Achieving Competitive Customized Employment through Specialized Services (ACCESS)

项目总结/摘要 自闭症谱系障碍（ASD）包括一组神经发育障碍，其定义为： 特征包括跨多种环境的社会沟通缺陷和限制性的，重复的模式， 行为，兴趣或活动（阿帕2000，2011）。ASD是一种越来越普遍（1/68）和昂贵的 在美国社会的条件。只有6-10%的ASD成年人获得有竞争力的就业（Cedurland， Hagberg，Billstedt，Gillberg，& Gillberg，2008; Taylor & Seltzer，2011; Wilczynski，Tramell，& Clarke，2013）.到 对ASD成年人的竞争性就业率产生有意义的影响，职业服务必须 加强就业匹配和就业定制。定制的就业过程 提供了通过专业服务实现有竞争力的定制就业的框架 （Access）干预措施，这是要测试。这一进程已显示出改善就业的潜力 在患有ASD的成年人中进行匹配;然而，该模型尚未经过实验测试（Heath，Ward，& Reed， 2013年）。此外，该过程的就业定制部分尚未应用于成年人 患有ASD，必须适应于解决这一人群在获得， 最后，保持就业竞争力。ACCESS干预有望改善 通过改善ASD求职者的就业匹配和定制来实现功能成果。的 这个R34应用程序的目标是改进和测试一种可以由社区为基础的 职业康复（VR）服务从业人员，以提高成人的就业竞争力 (age 22+）诊断为ASD。本申请的主要目的是：1）完善培训，治疗和 研究方案，以测试接入干预; 2）检查的可行性和可接受性接入在一个 迭代开放试验; 3）检查ACCESS相对于 在30名ASD成人的随机对照试验中进行常规护理。在迭代地改进训练之后， 治疗和研究方案，研究小组希望收集令人信服的证据， ACCESS干预的有效性，以支持由认证的 VR从业者到ASD成年人。这项研究有可能极大地改变目前的做法 通过为研究和政策决定提供信息，并通过定制就业安置战略， 使用干预平台解决患有ASD的成年求职者的具体支持需求 由VR报销。鉴于早期的证据有关的承诺，定制的干预措施，访问有 这是一个巨大的潜力，为这一群体和支持他们的利益攸关方带来深远的利益。

PROJECT SUMMARY/ABSTRACT Autism spectrum disorders (ASD) encompass a group of neurodevelopmental disorders whose defining features include deficits in social communication across multiple contexts and restrictive, repetitive patterns of behavior, interest, or activities (APA 2000, 2011). ASD is an increasingly prevalent (1 in 68) and costly condition in American society. Only 6-10% of adults with ASD obtain competitive employment (Cedurland, Hagberg, Billstedt, Gillberg, & Gillberg, 2008; Taylor & Seltzer, 2011; Wilczynski, Tramell, & Clarke, 2013). To have a meaningful impact on competitive employment rates for adults with ASD, vocational services must improve both employment matching and employment customization. The customized employment process provides the framework for the Achieving Competitive Customized Employment through Specialized Services (ACCESS) intervention that is to be tested. This process has demonstrated potential to improve employment matching in adults with ASD; however, the model has not been experimentally tested (Heath, Ward, & Reed, 2013). Additionally, the employment customization component of the process has yet to be applied to adults with ASD and must be adapted to address specific challenges that this population face in gaining and, ultimately, maintaining competitive employment outcomes. The ACCESS intervention promises to improve functional outcomes by improving both employment matching and customization for job seekers with ASD. The goal of this R34 application is to refine and test an intervention that can be utilized by community-based Vocational Rehabilitation (VR) service practitioners to improve competitive employment outcomes for adults (age 22+) diagnosed with ASD. The primary aims of this application are to: 1) refine training, treatment and study protocols to test the ACCESS intervention; 2) examine the feasibility and acceptability of ACCESS in an iterative open trial; and 3) examine the feasibility, acceptability and preliminary effects of ACCESS relative to usual care in a randomized controlled pilot trial of 30 adults with ASD. After iteratively improving training, treatment, and study protocols, the research team expects to gather convincing evidence of the feasibility and effectiveness of the ACCESS intervention to support a larger randomized controlled trial delivered by certified VR practitioners to adults with ASD. This research study has the potential to dramatically shift current practice paradigms by informing research and policy decisions and by customizing employment placement strategies to address the specific support needs of adult job seekers with ASD using the platform of an intervention already reimbursed by VR. Given early evidence regarding the promise of customized interventions, ACCESS has the potential to yield far-reaching benefits for this population and the stakeholders who support them.