Community and Facility-Based Employment of Adults on the Autism Spectrum
Objectives: To describe the paid employment experiences of 1,991 adults, ages 30 to 65 years, on the autism spectrum who receive services through a state ID/DD service agency. Additionally, we explored factors associated with paid community-based employment and compared them to those associated with paid facility-based positions.
Methods: We analyzed findings from the National Core Indicators Adult Consumer Survey of adults with intellectual disability (ID) or a developmental disability (DD) who receive at least one service in addition to case coordination through their state ID/DD agency. There were 4,000 participants with autism in the 2014-15 ACS representing 32 states and one region. We used bivariate statistics and logistic regression to identify correlates of paid employment of each type.
Results: Most respondents were white (70%), non-Hispanic (89%), male (72%), with co-occurring ID (87%). One-fifth and had a co-occurring DD (21%). About half (59%) primarily used spoken language; had a legal guardian (53%); took medication to treat mood disorders, anxiety, or psychotic disorders (59%) or for behavioral challenges (47%); and received any Home and Community Based Services funding (56%). A small percentage received ICF/ID funding (8%). Overall, 29% held paid employment in the two weeks prior to the survey. In total, 12% worked for pay in the community - averaging 29 hours and earning $231/biweekly – and 18% worked for pay in a facility-based position- averaging 34 hours and earning $73/biweekly.
Community-based employment was significantly less likely for those who were black (OR: 0.40); female (0.56); used primarily non-spoken expression (0.19); took medication for behavior problems (0.64); or had moderate (0.38), severe (0.23), or profound ID (0.23). Community-based employment was significantly more likely for those with co-occurring DD (1.71). Adults with mild ID were more likely than adults who have no ID to have facility-based employment (OR: 1.74), while adults with profound ID were less likely (0.44). Adults who received ICF/ID funding were more likely to have a facility-based position (3.66).
Conclusions: This study describes the low employment rates and the associations with community versus facility-based paid employment for a sample of adults with autism in a large state-based survey. Future study might explore how services and supports such as Vocational Rehabilitation and Social Security Benefits influence community-based versus facility-based outcomes.