"[I] don't wanna just be like a cog in the machine": Narratives of autism and skilled employment.

LAY ABSTRACT: Autistic people are less likely to be employed than the general population. Autistic people with skilled training (e.g. training for jobs in acting, plumbing, science, or social work) might be even less likely to get a good job in their field. Little is known about the experiences of autistic people in skilled employment or what employment success means to them. We interviewed 45 autistic people with skilled training in a wide range of fields, 11 job supervisors, and 8 topic experts. We asked them about their experiences, what they felt helped them to be successful at work, and what employment success means to them. Participants talked about the high stakes of disclosure, taking unconventional pathways to careers, disconnects with service and support systems, mental health challenges from trauma and burnout, the autistic advantages in the workplace, and complex dimensions of discrimination. Participants said success meant opportunities for growth, good work/life balance, financial independence, sense of community, and feeling valued, accepted, and like their work had meaning. Things that helped them be successful included flexible, accepting workplaces, supportive and respectful supervisors, and direct communication. What we learned suggests that an individualized, wholistic approach to autism employment intervention that considers both employers and employees and employee mental health could be useful. We also recommend more research into disclosure and destigmatizing disability at work.

Evaluating the My Life self-determination model for older youth in foster care: Establishing efficacy and exploring moderation of response to intervention.

Limited rigorous research has been conducted to evaluate the impact of interventions designed to promote the successful transitions of young people exiting foster care. The current study builds on previous experimental evaluations of the My Life Model (MLM) for self-determination enhancement, which demonstrated effectiveness in improving educational and transition-to-adulthood outcomes for youth in foster care with disabilities, including those with mental health challenges. The model features one-on-one youth-directed coaching and near-peer mentoring to increase self-determination and goal achievement. The current study was the first to test the impact of the model with a diverse population-based cohort of youth aged 16.5-18.5 in foster care (N=293), including those with and without disabilities, on key model outcome indicators of self-determination and self-efficacy. This study also explored potential moderation by disability status, trauma symptoms, placement stability, and placement restrictiveness. Findings show that, compared to the randomized control group, the treatment group had greater post-intervention and one-year follow-up gains on several indicators of self-determination. Moderation analysis demonstrated no difference in intervention effectiveness for youth with or without disabilities, suggesting the universality of this approach. Findings also suggest that foster youth participants with low-to-average risks in terms of placement stability, placement restrictiveness, and traumatic stress levels seem to benefit most from the intervention, although youth who are at higher risk due to low placement stability, high placement restriction, and high traumatic stress still showed some benefit of participating in the intervention on some measures. My Life is one of only a few intervention models with experimental evidence of effectiveness with older youth in foster care. This validation study establishes that the approach has benefits for both youth with and without disabilities, as well as providing the first information available on the influence of critical barriers facing many youth in care.

The relation of abuse to physical and psychological health in adults with developmental disabilities.

BACKGROUND: People with developmental disabilities are at disproportionately high risk of abuse. Although considerable evidence exists on the health-related consequences of abuse in the general population, little is known about those consequences in people with developmental disabilities. OBJECTIVE: To examine the relation of abuse with psychological and physical health outcomes in adults with developmental disabilities. METHODS: We used an accessible audio computer-assisted self-interview to collect anonymous data on demographic and disability characteristics, childhood and adult abuse experiences, and physical and psychological health from 350 women and men with developmental disabilities. Abuse experience was reflected by five factor scores consisting of three child abuse factors (childhood sexual abuse, childhood physical abuse, childhood disability-related abuse) and two adult abuse factors (adult sexual abuse, adult mixed abuse). We examined each of four health outcomes (depression, post trraumatic stress disorder, physical health symptoms, secondary health conditions) separately to determine the extent to which childhood and adult abuse experiences uniquely predicted psychological and physical health outcomes above and beyond demographic and disability-related characteristics. RESULTS: All five abuse factor scores were significantly related to all four health outcomes. When examined simultaneously, childhood disability-related abuse and adult mixed abuse accounted for unique variance in outcomes. Exploratory analyses revealed no difference in the impact of abuse by gender. CONCLUSIONS: In this study, childhood disability-related abuse and adult mixed abuse significantly predicted lower levels of psychological and physical health in a sample of adults with developmental disabilities. Our findings highlight the importance of addressing abuse and its sequalae in the developmental disabilities community.

Perspectives of Youth in Foster Care on Essential Ingredients for Promoting Self-determination and Successful Transition to Adult Life: My Life Model.

Research clearly documents the serious challenges and poor outcomes experienced by many young people exiting foster care, as well as compounded disparities for the high percentage of youth in care who are identified with disabilities and/or mental health challenges. However, very little research has been conducted to specify or validate effective models for improving the transition trajectories of youth exiting care. Evidence suggests the My Life self-determination enhancement model offers a promising approach for supporting youths' self-determined and positive transition to adulthood. The model includes youth-directed, experientially oriented coaching in the application of self-determination skills to achieve youth-identified transition goals, coupled with peer mentoring workshops that provide opportunities for learning, networking and fun. This in depth qualitative study of 10 youth who completed the My Life intervention focused on investigating coaching and mentoring elements and processes that youth participants identify as most important to their success, with the intention of informing the further development of youth-directed approaches to supporting young people who are transitioning to adulthood. Themes emerged around the centrality of youth self-direction, important processes in the coaching relationship, the essential value of experiential activities and self-determination skill development, and peer mentoring experiences that youth identified as fostering their success. Implications are discussed for research and practice in supporting youth exiting foster care.

Community-Based Participatory Research to Adapt Health Measures for Use by People With Developmental Disabilities.

BACKGROUND: People with developmental disabilities (DD) are often not included as participants in research owing to a variety of ethical and practical challenges. One major challenge is that traditional measurement instruments may not be accessible to people with DD. Participatory research approaches promise to increase the participation of marginalized communities in research, but few partnerships have successfully used such approaches to conduct quantitative studies people with DD. OBJECTIVE: To use a community-based participatory research (CBPR) approach to create an accessible, computer-assisted survey about violence and health in people with DD, and to psychometrically test adapted health instruments. METHODS: Our academic-community partnership, composed of academic researchers, people with DD, and supporters, collaboratively selected and modified data collection instruments, conducted cognitive interviews and pilot tests, and then administered the full survey to 350 people with DD. RESULTS: Although team members sometimes had opposing accommodation needs and adaptation recommendations, academic and community partners were able to work together successfully to adapt instruments to be accessible to participants with a wide range of DD. Results suggest the adapted health instruments had strong content validity and all but one had good to excellent internal consistency reliability (alpha, 0.81-0.94). The majority of participants (75%) responded that all or most of the questions were easy to understand. CONCLUSIONS: Researchers should consider using participatory approaches to adapting instruments so people with DD can be validly included in research.

An Exploratory Study of a Computer-Assisted Abuse Awareness and Safety Planning Program for Men With Disabilities: The Men's Safer and Stronger Program.

Interpersonal violence (IPV) is a serious and often unrecognized problem for men with disabilities (MWD). However, abuse awareness programs and outcome measures have not been systematically evaluated in MWD. This article reports findings from an exploratory study (n = 31) of the Safer and Stronger Program for Men with Disabilities (Men's SSP), an audio computer-assisted self-interview (ACASI) abuse awareness program. Preliminary findings suggest it is sensitive toward detecting abuse and it allows MWD to privately and independently self-identify IPV experiences. Preliminary psychometric data on a battery of abuse and safety awareness outcome measures suggest that they are reliable in this population.

Better futures: a randomized field test of a model for supporting young people in foster care with mental health challenges to participate in higher education.

The purpose of the study was to conduct a preliminary efficacy evaluation of the Better Futures model, which is focused on improving the postsecondary preparation and participation of youth in foster care with mental health challenges. Sixty-seven youth were randomized to either a control group that received typical services or an intervention group, which involved participation in a Summer Institute, individual peer coaching, and mentoring workshops. Findings indicate significant gains for the intervention group on measures of postsecondary participation, postsecondary and transition preparation, hope, self-determination, and mental health empowerment, as compared to the control group. Youth in the intervention group also showed positive trends in the areas of mental health recovery, quality of life, and high school completion. Implications for future research and practice are discussed, while emphasizing the capacities of youth in foster care with mental health conditions to successfully prepare for and participate fully in high education.

Development of an audio-computer assisted self-interview to investigate violence and health in the lives of adults with developmental disabilities.

BACKGROUND: Audio computer-assisted self-interviews (ACASIs) have safely and effectively obtained sensitive research data from the general public and have been recommended for use with people with disabilities. However, few studies have used ACASIs with people with disabilities and ACASIs have not been used to investigate the relationship between disability, interpersonal violence (IPV), and physical and psychological health among people with developmental disabilities (PWDD). OBJECTIVE: We developed an accessible ACASI specifically designed to allow PWDD to answer questions independently, while privately and securely collecting anonymous data related to their disability, IPV experiences, and physical and psychological health. METHODS: We used a safety protocol to apply community based participatory research (CBPR) principles and an iterative process to create, test, and administer a cross-sectional ACASI survey to 350 adults with developmental disabilities in urban and rural locales. RESULTS: Most participants completed the ACASI independently and reported that its accessibility features allowed them to do so. Most also agreed that the ACASI was easy to use, its questions were easy to understand, and that they would prefer using an ACASI to answer IPV and health-related questions rather than in a face-to-face interview. The majority agreed that health and safety were critical issues to address. CONCLUSIONS: ACASI technology has the potential to maximize the independent and private participation of PWDD in research on sensitive topics. We recommend further exploration into accessibility options for ACASI technology, including hardware and Internet applications.

Reaching everyone: Promoting the inclusion of youth with disabilities in evaluating foster care outcomes.

Efforts to evaluate foster care outcomes must avoid systematic exclusion of particular groups. Although often unrecognized as such, youth with disabilities are highly overrepresented in the U.S. foster care system, and yet youth with some disabilities, including those with intellectual, serious emotional, and physical impairments may be underrepresented in research and evaluation studies evaluating foster care outcomes. The recruitment and retention of youth with various disabilities in such studies can be impeded by under-identification of disability and relatively high placement and school mobility. Furthermore, youth with various disabilities may experience more disappointing outcomes than foster youth overall, underscoring the importance of including these youth in outcome tracking efforts. This is especially relevant given the recent implementation of the National Youth in Transition Database (NYTD), which requires that state child welfare agencies gather baseline information about youth in foster care at age 17, and then survey outcomes at 19 and 21. To promote the full participation of foster youth with disabilities in such outcome evaluation, this paper describes successful strategies for identifying and retaining participants that were used in three separate longitudinal intervention studies. These strategies include the systematic recruitment of foster youth by special education status, and creative use of validated tracking and retention strategies incorporating minor accommodations as needed.

Gender, health ambiguity, and depression among survivors of first stroke: a pilot study.

OBJECTIVE: To investigate the association between health ambiguity and depressive symptoms among stroke survivors and whether survivor gender moderates this association. DESIGN: Cross-sectional survey study. SETTING: General community. PARTICIPANTS: Survivors of first stroke (N=36) recruited through provider referral, support groups, and print and Web-based sources. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Depressive symptoms as measured by the Patient Health Questionnaire-9. RESULTS: Health ambiguity (ß=.984, P<.001), gender (ß=1.010, P<.01), and the interaction of the 2 variables (ß=-1.269, P<.05) were significantly associated with depressive symptoms. Simple slopes tests indicated that the association between health ambiguity and depressive symptoms was stronger for male versus female survivors. CONCLUSIONS: Gender and health ambiguity impact survivor depressive symptoms, independently and in conjunction with one another. Results are promising, and further research with larger samples and more comprehensive statistical models is needed to confirm these findings.

Assessing Restrictiveness: A Closer Look at the Foster Care Placements and Perceptions of Youth With and Without Disabilities Aging Out of Care.

The aim of the study was to examine the experience of restrictiveness among transition-aged youth with disabilities in foster care. Utilizing a sample of 207 youth, placement types were explored for differences in disability status, race and sex. Further, youth perceptions of restriction around communication, movement around one's home, and access to the community were examined for youth receiving special education services (SPED), youth receiving developmental disability services (DD), and youth without disabilities. Youth with disabilities were more likely to be placed in more restrictive placement types and had significantly higher levels of perceived restriction around communication, movement, and community when compared to youth without disabilities. Additionally, males with disabilities experienced higher levels of restrictiveness, particularly those who received DD services, while White youth with disabilities also experienced greater community restrictiveness.

Prevalence of interpersonal violence against community-living adults with disabilities: a literature review.

OBJECTIVE: To review the empirical literature on the prevalence of interpersonal violence (IPV) against people with disabilities. METHOD: The authors searched for, obtained, and reviewed 6,000 abstracts published between January, 2000 and August, 2010 via searches in PsycINFO and PubMed. Subsequently, 177 potentially applicable full-text articles were independently assessed for inclusion; 22 articles describing 21 individual studies were included in this review. RESULTS: The prevalence of IPV varied depending on the time frame, the definition and type of violence, perpetrator, and disability. Prevalence of any type of IPV among women with disabilities ranged from 26.0%-90.0% for lifetime; 4.9%-29.1% for the past 5 years; and 2.0%-70.0% for the past year. In some studies, when compared to women without disabilities, women with disabilities experienced more lifetime, 5 year, and past year physical and sexual IPV. Prevalence of any IPV in men with disabilities ranged from 28.7%-86.7% for lifetime; 24.9% for the past 5 years; and 36.7% for the past year. CONCLUSIONS/IMPLICATIONS: IPV occurs at elevated and disproportionate rates among women and men with disabilities, especially when assessed over the course of their lives. Future research that relies on standard definitions of disability and violence, uses accessible measurement, and examines IPV in diverse populations of people with disabilities will strengthen future reviews and better inform research and policy priorities on disability and violence.

Expanding poststroke depression research: movement toward a dyadic perspective.

Research on depression following stroke has traditionally been oriented toward understanding the experiences of individual survivors or their spousal caregivers outside of the context of their committed relationship. Moving toward a dyadic orientation to the problem of poststroke depression, in which the stroke survivor-spouse dyad is viewed as the primary unit of analysis, will open the door to new lines of inquiry and may eventually lead to more effective treatments for survivors and their spouses. The first half of this article discusses the rationale for moving poststroke depression research toward a more dyadic perspective and highlights current efforts in this area. The second half of this article discusses some methodological challenges associated with dyadic data and the practical benefits of one statistical methodology, multilevel modeling, for examining depression in survivor-stroke dyads.

Facilitators and barriers to disclosing abuse among women with disabilities.

An anonymous audio computer-assisted self-interview (A-CASI) designed to increase awareness of abuse was completed by 305 women with diverse disabilities. Data were also collected about lifetime and past year abuse; perpetrator risk characteristics; facilitators and barriers to disclosing abuse; abuse disclosure to a health provider, case manager, or police officer; and whether a health provider had ever discussed abuse or personal safety. A total of 276 (90%) women reported abuse, 208 (68%) reported abuse within the past year. Women who reported the most abuse experiences in the past year and the most dangerous perpetrators endorsed fewer facilitators and more barriers, but were also more likely to have ever disclosed abuse. Only 15% reported that a health provider had ever discussed abuse and personal safety.

Poststroke depression: social workers' role in addressing an underrecognized psychological problem for couples who have experienced stroke.

Depression is the most common psychological challenge faced by many individuals and families following stroke. Fortunately, poststroke depression is treatable, and even preventable, if social work and other rehabilitation practitioners understand the most common risk factors and become familiar with measures for assessing for depression among patients with medical comorbidities such as stroke.The purpose of this article is to raise awareness among readers about the strong potential for depression following stroke and to provide an overview of common assessment measures. On the basis of increasing numbers of patients being cared for by informal caregivers following discharge from inpatient care facilities, growing evidence of the interconnectedness of couples' emotional well-being and the significance of couples-level factors like relationship quality and coping in the well-being of couples experiencing stroke, and current needs for effective interventions for poststroke depression, a secondary purpose of this article is to describe the importance of assessing and treating survivors in the context of their committed relationships.

Efficacy of a computerized abuse and safety assessment intervention for women with disabilities: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of a computerized disability-specific abuse assessment intervention on abuse awareness, safety self-efficacy, and safety promoting behaviors of women with diverse disabilities. RESEARCH DESIGN: A randomized control group design was used, with the intervention group completing the assessment intervention both at Time 1 (T1) and 3 months later at Time 2 (T2) and control participants completing it for the first time at T2. Analyses compared intervention and control groups at T2 and evaluated change over time in intervention group participants. The relationship between outcome variables (abuse awareness, safety self-efficacy, safety behaviors) was also explored. RESULTS: The intervention group had greater abuse awareness than the control group at T2, and abuse awareness increased from T1 to T2 among women in the intervention group, particularly among women who had experienced little or no abuse in the past year. Both abuse awareness and safety self-efficacy were significantly related to safety behaviors. CONCLUSIONS: The computerized program offers promise as a nonthreatening method of conducting abuse assessments among women with disabilities while also serving as an intervention to enhance abuse awareness.

Development of measures of abuse among women with disabilities and the characteristics of their perpetrators.

Three hundred and five women with diverse disabilities completed an anonymous audio computer-assisted self-interview designed to increase women's awareness of abuse. Data were also collected regarding abuse experienced in the past year and the risk characteristics of their perpetrators. Overall, 68% reported some type of abuse. Preliminary evidence for the validity and reliability of questions to assess abuse and perpetrator risk characteristics was found. Latent class analysis revealed four distinct classes of abuse experiences: sexual abuse, physical abuse, multiple forms of abuse, and minimal abuse and three classes of perpetrator risk characteristics: controlling characteristics, noncontrolling characteristics, and minimal risk characteristics.

Interpersonal violence and women with disabilities: analysis of safety promoting behaviors.

Very little information exists related to the interpersonal violence safety promoting behaviors of women with disabilities. Information about women's use of safety promoting behaviors was gathered from 305 disabled and deaf women who completed an anonymous Audio Computer-Assisted Self-Interview. Exploratory factor analyses revealed factors related to seeking abuse-related safety information, building abuse-related safety promoting skills, using relationship support, planning for emergencies, taking legal action, and managing safety in personal assistance relationships. Four of these factors demonstrated significant relationships to women's experience of different forms of abuse and their perpetrator's characteristics.

Development of an accessible Audio Computer-Assisted Self-Interview (A-CASI) to screen for abuse and provide safety strategies for women with disabilities.

To increase safety and minimize the risk of interpersonal violence, it is critical that women with disabilities and Deaf women have an opportunity to identify whether or not abuse is happening in their lives. Awareness and knowledge of what constitutes abusive behaviors is an essential first step in addressing interpersonal violence. This article includes a description of the development and evaluation of the Safer and Stronger Program (SSP), an audio computer-assisted self-interview program, which was created for women with disabilities and Deaf women for the purposes of increasing awareness of abuse, encouraging safety-planning behaviors, and providing information about community resources.

Are we ignoring youths with disabilities in foster care? An examination of their school performance.

This study examined the extent to which the academic achievement of adolescents receiving both foster care and special education services differs from the performance of youths involved in only foster care, special education, or general education. Extant school data were collected on 327 students, ages 13 through 21, who attended school in a large urban school district in Oregon. The study also collected information about students' general foster care experiences, such as length of time in care and type and number of placements. Analyses revealed that foster care youths in special education typically demonstrated lower performance on academic variables in contrast to one or more of the comparison groups. These youths also appeared to experience more restrictive special education placements than youths in special education only. Although foster care or special education status alone appears to place a student at risk of academic difficulties, the negative impact of interfacing with both systems appears multiplicative. Greater attention, commitment, and time must be given to the educational needs of foster care youths with disabilities by both education and child welfare professionals.