The effectiveness of an autistic-delivered peer-support intervention for autistic adults: Community Autism Peer Specialist (CAPS) program

摘要 美国大约有540万成年人(每45人中就有一人)被认为患有自闭症谱系障碍 (自闭症)，但缺乏支持他们充分发挥潜力的服务。尽管通常情况下 与自闭症相关的服务需求被概念化为一种儿童障碍，一直持续到成年。核心的社交和 ASD的沟通障碍，报告的变化困难，以及高共生率的精神 健康状况往往导致对作为健康决定因素的主要生活领域的参与有限， 包括社会和社区参与、就业、住房和交通。过渡到 成年不仅与发展挑战有关，而且还是一个“服务悬崖”，由此支持 以前通过教育系统提供的服务不再可用。同辈- 所提供的干预措施已成为一种有效的、以证据为基础的方式，可在以下方面提高成果 其他临床人群，如患有严重精神疾病的成年人，在加强社会保护方面的有效性 网络，赋予参与者权力，减少对住院服务的使用，并提高生活满意度。在… 目前，关于自闭症患者主导的同伴支持干预措施的有效性的研究有限，尤其是 那些针对社区职能的广泛方面的活动。拟议的研究旨在提炼、手册和 测试一项旨在支持自闭症青少年社区参与的自闭症同伴支持试点计划 成人，目标是为大规模测试以及未来的传播和可持续性做好准备。第一 这项建议的目的是加强自闭症-同伴递送干预(社区)试点的结构 自闭症同行专家，或CAPS)，目前在费城作为医疗补助报销服务使用。 这将包括开发一个手册和保真工具，以促进评价和系统执行。 第二和第三个目标是进行混合型1有效性-实施随机控制 对40名自闭症青少年进行试验，以检验干预和研究的可行性和可接受性 程序，同时也审查拟议的目标行动机制(例如，自我效能、工作联盟、 感知的社会支持)和临床结果，如社区参与、孤独和复原力。 这项工作将收集更多证据和实施信息，以支持全动力R01- 资助的临床试验。拟议的努力将涉及不同的自闭症患者群体的大量参与 所有阶段的成年人以及多个社区合作伙伴，包括一名医疗补助付款人。该项目已 为自闭症成年人扩大服务选择的巨大潜力，并有望拥有广泛的， 可扩展的影响。

Abstract Approximately 5.4 million adults in the United States (1 in 45) are believed to have autism spectrum disorder (ASD), but there is a lack of services available to support them in reaching their full potential. Although typically conceptualized as a childhood disorder, ASD-related service needs persist into adulthood. The core social and communication impairments of ASD, reported difficulties with change, and a high rate of co-occurring mental health conditions often result in limited participation in major life areas that are determinants of health, including social and community participation, employment, housing, and transportation. The transition to adulthood is not only associated with developmental challenges, but also a “services cliff” whereby supports and services that were previously available through the education system are no longer available. Peer- delivered interventions have emerged as a potent, evidence-based modality for enhancing outcomes among other clinical populations, such as adults with serious mental illnesses, with effectiveness in enhancing social networks, empowering participants, reducing the use of inpatient services, and increasing life satisfaction. At present, there is limited research on the effectiveness of autistic-led peer support interventions, especially those that target broad aspects of community functioning. The proposed study seeks to refine, manualize, and test a pilot autistic peer support program aimed at supporting community participation among autistic young adults, with the goal of preparing it for large-scale testing and future dissemination and sustainability. The first aim of this proposal is to enhance the structure of a pilot autistic-peer delivered intervention (Community Autism Peer Specialists, or CAPS) that is currently in use as a Medicaid-reimbursed service in Philadelphia. This will include developing a manual and fidelity tool to facilitate evaluation and systematic implementation. The second and third aims are to conduct a hybrid type 1 effectiveness-implementation randomized controlled trial with 40 young autistic adults to test the feasibility and acceptability of the intervention and research procedures, while also examining proposed target mechanisms of action (e.g., self-efficacy, working alliance, perceived social support) and clinical outcomes such as community participation, loneliness, and resilience. This work will gather additional evidence and implementation information to support a fully-powered R01- funded clinical trial. The proposed efforts will involve substantial engagement of a diverse group of autistic adults in all phases along with multiple community partners, including a Medicaid payer. The project has tremendous potential to expand service options for autistic adults and is uniquely poised to have broad, scalable impact.