518996 research-article2014
AUT10.1177/1362361313518996AutismShattuck and Roux
Commentary
Commentary on employment supports research
The authors of “Vocational support approaches in autism spectrum disorder: A synthesis review of the literature” have written a commendable review that finds a very weak academic evidence base about employment supports. Although the majority of a typical lifetime is spent in adulthood, we know the least about this stage of life—by far—when it comes to autism spectrum disorders (ASDs). The authors make thoughtful suggestions for advancing this important area of research. We wish to offer complementary ideas rooted in life course and public health perspectives. These perspectives shift the focus of attention from the individual to the social level of analysis, shine light on measurement ideas seldom discussed in employment intervention research, and offer a set of research approaches that could help advance this area of inquiry. In contrast to the dearth of research on vocational supports, many ASD program innovations are happening outside of academia (Autism Speaks, 2012). An outpouring of grassroots efforts and billions of public dollars for services each year aim to foster better outcomes for those affected by autism. In real-world settings, the problem is less about a shortage of effort than a shortage of processes for learning from effort. Our ability to meaningfully measure efforts and outcomes at program and population levels is woefully underdeveloped. Imagine if a large corporation tried to operate without financial statements—without a clear picture of sales, expenditures, customer satisfaction, or assets. The company would quickly go under. Yet, this state of affairs is commonplace in many autism services. At a population level, we are almost completely unable to clearly describe the resources expended on services or measurable indicators of the population outcomes we hope to influence— including the employment rate. Tracking sales and inventory, mining “Big Data,” visualizing performance indicators with data dashboards, and the huge toolbox of measurement approaches used in continuous quality improvement practices are transforming the landscape of business and health-care administration around the world. Wise organizations invest in creating measurement feedback loops to learn from experience in ways that help improve future performance.
Autism 2015, Vol. 19(2) 246–247 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361313518996 aut.sagepub.com
We need a corresponding measurement revolution for ASD services, including employment supports. An abundance of opportunities exist for collaborating with community agencies to create practice-based evidence. Scientists with advanced training in measurement and analysis methods are uniquely positioned to be useful in this endeavor. A public health approach emphasizes collaborating for success. When it comes to solving the employment problem, our most important partners are employers, adults on the autism spectrum, and family members. A collaborative partnership perspective underscores learning with others to collectively understand and solve problems. Finally, a life course public health lens also demands investigation of the social–ecological context of employment. Our developmental theories generally support a biopsychosocial framework for understanding disability (World Health Organization (WHO), 2001). However, the vast majority of scientific thinking and inquiry in the field of autism hovers at the biological and psychological levels. Unemployment is not just an individual predicament, it is a social problem. Social problems cannot be solved entirely through a focus on modifying individual behaviors and abilities, although this is certainly an important pursuit. We also need to examine the social environment and the impact of interventions targeting a community or policy level. We enthusiastically endorse the Review authors’ call for more research on the role of workplace peers in fostering job success. Other topics of inquiry could include social networks, workplace and social policies, and identifying ways successful employment programs benefit businesses and communities in addition to those on the autism spectrum. Can we challenge ourselves to study the strengths and benefits people on the autism spectrum contribute to workplaces and society? Employment is also a highly dynamic social phenomenon that is continually changing. For example, the longterm growth in the percentage of jobs in the service sector (where every job description emphasizes interacting with others) is uniquely disabling to people for whom social interaction is problematic. Furthermore, the racial and
Downloaded from aut.sagepub.com at TEXAS A & M INTL UNIV on March 14, 2015
247
Shattuck and Roux ethnic diversity of the population and income inequality have been growing. This means more adults on the autism spectrum will be from non-White families that have limited financial means—a fact rarely acknowledged in autism services research (Shattuck et al., 2012). There can be no such thing as a perfectible intervention model for a problem whose social–ecological context is continually shifting. Alternatively, public health program evaluation and continuous quality improvement methods are rooted in an outlook that assumes the task of intervention development and improvement is never finished and always involves tailoring to community settings. As a whole, fostering innovation in applied populationlevel measurement approaches; partnering with community organizations, autistic adults, families and employers; and broadening the focus of inquiry to emphasize the importance of social–ecological context must all be parts
of advancing the science of improving the quality of life of people affected by autism. References Autism Speaks (2012) Employment Think Tank Report (Internet). Available at: http://www.autismspeaks.org/sites/default/ files/as_think_tank_exec_summary_web1.pdf Shattuck PT, Roux AM, Hudson LE, et al. (2012) Services for adults with an autism spectrum disorder. Canadian Journal of Psychiatry 57(5): 284–291. World Health Organization (WHO) (2001) International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.
Downloaded from aut.sagepub.com at TEXAS A & M INTL UNIV on March 14, 2015
Paul T Shattuck and Anne M Roux Drexel University, USA
AUT10.1177/1362361313518996AutismShattuck and Roux
Commentary
Commentary on employment supports research
The authors of “Vocational support approaches in autism spectrum disorder: A synthesis review of the literature” have written a commendable review that finds a very weak academic evidence base about employment supports. Although the majority of a typical lifetime is spent in adulthood, we know the least about this stage of life—by far—when it comes to autism spectrum disorders (ASDs). The authors make thoughtful suggestions for advancing this important area of research. We wish to offer complementary ideas rooted in life course and public health perspectives. These perspectives shift the focus of attention from the individual to the social level of analysis, shine light on measurement ideas seldom discussed in employment intervention research, and offer a set of research approaches that could help advance this area of inquiry. In contrast to the dearth of research on vocational supports, many ASD program innovations are happening outside of academia (Autism Speaks, 2012). An outpouring of grassroots efforts and billions of public dollars for services each year aim to foster better outcomes for those affected by autism. In real-world settings, the problem is less about a shortage of effort than a shortage of processes for learning from effort. Our ability to meaningfully measure efforts and outcomes at program and population levels is woefully underdeveloped. Imagine if a large corporation tried to operate without financial statements—without a clear picture of sales, expenditures, customer satisfaction, or assets. The company would quickly go under. Yet, this state of affairs is commonplace in many autism services. At a population level, we are almost completely unable to clearly describe the resources expended on services or measurable indicators of the population outcomes we hope to influence— including the employment rate. Tracking sales and inventory, mining “Big Data,” visualizing performance indicators with data dashboards, and the huge toolbox of measurement approaches used in continuous quality improvement practices are transforming the landscape of business and health-care administration around the world. Wise organizations invest in creating measurement feedback loops to learn from experience in ways that help improve future performance.
Autism 2015, Vol. 19(2) 246–247 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361313518996 aut.sagepub.com
We need a corresponding measurement revolution for ASD services, including employment supports. An abundance of opportunities exist for collaborating with community agencies to create practice-based evidence. Scientists with advanced training in measurement and analysis methods are uniquely positioned to be useful in this endeavor. A public health approach emphasizes collaborating for success. When it comes to solving the employment problem, our most important partners are employers, adults on the autism spectrum, and family members. A collaborative partnership perspective underscores learning with others to collectively understand and solve problems. Finally, a life course public health lens also demands investigation of the social–ecological context of employment. Our developmental theories generally support a biopsychosocial framework for understanding disability (World Health Organization (WHO), 2001). However, the vast majority of scientific thinking and inquiry in the field of autism hovers at the biological and psychological levels. Unemployment is not just an individual predicament, it is a social problem. Social problems cannot be solved entirely through a focus on modifying individual behaviors and abilities, although this is certainly an important pursuit. We also need to examine the social environment and the impact of interventions targeting a community or policy level. We enthusiastically endorse the Review authors’ call for more research on the role of workplace peers in fostering job success. Other topics of inquiry could include social networks, workplace and social policies, and identifying ways successful employment programs benefit businesses and communities in addition to those on the autism spectrum. Can we challenge ourselves to study the strengths and benefits people on the autism spectrum contribute to workplaces and society? Employment is also a highly dynamic social phenomenon that is continually changing. For example, the longterm growth in the percentage of jobs in the service sector (where every job description emphasizes interacting with others) is uniquely disabling to people for whom social interaction is problematic. Furthermore, the racial and
Downloaded from aut.sagepub.com at TEXAS A & M INTL UNIV on March 14, 2015
247
Shattuck and Roux ethnic diversity of the population and income inequality have been growing. This means more adults on the autism spectrum will be from non-White families that have limited financial means—a fact rarely acknowledged in autism services research (Shattuck et al., 2012). There can be no such thing as a perfectible intervention model for a problem whose social–ecological context is continually shifting. Alternatively, public health program evaluation and continuous quality improvement methods are rooted in an outlook that assumes the task of intervention development and improvement is never finished and always involves tailoring to community settings. As a whole, fostering innovation in applied populationlevel measurement approaches; partnering with community organizations, autistic adults, families and employers; and broadening the focus of inquiry to emphasize the importance of social–ecological context must all be parts
of advancing the science of improving the quality of life of people affected by autism. References Autism Speaks (2012) Employment Think Tank Report (Internet). Available at: http://www.autismspeaks.org/sites/default/ files/as_think_tank_exec_summary_web1.pdf Shattuck PT, Roux AM, Hudson LE, et al. (2012) Services for adults with an autism spectrum disorder. Canadian Journal of Psychiatry 57(5): 284–291. World Health Organization (WHO) (2001) International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.
Downloaded from aut.sagepub.com at TEXAS A & M INTL UNIV on March 14, 2015
Paul T Shattuck and Anne M Roux Drexel University, USA
