A Hybrid Effectiveness-Implementation RCT of Virtual Interview Training for Autistic Transition-Age Youth

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Project Summary: Pre-employment transition services is federally-mandated by the Workforce Innovation and Opportunities Act (2014) to help prepare autistic transition-age youth for the workforce prior to existing high school. However, there are few evidence-based practices implemented within pre-employment transition services, which contribute to low employment rates among autistic transition-age youth. A limitation of pre-employment transition services is the job interview component, which utilizes teacher-led role-play training that lacks empirical validation, is resource-intensive, and does not adhere to best practices to train sustainable changes in behavior (e.g., repeated practice, scaffolding, token economy). Moreover, the autism community as voice the need for better job interview preparation. To fill this training need, our team (via R34 MH111531) partnered with the autism community to adapt Virtual Reality Job interview Training (VR-JIT, an internet-delivered job interview simulator with four levels of automated feedback with elearning job interview content) to meet the needs of autistic transition-age youth (now called Virtual Interview Training for Transition Age Youth (VIT)). Our subsequent randomized controlled trial demonstrated several aspects of VIT feasibility, including delivery by local teachers at five schools, training teachers as VIT implementers, and completing the pilot RCT (i.e., recruitment, enrollment, study completers). The results of this pilot study demonstrated that VIT was initially effective at improving job interview skills, job interview anxiety, and competitive employment within 6 months of completing VIT. Thus, the overarching goal of this study is to conduct a fully-powered trial to evaluate the impact of VIT across approximately 16 schools via a hybrid type 1 effectiveness-implementation RCT. Our specific aims are to 1) Evaluate whether pre-employment transition services (ETS) with VIT, as compared to ETS with an active control intervention (i.e., job interview didactics/elearning with a series of 3-5 minutes videos of employed autistic adults talking about their career pathways), enhances employment outcomes; 2) Evaluate mechanisms of employment outcomes and psychological distress by nine months post- randomization; and 3) Conduct a multilevel, mixed-method process evaluation to assess initial implementation outcomes (i.e., facilitators, barriers, scalability, and affordability of VIT implementation).