Mental health counseling is rated as most helpful by autistic adults: Service perspectives in adulthood

LAY ABSTRACT

The number of autistic adults is growing, but there are fewer services to support them in adulthood. Many autistic adults need some support services to lead successful adult lives. We know a lot about the services autistic adults use and some of the problems with using these services, but we do not know which services are most helpful to them and how the services they use relate to how they interact with their communities. Forty autistic adults took part in a study about service use and community participation. They completed surveys, interviews, and carried a global positioning system tracker. They answered questions about which services are most helpful in adulthood, things that make it hard to use services, and what services they needed. Most participants used two services in the past 2 years, most frequently mental health and employment services. Adults who were currently seeing a mental health counselor were more likely to be working full-time and visit more locations in the community compared to those who were not seeing a counselor. Mental health services were reported as the most helpful service they received as adults, followed by employment services. We often focus on the importance of employment services after high school, but our findings show a need for both mental health and employment services for autistic adults.

View of the Work Community and Vocational Rehabilitation Services Among Adults With Autism Spectrum Disorder

Many adults diagnosed with autism spectrum disorder (ASD) face challenges in establishing and maintaining employment. These difficulties may be related to ASD symptomology or employer attitudes; however, vocational rehabilitation (VR) can provide employment-related resources. This study sought to understand how adults with ASD view their integration into workplace communities and VR services. Qualitative data were collected from 24 adults with ASD, and analysis identified themes surrounding the importance of workplace contributions, interesting work, and positive workplace relationships contributing to feeling integrated into the workplace community. Responses were also examined for perspectives on the role of VR in supporting workplace integration. Findings indicate the importance of attending to individual employment preferences and the need for long-term VR follow-along services to explore opportunities for employment growth. Implications and future recommendations for research and practice are also discussed.

Beyond Friendship: The Spectrum of Social Participation of Autistic Adults

Difficulties with social interactions and communication that characterize autism persist in adulthood. While social participation in adulthood is often marked by social isolation and limited close friendships, this qualitative study describes the range of social participation activities and community contacts, from acquaintances to close relationships, that contributed to connection from the perspective of 40 autistic adults. Qualitative data from interviews around social and community involvement were analyzed and revealed five main contexts where social participation occurred: vocational contexts, neighborhoods, common interest groups, support services and inclusive environments, and online networks and apps. Implications for practice to support a range of social participation include engaging in newer social networking avenues, as well as traditional paths through employment and support services.

Sensory Processing and Community Participation in Autistic Adults

Background

Sensory processing differences have been shown to impact involvement in community activities. However, relatively little is known about how these differences affect community participation in autistic adults.

Objective

The objective of this study was to explore how sensory processing patterns of autistic adults impact community participation, including where people go, what they do, the amount of time in the community, and preferred locations.

Methods

We used data gathered from six autistic adults and their caregivers who participated in two studies. From Study 1, we reviewed results of the Adolescent and Adult Sensory Profile (AASP) and transcripts from interviews with caregivers. From Study 2, we reviewed GPS tracking data and transcripts from structured interviews with autistic adults focused on community participation. We read transcript data, identified quotes related to sensory processing and community participation and constructed individual participant narratives which linked findings from interviews, AASP, and GPS tracking.

Results

Participants included three males and three females ranging in age from 29 to 51. Each participant had a unique sensory processing profile that influenced where they went, the activities in which they engaged, how much time they spent in the community, and their preferred locations. Those whose sensory processing patterns indicated sensory sensitivity and sensory avoiding described the experience of certain environments as overwhelming and fatiguing and thus spent less time in the community and visited fewer places than those with other sensory processing patterns.

Conclusion

Results highlight the importance of sensory processing, especially as it impacts participation in the community. Sensory processing patterns should be considered along with other personal and contextual factors when assessing community participation and personal sensory processing patterns should be matched with activities and environmental demands.

Applying Environmental Context to Rehabilitation Research Using Geographic Information Systems and Global Positioning Systems Geospatial Technologies

Background

The International Classification of Functioning, Disability, and Health includes important considerations of environmental context in understanding disability, but the environmental impact is often difficult to measure.

Purpose

Demonstrates the use of Geographic Information Systems (GIS) and Global Positioning Systems (GPS) in rehabilitation research in assessing accessibility and participation; describes how to use these methods, and presents several considerations in using GIS and GPS in research.

Method

Using methods from public health and medical geography, this article describes how to apply GIS and GPS technologies to rehabilitation research to measure community participation and accessibility to resources.

Findings

Directions for using ArcGIS functions and case examples joining these mapping technologies with rehabilitation measures are provided.

Conclusions

Together with traditional measures, these technologies may provide rehabilitation researchers a more comprehensive approach to assessing accessibility and participation.

Tablet therapy as an assistive technology-based treatment for anxiety in pediatric oncology

The painful interventions and invasive procedures associated with pediatric cancer treatment can result in anxiety. Anxiety can be reduced or better controlled through distraction and thought retraining. Although art therapy, non-electronic play therapy, music therapy, and traditional counseling are often used to alleviate stress and anxiety, new technology innovations are proving to be additional options to decrease stress and anxiety through distraction and attention shifting. Tablet-based interventions are emerging as an easily available and effective means of reducing stress and fear prior to operations, and have potential applications to reduce anxiety for patients before receiving chemotherapy, during time spent in hospital rooms, and while experiencing distressing physiological symptoms. This paper reviews the research on tablet therapy and discusses the application of assistive technologies in clinical oncology settings to reduce pediatric anxiety throughout the treatment process.

Novel approaches to measuring community integration in adults with cerebral palsy

Purpose: Rehabilitation goals often focus on increasing community integration for adults with disabilities and are measured by objective assessments. Research methods have lagged behind in capturing current conceptualizations of community integration as a multidimensional construct that incorporates participation, social supports, and feelings of belonging in the community. This paper addresses this challenge by describing a multi-method approach to assessing community integration for adults with cerebral palsy.Methods: Measures include standardized questionnaires, qualitative methods, measures of function and physical activity, and geospatial measures using Geographic Information System mapping and Global Positioning System tracking. These objective and subjective data are used to determine where adults spend time and are most active, and which activities and social connections are associated with feeling integrated into the community.Results: Two case examples highlight the importance of using a multi-method approach to assess community integration for adults with cerebral palsy. Results of objective clinical measures were comparable among case examples; however, actual experiences of feeling connected to the community were vastly different.Conclusions: Multiple measures are required to capture the complexity of community integration. Relying solely on objective measures may not provide a complete picture of community integration.IMPLICATIONS FOR REHABILITATIONCommunity integration is a complex construct that incorporates participation, socialization, and feelings of belonging in the community.New methods and measures are needed to assess the many aspects of community integration in adults with disabilities.A multi-method approach is recommended to provide a richer characterization of community integration in individuals with disabilities.A combination of quantitative and qualitative measures addressing the physical, social and psychological aspects of community integration should be used.

Safe Spaces, Agency, and Connections to “Regular Stuff”: What Makes Permanent Supportive Housing Feel Like “Home”

Permanent, supportive housing for people with a history of homelessness is often a first step toward regaining stability in other life areas, but such housing may not always feel like “home.” Whether supportive housing feels like “home” has received increasing attention due to links with positive identity reconstruction, housing stability, and improved community engagement. This qualitative study explored what makes supportive housing feel like “home” for individuals who were once homeless. Semi-structured interviews were completed among 37 adults with physical and/or psychiatric disabilities who were currently living in congregate or independent permanent housing in Boston, Massachusetts. Three themes emerged regarding what makes housing feel like “home”: (a) safe spaces, (b) connections to “regular stuff” and past occupations, and (c) agency to choose and pursue personal goals. Feelings of “home” were associated with a safe, peaceful environment where participants preferred to spend time in solitary activities. However, housing that felt like “home” also provided a base to engage in daily routines and community activities, reconnecting participants to “everyday things people do.” Findings are interpreted related to constructing a new, nonhomeless identity, and current issues of social isolation and limited community integration affecting individuals who were once homeless.

Accessibility patterns and community integration among previously homeless adults: a Geographic Information Systems (GIS) approach

Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community.

Change patterns of homeless individuals with mental illness: a multiple case study

This multiple case study illuminates the individual change trajectories of four homeless men with mental illnesses who participated in a manualized life skills intervention to improve housing retention. Readiness-to-change, life skills knowledge and trauma symptoms were measured at baseline, post-intervention and at 3-6 months follow-up. Cluster analysis identified two patterns of readiness-to-change: engaged and pre-engaged. Change is non-linear and baseline readiness is not necessary to benefit from the intervention. Examining individuals' lives in context illuminated the change process and demonstrated that varied patterns can lead to successful outcomes for housing stability and community reintegration.

Measuring community integration using Geographic Information Systems (GIS) and participatory mapping for people who were once homeless

Measures of community integration rely on self-report assessments that often quantify physical or social participation, but fail to capture the individual׳s spatial presence in the community. The current study documents the activity space, or area of daily experiences, of 37 individuals who were once homeless through participatory mapping and Geographic Information Systems (GIS). Contrary to expectations, there was no significant relationship between activity space size and community integration measures, except a negative association with physical integration. Further analysis revealed, however, that continued use of homeless services, geographically spread throughout the city, was associated with larger activity space size, but may be counterproductive to social and psychological integration efforts. Analysis of the types of locations identified revealed high importance given to leisure locations and ongoing involvement with medical and mental health locations. Finally, community integration outcomes did not differ significantly by demographics or housing type, but rather degree of family involvement and feeling like home, factors that may have more potential for change.

Readiness-to-change cluster profiles among adults with mental illness who were homeless participating in a life skills intervention

This longitudinal study examined differences in intervention outcomes based on readiness-to-change cluster profiles among 73 adults with a mental illness at risk for homelessness participating in a manualized life skills intervention. Intervention topics included money management, food management, safe community participation, and room- and self-care. Life skill knowledge and readiness-to-change, measured using the University of Rhode Island Change Assessment, was examined at baseline, post-intervention, and 3-6 months later. Two scoring patterns emerged for readiness-to-change at each time point: Pre-Engaged and Engaged. Participants who were Engaged at the time of assessment scored significantly better than Pre-Engaged on post-intervention life skill testing, however group identification changed over time. Baseline readiness-to-change did not predict future performance or attrition, and therefore may not provide accurate indication of client investment for future learning or participation. Further investigation is needed to determine what factors contribute to Engaged membership.

Cognitive Predictors of Life Skill Intervention Outcomes for Adults With Mental Illness at Risk for Homelessness

OBJECTIVE. We investigated the effectiveness of a life skills intervention for people with mental illness who have been homeless.

METHOD. In this longitudinal outcomes study, we used Situated Learning Theory (Lave & Wenger, 1991) to provide group and individual sessions to 38 participants from two housing programs after completing baseline Allen Cognitive Level Screen–2000 (ACLS–2000; Allen Conferences, 2000) and Practical Skills Tests (PSTs). Data were analyzed using linear mixed-effects regression models.

RESULTS. The PST scores of participants with higher ACLS–2000 scores significantly increased over time (food management, p = .021; money management, p = .039; safe community participation, p = .02). Participants with lower ACLS–2000 scores demonstrated an even greater change over time.

CONCLUSION. Most participants, including those with lower ACLS–2000 scores, improved and retained life skills knowledge over time, challenging the premise that people with mental illness should be excluded from mixed-level group interventions.