The interplay of supports and barriers during the transition to adulthood for youth on the autism spectrum

PURPOSE

Transition to adulthood is a complex process that involves important life domains such as education, work, independent living, community, health, and social relationships. Autistic youth face the transition with greater challenges than their peers, and there continues to have significant gaps in the services as they approach young adulthood. The study was conducted to understand the complex interplay between supports and barriers to participation in the transition process.

METHOD

Data was collected through six focus groups with 24 participants (7 parents, 11 practitioners, 6 autistic youth), digitally audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Four themes were reported: Inadequacy of Services, Ambivalence about Formal Services and Support, Understanding Good Partnership, and Evolving Parental Involvement. While parents and practitioners see the fragmented services and lack of comprehensive support as the most prominent challenge, autistic youth feel ambivalent about the type of services they need. Practitioners address the importance of establishing an appropriate level of engagement with parents in the transition process. Autistic youth expect their parents to set a boundary that affirms their independence.

CONCLUSIONS

Our study highlights the need to elicit input across different stakeholders to make transition services centralized, easily accessible, and individualized.Implications for RehabilitationIt is important to have a systematic road map, early preparation of families and autistic youth about the array of adult transition services, and a centralized hub of information to be disseminated.Disability service agencies should develop and implement plans for enhancing outreach and services to transition youth on the autism spectrum and their families.Practitioners need to identify locally available resources and channels for outreach and make available service more visible by producing transition-related materials with examples of current legislative information, problem solving, and best practices.Practitioners should consider how autistic youth identify their needs and wants may be different than how service providers and parents conceptualize them.It is critical to capitalize appropriate levels of caregivers/family support and engagement by provision of education about policies and guidelines for communication and collaboration.

Factors influencing special education teachers' self-efficacy to provide transitional services for students with disabilities

This study examined factors that may influence the self-efficacy level of special education teachers in delivering transition services to students with disabilities. Five independent variables were examined: attitudes, preparation level, teaching experiences, academic degree level, and level of available resources. The current study sample comprised 231 intermediate and secondary special education teachers in the city of Riyadh, Saudi Arabia. The results showed that attitudes are the best predictor of teachers' self-efficacy to provide transitional services for students with disabilities. Teacher preparation for transition services was the second most important variable that was positively associated with teachers' self-efficacy.

College-Based Transition Services' Impact on Self-Determination for Youth With Intellectual and Developmental Disabilities

Most youth in transition services with labels of intellectual and developmental disabilities (IDD) have poorer employment outcomes than their peers with other or without disabilities. One alternative approach to address this challenge provides youth with IDD access to transition services in the context of a college or university campus. College-based transition services (CBTS) provide students with IDD access to college courses, internships, and employment during their final 2 to 3 years of secondary education. A quasi-experimental design evaluation of one college-based transition services model, Think College Transition, found that, after controlling for student baseline scores, the college-based transition services had a significant effect on students' scores of self-determination at post-test. Implications for further refining the model are discussed.

Transition services for high school students with intellectual disability in Saudi Arabia: issues and recommendations

In 2005, Saudi high schools began providing transition services for students with intellectual disability. However, recent studies have found that these services need improvement. Therefore, this study explored current transition services to help identify challenges that weaken these services and to recommend improvements for them. Eleven teachers of students with intellectual disability were interviewed, and data were analyzed qualitatively. Study findings concluded that four main issues must be addressed to advance Saudi transition services: (1) special education teacher preparation programs, (2) transition services' policies and regulations, (3) Individualized Transition Plans, and (4) collaborative practices.

Transition Home Plus Program Reduces Medicaid Spending and Health Care Use for High-Risk Infants Admitted to the Neonatal Intensive Care Unit for 5 or More Days

OBJECTIVE

To evaluate the effects of a transition home intervention on total Medicaid spending, emergency department visits, and unplanned readmissions for preterm infants born at ≤36^6/7 weeks gestation and high-risk full-term infants.

STUDY DESIGN

The Transition Home Plus (THP) program incorporated enhanced support services before and after discharge from the neonatal intensive care unit (NICU) provided by social workers and family resource specialists (trained peers) working with the medical team from October 2012 to October 2014. Rhode Island Medicaid claims data were used to study the 321 infants cared for in the NICU for ≥5 days, who were enrolled in the THP program. THP infants were compared with a historical comparison group of 365 high-risk infants born and admitted to the same NICU in 2011 before the full launch of the THP program. Intervention and comparison group outcomes were compared in the eight 3-month quarters after the infant's birth. Propensity score weights were applied in regression models to balance demographic characteristics between groups.

RESULTS

Infants in the intervention group had significantly lower total Medicaid spending, fewer emergency department visits, and fewer readmissions than the comparison group. Medicaid spending savings for the intervention group were $4591 per infant per quarter in our study period.

CONCLUSIONS

Transition home support services for high-risk infants provided both in the NICU and for 90 days after discharge by social workers and family resource specialists working with the medical team can reduce Medicaid spending and health care use.

Young adults with spina bifida transitioned to a medical home: a survey of medical care in Jacksonville, Florida

OBJECT The transition of the young adult with spina bifida (YASB) from pediatric to adult health care is considered a priority by organized pediatrics. There is a paucity of transition programs and related studies. Jacksonville Health and Transition Services (JaxHATS) is one such transition program in Jacksonville, Florida. This study's purpose was to evaluate the health care access, utilization, and quality of life (QOL) of a group of YASBs who have transitioned from pediatric care. METHODS A survey tool addressing access to health care and quality of health and life was developed based on an established survey. Records of the Spinal Defects Clinic held at Wolfson Children's Hospital and JaxHATS Clinic were reviewed and YASBs (> 18 and < 30 years old) were identified. RESULTS Ten of the 12 invited YASBs in the Jacksonville area completed the surveys. The mean age of respondents was 25.1 years. All reported regular medical home visits, 8 with JaxHATS and 2 with other family care groups. All reported easy access to medical care and routine visits to spina bifida (SB) specialists; none reported difficulty or delays in obtaining health care. Only 2 patients required emergent care in the last year for an SB-related medical problem. Seven respondents reported very good to excellent QOL. Family, lifestyle, and environmental factors were also examined. CONCLUSIONS In this small group of YASBs with a medical home, easy access to care for medical conditions was the norm, with few individuals having recent emergency visits and almost all reporting at least a good overall QOL. Larger studies of YASBs are needed to evaluate the positive effects of medical homes on health and QOL in this population.