Abstract
This study provides evidence of soft skills improvement and confidence in delivering a manualized intervention by occupational therapy master’s-level students (OTS) as near-peer facilitators of the Assistive Soft Skills & Employment Training (ASSET) program with an autism spectrum disorder (ASD) population.
Obtaining employment is an important milestone and can improve a person’s independence level, self-esteem, contribution to society, and overall quality of life. However, people with autism spectrum disorder (ASD) experience considerable challenges in obtaining and maintaining work (Shattuck et al., 2012). Although many people with ASD want to work (Sosnowy et al., 2018), difficulties with job seeking, attainment, and tenure continue to pose barriers, and they highlight the need for more effective supports (Chen et al., 2015). To address the unique transition needs of young adults with ASD, employment-based programming has been developed specifically for this population (e.g., Gorenstein et al., 2020; Sung et al., 2019). Most interventions focus on technical or specific job skills instruction, with very few targeting soft skills, or the social communication skills necessary for interacting with others and succeeding in the workplace (Phillips et al., 2014). Teaching soft skills is crucial to improving work readiness and retention for people with ASD, given their underlying social skills deficits and the value employers place on soft skills (Ju et al., 2012).
Rehabilitation programs have recently begun to focus on soft skills as instrumental to employment outcomes. For example, the SUCCESS (Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills; Baker-Ericzén et al., 2018), ASSET (Assistive Soft Skills and Employment Training; Connor et al., 2020; Sung et al., 2019), JOBSS (Job-Based Social Skills; Gorenstein et al., 2020), and CommunityWorks Canada (Nicholas et al., 2019) programs each address soft skills and have been associated with improvements in executive functioning, social communication skills (Baker-Ericzén et al., 2018), self-confidence (Sung et al., 2019), and even mental health (Connor et al., 2020). Although some programs have measured employment gains (Baker-Ericzén et al., 2018; Gorenstein et al., 2020; Nicholas et al., 2019), none of these gains were statistically significant, and all projects had study design limitations, exemplifying how difficult it is to track meaningful change in employment in this population. Specifically, the ASSET program, a manualized, group-delivered soft skills intervention, has demonstrated preliminary efficacy in promoting social skills, self-confidence, and psychological wellness among young adults with ASD (Connor et al., 2020; Sung et al., 2019).
In addition, peer-based instruction and interventions (PBII) are a widely used, empirically based approach to teaching various skills to people with ASD (Chang & Locke, 2016). PBII involves similar-age, often neurotypical peers facilitating social interaction with people with ASD and is thought to be effective because it promotes natural opportunities to model and practice appropriate social behavior and skills (Steinbrenner et al., 2020). In this study, we incorporated PBII by having near-peer master’s-level occupational therapy students deliver the ASSET program to young adults with ASD on a college campus. For the purpose of this study, near-peer describes the incorporation of occupational therapy students as group facilitators. These facilitators were considered peers because both the students and the participants were in a similar life stage that was focused on transitioning to an early career. Although several soft skills interventions for young adults with ASD are being developed, interventions that use typically developing peers as instructors or facilitators of soft skills training have yet to be examined. The purpose of this study was to examine the preliminary efficacy of the ASSET program using near-peer occupational therapy student facilitators to promote improvements in psychosocial outcomes among young adults with ASD. In this article, we use person-first language to describe our participants; however, we recognize that many in the autism community choose to identify as autistic.
Method
Design
In this pretest–posttest, single-group study, we examined the effects of the ASSET program, as facilitated by occupational therapy students, on the psychosocial functioning of young adults with ASD immediately after the intervention.
Participants
A convenience sample (Table 1) of 14 (M age = 21.57 yr, SD = 3.57) was recruited via flyers posted on two college campuses and in the community. The consent process included an explanation of the study’s purpose, a description of the program overview, and written consent. Sixteen people applied; 15 were eligible per the criteria (age 17–30 yr, ASD diagnosis, no intellectual disability, identified social problems, fluent verbal communication, ability to read and comprehend questionnaires). One person declined to take part because of a scheduling conflict. The retention rate was 100%; the attendance rate was 94%.
Participant Characteristics
Note. N = 14. Percentages may not total 100 because of rounding.
Range = 17–28. bRange = 2–33.
Procedure
Participants independently completed self-report assessments within 3 days before and 3 days after the intervention. The time to complete each survey was <45 min per person.
Intervention
The ASSET intervention is a 12-session, empirically based, manualized, group soft skills program that has been previously validated with the ASD population (see details in Connor et al., 2020; Sung et al., 2019, and Table 2 for information on session topics). Group sessions were held weekly for 2.5 hr in a conference room on the Florida Gulf Coast University campus. Each session followed a didactic discussion–practice sequence with explicit instruction and experiential activities, including a social hour, to promote generalization of skills. Sessions were co-facilitated by two occupational therapy students supervised by the principal investigator (Annemarie Connor). Co-facilitators rotated among a group of four trained occupational therapy students so that one facilitator was consistent between adjacent sessions and had first-hand knowledge of the previous session. Evidence-based instructional strategies were incorporated throughout each session and included social skills training, visual supports, immediate and specific feedback, video modeling, and direct instruction (Steinbrenner et al., 2020).
Overview of the ASSET Program
Note. ASSET = Assistive Soft Skills and Employment Training; IDEAL = Identify, Describe, Explore, Anticipate, Look/Learn.
Participant Changes From Baseline to Postintervention
Note. 0.20 <d> 0.50 = small effect size; 0.50 <d> 0.80 = medium effect size; d > 0.80 = large effect size; decreased SRS–2 scores and increased GSE and IABQ scores indicate improvement. GSE = General Self-Efficacy Scale; IABQ = Informal Adaptive Behavior Questionnaire; SRS–2 = Social Responsiveness Scale (2nd ed.); T1 = Time 1; T2 = Time 2.
p < .05.
p < .01.
Instruments
All instruments aligned with the study’s constructs of interest (social functioning, self-efficacy, adaptive behavior), demonstrated good internal consistency reliability with previous ASSET cohorts (Connor et al., 2020; Sung et al., 2019), and had strong diagnostic validity (Constantino & Gruber, 2012; Harrison & Oakland, 2015) and construct validity (Schwarzer & Jerusalem, 1995).
Social Functioning
The Social Responsiveness Scale (2nd ed.; SRS–2; Constantino & Gruber, 2012) is a 65-item self-report questionnaire that provides both subscale and composite scores describing social functioning. Responses on the Likert-type scale can range from 1 (not true) to 4 (almost always true). Raw scores were converted to T scores. T scores ≥60 indicate clinically significant social deficiencies that may interfere with everyday social interaction. Cronbach’s α in our sample was .86.
Self-Efficacy
The General Self-Efficacy Scale (Schwarzer & Jerusalem 1995) is a 10-item self-report inventory used to measure perceived ability to cope with challenges and ability to set goals, invest effort, persist when facing barriers, and recover from setbacks. Responses on the Likert-type scale can range from 1 (not true at all) to 4 (exactly true). Mean scores were computed, with higher scores indicating stronger self-efficacy. Cronbach’s α in our sample was .84.
Adaptive Behavior
The Informal Adaptive Behavior Questionnaire (IABQ) was adapted from the Adaptive Behavior Assessment System (3rd ed.; Harrison & Oakland, 2015) to measure overall adaptive behavior as a combined score of items related to social, communication, self-direction, and work functioning. The Likert-type questions are rated on a scale ranging from 1 (never) to 3 (always). A total score was calculated, with higher scores indicating higher adaptive behavior. Cronbach’s α in our sample was .88.
Participant Experience
Participant satisfaction was measured using the ASSET User Rating Profile (URP; Sung et al., 2019), which consists of 17 Likert-type questions that are rated on a scale ranging from 1 (strongly disagree) to 5 (strongly agree). Soft skills improvement was assessed with the Perceived Improvement Questionnaire (PIQ), which consists of seven Likert-type questions that are rated on a scale ranging from 1 (not improved at all) to 4 (largely improved); soft skills confidence was assessed with the Perceived Confidence Questionnaire (PCQ), which consists of six Likert-type questions that are rated on a scale ranging from 1 (much less confident) to 5 (much more confident). Mean scores were computed for the URP, PIQ, and PCQ, with higher scores indicating more positive perceptions. Cronbach’s α scores in our sample were .90, .89, and .90, respectively.
Data Analysis
We used descriptive statistics to report participant experience ratings at posttest (Time 2). Paired t tests were used to compare pre–post mean scores for repeated measures; the α level was set at .05 given the pilot nature of the study (Feise, 2002). We used Cohen’s d to assess effect sizes.
Results
The URP, which measured participant satisfaction and experience, indicated high positivity (M = 4.47, SD = 0.38, range = 3.76–5.00) with the near-peer intervention. The PIQ results indicated large perceived improvements in soft skills (M = 3.41, SD = 0.55, range = 2.00–4.00), and the PCQ results indicated strong perceived soft skills confidence (M = 4.18, SD = 0.67, range = 3.00–5.00) after the intervention. In regard to preliminary efficacy, on average, participants made statistically significant (p ≤ .03) and medium to large improvements across social functioning (d = 0.55), self-efficacy (d = 0.79), and adaptive behavior (d = 0.54). Efficacy details are presented in Table 3.
Discussion
The results of this PBII, near-peer intervention not only support the feasibility of having occupational therapy students facilitate the intervention but also describe preliminary efficacy in improving self-perceived social functioning, self-efficacy, adaptive behavior, soft skills performance, and confidence. Psychosocial gains documented in the current study have been associated with enhanced employment outcomes in similar programs, such as SUCCESS (Baker-Ericzén et al., 2018), JOBSS (Gorenstein et al., 2020), and JobTIPS (Strickland et al., 2013). Moreover, on average, social functioning scores in our sample fell below the SRS–2 clinical cutoff score (T = 60) after the intervention, indicating clinically meaningful improvements in social functioning. Gains may be attributable not only to the 12-session soft skills curriculum but also to the organization of the social environment, incorporation of ASD evidence-based strategies (Steinbrenner et al., 2020), gradual unpacking of topics related to workplace success, near-peer influence, formal and informal opportunities to practice soft skills in sessions and during the built-in social hour, and high satisfaction with program content and near-peer delivery.
Limitations
Given the pilot status of this study and the small sample size, p values were not adjusted to correct for potential Type I error (Feise, 2002); also, the use of self-report measures may have introduced bias. Moreover, three measures (URP, PIQ, PCQ) were program specific. Although each demonstrated good internal consistency reliability (α > .80) in our sample, further validation is warranted. Because of the recruitment challenges with this population and the need to limit group sizes, larger samples may be achieved by pooling data from future cohorts. Finally, although this and previous studies (Baker-Ericzén et al., 2018; Connor et al., 2020; Gorenstein et al., 2020; Nicholas et al., 2019) have tracked psychosocial outcomes such as self-efficacy and executive functioning as prerequisites to employment, employment outcomes could not be fairly assessed in the current study secondary to job-seeking disruptions related to the coronavirus disease 2019 pandemic. Moreover, employment was not an immediate goal of more than one-third of our sample, who were full-time students.
Implications for Occupational Therapy Practice and Education
This study has the following implications for occupational therapy practice and education: The ASSET program was associated with clinically meaningful improvements in social functioning, self-efficacy, and adaptive behavior, which are essential skills that are often lacking among young adults with ASD. The key intervention components of the ASSET program are all current evidence-based practices in the management of ASD (Steinbrenner et al., 2020). Trained and supervised occupational therapy students can effectively deliver the manualized intervention as near-peer facilitators, elicit positive feedback and high levels of participant satisfaction, and replicate and extend previously reported participant gains.
Conclusion
Our results provide Level 3 evidence (Lieberman & Scheer, 2002) in support of the preliminary efficacy of occupational therapy students as near-peer facilitators of the ASSET program. We observed measurable gains in participants’ social skills, confidence, and adaptive functioning, in conjunction with high levels of satisfaction, and noted that the use of occupational therapy students as near-peer group facilitators shows a potential to elicit positive changes in young adults with ASD. Replication of this study on other college campuses is warranted for generalizability purposes.
Footnotes
Acknowledgments
We declare no conflicts of interest and no financial relationships relevant to this article to disclose. This research was funded by an Intervention Research Grant from the American Occupational Therapy Foundation.