Abstract
Employment outcomes for transition-age youth with autism spectrum disorder (TAY-ASD) following Vocational Rehabilitation (VR) services declined between 2002 and 2011; although a few states showed significant progress. We examined inter-state variation in VR service use and outcomes among TAY-ASD in 2014–2016, finding significant differences in the percentage of TAY-ASD who received VR services, entered VR services during secondary school, had timely development of an employment plan, and were employed at VR exit. Inter-state differences remained significant after adjusting for the influence of individual-level demographics and state-level unemployment and fiscal capacity, suggesting other factors influence variation. Future research should monitor whether changes in the VR program, via the 2014 Workforce Innovation and Opportunity Act, move the needle on VR outcomes for TAY-ASD.
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Change history
04 April 2019
The original version of this article unfortunately contained mistakes in Table 1 values. Some of the values in “TAY-ASD who received services” were incorrect. The corrected Table 1 is given below.
References
Alsaman, M. A., & Lee, C.-L. (2016). Employment outcomes of youth with disabilities in vocational rehabilitation: A multilevel analysis of RSA-911 data. Rehabilitation Counseling Bulletin, 60(2), 98–107.
Anderson, C., & Butt, C. (2018). Young adults on the autism spectrum: The struggle for appropriate services. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-018-3673-z.
Anderson, C., Lupfer, A., & Shattuck, P. T. (2018a). Barriers to receipt of services for young adults with autism. Pediatrics, 141(Supplement 4), S300–S305.
Anderson, K. A., Roux, A. M., Kuo, A., & Shattuck, P. T. (2018b). Social-ecological correlates in adult autism outcome studies: A scoping review. Pediatrics, 141(Supplement 4), S306–S317.
Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31(2), 285–293.
Bureau of Economic Analysis (2018). Real gross domestic product (GDP) of the United States in 2016, by state (in billion chained 2009 U.S. dollars). U.S. Department of Commerce. http://www.statista.com. Accessed 9 July 2018.
Bureau of Labor Statistics (2018). Unemployment rates for states, 2016 annual averages. U.S. Department of Labor. http://www.bls.gov/lau/lastrk16.htm. Accessed 9 July 2018.
Burgess, S., & Cimera, R. E. (2014). Employment outcomes of transition-aged adults with autism spectrum disorders: A state of the states report. American Journal on Intellectual and Developmental Disabilities, 119(1), 64–83.
Cao, L., & Yoon, A. (2017). Gross domestic product by state. U.S. Bureau of Economic Analysis. http://apps.bea.gov/scb/pdf/2017/06%20June/0617_gdp_by_state.pdf.
Chan, J. Y., Wang, C.-C., Ditchman, N., Kim, J. H., Pete, J., Chan, F., et al. (2014). State unemployment rates and vocational rehabilitation outcomes: A multilevel analysis. Rehabilitation Counseling Bulletin, 57(4), 209–218.
Chen, J. L., Leader, G., Sung, C., & Leahy, M. (2015a). Trends in employment for individuals with autism spectrum disorder: A review of the research literature. Review Journal of Autism and Developmental Disorders, 2(2), 115–127.
Chen, J. L., Sung, C., & Pi, S. (2015b). Vocational rehabilitation service patterns and outcomes for individuals with autism of different ages. Journal of Autism and Developmental Disorders, 45(9), 3015–3029.
Cimera, R. E., Burgess, S., & Wiley, A. (2013). Does providing transition services early enable students with ASD to achieve better vocational outcomes as adults? Research and Practice for Persons with Severe Disabilities, 38(2), 88–93.
Clancy, C. M., Glied, S. A., & Lurie, N. (2012). From research to health policy impact. Health Services Research, 47(1pt2), 337–343.
Coleman, D. M., & Adams, J. B. (2018). Survey of vocational experiences of adults with autism spectrum disorders, and recommendations on improving their employment. Journal of Vocational Rehabilitation, 49(1), 67–78.
Fabian, E., Dong, S., Simonsen, M., Luecking, D. M., & Deschamps, A. (2016). Service system collaboration in transition: An empirical exploration of its effects on rehabilitation outcomes for students with disabilities. Journal of Rehabilitation, 82(3), 3–10.
Giesen, J. M., & Cavenaugh, B. S. (2013). Disability insurance beneficiaries with visual impairments in vocational rehabilitation: Socio-demographic influences on employment. Journal of Visual Impairment & Blindness, 107(6), 453–467.
Hemmeter, J., Mann, D. R., & Wittenburg, D. C. (2017). Supplemental security income and the transition to adulthood in the United States: State variations in outcomes following the age-18 redetermination. Social Service Review, 91(1), 106–133. https://doi.org/10.1086/691219.
Honeycutt, T., Bardos, M., & McLeod, S. (2015a). Bridging the gap: A comparative assessment of vocational rehabilitation agency practices with transition-age youth. Journal of Vocational Rehabilitation, 43(3), 229–247.
Honeycutt, T., Martin, F., & Wittenburg, D. (2017). Transitions and vocational rehabilitation success: Tracking outcomes for different types of youth. Journal of Vocational Rehabilitation, 46(2), 137–148.
Honeycutt, T., Thompkins, A., Bardos, M., & Stern, S. (2013). State differences in the vocational rehabilitation experiences of transition-age youth with disabilities. Princeton: Mathematica Policy Research. http://www.disabilitypolicyresearch.org//DRC/.
Honeycutt, T., Thompkins, A., Bardos, M., & Stern, S. (2015b). State differences in the vocational rehabilitation experiences of transition-age youth with disabilities. Journal of Vocational Rehabilitation, 42(1), 17–30.
Jansen, M. W., Van Oers, H. A., Kok, G., & De Vries, N. K. (2010). Public health: Disconnections between policy, practice and research. Health Research Policy and Systems, 8(1), 37.
Kaya, C., Chan, F., Rumrill, P., Hartman, E., Wehman, P., Iwanaga, K., et al. (2016). Vocational rehabilitation services and competitive employment for transition-age youth with autism spectrum disorders. Journal of Vocational Rehabilitation, 45(1), 73–83.
Kaya, C., Hanley-Maxwell, C., Chan, F., & Tansey, T. (2018). Differential vocational rehabilitation service patterns and outcomes for transition-age youth with autism. Journal of Applied Research in Intellectual Disabilities, 31(5), 862–872.
Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017). Designing and managing programs: An effectiveness-based approach (5th edn.). Washington, DC: SAGE.
Lawer, L., Brusilovskiy, E., Salzer, M. S., & Mandell, D. S. (2009). Use of vocational rehabilitative services among adults with autism. Journal of Autism and Developmental Disorders, 39(3), 487–494.
Luecking, R. G., Fabian, E. S., Contreary, K., Honeycutt, T. C., & Luecking, D. M. (2017). Vocational rehabilitation outcomes for students participating in a model transition program. Rehabilitation Counseling Bulletin, 61(3), 154–163.
Maas, C. J., & Hox, J. J. (2005). Sufficient sample sizes for multilevel modeling. Methodology, 1(3), 86–92.
Martin, L. L., & Kettner, P. M. (2009). Measuring the performance of human service programs. Los Angeles: SAGE.
Merlo, J., Chaix, B., Ohlsson, H., Beckman, A., Johnell, K., Hjerpe, P., et al. (2006). A brief conceptual tutorial of multilevel analysis in social epidemiology: Using measures of clustering in multilevel logistic regression to investigate contextual phenomena. Journal of Epidemiology & Community Health, 60(4), 290–297.
Migliore, A., Butterworth, J., & Zalewska, A. (2014). Trends in vocational rehabilitation services and outcomes of youth with autism: 2006–2010. Rehabilitation Counseling Bulletin, 57(2), 80–89.
Migliore, A., Timmons, J., Butterworth, J., & Lugas, J. (2012). Predictors of employment and postsecondary education of youth with autism. Rehabilitation Counseling Bulletin, 55(3), 176–184.
Miller, N. A., Ramsland, S., Goldstein, E., & Harrington, C. (2001). Use of medicaid 1915(c) home- and community-based care waivers to reconfigure state long-term care systems. Medical Care Research and Review, 58(1), 100–119. https://doi.org/10.1177/107755870105800106.
Nicholas, D. B., Hodgetts, S., Zwaigenbaum, L., Smith, L. E., Shattuck, P., Parr, J. R., et al. (2017). Research needs and priorities for transition and employment in autism: Considerations reflected in a “Special Interest Group” at the International Meeting for Autism Research. Autism Research, 10(1), 15–24.
Nye-Lengerman, K. (2017). Vocational rehabilitation service usage and outcomes for individuals with autism spectrum disorder. Research in Autism Spectrum Disorders, 41, 39–50.
Parish, S. L., Thomas, K. C., Rose, R., Kilany, M., & Shattuck, P. T. (2012). State medicaid spending and financial burden of families raising children with autism. Intellectual and Developmental Disabilities, 50(6), 441–451.
Partnerships in Employment. (2014). Vocational rehabilitation: Observations from partnerships in employment state projects. http://www.partnershipsinemployment.com.
Pharr, J. R., Moonie, S., & Bungum, T. J. (2011). The impact of unemployment on mental and physical health, access to health care and health risk behaviors. ISRN Public Health, 2012, 7
Pillay, Y., & Brownlow, C. (2016). Predictors of successful employment outcomes for adolescents with autism spectrum disorders: A systematic literature review. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-016-0092-y.
Poppen, M., Lindstrom, L., Unruh, D., Khurana, A., & Bullis, M. (2017). Preparing youth with disabilities for employment: An analysis of vocational rehabilitation case services data. Journal of Vocational Rehabilitation, 46(2), 209–224.
Roux, A. M., Anderson, K. A., Rast, J. E., Nord, D., & Shattuck, P. T. (2018). Vocational rehabiltiation experiences of transition-age youth with autism spectrum disorder across states: Prioritizing modifiable factors for research. Journal of Vocational Rehabilitation. https://doi.org/10.3233/JVR-180976.
Roux, A. M., Rast, J. E., Anderson, K. A., & Shattuck, P. T. (2016) National autism indicators report: Vocational rehabilitation. Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University. Accessed at http://drexel.edu/autismoutcomes/publications-and-reports/publications/National-Autism-Indicators-Report-Vocational-Rehabilitation/.
Roux, A. M., Rast, J. E., Nye-Lengerman, K., Purtle, J., Lello, A., & Shattuck, P. T. (2018). Identifying patterns of state vocational rehabilitation performance in serving transition-age youth on the autism spectrum. Autism in Adulthood. https://doi.org/10.1089/aut.2018.0018.
Roux, A. M., Shattuck, P. T., Cooper, B. P., Anderson, K. A., Wagner, M., & Narendorf, S. C. (2013). Postsecondary employment experiences among young adults with an autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 931–939.
Schur, L. (2002). The difference a job makes: The effects of employment among people with disabilities. Journal of Economic Issues, 36(2), 339–347.
Sevak, P., O’Neill, J., Houtenville, A., & Brucker, D. (2018). State and local determinants of employment outcomes among individuals with disabilities. Journal of Disability Policy Studies, 29(2), 119–128.
Shattuck, P. T., & Parish, S. L. (2008). Financial burden in families of children with special health care needs: Variability among states. Pediatrics, 122(1), 13–18.
Stegmueller, D. (2013). How many countries for multilevel modeling? A comparison of frequentist and Bayesian approaches. American Journal of Political Science, 57(3), 748–761.
Taylor, J. L., & Henninger, N. A. (2015). Frequency and correlates of service access among youth with autism transitioning to adulthood. Journal of Autism and Developmental Disorders, 45(1), 179–191.
Taylor, J. L., & Seltzer, M. M. (2011). Employment and post-secondary educational activities for young adults with autism spectrum disorders during the transition to adulthood. Journal of Autism and Developmental Disorders, 41(5), 566–574.
Thomas, K. C., Parish, S. L., Rose, R. A., & Kilany, M. (2012). Access to care for children with autism in the context of state medicaid reimbursement. Maternal and Child Health Journal, 16(8), 1636–1644.
Toikka, R., Gais, T., Nikolov, P. V., & Billen, P. (2004) Spending on social welfare programs in rich and poor states. No. 0410006. EconWPA.
U.S. Census Bureau Population Division. (2017). Annual estimates of the resident population: April 1, 2010 to July 1, 2016. American Fact Finder. factfinder.census.gov. Accessed 9 July 2018.
U.S. Department of Education. (2016b). ‘WIOA State Plan for the State of Michigan’ Office of Special Education and Rehabilitative Services. https://www2.ed.gov/about/offices/list/osers/rsa/wioa/state-plans/mi.pdf.
U.S. Department of Education. (2017a). Vocational rehabilitation state grants. https://www2.ed.gov/programs/rsabvrs/index.html. Accessed 20 August 2018.
U.S. Department of Education. (2018). Fiscal years 2017–2019. State tables for the U.S. Department of Education. https://www2.ed.gov/about/overview/budget/statetables/19stbystate.pdf. Accessed 8 October 2018.
U.S. Department of Education. (2017b). ‘Workforce Innovation and Opportunity Act State Plans.’ Office of Special Education and Rehabilitative Services. https://www2.ed.gov/about/offices/list/osers/rsa/wioa/state-plans/index.html.
U.S. Department of Education. (2013). ‘Revision of PD-13-05 Vocational Rehabilitation Program Case Service Report (RSA-911) Data Elements’ Office of Special Education and Rehabilitative Services. Rehabilitation Services Administration RSA-PD-14-101.
U.S. Department of Education RIN 1820–AB70. (2016a). State Vocational Rehabilitation Services Program; State Supported Employment Services Program; Limitations on Use of Subminimum Wage; Final Rule’ U. S. Department of Education Vol. 81, No. 161 [Rules and Regulations]. August 19, 2016. The Federal Register 55630.
Wei, X., Wagner, M., Hudson, L., Jennifer, W. Y., & Shattuck, P. (2014). Transition to adulthood employment, education, and disengagement in individuals with autism spectrum disorders. Emerging Adulthood, 3(1), 37–45.
Wight, V. R., Chau, M., Aratani, Y., Schwarz, S. W., & Thampi, K. (2010). A profile of disconnected young adults in 2010. New York, NY: National Center for Children in Poverty Mailman School of Public Health Columbia University. http://www.nccp.org/publications/pdf/text_979.pdf.
Wilson, S. H., & Walker, G. M. (1993). Unemployment and health: A review. Public Health, 107(3), 153–162.
Acknowledgments
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under UJ2MC31073: Maternal and Child Health-Autism Transitions Research Project. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. This project was also supported by funding from the Organization for Autism Research (OAR), Inc. Applied Research Grant, under the title “Association of state-level factors with vocational outcomes for transition-age youth with autism.”
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AR, JR, and PS contributed to the conceptualization of the study and initial drafting of the manuscript. JE completed the data analysis and table preparation. AR, JR, and PS reviewed the final manuscript, and AR completed revision and publication preparation. All authors approved the final manuscript.
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Ms. Roux, Ms. Rast, and Dr. Shattuck each declare that they have no conflicts of interest.
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Roux, A.M., Rast, J.E. & Shattuck, P.T. State-Level Variation in Vocational Rehabilitation Service Use and Related Outcomes Among Transition-Age Youth on the Autism Spectrum. J Autism Dev Disord 50, 2449–2461 (2020). https://doi.org/10.1007/s10803-018-3793-5
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DOI: https://doi.org/10.1007/s10803-018-3793-5