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Supported Employment and Autism Ranking: Limited positive evidence

Supermarket employee Supported employment (also known as supported competitive employment or the supported work model of competitive employment) is a service provided to disadvantaged adults looking to find and retain a job.


It is based on the idea that, with appropriate help, disadvantaged adults can find and retain a job in the competitive marketplace rather than being unemployed or working in a sheltered workshop.

Supported employment programmes share common elements such as:

  • job development, including helping someone find appropriate jobs
  • job placement, including matching someone to an appropriate job
  • job-site training, which involves on-site skill training
  • assessment, which is an ongoing process to determine how the new worker is performing
  • job retention, which involves advocacy and procedures to ensure long-term job maintenance

Supported employment programmes are used to help a wide range of disadvantaged adults, including autistic people and people with other disabilities.

Our Opinion

There is a limited amount of low quality research evidence to suggest that supported employment programmes may increase employment rates among some autistic adults.

There is insufficient high quality research evidence to determine whether supported employment programmes may improve the overall quality of life among autistic adults.

There is a need for large scale, high quality research to determine if supported employment programmes can provide benefits of any kind to autistic adults.

There is a need for research to determine if any factors (such as age, gender, severity of autism symptoms, previous employment experience, and the level and quality of vocational preparation) influence the success of such schemes.

Any such research should involve autistic people to review the efficacy and ethical basis of the programmes.

Disclaimer

Please read our Disclaimer on Autism Interventions

Audience

Supported employment is designed to help people who are disadvantaged in the labour market, including autistic people and other conditions or disabilities

According to Wehman and Kregel (1998),

“The target population that supported employment programs are designed for are those individuals who are severely handicapped and who traditionally have been excluded from competitive employment.”

In practice, some supported employment programmes (such as the US Vocational Rehabilitation System) are designed to help anyone with a disability while other, more specialist programmes (such as the Prospects supported employment service which used to be run by the National Autistic Society in the UK) are specifically designed to help autistic individuals.

Aims and Claims

Aims

Supported employment schemes for people with disabilities may have a number of different aims. For example, according to O’Bryan et al (2000),

“A key assumption underlying the specialist sector's approach to supported employment is that the workplace is the best place to learn a job. As a matter of principle, it starts from the assumption that all disabled people may wish to access paid work, and that no individual or group should be seen as 'unemployable'. It is concerned with addressing some of the social, attitudinal, policy and practice barriers that exclude groups from paid work.

“The approach also attempts to set paid work in its wider social context. It is concerned with inclusion, in terms of both economic and social participation; it is meant to be about 'real' jobs in ordinary (unsegregated) workplaces.”

Claims 

There have been various claims made for supported employment. For example

  • Hillier A. et al. (2007) reported. "Increases in employment rates and income were found for program participants, and 7 participants retained their initial job placements through the 2-year period. Employers rated program participants highly on a range of important job skills, although these individuals continued to experience social challenges in the workplace. .... Overall, the results suggest that individuals on the autism spectrum can be successful in competitive, entry-level employment."
  • Howlin, Alcock and Burkin (2005) reported. "Individuals supported by Prospects show a rise in salaries, contribute more tax and claim fewer benefits. Satisfaction with the scheme is high among clients, employers and support workers. Moreover, there are many non-financial benefits, which are difficult to quantify."
  • Keel, Mesibov and Woods (1997) reported. "Division TEACCH has served over 100 persons through its program placing 96 of them in jobs across the state. A retention rate of 89% demonstrates the success of the program which is due in large part to the broad array of long-term support services provided to each person based on individual needs."

Key Features

Definitions

There are a number of definitions of supported employment. For example, according to O’Bryan et al (2000),

"Supported employment agencies inevitably vary in their approach (and in the extent to which they are able to put the ideals of supported employment into practice) but typically offer a combination of:

  • Helping people identify their skills and preferences through the development of a vocational profile
  • Job development to find the person's preferred job through contact with employers
  • Job analysis to find out more about the workplace, co-workers, and the support the individual might need in that environment;
  • Job support to ensure that both the employee and employer receive 'just enough' creative assistance, information and back-up to achieve success, with this support continuing as long as it is needed
  • Career support to help people think in the longer term about career progression."

Key Elements

Whichever definition is used, comprehensive supported employment packages normally contain a range of elements. For example

According to Wehman and Kregel (1998)

“Supported competitive employment, also known as the supported work model of competitive employment, has five key features: (a) job development, or locating appropriate jobs; (b) job placement, or the appropriate matching of the person to the job; (c) job-site training, which involves on-site skill training by the staff person assigned to the new worker; (d) assessment, which is an ongoing process to determine how the new worker is performing; and (e) job retention, which involves advocacy and procedures to ensure long-term job maintenance.”

According to García-Villamisar and Hughes (2007),

'Within each supported employment programme, there is an emphasis on using individual strengths and interests, identifying appropriate jobs and settings, applying structured teaching techniques, collaborating with families, caregivers and employers, providing necessary long-term support services, and ensuring the appropriate 'fit' so that the employee, employer and family/caregiver are all satisfied.'

Models

There are various models of autism-specific supported employment programmes. For example, according to the TEACCH Autism Program website, accessed on 17 February 2017, the TEACCH Autism Program provides four different models of supported employment.

“In an effort to provide each individual with ASD the greatest chance of obtaining and maintaining successful, competitive employment, the TEACCH Supported Employment Program has developed four models of support: One-to-One Placement, Mobile Crew, Group Shared Support Site, and Standard Placement. 

“Each of these models incorporates the use of a "job coach," a trained professional, employed by TEACCH, who provides on-going support for the individual or individuals with ASD. The job coach follows the TEACCH philosophy to implement intervention strategies to teach the individual with ASD the necessary vocational and social skills required in the employment setting. Job Coaches also educate coworkers and supervisors about ASD, and act as liaisons between the individuals with ASD and their employers. These four distinct, yet similar models of support are seen in a wide array of vocational settings. Supported Employment has placed people with ASD in areas such as Manufacturing, Food Service, Office or Clerical, Landscaping, Grocery or Warehouse, Libraries, and Janitorial Services.”

Cost and Time

Cost

The costs of supported employment schemes vary enormously, depending on which organisation is providing the support and the level of support required by the individual employee.

Time

The amount of time required by an employee receiving supported employment varies enormously, depending on the needs of the individual. For example, some employees may only require time-limited support in a particular job while others may require support during their whole career.

Risks and Safety

Hazards

We have unable to identify any hazards in undertaking supported employment for autistic people.

Contraindications

There are no known contraindications (something which makes a particular treatment or procedure potentially inadvisable) for supported employment.

However, there are some autistic people who simply can't cope with the anxiety of holding down a paid job, supported or not. They are however often happy to do unpaid voluntary work in a supported context

Research has shown that supported employment may be appropriate for many autistic people, including some with learning disabilities and challenging behaviours.

Suppliers and Availability

Suppliers 

There are a number of national and local organisations which run supported employment programmes in the UK and other countries.  For more details of organisations in the UK please contact the British Association for Supported Employment or visit the ‘Employment’ section of the Autism Services Directory.

Credentials

We have been unable to identify any mandatory qualifications or credentials for organisations or individuals providing supported employment for autistic employees.

History

Supported employment began in the USA and then spread to other countries such as the UK. According to the O’Bryan et al (2000)

"Initially this form of supported employment focussed primarily on people with learning difficulties. In recent years, however, many agencies have become more generic, working with a much wider range of people, including those with long-term mental health needs."

In the UK a specialised, autism-specific supported employment service, Prospects, was set up in 1974 in collaboration with The National Autistic Society, St George's London University, and the Employer's Forum on Disability in 1994.  

The National Autistic Society no longer provides a supported employment programme but there are a number of national and local organisations which do run supported employment programmes.

Current Research

We have identified 18 studies of supported employment programmes for autistic people published in English-speaking, peer-reviewed journals.

The studies had more than 400 adults and all but one reported positive benefits. The positive benefits included lengthy periods of continuous employment, income generated through employment (salary), a decrease in claims on the state (benefits), improved communication and social skills, increased independence etc.
 
Many of the studies reported on the efficacy or otherwise of specific supported employment programmes. For example
  • Mawhood and Howlin (1999) and Howlin et al (2005) reported on the Prospects supported employment programme run by the National Autistic Society in the UK
  • Lynas (2014) reported on Project ABLE, run by the Orchardville Society in Belfast, UK.
  • Keel et al (1997) reported on the TEACCH-supported employment programme run by TEACCH in North Carolina, USA.
  • McLaren et al (epub) reported on the Individual Placement and Support (IPS) model, run by the Dartmouth IPS Supported Employment Center in New Hampshire, USA.
  • Various studies inc. including Ham et al (2014); Scahall et al (2015); Wehman et al (2016) reported on the Project Search (plus ASD Supports) run by Business Connections in Virginia.
Two of the studies (Garcia-Villamisar, Wehman and Navarro, 2002; Garcia-Villamisar and Hughes, 2007) were longitudinal follow-up studies of a previous study (Garcia-Villamisar, Ross and Wehman, 2000) and compared the efficacy of a supported employment programme against a sheltered employment programme over a five year period. These studies reported that the autistic people who participated in the supported employment programme eventually improved their quality of life level in a very meaningful way whereas those who participated in the sheltered employment programme did not.
 
Please note: There were a number of studies that we did not include. For example,
  • We identified a number of studies which looked at some of the components of supported employment programmes (such as job training, audio coaching etc.) but were not complete programmes
  • We identified a number of studies which were retrospective reviews of large vocational datasets which reported that supported employment was beneficial to autistic adults.

Status Research

There are some potential limitations to some of the research studies identified to date. For example:

  • Some of the studies (such as Wehman et al, epub) did not independently verify the diagnosis of autism using established diagnostic tools like the ADOS or ADI-R.
  • Some of the studies (such as Burt, Fuller, and Lewis, 1991; Ham et al, 2014; and Wehman et al, 2013) were very small scale, with less than five participants.
  • The majority of the studies (such as Keele et al, 1997; Lynas et al, 2014; Wehman et al, 2016) were retrospective case reports or chart reviews, with no kind of experimental control.
  • Only two studies used a randomised controlled design (Wehman et al, 2014 and Wehman et al, epub) and the second of these was a follow up study to the first but with the addition of more participants.
  • Some of the studies (Wehman et al, 2014 and Wehman et al, epub) examined supported employment plus ASD Supports (a programme based on an internship model) making it difficult to know if any benefits arose from the supported programme by itself or from the combined programme.
  • Some of the studies did not use standardised, robust outcome measures. For example, Hillier et al. (2007) used self report measures, which are difficult to validate because responses can often be skewed in a positive direction.
  • Some of the studies (such as García-Villamisar and Hughes, 2007; Keel et al, 1997) did not report on significant outcome measures, such as the satisfaction or otherwise of the employee/s being supported; the satisfaction of the employer/s; or the cost of the support programme and/or the income received by the employee/s
  • Some of the studies (such as Howlin et al, 2005; Keele et al, 1997; Lynas et al, 2014) were undertaken by staff from the organisations which set up or ran the supported employment programme.
  • A significant proportion of the studies (one third) were undertaken by members of the same research group (Wehman, Schall etc).
Please see Why Some Autism Research Studies are Flawed for a full list of potential flaws in scientific research studies.

Future Research

Summary of Existing Research

There is a limited amount of low quality research evidence to suggest that supported employment programmes may increase employment rates among some autistic adults.

There is insufficient high quality research evidence to determine whether supported employment programmes may improve the overall quality of life among autistic adults.

There is very little research which involves autistic people to review the efficacy and ethical basis of the intervention.

Recommendations for Future Research

We agree with Taylor et al (2012) who stated

“Studies are also needed that illuminate which aspects of multifaceted supported employment programs have the greatest impact. Studies that do show evidence of effectiveness in this area should collect longer-term data to describe the degree to which findings, including the duration of employment, continue after the intervention itself is removed. These studies should also broaden the outcomes measured, to include other functional outcomes such as quality of life, educational attainment, residential outcomes, and social outcomes. Furthermore, it will be important for such studies to demonstrate and study the financial impact of specific programs over time on an individual, family, and systems level.

“Research is also necessary to understand how individual differences such as the severity of ASD symptoms, sociodemographic factors, and physical and mental health comorbidities may affect the transition to adulthood as well as treatment over an individual's life span.”

Any such research should involve autistic people to review the efficacy and ethical basis of the programmes.

Studies and Trials

This section provides details of scientific studies into the effectiveness of supported employment for autistic people which have been published in English-language, peer-reviewed journals.

If you know of any other publications we should list on this page please email info@informationautism.org

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Studies and Trials

Other Reading

This section provides details of other publications on this topic.

You can find more publications on this topic in our publications database.

If you know of any other publications we should list on this page please email info@informationautism.org

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Other Reading

Additional Information

Lawer et al (2009) reported on the experiences of 1,707 autistic people in the USA Vocational Rehabilitation System. They stated that, while autistic adults received the most expensive set of support services compared to people with other disabilities, they were more likely to be competitively employed compared to people with other disabilities, particularly if they received supported employment programmes.

Wehman et al (2014) reported on data from the Rehabilitation Services Administration Case Service Report (RSA-911) database for fiscal year 2009. The sample included 23,298 youth with intellectual and developmental disabilities aged between 16 and 25 years old at the time of application. They reported that “The effect of supported employment was especially strong for youth who were Social Security beneficiaries, special education students, and individuals with intellectual disabilities or autism who were high school graduates.” 

Mavranezouli et al. (2014) assessed the cost-effectiveness of supported employment for autistic adults in the United Kingdom versus standard day care. They reported that supported employment resulted in better outcomes than standard day care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (that is, it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for autistic adults in the United Kingdom are cost-effective compared with standard care. 

 

Related Additional Information

Updated
17 Jun 2022
Last Review
01 Aug 2017
Next Review
01 Oct 2023
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