they will have such a video to share with you. Regardless of the source, while the video should look professional, the content is more important than the technical aspects. To get additional ideas, watch this Employment Success Story from Australia or Ashley’s Story from Washington state. A quick search of Google or YouTube will provide more examples, as well as tutorials on how to create your own videos. 6. Copy the Surveys To create a custom Google pre-survey, click this link. Be sure to make a copy of the form and do not use the original form if you want the data from the surveys. If you simply use the existing form, all the data will go to Ilene Allinger Candreva, the original creator of the presentation and materials. To create a custom post-survey, click this link. As with the pre-survey, make a copy of this post-survey form. 7. Customize the Materials Customize the presentation and script as appropriate. If your Regional Center uses a specific template for PowerPoint presentations, then you will need to import this presentation into that template. There are a variety of ways to do that, one of which is detailed here. Directions for customizing the presentation are found on each slide. Be sure to assign sections and label the corresponding slides if working with a co-presenter. As part of arranging presentations, ask whether or not the site will have reliable internet access. If not, download your presentation materials (presentation, script, and video) onto your computer. You will need the following websites for updating and/or customizing your presentation: national employment rate, national employment rates for disabled adults, and employment rates for your Regional Center. Links to these websites are also found in the script. 8. Embed the QR Codes Follow the directions found on this website to create a custom QR code and to embed that code in your presentation.Be sure to change the Settings on your copy of the form to allow people from outside your organization to respond to the QR code. You will need 3 different QR codes: pre-survey, post-survey, and landing page. 9. Build a Landing Page Towards the end of the presentation, you list some employer supports that can be accessed virtually. If possible, work with your IT department to add a page for these resources. The webpage should be customized to match the style of your Regional Center and can include any links that you feel are relevant. You will want to include a Contact Me button that allows visitors to send you an email with questions. 77 An example of what a landing page might look like can be found here. This step is optional but highly recommended. If you do not create a landing page, then edit the script to reflect this fact. 10. Track Proactive Outreach Communication materials, including an email template and sample flyer, can be found in the Communication Material folder. These materials should be cutomized to your specific organization. Using the Tracking Form as a guide, begin proactive outreach to existing community groups. Begin by making your own copy of the form. The first column contains a list of organizations that may be interested in your presentation. Use the links in the second column to connect to the national websites; from there, locate a local chapter and its contact information. Once you have that information, send an email or make a phone call (as appropriate) and offer your presentation for one of their regularly scheduled meetings. This type of presentation may be most appropriate in April (Autism Acceptance Month) or October (National Disability Employment Month). The program chairs for most organizations arrange their presentation months in advance so it’s a good idea to begin your outreach as soon as possible. If you are having trouble connecting with these community groups, it might be helpful to ask fellow Regional Center employees and your vendors if they belong to any of these groups and can connect you with the appropriate person. Your colleagues and vendors may also be members of groups not on the list that would welcome your presentation; be sure to ask for those suggestions and connections as well. Make careful note of how long each group wants you to speak so that you can tailor your presentation to meet their needs. This information can go in the column labeled Duration on your Tracking Form. Add other columns as necessary to capture all important information. Keep in mind that there may be multiple local chapters of an organization. For example, in Monterey County alone, there are 11 different chapters of the Rotary Club, each one an excellent candidate for your presentation. 11. Rehearse the Presentation Rehearse your presentation until you are comfortable giving it. Time the presentation so you know how long it will take so that you can adjust as necessary to meet the time requirements of each group. 12. Confirm the Presentations The week before your presentation, reach back out to your contact person at the community organization and confirm all the details. Find out if they have a projector for your PowerPoint presentation, internet connection, and a microphone and prepare accordingly. 13. Give the Presentation Relax and have fun during your presentation. Be confident – you might not know everything there is to know about employment for autistic adults but in this setting, you are the expert. You might also rehearse answers for any questions that you think you might get. It is 78 critical to be prepared to address any requests for an autistic applicant that an audience member may have. Plan ahead your response so that you can give it smoothly and authoritatively. For example, say “I will connect you with <insert name here> as soon as I return to the office” if an employer is eager to move forward in hiring. 14. Follow Up the Presentation Your job does not end with the applause – there is follow up work to do when you return to the office. First, send a thank you note to your host at the community group and let them know if you are available for presentations on other topics or if you can do this presentation again in a different setting. Second, review the survey results and compare pre- and post-survey scores. If indicated, bolster a section of your presentation that seems to consistently receive low scores as these scores may indicate a lack of clarity. Third, forward all referrals to the appropriate vendor, reminding them to contact the prospective employer as quickly as possible. Ask the vendor to let you know if they do not have any appropriate candidates for the job so that you can send the information off to another vendor. Fourth, respond to any requests for additional information as appropriate. 15. Update Supervisors and Colleagues Periodically, let people know about your success: the number of presentations given and audience members reached, improvements in survey scores, and (most importantly) a count of autistic adults employed as a result of these presentations. CONCLUSTION Congratulations! If you have made it this far, then you have begun to impact the low employment rates of autistic adults in your area. You have gained the support of your supervisors and others within your organization. You have successfully customized the PIEPAA presentation to meet your specific needs and conducted outreach to local community, services, and professionals groups. Hopefully, you have also given several presentations and are beginning to make connections between prospective employers and employment service vendors. Now it’s time to track – and share – your successes and impact to your community! 79 Frequently Asked Questions How much time will this program take to run? This program will require an estimated four (4) hours a month to complete. Plan to spend one to two-hours a month arranging speaking events and following up on presentations and another one to two-hours a month actually giving the presentations (including travel time). However, those four hours will typically not be consecutive hours: you will more than likely spend 15-minutes here and there throughout the month, managing the program. What equipment will be required to run this program? To arrange the speaking engagements, you will need a phone number and/or an email address. To give the presentation, you will need a laptop computer capable of running the slide show and the video. Where can I find an autistic co-presenter? Co-presenters can be found by: ● Reaching out to your advisory boards or to your Board of Directors ● Looking internally for autistic Regional Center employees ● Contacting vendors who supply employment services How do I make this ‘success story’ video? In the ideal world, you would contract with a video production company to shoot and edit the video. However, for PIEPAA’s purposes, you can create a surprisingly professional quality video with your cell phone and some editing software. You can even use still photos and voice-over as a substitute for an actual video. While the video should look professional, the content is more important than the technical aspects. Also, consider contacting your vendors that supply employment support. It is possible that they will have such a video to share with you. What should be included in this video? Ideally, a job placement with a recognized leader (either individual or industry) would be the focus of this story. It can be in video form or a series of slides, with a recorded voice-over. The goal here is to establish the idea that hiring autistic adults can be beneficial and is something that leaders in the area support. Essential elements of this video include the following: ● Description of the job that the autistic employee is doing (video of them doing the job is ideal) ● Endorsement by employer, highlighting benefits to the business ● Positive reactions by the autistic employee’s colleagues ● Partnership/support from employment agency, including barriers overcome through this support Why is this video necessary? Showing that respected leaders have tried hiring autistic adults and endorse it helps the reluctant employer believe that ‘others important to me support this idea.’ This change in subjective norms is an important part of the behavior change that you will ask for in the Next Steps slides. The presentation is too long/too short. Now what? Feel free to reduce the length of the presentation to meet the requirements of your audiences. You might want to cut out whole 80 sections or reduce each section by a slide or two. Do what seems to meet your audience’s needs the best. If you need to increase the length of your presentation, consider adding personal stories, from employers, employees, service providers, family members, etc. These can be in the form of simple videos or written testimonials that you read outloud. Another way to increase the length of your presentation is to add a section on the advantages of hiring autistic adults or information on your Regional Center and its services. Finally, consider adding a section on how to support an autistic employee or colleague. 81 RESULTS FROM THE PILOT PROGRAM From January to April 2023, a variety of stakeholders provided feedback (individually and in focus groups) on various components of the program. Below is a summary of that feedback. COMPONENT FEEDBACK Entire concept ● Very do-able concept that meets a variety of mandates ● Highlight the proactive outreach as this is very innovative ● Some form of contact with autistic adult should be included – autistic presenter is ideal, success story video will suffice Embedding in Regional Centers ● Natural fit for Regional Centers and their Employment Specialists ● Presented low-fidelity prototype to 3 Regional Centers and all were interested in implementing PIEPA ● Currently working with North LA Regional Center to develop and implement a pilot program Survey forms ● Initial QR code linked to the editor version of the form. ● New QR Code created to link to responder version of form ● Questions were understandable ● Some questions needed editing (completed) ● Survey itself prompted discussions with takers Landing page ● Concept helpful ● Better if buttons actually worked ● Consider organizing differently: divide into subsections, provide overview of info found, use words rather than logos Presentation materials ● Pending review from autistic adults ● Pending review from employment service providers Presentation outcomes ● Pending pilot presentation with Regional Center ● Pending focus group of employees Pilot Program Outcomes 82 The Program to Improve Employment Prospects for Autistic Adults was piloted in its entirety in late April 2023. This pilot presentation was given to an audience of 33 people, all of whom were invited to complete the pre- and post-presentation surveys. The pre-presentation survey was completed by 29 individuals while the post-presentation survey was completed by only 23 people. This gives us a response rate of almost 80%. The survey results were matched and the scores of individuals who did not complete both surveys were discarded. The surveys utilized a Likert scale to measure changes in knowledge and attitudes as well as a predicted change of behavior; these three areas align with the short-, mid- and long-term outcomes of the PIEPAA logic model. All three of these areas showed improvement, with knowledge about autism increasing the most (3.84 points). The predictive behavior change (“I would hire an autistic adult if they were qualified”) increased an average of 2.32 points while the attitude change increased only 0.90 points. It is possible that a social desirability bias impacted these scores. A chart and graph illustrating these changes can be found below. The surveys also asked if the responder identified as neurodivergent. During the pre- presentation survey six people responded by saying that they did not know what that term meant; in the post-presentation survey, all six of them responded as No, indicating that they now understood the term. 83 REFERENCES Austin, R. D., & Pisano, G. P. (2017, May 17). Neurodiversity as a competitive advantage: Why you should embrace it for your business. Harvard Business Review, 95(3), 96-103. Baker-Ericzen, M. J., El-Shamy, R., & Kammes, R. R. (2022). Current status of evidence-based practices to enhance employment outcomes for transition age youth and adults on the autism spectrum. Current Psychiatry Reports, https://doi.org/10.1007/s11920-022-01327- 2 Bury, S. M., Hedley, D., Uljarevic, M., & Gal, E. (2020). The autism advantage a work: A critical and systematic review of the current evidence. Research in Developmental Delays, 105, 103750-10376 Chan, F., Strauser, D., Maher, P., Lee, E. J., Jones, R., & Johnson, E. T. (2010). Demand-side factors related to employment of people with disabilities: A survey of employers in the Midwest region of the United States. Journal of Occupational Rehabilitation, 20(4), 412- 419. Gonzales, M. (2022, October 15). Why belonging matters. SHRM. https://www.shrm.org/hr- today/news/all-things-work/pages/why-belonging-matters.aspx Gronholm, P. C., Henderson, C., Deb, T., & Thornicroft, G. (2017). Interventions to reduce discrimination and stigma: The state of the art. Social Psychiatry and Psychiatric Epidemiology, 52(3), 249-258. International Council on Development and Learning. (2022). Autism myths and facts. https://www.icdl.com/parents/about-autism/autism-myths- facts?gclid=Cj0KCQjwqc6aBhC4ARIsAN06NmOX1j5pY4GRqiHiIZs2uF8Fr5YhotJP_j Y2_h2TQk79eRK6kGfavUIaArzQEALw_wcB 84 PIEPAA Presentation Slide 1 See SCRIPT for SLIDE #1 Add QR code Slide 2 See SCRIPT for SLIDE #2 Things to customize • Add your name, job title, and contact information • Add your company’s logo • Use the link in the script to create your own google form and a QR code Slide 3 See SCRIPT for SLIDE #3 Things to customize • Add the QR code for the pre-survey INTRODUCTIONS • Name • Job • Age ncy • Contact info Paste QR Code here Paste your logo here AGENDA • Describe the current status of employment for autistic adults • Address some common myths and misconceptions • Build a business case for hiring autistic adults • Share a local success story • Describe supports available to employers • Answer questions Paste QR Code #1 here 85 Slide 4 See SCRIPT for SLIDE #4 Things to customize • Add the QR code for the pre-survey Picture credit: xminds.org (https://xminds.org/Identity-First/) Slide 5 See SCRIPT for SLIDE #5 Things to customize • None Slide 6 See SCRIPT for SLIDE #6 Picture credit: https://stimpunks.org/glossary/neuro divergent/ Paste QR Code #1 here A WORD ABOUT LANGUAGE CHOICE THE SITUATION NEURO WHAT? 86 Slide 7 See SCRIPT for SLIDE #7 Picture credit: https://stimpunks.org/glossary/neuro divergent/ Slide 8 See SCRIPT for SLIDE #8 Picture credit: https://www.istockphoto.com/photo/ business-people-at-office- gm172457561-23653701 Slide 9 See SCRIPT for SLIDE #9 Picture credit: https://www.istockphoto.com/photo/ business-people-at-office- gm172457561-23653701 https://www.bostonglobe.com/metr o/2015/12/04/stolen-rare-map- returned-boston-public- library/B5kgP1M8yi0fdWwxT0fY2K /story.html NEURO DIVERSITY WHAT IS AUTISM? WHAT IS AUTISM? 87 Slide 10 See SCRIPT for SLIDE #10 Picture credit: https://www.istockphoto.com/photo/ business-people-at-office- gm172457561-23653701 https://www.bostonglobe.com/metr o/2015/12/04/stolen-rare-map- returned-boston-public- library/B5kgP1M8yi0fdWwxT0fY2K /story.html https://www.medicalnewstoday.co m/articles/320562 Slide 11 See SCRIPT for SLIDE #11 Things to customize • None Picture credit: https://www.reddit.com/r/autism/co mments/f8ddvf/made_my_own_versi on_of_a_common_symbol_for_autism / Slide 12 See SCRIPT for SLIDE #12 Things to customize • None WHAT IS AUTISM? AUTISM IS… THE SITUATION 88 Slide 13 See SCRIPT for SLIDE #13 Things to customize • None Picture credit: https://www.chieflearningofficer.com/2018/0 3/01/diversity-learnings-business-2/ Slide 14 See SCRIPT for SLIDE #14 Things to customize • Add picture of famous landmark or physical feature of your area in place of the tree and ocean • Add picture of your Regional Center Logo Slide 15 See SCRIPT for SLIDE #15 Things to customize • Add picture of famous landmark or physical feature of your area in place of the tree • Add graph from the link in the script. Note – you might want to re- make the graph in excel as the graph on the DDS website is deceptively successful. It does not show the percentage of people working out of 100% (as this one does) but rather, as it uses 20% as the top number, making it look as if WHAT’S THE ISSUE? IN OUR BACKYARD IN OUR BACKYARD 89 almost every autistic adult was working. Slide 16 See SCRIPT for SLIDE #16 Things to customize • None Slide 17 See SCRIPT for SLIDE #17 Things to customize • None Picture credits: https://www.brooklynpaper.com/this- guy-draws-new-york-from-memory/, https://bigbangtheory.fandom.com/w iki/Sheldon_Cooper, https://simple.wikipedia.org/wiki/Bill_ Gates MYTHS AND MISCONCEPTIONS MYTH #1 90 Slide 18 See SCRIPT for SLIDE #18 Things to customize • None Picture credits: https://www.imdb.com/media/rm348 6694144/tt0095953, https://heavy.com/entertainment/star -trek/actors-who-played-spock/, https://www.ranker.com/list/famous- people-with-autism/celebrity-lists Slide 19 See SCRIPT for SLIDE #19 Things to customize • None Picture credits: https://en.wikipedia.org/wiki/Temple _Grandin, https://www.disabled- world.com/disability/awareness/famo us/asp.php, https://www.ranker.com/list/famous- people-with-autism/celebrity-lists Slide 20 See SCRIPT for SLIDE #20 Things to customize You need to create your own video of a local success story that includes to following elements: Here are some examples • https://www.facebook.com/Autism SpectrumAustralia/videos/1015511 3030761228/ • https://www.thinkwork.org/project /real-work-stories?page=2 MYTH #2 MYTH #3 PERSONAL STORY OR VIDEO 91 Slide 21 See SCRIPT for SLIDE #21 Things to customize • None Picture credits: Slide 22 See SCRIPT for SLIDE #22 Things to customize • None Picture credits: https://www.shrm.org/resourcesandt ools/hr- topics/technology/pages/people-and- tech-work-together-for-intelligent- hiring.aspx BUSINESS CASE STABLE WORKFORCE 92 Slide 23 See SCRIPT for SLIDE #23 Things to customize • None Picture credits: https://www.food- safety.com/articles/6628-the- e2809cae2809d-in-culture-a-toolbox- to-drive-positive-food-safety- behaviors Slide 24 See SCRIPT for SLIDE #24 Things to customize • None Picture credits: https://www.freepik.com/premium- photo/close-up-unrecognizable- person-giving-paper-bag-volunteers- during-help-donations-event-copy- space_17835226.htm Slide 25 See SCRIPT for SLIDE #25 Things to customize • None Picture credits: https://www.biblemoneymatters.com /how-to-increase-your-income- without-a-raise/ POSITIVE CULTURE ENHANCED PRODUCTIVITY INCREASED PROFITS 93 Slide 26 See SCRIPT for SLIDE #26 Things to customize • None Picture credits: Slide 27 See SCRIPT for SLIDE #27 Things to customize • None Picture credits: https://thoughtsfromparis.com/thoug hts/i-ran-over-my-groceries/, https://www.exceltip.com/excel- errors/formula-errors-in-excel-and- solutions.html, https://www.thesun.co.uk/living/3089 472/eating-food-thats-fallen-on-the- floor-is-safe-as-long-as-you-stick-to- the-five-second-rule/, https://www.sciencefocus.com/the- human-body/why-do-people-scratch- their-heads-when-confused/ COMMON CONCERNS SKILL LEVEL 94 Slide 28 See SCRIPT for SLIDE #28 Things to customize • None Picture credits: https://choosework.ssa.gov/blog/201 7-07-10-mm-the-low-and-no-cost-of- reasonable-accommodations Slide 29 See SCRIPT for SLIDE #29 Things to customize • None Picture credits: https://www.core77.com/posts/25935 /the-uncomfortable-series-from-kk- studio-turns-everyday-product- designs-upside-down-25935 Slide 30 See SCRIPT for SLIDE #30 Things to customize • None Picture credits: https://www.snapforce.com/blog/pip edrive-pricing-is-too-expensive/, ACCOMMODATION COSTS Policy or procedure Work environment DISCOMFORT ADDITIONAL EXPENSES 95 Slide 31 See SCRIPT for SLIDE #31 Things to customize • None Slide 32 See SCRIPT for SLIDE #32 Things to customize • None Picture credits: https://enableservices.co.uk/services/j ob-coaching-2/ Slide 33 See SCRIPT for SLIDE #33 Things to customize • None Picture credits: https://www.mlive.com/news/2021/0 5/when-parents-get-to-keep-their- college-students-1400-stimulus- check.html PERSONNEL MONETARY 96 Slide 34 See SCRIPT for SLIDE #34 Things to customize • None Picture credits: https://www.virtualjobcoach.org/, https://askjan.org/, https://www.autism.org.uk/advice- and- guidance/topics/employment/employi ng-autistic-people/employers, https://www.calautism.org/programs /employment-programs/, https://researchautism.org/self- advocates/job-seekers- resources/?gclid=CjwKCAjwzuqgBhAcE iwAdj5dRuv4lV9L8hya2fQ1xl5d_XH2A gI1- Czz8DTvWIlDE7IGAf7GGFFHeRoCTX4Q AvD_BwE, https://autisticadvocacy.org/ Slide 35 See SCRIPT for SLIDE #35 Things to customize • None Picture credits: VIRTUAL NEXT STEP 97 Slide 36 See SCRIPT for SLIDE #36 Things to customize • None Picture credits: Slide 37 See SCRIPT for SLIDE #37 Add QR code NEXT STEPS Paste QR Code #2 here 98 Storyboard for Video 99 100 101 Sample Wireframe Landing Page CONTACT ME RESOURCES FOR EMPLOYERS 102 Tracking Form ORGANIZ ATION NATIONA L WEBSITE LOCAL WEBSITE CONTACT PERSON PHONE EMAIL INITIAL CONTACT FOLLOW UPS SCHEDUL ED FOR DURATIO N LOCATIO N NOTES BRING PROJECT OR? RELIABL E INTERNE T? MICROPH ONE? Rotary Club Rotary.org Optimists Optimist Internationa l Junior League Junior League Internationa l PEO PEO Internationa l Lions Club Lions Club Internationa l Kiawani Kiwanis Internationa l Moose Lodge Moose Internationa l Elks Club Order of Elks American Legion American Legion Toastmaster s Toastmaster s Veteran's of Foreign Wars VFW Knights of Columbus Knights of Columbus Business Networking Internationa l Business Networking Internationa l Network After Work Network After Work 103 ORGANIZ ATION NATIONA L WEBSITE LOCAL WEBSITE CONTACT PERSON PHONE EMAIL INITIAL CONTACT FOLLOW UPS SCHEDUL ED FOR DURATIO N LOCATIO N NOTES BRING PROJECT OR? RELIABL E INTERNE T? MICROPH ONE? Rotary Club Rotary.org Optimists Optimist Internationa l Junior League Junior League Internationa l PEO PEO Internationa l Lions Club Lions Club Internationa l Kiawani Kiwanis Internationa l Moose Lodge Moose Internationa l Elks Club Order of Elks American Legion American Legion Toastmaster s Toastmaster s Veteran's of Foreign Wars VFW Knights of Columbus Knights of Columbus 104 External Flyer/Marketing 105 Phone Script PHONE SCRIPT FOR PROACTIVE COMMUNITY OUTREACH Because of the fluid nature of phone conversation, it is impossible to provide a word-for-word script for them. When speaking with the potential host, however, it is important to include the following points: • Your name, your job title, and your organization. • Presentation is provided free of charge. • Duration is about 30 minutes but can be adjusted to meet the group’s needs. • No internet is required. • Projector screen and projector are needed (unless you have a projector that you can bring.) • Follow-up information and support, from you or from a vendor, is available and will be offered in the presentation. • Appropriate months for this presentation include April (Autism Acceptance Month) and October (National Disability Employment Awareness Month). Presentation is suitable for all times of the year, not just those months. Email Template EMAIL TEMPLATE FOR PROACTIVE COMMUNITY OUTREACH Dear <insert name here> My name is <your name> and I am the Employment Specialist for the <insert regional center name>. Part of my job is community outreach and education, and I am contacting you to offer to make a presentation on the business case for hiring autistic adults. The presentation is approximately 30 minutes in length, but the duration can be adjusted to meet your program needs. There is no cost for this presentation. You can find more information about <insert regional center name> here (place link to website home page here). For information specific to my programing, please click here (place link to employment page or other appropriate page here). If you interested in more information, please let me know. I can be reached at this email or the phone below. Regards, <insert signature line here> <insert phone number here> 106 Appendix H: Pilot Program Data and Graphs Pre-presentation raw data How much do you know about hiring and/or working with autistic employees? How do you feel about hiring and/or working with autistic employees? Assuming they were a good fit for the job, how likely are you to hire an autistic applicant? Do you identify as neurodivergent? 1 3 5 No 1 3 6 Yes 1 3 6 No 1 4 7 Yes 1 4 7 IDK 1 5 7 IDK 1 6 7 IDK 1 7 8 No 1 7 8 No 1 7 8 IDK 1 8 8 No 1 8 9 Yes 1 8 9 Yes 1 8 3 NO 1 3 4 Yes 2 4 5 IDK 2 5 5 NO 2 10 5 No 3 10 7 No 4 10 5 IDK 4 10 4 Yes 5 10 10 No 5 10 10 Yes Average 2.12 7.71 6.76 107 Post-presentation raw data How much do you know about hiring and/or working with autistic employees? How do you feel about hiring and/or working with autistic employees? Assuming they were a good fit for the job, how likely are you to hire an autistic applicant? Do you identify as neurodivergent? 8 10 10 Yes 6 10 10 Yes 8 10 10 No 8 10 10 No 1 8 10 IDK 7 10 10 No 5 9 9 No 9 10 10 Yes 4 10 10 Yes 8 10 10 No 3 4 5 No 5 5 7 No 6 7 8 Yes 7 9 8 No 9 8 10 No 8 10 10 No 5 8 8 No 5 5 9 Yes 1 10 10 No 2 10 10 Yes 9 10 10 Yes 10 10 10 Yes 3 5 5 No Average 5.96 8.61 9.09 108 Knowledge Attitude Predicted Behavior Pre-presentation average 2.12 7.71 6.76 Post-presentation average 5.96 8.61 9.09 2.12 7.71 6.76 5.96 8.61 9.09 0 1 2 3 4 5 6 7 8 9 10 Knowledge Attitude Predicted Behavior Changes in Average Scores Pre-presentation average Post-presentation average 109 Appendix I: Theory of Change Illustration of the Theory of Planned Behavior Change 110 Theory of Planned Behavior Change applied to PIEPAA 111 112 Appendix J: Design Criteria PIEPAA DESIGN CRITERIA Design Goal • Autistic adults of all levels of support needs want to work and research (quantitive and qualitative) prove that successful employment is possible. This information needs to reach a wider audience. • Design addresses the major barrier of stigma, addressing the social and/or functional barrier to employment. • Knowledge, personal contact with a successfully employed autistic adult, focus on helpful skills, and request for behavior change must be included in the presentation User Perceptions • Research shows that employment increases the quality of life of autistic adults. Personal and anecdotal experience bears this out. • Ease of use = fully prepared presentation materials, customizable and completely ready to implement. Available in variety of formats. Physical Attributes • Intervention must have way to track changes in knowledge, attitudes, and behavior change built into it. • Be portable so it can be delivered in multiple community sites. • Must be able to view presentation both with and without access to internet. Functional Attributes • Should be appropriate for virtual presentations as well as in- person presentations. • Software for all portions must be readily accessible to the average user. Constraints • Current California budget shortfall may reduce funding to all RCs, resulting in ESs who stretched too thin to be proactive. • Pervasive stigma 113 CRITERIA WIDER OPPORTUNITY SPACE MUST • Consult with adult autistics during planning. • Focus on autistics with high support needs, limited verbal skills, and/or intellectual disabilities. • Be located in integrated setting. • Address the demand side of the issue. • Be financially sustainable. • Educate employers. • Address stigma within the system. • Incorporate adult autistics in all phases of planning and execution through CBPR. • Focus on the severely handicapped. • Hold high expectations for all areas of the autistic adult’s life. • Include a fee-for-service component funded by DDS, Regional Centers and DOR. • Address stigma within the entire community. COULD • Be located on a college campus. • Actively include parents in some capacity. • Educate general community about autism and the benefits of diversity and inclusion. SHOULD • Include a mechanism for accountability of implementation. • Involve adult autistics in the execution. • Incorporate families of autistic adults. • Utilize primarily (if not exclusively) on-the-job training. • Be developed into a scalable, replicable curriculum that could be utilized as a social enterprise. • Incorporate adult autistics in all phases of planning and execution through CBPR. • Educate general community about autism and the benefits of diversity and inclusion. WON’T • Require pre-vocational training before job placement. • Be located in a segregated setting. • Focus on changing the autistic adult. • Hold adult autistics to a higher employment standard than neurotypical people. • Include transportation as part of its services. 114 Appendix K: Competitive Analysis Regional Center(s) Dept of Rehab Autism Speaks Autistic Self-Advocacy Network Direct Competitors Indirect Competitors Company Profile Company Highlights website website website website Key Competitive Advantage Familiarity with population Connections to local employers Recognized brand name Run by and for autistic adults Target Market Market Information CA with DD All CA National – could reach all Americans National, focus on autistics, self-advocacy Market Share Mandated to provide outreach to entire catchment area Available to provide outreach to entire catchment area National – could conceivably reach all Americans National Marketing Strategy Passive, expects people to ask for presentations Passive, expects people to ask for presentations Passive, website materials only Passive, website materials only Products & Services Product Information Community outreach and education on all aspects of DD Community outreach on all services and populations served Passive educational materials in form of videos and literature Passive educational materials in form of videos and literature Pricing Free Free Free Free Distribution Channels Reactive, when asked Reactive, when asked Online Online Strengths SWOTT Information Well known, connections with vendors Well known, connections with vendors Well known nationally, strong funding base High levels of stakeholder input Weaknesses Does not do proactive outreach Does not do proactive outreach. Serves wider variety of people Seen as hate group by many in autism field Less well known, perceived as only serving LSN Opportunities Mandated to do such outreach. HCBS Final Rule. Increasing interest in autism and employment. HCBS Final Rule in effect. Increasing interest in autism and employment. Develop targeted materials for a proactive national campaign Provide proactive national outreach and trainings for local presenters Threats Systems overhaul. No employment codes. Lack of funding. Lack of expertise. Lack of funding. Lack of expertise. Disliked by autistic community. Lack of stakeholder input across all offerings Small, underfunded, focused on other areas Trends Passive – defines outreach as placing brochures in their lobby Passive outreach. Webpage available at state level Presents info primarily from medical model of autism More focused on education autistic adults rather than general population 115 Appendix L: Budgets Start-up Budget (FY 2023-2024) Category $’s Totals Notes REVENUE DDS (new) 0 DDS (reallocated) $4,258 Reallocated from existing budget. Includes: 3% of current ES salary, 10 hours staff tech salary and travel money Total REVENUE $4258 EXPENSES Personnel Exp Wages/Salaries Emp. Spec $2,066 4 hours/month, 10 hours/start-up (58 hours total) Sub-total $2,066 Reflects mandatory 14% contribution to CALPERS (California retirement program) for 3% of ES time Benefits (@ 35%) $634 Total Pers. Exp. $2,700 Other Operating Exp Occupancy/Rent* $210 Fixed cost, reallocated from existing budget Equip. maintenance* $118 Includes phones Tech/computers $0 Laptops and traveling projectors already owned Printing* $4 Fixed cost, reallocated from existing budget Travel & Enter. $500 1000 miles, .50 cents per mile Utilities* $53 Fixed cost, reallocated from existing budget Security* $1 Fixed cost, reallocated from existing budget Insurance* $13 Fixed cost, reallocated from existing budget Website modification $600 6 hours at $100/hour, use in-house tech support General/overhead* $58 Fixed cost, reallocated from existing budget Total Other Op Exp $1, 556 Total EXPENSES $4, 257 SURPLUS/DEFICIT $1 *Amounts based on San Andreas Regional Center’s FY 2021-2022 program budget, divided by current number of employees NOTE: While the total budget for each Regional Center varies, the formulas used to calculate their income from DDS are the same across the state. Thus, the revenue and cost per employee remains approximately the same regardless of Regional Center. 116 Ongoing Budget (FY 2024-2025+) Category $’s Totals Notes REVENUE DDS (new) 0 DDS (reallocated) $3, 115 Reallocated from existing budget. Includes: 2% of current ES salary and travel money Total REVENUE $3, 115 EXPENSES Personnel Exp Wages/Salaries Emp. Spec $1, 710 4 hours/month Sub-total $1, 710 Reflects mandatory 14% contribution to CALPERS (California retirement program) for 2% of ES time Benefits (@ 35%) $525 Total Pers. Exp. $2, 235 Other Operating Exp Occupancy/Rent* $174 Fixed cost, reallocated from existing budget Equip. maintenance* $97 Includes phones Tech/computers $0 Equipment already owned Printing* $3 Fixed cost, reallocated from existing budget Travel & Enter. $500 1000 miles, .50 cents per mile Utilities* $43 Fixed cost, reallocated from existing budget Security* $1 Fixed cost, reallocated from existing budget Insurance* $11 Fixed cost, reallocated from existing budget Website modification $0 Included in general maintenance of website General/overhead* $48 Fixed cost, reallocated from existing budget Total Other Op Exp $878 Total EXPENSES $3, 113 SURPLUS/DEFICIT $2 *Amounts based on San Andreas Regional Center’s FY 2021-2022 program budget, divided by current number of employees NOTE: While the total budget for each Regional Center varies, the formulas used to calculate their income from DDS are the same across the state. Thus, the revenue and cost per employee remains approximately the same regardless of Regional Center. 117 Appendix M: The Lanterman Act THE LANTERMAN ACT A b r i e f o v e r v i e w Powerful Legislation The Lanterman Developmental Disabilities Act (AB 846), also known as the Lanterman Act, is a California law that establishes the rights and responsibilities of individuals with developmental disabilities. This powerful legislation establishes what such citizens are entitled to and defines the service delivery system. The Lanterman Act created regional centers and charged them with planning and coordinating services and supports for persons with developmental disabilities and their families. Eligibility Occurs before the age of 18, and Can be expected to continue indefinitely, Constitutes a substantial disability, and Is not solely physical in nature. To be eligible for services, an individual must have a developmental disability. This has been defined as a disability that: It includes intellectual disability, cerebral palsy, epilepsy, autism, and “disabling conditions found to be closely related to intellectual disability or to require treatment similar to that required for mentally retarded individual." Regional Centers The Regional Centers are a network of 21 community-based non-profits that provide assessment, diagnosis, information, referral, lifelong individualized planning, and service coordination. Driven by the individual program plan, the Regional Centers either purchase the necessary services or assist families and individuals in accessing community and other services. 118 Appendix N: Internal Communication Materials Informational Presentation: PowerPoint Slide 1 PROGAM TO IMPROVE THE EMPLOYMENT PROSPECTS OF AUTSTIC ADULTS Proactive outreach for long-term impact 119 Slide 2 SCRIPT: The Program to Improve the Employment Prospects of Autistic Adults is designed to address a major barrier to their employment: stigma. It consists of a PowerPoint presentation (already created and ready for customizing to meet the needs of our Regional Center) and a video success story. Both things address myths and misconceptions regarding autism and build a strong business case for hiring autistic adults. The incorporation of a local success story illustrates that this is actually do-able and, just as importantly, is something happening in our community. This whole program can be easily incorporated into our existing community outreach and education programs and will help vendors to fulfill HCBS Final Rule – as you know, employment is an area that our service providers are struggling to comply with this ruling. There’s just not a lot of interested employers out there and why? They are concerned about a variety of easily fixable – or even non-existent – barriers. The video is something that we will have to create or to borrow from a local service provider. The program comes with a storyboard and suggestions on how to create this video, so I don’t expect it to be that hard to do. WHAT? • PowerPoint presentation • Video success story • Address myths and misconceptions regarding autism • Build a strong business case for hiring autistic adults 120 Slide 3 I would be giving this presentations, but the really exciting thing is who I would be giving them too. Rather than waiting for people to contact our Regional Center and to request such a presentation (an you know how often that happens!), I would be proactively contacting existing professional, civic, social, community, governmental groups – groups like the Rotary Club or the Junior League. These organizations are actively seeking presentations such as this one and there is an endless list of possibilities. While some of these organizations are not strictly limited to employers, they are typically filled with community leaders and difference-makers. If these individuals are not hiring now, they may be hiring later – or they may have a lead to someone who is hiring. The program comes with a list of potential host organizations and a way of tracking who I have talked to about what and when. It’s all very organized and ready to go. WHO? • Given by Employment Specialist • Given to community, service, professional, and governmental groups with standing meetings 121 Slide 4 Now these groups all have regular meetings, some weekly, some monthly, some quarterly. My goal is to present to 12 different organizations per year. I’d love to do one per month but really, I expect to book more presentations in April and October. This will take some time to get started – some of it in customizing the presentation, some in finding the video, but a lot will be spend reaching out to and following up with the targeted organizations. I think it will take me 10 hours or so to get started – maybe 1.5 workdays? After that, I figure it will be about 4 hours a month to run the program – 1 hour for commuting, 1 hour for presentation, 1 hour for logistics relating to the presentation and 1 hour to continue to do proactive outreach. I am already doing community education and outreach, so this isn’t additional time. It’s simply a new way of focusing that work. WHEN? • During these groups’ existing (standing) meetings • Goal: 1 presentation per month (12 per year) • Popular months: October (National Disability Employment Month) and April (Autism Acceptance Month) • Requires approximately 10 hours of start up time and 4 hours monthly 122 Slide 5 As I mentioned before, it’s all about PROACTIVE outreach – that’s what sets this program apart from what we are doing now. Well, that and the fact that this program incorporates the best practices of stigma reduction interventions and we both know the huge role stigma – particularly in the form of low expectations and unconscious bias – plays in the current low employment rates. Because these are regularly scheduled meetings, people are already planning to attend so we aren’t scrambling for an audience. The program also comes with pre- and post-presentation surveys that will help us get some idea of how many people we are reaching and show us how much we are impacting their knowledge and attitudes about autism and autistic workers. It’s done through a QR code and provides those attending a way to connect with us, to indicate that they want more information or have a job opening. Now, I will make it abundantly clear that I don’t do job placement and that I will connect them with a service provider who does but it is still a job lead. And yes, I will be reaching out to our vendors who do employment to let them know about what I’m doing. I’ll ask for any leads for presentations that they might have and let them know that I may be passing on job leads to them. In our conversations, I will impress upon them the need to swiftly follow up on these leads or to let me know if they cannot. HOW? • Presentations arranged through proactive outreach to existing community, civic, social, service, professional, and governmental organizations • Presentation made virtually or in-person at a regularly-scheduled meeting 123 Slide 6 The employment rate of disabled adults, in general, has not really changed in 30 years. And currently, more and more autistic students are aging out of the public school system, leaving them with nowhere to go and little beyond our day programming to do. This presentation has the potential to create jobs, both immediately (as in someone at the presentation reaches out to hired) and in the long-run – like when one of our vendors approaches an employer about doing a PIP and the employer already knows that this is a good business deal. WHY? • To change attitudes of community members, including potential employers • To create connections among employers and employment service vendors • TO INCREASE EMPLOYMENT AMONG AUTISTIC ADULTS 124 Infographic 3 5 % The annual cost of autism and unemployment is expected to be $1.36 trillion by 2030. Money's draining Stigma and discrimination against autistic individuals. The #1 barrier to employment is... Over the next decade, 1.5 million more autistics will reach adulthood Population's Growing 35% of them will never find any type of employment Nobody's Working *Blaxil, M., Rogers, T. & Nevision, C. (2022). Autism tsunami: The impact of rising prevalence on the societal cost of autism in the United States. Journal of Autism and Developmental Disorders, *Mason, N., Capp, S. J., Stewart, G. R., Kempton, M. J., Glaser, K., Howlin, P., & Happe, F. (2020). A meta- analysis of outcome studies of autistic adults: quantifying effect size, quality, and meta-regression. Journal of Autism and Developmental Disorders, 51 3165-3179 *Roux, A. M., Shattuck, P. T., Rast, J. E., Rava, J. A., and Anderson, K. A. (2015). National Autism Indicators Report: Transition into Young Adulthood. References Autistic employees bring focus, loyalty, and productivity to their jobsites. Unique Skills Autism & Employment Unemployment is more than just not having a job. It impacts the individual, their community and our nation. 5 Things to Know About Over 60% of autistic adults are reported to have a poor or very poor quality of life Quality of Life Declining 125 Sample newsletter article The <insert name here> Regional Center is excited to announce a new community outreach and education program. Run by our Employment Specialist, <insert name here>, it offers community, social, civic, and professional groups a no-cost presentation that builds a business case for hiring autistic adults. The presentation can be done live or virtually, depending on the hosting organization’s needs. “Quote from ES here,” said <insert name here>. <Name> will be engaged in proactive outreach to existing groups over the next several weeks and is scheduled to begin presentations shortly thereafter. If know of a group that would be interested in learning more about this opportunity, please contact <insert contact info here>. Working together, we can make a difference in the employment rates of autistic adults, both now and in the future. 126 Internal Marketing Flyer 127 Appendix O: Communication Plan TYPE AUDIENCE GOALS SCHEDULE MATERIALS WHO Kick-off meeting Supervisor and/or colleagues Introduce program internally, set expectations, solicit support and contacts TBD, one-time event at regular staff meeting 5W PowerPoint, infographic, 5W flyer, newsletter announcement Employment specialist Leadership support Board members Introduce program internally, set expectations, solicit TBD, one-time event at regular board meeting 5W PowerPoint, infographic, 5W flyer Employment specialist Status updates/reports All stakeholders Update stakeholders, track referrals and placements As needed, yearly work summary Varied including emails, work summary report, announcements Employment specialist PIEPAA presentations Potential host groups Change attitudes and norms, recruit potential employers, At least 12 times per year ‘Why hire?’ PowerPoint, schedule tracker, phone script, email template Employment specialist ES Roundtable Other employment specialists Introduce program, track successes, address challenges One-time presentation at monthly Roundtable, ongoing as needed 5W PowerPoint, infographic, 5W flyer Employment specialist Partnership meetings Employment service providers, Workforce Advisory Board Introduce program, discuss changes, obtain input, track referrals and placements Ongoing at monthly meetings 5W PowerPoint, infographic, 5W flyer Employment specialist Website General community, potential employers Provide additional information, facilitate contacts One-time creation, ongoing maintenance as needed 5W flyer, newsletter announcement, infographic, QR code IT staff with Employment specialist Survey results Audience for ‘Why Hire?’ presentations Track presentation impact, gather potential employer contact information On-going, immediately following each presentation QR code, pre- and post- presentation surveys, data from surveys Employment specialist Success story video Audience for ‘Why Hire?’ presentations Change attitudes and norms, recruit potential employers, illustrate successful placement Create once and use in ongoing presentations Pictures or video, script, storyboard Employment specialist and IT staff External marketing General community, potential employers Inform community about ‘Why Hire?’ presentations, change attitudes, recruit potential employers One-time announcement, annual reminders (April, October) 5W flyer, local news outlets Employment specialist, Social Media team 128 Appendix P: EPIS Framework Outer Context Sociopolitical: • Lanterman’s Act • HCBS Final Rule Funding: • Predictable and stable Clients/Advocacy: • APSE, E1st • Passage of SB369 Inter-organizational Setting: • Necessary partnerships exist Leadership: • Publicly stated support for employment Sociopolitical: • Stigma in general population • HCBS/Lanterman’s Act Funding: • Budget can be impacted by overall economy Clients/Advocacy: • APSE, E1st • Self-determination program Inter-organizational Setting: • ES monthly roundtable Leadership: • Publicly stated support Organizational characteristics: • HCBS Final Rule pressure Individual adopters: • Deep understanding and experience with client group Client Characteristics: • Familiar with client needs Leadership: • C-suite staff supportive Resources/Funding: • Ongoing budget support from DDS Organizational characteristics: • Some RCs hold low expectations Individual adopters: • Committed to employment • 3 ES supportive of PIEPPA Client Characteristics: • Increasing # autistic adults Leadership: • C-suite staff supportive Resources/Funding: • Ongoing budget support from DDS Organizational characteristics: • ES required to do outreach. Individual adopters: • May be overworked – high caseloads Client Characteristics: • Advocating for employment Leadership: • Not all leaders support employment or outreach Resources/Funding: • Ongoing budget support from DDS Exploration Phase Phase Preparation Phase Implementation Phase EPIS: PIEPAA and the California Regional Centers Sustainment Phase Inner Context Organizational characteristics: • ES position secure Individual adopters: • Committed to employment Client Characteristics: • Familiar with client needs Leadership: • C-suite staff supportive Resources/Funding: • Existing postion • Ongoing budget support from DDS • High rates of staff turnover Interagency Collaboration Lanterman’s Act Sociopolitical: • HCBS/Lanterman’s Act Funding: • Position and materials budgeted for Clients/Advocacy: • RAC, SDP, SCDD Inter-organizational Setting: • Established relationship with generic resources Leadership: • History of successful implementations Sociopolitical: • HCBS/ Lanterman’s Act Funding: • No service codes for employment support Clients/Advocacy: • Growth of SDP Inter-organizational Setting: • Run out of groups for presentations. Leadership: • May lose interest as distance from HCBS grows 129 DETAILED CONSIDERATION OF EPIS FRAMEWORK EXPLORATION PREPARATION IMPLEMENTATION SUSTAINMENT OUTER FACILITATORS Sociopolitical • HCBS Final Rule • Lanterman Act • SB369 • HCBS Final Rule • Lanterman Act • Budget agreement provision requiring work • Lanterman Act • That plan that involves DOR, RC and school • Lanterman Act • That plan that involves DOR, RC and school • HCBS Final Rule Funding • Predictable budget • Predictable budget • Funding for materials in place • Predictable budget • Position/materials budgeted for • Predictable budget • Position/materials budgeted for Clients/advocacy • APSE, E1st • Adults served. • SB369 • Population (qual. and quant.) known. • • RAC, ARCA, SCDD • APSE • APSE • TASH Interorganizational Networks • Connections to vendors • Connections to employers • Connections to school districts • Connections to vendors • Connections to employers • Connections to school districts • WIOA, DOR • ES Roundtable • Connections to vendors • Connections to employers • Connections to school districts • WIOA, DOR • ES Roundtable • Connections to vendors • Connections to employers • Connections to school districts • Connections to community members • WIOA, DOR • ES Roundtable Leadership (I) • • • DDS leadership has history of successful implementation of new programs • History of sustaining programs • • • • OUTER CHALLENGES Sociopolitical • Lack of will to create employment in general population. • Stigma. • Lack of will to create employment in general population. • Stigma. • Lack of will to create employment in general population. • Stigma. • Lack of will to create employment in general population. • Stigma. Funding • Entire budgets can be impacted by changes in economy. • • Entire budgets can be impacted by changes in economy. • • Entire budgets can be impacted by changes in economy. • No existing service codes for employment • Entire budgets can be impacted by changes in economy • No existing service codes for employment Clients/advocacy • Parents supporting SB369 • • Adult Day Programs complaining • 130 Interorganizational Networks • Lack of connections to existing groups • Lack of connections to existing groups • Lack of connections to existing groups • Lack of connections to existing groups • Running out of groups to present to Leadership (I) • Still promoting puzzle piece and autism acceptance. • May be reluctant to carve out this particular kind of outreach • May not prioritize this form of outreach • May not prioritize this form of outreach INNER FACILITATORS Organizational characteristics inc. client/culture • HCBS Final Rule is hot topic of discussion. • Structured to support this (ES position exists) • ES job description contains requirement to do this • ES job description contains requirement to do this. • Structured to support this (ES position exists) • ES job description contains requirement to do this. • Structured to support this (ES position exists) • ES job description contains requirement to do this. • Structured to support this (ES position exists) Individual adopter characteristics • ES, by position, committed to employment. • Champion in 3 RCs identified. • ES, by position, committed to employment. • Champion in 3 RCs identified. • ES, by position, committed to employment. • May like giving presentations • ES, by position, committed to employment. • May find presentations enjoyable and seek more Client characteristics • Currently serving adults • Familiar with client needs • Clients want to work • Clients and families advocating for employment. • Increasing # of adults • Clients and families advocating for employment. • Clients and families advocating for employment. Leadership • Some C-Suite staff supportive of employment • Some C-Suite staff supportive of employment • Some C-Suite staff supportive of employment • Some C-Suite staff supportive of employment Staffing (I/S) • • • Position already exists • Position already exists Resources (S) • • • Funding for ES exists • Funding for ES exists INNER CHALLENGES Organizational characteristics inc. client/culture • Culture varies by RC. Some RCs have low expectations for clients. • Local RC focused on housing, per survey. • Not ready for change. Culture has been pervasive for years • SCs may not perceive need for this service. • Not ready for change. Culture has been pervasive for years • Traditionally refer clients to day programs • Traditionally refer clients to day programs. Individual adopter characteristics • Overworked • ES may not see stigma as a barrier. • Overworked. • Overworked. 131 • ES may not see stigma as a barrier • Overworked. • May not like to give presentations • May not like to give presentations Client characteristics (?) • Clients may not know they can work. May not express interest • Spectrum of support needs • Clients may not know they can work. May not express interest • Many clients with ID. • Spectrum of support needs • Clients may not know they can work. May not express interest • Clients with ID. • Spectrum of support needs • Clients may not know they can work. May not express interest. • Spectrum of support needs Leadership • Leadership varies, local leadership does not support progressive thought and growth • Leadership varies, local leadership does not support progressive thought and growth • Leadership varies, local leadership does not support progressive thought and growth • Leadership varies, local leadership does not support progressive thought and growth Staffing (I/S) • • • Staff turnover at ES position low • Staff turnover at ES position low Resources (S) • • • • 132 Appendix Q: Implementation Timeline Prep/Update KEY PARTICIPANTS FALL 2022 SPR 2023 SUMMER 2023 FALL 2023 SPR 2024 SUM 2024 FALL 2024 Focused work Completed JUN JUL AUG SEPT OCT NOV DEC PROPOSAL Submit draft proposal Self, primary and secondary faculty reviewers, peer reviewers, external advisor Present draft proposal Submit final proposal Final proposal approved PHASE 1: PILOT DEVELOP PRESENTATION Research: stigma reduction protocols, PBT, statistics, etc Self, external advisor, faculty advisor, subject matter experts, videographers, actors Develop personal stories Write scripts/outlines Create storyboard Create surveys Writ manual Develop presentation slides 133 VET PRESENTATION Consult w/autistic adults Self, external advisor, faculty advisor, representatives from stakeholder groups Consult w/employment support providers Consult w/employers and hiring managers PILOT PRESENTATION Develop pre/post measurement tools Self, external advisor, faculty advisor, pilot audience (business owners, hiring managers, community members) Administer pre/post tools Give presentations Adjust and repilot presentation as indicated EVALUATE PRESENTATION Conduct structured interviews Self, external advisor, faculty advisor, data analysts Analyze pre/post measurement tools Analyze all data 134 Adjust presentation as indicated HOUSE PROGRAM Outreach to RCs Self, external advisor, Employment Specialists ES Roundtable Individual outreach (support, marketing) Hand off training and presentation materials Adjust and update materials as necessary CREATE MISSING PIECES Communication materials Self, external advisor, faculty advisor Marketing materials Implementation plan Communication plan Financial plan PHASE 2: STATEWIDE IMPLEMENTATION EXPANSION Support ESs in multiple RCs Self, Regional Center staff, 135 Gather and analyze date Employment Specialists Revise, update, customized presentation as necessary PHASE 3: NATIONAL IMPLEMENTATION EXPANSION Apply to disability and employment conferences Self, Employment Specialists, Faculty advisor (?) Apply to social work conferences Present at conferences Follow up to connections made at conferences

Abstract (if available)

Abstract This paper proposes a novel intervention (the Program to Improve Employment Prospects for Autistic Adults or PIEPAA) to address the high unemployment rates of autistic adults with high support needs (HSN), low verbal skills (LVS), and/or intellectual disability (ID). This unemployment results in a lower economic status, poor physical and mental health, loss of autonomy, and many other negative outcomes. Multiple, ineffective solutions currently exist in the form of employment models and federal and state policies. The Grand Challenge to Achieve Equality and Justice cites stigma as the root cause of social injustices and calls for new interventions to directly address this barrier. PIEPAA is a demand-side intervention that does this by increasing employers’ knowledge of autistic workers and reducing the associated stigma. Utilizing the Theory of Planned Behavior, the intervention addresses its key components (attitude, subjective norms, perceived behavior control) with regards to hiring autistic people. Evidence-based practices from medical-based stigma reduction programs form the basis of fact-filled and strengths-based presentations for existing community groups, highlighting the successful employment of local HSN, LVS and/or ID autistic adults, and asking for attainable behavior changes. The methodology of creating PIEPAA is detailed, including the use of human-centered design and input from multiple stakeholder groups. The paper concludes by discussing the strong feasibility of the proposed project, its scalability beyond the local setting, and the implications to the wicked problem of unemployment among autistic adults.

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Asset Metadata

Creator Candreva, Ilene Allinger (author)

Core Title The program to improve the employment prospects of autistic adults

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2023-08

Publication Date 08/04/2023

Defense Date 08/04/2023

Publisher University of Southern California. Libraries (digital)

Tag autism,demand-side,employers,employment,intervention,OAI-PMH Harvest,stigma

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Manderscheid, Ronald (committee chair)

Creator Email candreva@email.com,IAC.Candreva@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113296395

Unique identifier UC113296395

Identifier etd-CandrevaIl-12198.pdf (filename)

Legacy Identifier etd-CandrevaIl-12198

Document Type Capstone project

Rights Candreva, Ilene Allinger

Internet Media Type application/pdf

Type texts

Source 20230807-usctheses-batch-1079 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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