The Influence of Socioeconomic Position on Vocational Rehabilitation Service Utilization and Outcomes of Transition-Age Young Adults with Autism

Background: In the United States, the Vocational Rehabilitation (VR) program closes cases for approximately 19,000 transition-age youth and young adults with autism spectrum disorder (ASD) annually who apply for VR services are found eligible. The federal VR program provides grants to states to help individuals with disabilities find, maintain, or regain employment. Generally, about 70% of youth and young adults with ASD who are eligible for VR services receive them, and about 60% of service recipients are employed at VR exit. Disparities in who receives VR services, and who achieves employment, are understudied.

Objectives: We explored whether factors of socioeconomic position (e.g., race, ethnicity, public benefits use, education level) predict receipt of VR services, timely development of individual plans for employment services, and employment outcomes among young adults with ASD.

Methods: We analyzed VR service utilization and employment outcomes for 14,319 young adults with autism (ages 18-24) in the federal Rehabilitation Services Administration (RSA) database who had a VR case that closed in FFY 2016. We used binary analyses and logistic regression to examine the association of race and ethnicity, financial disadvantage, and education on VR service use and outcomes.

Results: Young adults with ASD in the RSA dataset were primarily male (82.7%), White (75%), receiving financial support from family and friends (68.6%), and had a “most significant” level of disability (71.2%). Fewer were non-Hispanic Black (10.9%), Hispanic (8.4%), or recipients of supplemental security income (SSI) benefits at the time of VR application (34.9%). Young adults with ASD were significantly less likely to receive VR services if they were other/multiple races and non-Hispanic (OR=0.81), Hispanic (OR=0.84) (compared to non-Hispanic White young adults), or if they had public health insurance (OR=0.71) or no insurance (OR=0.85) (compared to having any private insurance). They were slightly more likely to receive VR services if they were SSI beneficiaries (OR=1.1) compared to those who were not. Young adults with ASD were significantly more likely to experience timely development of an employment plan with each year increase in age (OR=1.18) and if they were Hispanic (OR=1.26), but less likely if they were SSI beneficiaries (OR=0.75). Young adults with ASD were significantly less likely to be employed at VR exit if they were female (OR=0.79), SSI beneficiaries (OR=0.77), or if they had public health insurance (OR=0.73) or no insurance (OR=0.71) (compared to any private insurance). They were slightly more likely to be employed at exit with each year increase in age (OR=1.11) or if they had any post-high school education (OR=1.22).

Conclusions:

We found significant differences in VR service utilization, timely development of employment plans, and successful employment following VR services based on several aspects of socioeconomic position including race, ethnicity, education level, receipt of public benefits and type of health insurance, in addition to gender. Reducing socioeconomic disparities is a stated priority in the 2017 federal plan for autism research. Results speak to the importance of recognizing the potential impacts of socioeconomic disadvantage on variation in VR program performance at the local, state, and national levels.