Community and Facility-Based Employment of Adults on the Autism Spectrum

Background: Approximately half of young adults with autism experience employment at least once between high school and their early twenties. The Workforce Innovation and Opportunity Act of 2014 and Employment First philosophy guide policy for people with disabilities in the U.S. and focus on increasing opportunities to experience community-based jobs with sustainable wages. However, we know little about the employment settings that adults with autism experience, particularly as they age further into adulthood.

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.