Vocational rehabilitation counselors’ experiences with clients diagnosed with autism spectrum disorder: Results of a national survey

Abstract

BACKGROUND: Although individuals with autism spectrum disorder (ASD) are accessing vocational rehabilitation services in larger numbers than previously, their vocational outcomes are extremely poor. The thoughts and experiences of vocational rehabilitation counselors in working with this population have not previously been explored.

OBJECTIVE: The current study was designed to gather information about vocational rehabilitation counselors’ experiences and thoughts on working with adults with ASD.

METHODS: An original 73-item survey was developed and disseminated to vocational rehabilitation counselors across the U. S. Participants were recruited through email and were asked to respond to a web-based survey.

RESULTS: A total of 932 vocational rehabilitation counselors representing 35 states participated in the survey. Although most respondents had a small caseload/workload of individuals with ASD, the majority had experiences working with this population. Respondents overwhelmingly agreed that social skill deficits presented barriers to workplace success. Almost all respondents indicated interest in receiving additional training in supporting their clients with ASD and felt these clients would benefit from social skill intervention programs.

CONCLUSIONS: The results of this study suggest that social skill deficits are critical to consider for practitioners working with individuals with ASD and researchers interested in exploring the efficacy of this work.

Keywords

Autism spectrum disorder supported employment vocational rehabilitation counselors

1 Introduction

The transition from high school to adulthood is an exciting time for most adolescents but for individuals with autism spectrum disorder (ASD) this transition period has been shown to be a major issue (Burgess & Cimera, 2014; Taylor & Malik, 2014; Wehman et al., 2014). Often services received through the school system are no longer available and many individuals with ASD are left navigating a limited service system without much support (Howlin, Alcock, & Burkin, 2005; Taylor & Seltzer, 2010). Shattuck, Wagner, Narendorf, Sterzing, and Henzley (2011) examined the use of the four main types of community resources (i.e., mental health services, medical evaluation and assessment, speech-language therapy, and case management) utilized by young adults with ASD during the first few years after leaving high school. Data from 410 post-high school young adults with ASD suggested that many individuals with ASD do not access community resources at the same rate as they did while in school. Specifically, the rates of community resources used by sample were 23.5% for medical services, 35% for mental health services, 41.9% for case management, and 9.1% for speech-language therapy. Notably, estimates of service use rate for speech-language therapy while in high school was found to be 74.6% which reflects a dramatic decrease in this type of service use upon leaving school for young adults with ASD.

Despite these data, current research suggests more transition-aged adults with ASD are accessing services through state vocational rehabilitation agencies (Burgess & Cimera, 2014). However, employment outcomes for this population have not improved with many individuals underemployed and living below the poverty threshold (Burgess & Cimera, 2014). In fact, studies have found a 70% + unemployment/underemployment rate of adults with ASD (Ballaban-Gil, Rapin, Tuchman, & Shinnar, 1996; Cameto, Marder, Wagner, & Cardoso, 2003; Howlin, Goode, Hutton, & Rutter, 2004). Though prevalence estimates continue to increase (Atladottir, 2007; Centers for Disease Control and Prevention, 2012, 2014; Kogan et al., 2009; Nassar et al., 2009) research efforts have largely focused on the younger population of individuals with autism spectrum disorder (ASD) (Hurlbutt & Chalmers, 2004; Taylor, Dove, et al., 2012). This is problematic as ASD is a life-long condition with even higher-functioning adults often impacted socially and vocationally (Ballaban-Gil et al., 1996; Billstedt, Gillberg, & Gillberg, 2007; Eaves & Ho, 2008; Howlin, Goode, Hutton, & Rutter, 2004; Taylor & Seltzer, 2011).

Adults with ASD have unique vocational needs compared to individuals with other developmental disabilities. For example, each person with ASD presents a variety of characteristics across diagnostic criteria (Hendricks, 2010). However, social language deficits are common across the population though at differing extents. Current research indicates that the low employment rate of individuals with ASD is not due to job skill deficiencies but rather social language difficulty (Dew & Alan, 2007; Holmes, 2007; Hurlburtt & Chalmers, 2004; Unger, 1999). Social language deficits in individuals with ASD present significant barriers to independence. However, there is a dearth of literature examining the effects of social skill intervention programs for individuals with ASD. In a recent Cochrane systematic review and meta-analysis on the effectiveness of social skills interventions for individuals with ASD, only five studies met the inclusion criteria; none of those studies included individuals older than 17 years (Reichow, Steiner, & Volkmar, 2012).

Although the number of individuals with ASD utilizing Vocational Rehabilitation services increased by more than 121% from 2002 to 2006 (Cimera & Cowan, 2009), there is little research evaluating employment strategies and outcomes of the services provided (Hendricks, 2010; Taylor, McPheeters, Sathe, & Dove, 2012). In a recent systematic review of vocational interventions for young adults with ASD, researchers identified only 5 studies of varying methodological quality that met their inclusion criteria (Taylor, McPheeters, et al., 2012). Although there were some promising results specifically supporting on-the-job supports, for example, the authors suggest additional research of methodological rigor is necessary to provide recommendations for practice. In a Campbell Systematic Review, Westbrook and colleagues (2012) supported the findings of Taylor et al. (2012). They were able to identify only two of the studies described by Taylor et al. (2012) as meeting their inclusion criteria and were unable to meta-analyze the available data. Clearly, there remains a dearth of literature that is able to provide practitioners with the information they need to guide their practice in supporting the employment endeavors of individuals with ASD. It remains unclear how service providers, such as vocational rehabilitation counselors, provide support to adults on their caseload with ASD given this lack of efficacy evidence.

The purpose of this study was to gather information about vocational rehabilitation counselors and their thoughts about and experiences in working with individuals with ASD. Specifically, it remains unclear whether vocational rehabilitation counselors feel confident and successful in supporting individuals with ASD. Also, what do vocational rehabilitation counselors view as the challenges in supporting this population? The following research questions were posed:

1. What factors (i.e., experience, number of clients with ASD, confidence level, education/training) are related to perceived ability to successfully support individuals with ASD in securing and maintaining employment?

2. What are the most common barriers in assisting clients with ASD in securing and maintaining employment?

3. What are the most commonly perceived needs in supporting the social skill development of individuals with ASD?

2 Method

To investigate the thoughts and experiences of vocational rehabilitation counselors in working with individuals with ASD, an original 73–item survey was designed (see Appendix A). This survey was then created in Qualtrics, an electronic survey development, distribution, and management system. In the fall of 2014, the author began distribution of the survey link via email. Emails available on state websites were located and utilized, however, many states did not provide vocational rehabilitation counselor contact information online. The author also contacted the Council of State Administrators of Vocational Rehabilitation’s (CSAVR) Research Committee which endorsed the survey and sent the link out to each of their state contacts. Many of those state representatives then forwarded the survey link to vocational rehabilitation counselors in their respective states. In addition, the author emailed state agency contacts listed on the SEDL Vocational Rehabilitation Service Models and Autism Spectrum Disorders project directory. A snowball sampling technique was also used in that each email participant was asked to forward the Qualtrics link to their vocational rehabilitation colleagues. Survey results were available immediately after a participant completed the survey in the private Qualtrics account of the author. Data were downloaded to SPSS v. 20 on July 10, 2015.

This research was approved by the University of Northern Colorado Institutional Review Board. Participants were provided with an informed consent once they clicked on the survey link. If they wished to participate in the study they simply clicked “next” and were directed to Question 1 of the survey. Participants were encouraged to answer all questions but not required to do so.

3 Results

3.1 Participants

A total of 1,009 participants started the survey. Of those, 932 representing 35 states answered Question 1 indicating they were currently employed as a vocational rehabilitation counselor and were directed to the next question. The remaining 77 participants indicated they were not currently employed as a vocational rehabilitation counselor and were directed to the end of the survey which thanked them for their time. Thus, only those participants who confirmed they were currently employed as vocational rehabilitation counselors answered the remainder of the survey items and were included in the results. Because survey participants were not required to answer all questions, the number of participants who responded varied across items. Specific n’s are provided in the results Tables and Figures for each survey question.

Table 1 outlines both the general experience level of the participants and the specific experience of the participants in working with clients with ASD. The results suggest the majority of participants have been working as vocational rehabilitation counselors for 10 years or less (62%). Further, participants indicated clients with ASD did not make up a large percentage of their current caseload with 91% of participants reporting 25% of their caseload or less. A majority of participants (85%) have worked with at least 6 individuals with ASD over the course of their career with 37% of participants reporting having worked with more than 25 individuals with ASD. The results also suggest the amount of time per week the participants work directly on cases of individuals with ASD is relatively small with 85% of participants reporting spending 5 hours or less on these cases.

The participants varied in their reported success in supporting individuals with ASD, their confidence in doing so and in counseling these clients, as well as how they rated their education and/or training in preparing them to work with individuals with ASD (see Table 2). A Spearman rank order correlation procedure was used to answer Research Question 1: What factors (i.e., experience, number of clients with ASD, confidence level, education/training) are related to perceived ability to successfully support individuals with ASD in securing and maintaining employment? The Spearman’s rho revealed a low, positive correlation between participants’ perceived success in assisting clients with ASD and their confidence in their ability to support clients with ASD (rs = 0.47, p < 0.001). The other three factors compared to perceived success revealed negligible correlations: experience (rs[822] = –0.08, p = 0.006), number of clients with ASD (rs[816] = –0.25, p < 0.001), and education/training (rs[889] = 0.29, p < 0.001).

Responses to questions related to community resources available (see Table 2) revealed many vocational rehabilitation counselors were unsatisfied with their options. For instance, only 25% of the respondents rated the community partnership options they have for placing their clients with ASD as “good” or “excellent.” Further, only 30% of respondents were “very satisfied” or “somewhat satisfied” with the resources available in their community to support the social functioning of their clients with ASD.

It’s clear that a lack of community resources presents barriers to assisting clients with ASD. Several additional survey items were designed to address Research Question 2: What are the most common barriers in assisting clients with ASD in securing and maintaining employment? As is shown in Appendix A, participants were asked to consider a number of potential barriers, social skill areas, or workplace supports when responding to a given question. Tables 3–6 present the results of these survey questions.

As shown in Table 3, the potential barriers respondents were asked to consider were found to largely be viewed as barriers to successful employment. Specifically, interviewing skills was noted to present the most significant challenge to their clients with ASD with 76% of respondents describing it as a significant barrier and less than 1% describing it as not a barrier at all. Conversely, only 10% of respondents rated level of family support as a significant barrier with 37% responding family support was not a barrier at all for the majority of their clients with ASD and 52% noting it as somewhat of a barrier. Table 4 presents the respondents’ ratings on placement considerations for their clients with ASD. Interestingly, the majority of respondents (73–87%) rated each of listed considerations as very important to consider. Social skill requirements of the job was the item rated by the most respondents (87%) as very important to consider. In fact, virtually all (99.8%) of the respondents rated it as either very important or somewhat important to consider.

The responses to the questions represented in Tables 5 and 6 are related in that they both deal with specific social skills and address Research Question 3: What are the most commonly perceived needs in supporting the social skill development of individuals with ASD? Respondents were first asked to rate the given social skill areas in terms of importance for their clients to master for successful employment (see Table 5). They were then asked to rate how consistently their current and/past clients with ASD demonstrated difficulty with the skill. Again, there was consensus among the respondents in that they overwhelmingly rated the social skills as either somewhat or very important to master (87–99%). Appropriate body proximity was rated by the highest percentage of participants (72%) as very important to master. Fewer respondents (28%) felt the ability to appropriately use gestures in conversation was a skill that was very important to master.

When asked about clients with ASD the respondents had worked with, the majority of respondents (91–98%) felt that some or a majority of their clients demonstrated difficulty with each of the social skills presented in the survey. Fifty-four percent of the respondents noted the ability to appropriately maintain a conversation to be a skill that a majority of their clients had difficulty with while only 29% noted appropriate body proximity to be troubling for a majority of their clients.

Finally, an overwhelming majority of respondents were interested in additional resources to support individuals with ASD on their caseload. Specifically, 94% (n = 821) of the respondents stated they would be interested in receiving additional training in supporting their clients with ASD. Further, 98% (n = 820) of respondents felt social skill interventions or supports would be beneficial for the majority of their clients with ASD they had workedwith.

4 Discussion

The purpose of this study was to explore the thoughts and experiences of vocational rehabilitation counselors in working with clients with ASD. A total of 932 vocational rehabilitation counselors representing 35 states began the survey with 783 completing the final question. Although clients with ASD did not make up a large portion of the respondents’ caseload/workload, there was consistency across experiences working with this population. Respondents seemed to agree with the literature (Dew & Alan, 2007; Holmes, 2007; Hurlburtt & Chalmers, 2004; Unger, 1999) that social skill deficits are a significant barrier to successful employment for individuals with ASD. While many of the respondents felt at least somewhat confident in their ability to support clients with ASD and somewhat successful in assisting them in successfully achieving employment, they were overwhelmingly interested in receiving additional training to support these clients. Unfortunately, individuals with ASD transitioning to adulthood often lose many of the supports they were provided in the school system (Howlin, Alcock, & Burkin, 2005; Taylor & Seltzer, 2010). Based on the results of this survey, one issue that may be contributing to the lack of services received by this population could be the dearth of community resources available.

It is clear that social skill deficits remain a challenge for adults with ASD and the author argues there remains a role for the speech-language pathologist, with their expertise in social language, to work with these individuals to support both social and workplace goals. Currently, few speech-language pathologists become official vocational rehabilitation service providers specifically with the intention of working with individuals with ASD. Although the vocational rehabilitation counselors felt that many of their clients with ASD struggled with social language, only 29% of the respondents felt “very confident” in their ability to adequately assess these skills. There remains a serious lack of valid and reliable social language assessment measures for the adult population with ASD. This has resulted in research that has relied on self-report or parent-report questionnaires as measures of social knowledge. Even high-quality studies have neglected performance outcome measures. Many adults with higher functioning ASD demonstrate within normal meta-pragmatic skills; that is, they understand what they should do in certain situations. However, they have significantly more difficulty with performance outcome measures of social language (Murza & Nye, 2013; Murza et al., 2014). A speech-language pathologist with expertise in the area of performance outcome measures of social language could provide important information on the strengths and weaknesses of clients for vocational rehabilitation counselors. Skilled speech-language pathologists could also help support individuals with ASD who are seeking or who have already secured employment address many of the specific social skills the respondents rated as important to master for their clients. This recommendation is certainly consistent with 98% of the respondents who felt social skill interventions for their clients with ASD would be beneficial.

It should also be noted that lack of familial support (1.94; SD = 0.67) and motivation (1.73; SD = 0.64) were rated lowest in terms of barriers to successful employment by the participants. Although the average ratings approached “somewhat of a barrier”, this supports the notion that social skill deficits are one of the most significant barriers individuals with ASD face in securing and maintaining employment.

4.1 Study limitations

There are several methodological limitations in the present study. First, the sample (n = 932), which may be considered a convenience sample, is likely not representative of the population of vocational rehabilitation counselors in the U.S. (N = 117,500) (Bureau of Labor Statistics, 2015). It is also possible that vocational rehabilitation counselors with an interest in ASD were more inclined to participate than counselors without an interest in ASD. In addition, although 35 states were represented in the sample, 12 states were represented by 10 participants or less with 4 of these states represented by only 1 participant. Participants were also asked about their experiences working with clients with ASD without a definition of the term provided. Finally, it is important to note that although the survey was developed based on several examples within the literature and was piloted with individuals that were not vocational rehabilitation counselors to provide feedback and to make changes regarding the formatting and wording of the questions, the survey itself was not validated.

4.2 Implications for researchers and practitioners

Despite these methodological limitations, the study does appear to be the first of its kind to explore the experiences and thoughts of vocational rehabilitation counselors in working with clients with ASD. As previously mentioned, the results of this survey provide several implications for speech-language pathologists to advocate for their role in supporting adults with ASD as they transition to the workforce. It also provides support for an additional focus on issues related to supporting individuals with ASD in pre-service vocational rehabilitation programs. The results also clearly support the development of additional community support resources for this population and for the vocational rehabilitation counselors who work to find appropriate work placements for them. As described in the introduction, there remains a serious dearth of research addressing what works in providing supports for this population. However, it is clear from this study and previous research that social skill deficits should be addressed in any intervention program designed to support individuals with ASD in securing and maintaining employment. Vocational rehabilitation counselors may also want to consider how they can build on the familial support and motivation of their clients to improve the employment services they are providing.

There are also several implications of these results for researchers. Future research that takes into account the heterogeneity of the population of adults with ASD is critical for practitioners to determine which supports are appropriate for which clients. Researchers are also encouraged to include social skill performance outcomes rather than self-report or knowledge-based outcomes to allow for more meaningful interpretations of intervention efficacy. Finally, it remains unclear how vocational rehabilitation counselors are currently supporting their clients with ASD, for example: What specifically do they consider when counseling these clients? How do they help their clients secure employment? How do they support their clients who are employed? How do they support community partners who work with individuals with ASD?

5 Conclusions

This study demonstrated that vocational rehabilitation counselors recognize social skill deficits of adults with ASD as barriers to successful employment. Although many vocational rehabilitation counselors feel comfortable supporting individuals with ASD, most feel they would benefit from additional training and feel community resources are lacking. Future studies should specifically explore how vocational rehabilitation counselors support their clients with ASD secure and maintain employment and determine which actions support sustained employment.

Conflict of interest

The authors have no conflict of interest to report.

Funding

This research was not funded by any internal or external grants.

Footnotes

Appendix A

A Survey of Vocational Rehabilitation Counselors’ Experiences Working with Clients with Autism Spectrum Disorder

1. Are you currently employed as a vocational rehabilitation counselor?

Yes

2. How confident do you feel in your ability to support clients with autism spectrum disorder in securing and maintaining employment?

Very confident

Somewhat confident

Neutral

Lacking confidence

Not confident at all

3. How successful have you been in assisting your clients with autism spectrum disorder in successfully achieving employment?

Very successful

Somewhat successful

Neutral

Somewhat unsuccessful

Very unsuccessful

4. How comfortable are you in counseling clients with autism spectrum disorder about employment?

Very comfortable

Somewhat comfortable

Neutral

Somewhat uncomfortable

Very uncomfortable

5. How confident do you feel in your ability to adequately assess the social functioning and needs of your clients?

Very confident

Somewhat confident

Neutral

Lacking confidence

Not confident at all

6. How would you rate the education and/or training you received in preparing you to work with clients who have autism spectrum disorder?

Excellent

Good

Fair

Poor

Very poor

I didn’t receive any education or training in this area

7. How would you rate the community partnership options you have when considering placement of your clients with autism spectrum disorder?

Excellent

Good

Fair

Poor

Very poor

8. How would you describe the following barriers to successful employment for the majority of your clients with autism spectrum disorder?

9. How would you rate the following considerations when placing a client with autism spectrum disorder into a work setting?

10. How satisfied are you with the resources available in your community to support the social functioning needs of your clients with autism spectrum disorder?

Very satisfied

Somewhat satisfied

Neutral

Somewhat dissatisfied

Very dissatisfied

11. How would you rate the following social skill areas in terms of importance for your clients to master for successful employment?

12. For this question, please consider the clients you currently have with autism spectrum disorder and those you’ve had in the past. For each social skill area, please rate how consistently you’ve noticed your clients demonstrating difficulty with it.

13. How long have you worked as a vocational rehabilitation counselor?

0–5 years

6–10 years

11–15 years

16–20 years

21–25 years

More than 26 years

14. Approximately what percentage of the clients on your caseload are identified as having autism spectrum disorder?

Less than 5%

6–25%

26–50%

51–75%

76–100%

15. Approximately how many clients with autism spectrum disorder have you worked with across your career as a vocational rehabilitation counselor?

Less than 5

6–25

26–50

51–75

76–100

More than 100

16. Approximately how many hours a week are you working directly on a case of someone with autism spectrum disorder?

Less than 1 hour per week

2–5 hours per week

6–10 hours per week

11–20 hours per week

21–30 hours per week

31–40 hours per week

More than 41 hours per week

17. Would you be interested in receiving additional training on supporting your clients with autism spectrum disorder?

Yes

18. Do you think social skill interventions or supports would be beneficial for the majority of clients with autism spectrum disorder you’ve worked with?

Yes

19. In which state do you work?

(Drop down menu) ▴

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