(PS3-A24) Feasibility and Acceptability During Community Implementation of the Stepped Transition to Employment and Postsecondary Success Program (STEPS)

Background: People with autism spectrum disorder (ASD) experience lower rates of employment and postsecondary school enrollment, compared to their age- and ability-matched peers. The Stepped Transition to Employment and Postsecondary Success program (STEPS; White et al., 2019) is a cognitive-behavioral intervention designed to support autistic individuals, aged 16-25, during the transition to adulthood and build age-appropriate independence. STEPS has demonstrated initial feasibility and efficacy with improving transition readiness in a randomized controlled trial. However, STEPS has not yet been used by, or tested within, community-based agencies. The current study examined the initial feasibility and acceptability of community implementation of STEPS in a Hybrid Type 1 implementation-effectiveness open trial (Organization for Autism Research Grant 2021A05).

Methods: Autistic adolescents and young adults (currently enrolled n=15; M age: 20.69 years; 26.67% female; 93.33% white) participated in STEPS, individually seen by 5 community-based providers (40% female), with an anticipated full sample of n=25 by August 2023. Treatment feasibility was evaluated by community providers’ fidelity to the STEPS treatment manual, assessed by provider-rated weekly session fidelity and confirmed by an independent rater who coded 20% of session videotapes. Providers also completed the Feasibility of Intervention Measure (FIM; Weiner et al., 2017) after completing their final STEPS participant in the trial. Acceptability was measured by low participant attrition. Additionally, acceptability was measured via participants’ and their parents’ ratings of satisfaction with the program, as well as providers’ ratings on the Acceptability of Intervention Measure (AIM; Weiner et al., 2017) and Intervention Appropriateness Measure (IAM; Weiner et al., 2017) at post-treatment.

Results: Program feasibility, as defined by community providers’ high fidelity to the treatment manual, was achieved. Average session fidelity to objectives was 88.67% per provider report on sessions conducted in the pilot to date (n=150 sessions) and 64.27% per independent rater report. Regarding program acceptability, only 1 participant out of the 15 enrolled or completed cases dropped out of the trial (< 10% attrition). Participants who have completed STEPS (n=7) and their parents also provided responses at post-treatment that suggest high program acceptability with average responses of moderate satisfaction or higher for the program’s helpfulness, impact, and time commitment. Community providers will provide ratings on the implementation measures (FIM, AIM, IAM) after seeing all assigned STEPS cases, which will be reported in the full poster for ABCT.

Conclusions: Initial findings suggest that STEPS is acceptable to autistic young people and their caregivers and that it can be implemented by community providers with high fidelity. Given the need for research-supported programming designed to help autistic individuals prepare for independence in adulthood, this first test of STEPS in the community suggests that the program could be sustainable and scalable within community-based agencies.