An Interview with Dr. Todd Harris and Amanda Duffy

An Interview with Dr. Todd Harris, Executive Director of Autism Services, Devereux Advanced Behavioral Health and Amanda Duffy, Program Director, MEd, BCBA, Devereux Advanced Behavioral Health Pennsylvania

Conducted by Maggie Haag, MEd, LSW
ASAT Lifespan Content Co-Coordinator

Maggie: Employment for individuals with autism and/or intellectual disabilities is currently a major focus of adult serving systems nationally, however, many service providers struggle to build strong program models for employment support for this population. Can you briefly describe your program model for supported employment and customized employment? What type of staff training do you provide?

Todd and Amanda: Our Community Adult Autism Partnership Program (CAAPP) is a highly individualized approach designed to capitalize upon a participant’s unique strengths and interests that will lead to successful employment. CAAPP is a program that falls under Devereux Autism Services in Pennsylvania. Our one-to-one program model weaves evidence-based approaches with the skills and interests of each individual and the needs of employers.

The key to the success of the CAAPP model is comprehensive staff training with a focus on using evidence-based instructional practices in employment settings. Staff are also trained on an individual participant’s learning and behavior support protocols. A behavior analyst monitors how well staff implement these protocols. In addition to clinical training, staff also receive guidance and support on managing specific employment issues, such as maintaining positive relationships with employers, developing natural support for the individuals on-site, and fading assistance. Equally important is staff training on building independence in community skills, self-determination, quality of life issues, appropriate socialization with co-workers, and so on. Finally, our staff is supported to become good communicators. Success for the individuals we serve is often dependent upon staff being able to navigate complex situations and effectively communicate to address issues.

Maggie: What is your process for assessing appropriate employment options for the individuals you serve?

Todd and Amanda: A comprehensive assessment prior to employment drives placement. Our staff completes a thorough record review to identify a participant’s history of supports, volunteer work, employment experiences, and areas that have been successful in the past — as well as what has not gone so well. Situational assessments, team interviews, direct observation and preference assessments are used to outline the participant’s preferences, strengths, and abilities. It also helps identify areas in which the participant displays little interest or does not currently have the skills to perform successfully.

This discovery process provides a guide in identifying a good employment match. For example, if the participant prefers a setting where they are not expected to interact with others, this may rule out working in the front of a restaurant as a server or busser, but working in the kitchen may be an option.

Maggie: There is a lot of discussion surrounding preparing individuals for employment, but less about sustaining employment once an individual obtains a job. What are some strategies that can be used to help an individual not only obtain, but maintain a job?

Todd and Amanda: There are some key components that should be in place that will pave the way for long-term employment success. Some of these include a comprehensive evaluation of an individual’s ability to work independently and a plan in place on how to address any issues that may arise in the future. For example, if the individual’s job responsibilities were to change in the future, what support can the employer provide to the individual to help them successfully navigate those changes? Will the participant know how to access additional natural support in the workplace when needed?

When it is evident that the employment opportunity is a good fit, support should be reduced gradually in an organized manner, as opposed to being removed abruptly. During this process, more naturalistic support and strategies will continue, such as task lists and visual reminders. We work closely with supervisors and co-workers to make sure they are comfortable and confident in the supports that are continued. If co-workers and supervisors are unsure of their role or unaware of supports, keeping a job becomes more difficult.

Equally essential to maintaining employment are frequent and regular check-ins between the individual and the employer; between the individual and our program staff; and between the employer and our program staff. We have found that these check-ins allow for proactive and preventive problem solving to occur before smaller issues become larger ones. As our program staff members begin to fade their presence on-site, these check-ins become even more important.

Maggie: We all hit “bumps in the road” at work, such as getting a task we have never done before or getting a new boss. How can we support individuals with autism at work through these bumps in the road?

Todd and Amanda: One of the limitations of community employment is that the focus is often on reducing job coaching support as quickly as possible, without a clear plan as to how to address potential issues that may arise. Initial discussion with the individual, the employer, and relevant team members should include what supports are available for the individual should they encounter obstacles down the road. For example, if the individual is expected to learn a new job responsibility, can a job coach be re-implemented temporarily with a clear plan to gradually reduce job coaching support to assist the individual with the new skills?

An important strategy to prevent the bumps from becoming mountains is educating employers in general about individuals with autism and the specific needs of the individual employee. We help employers to understand what events may be difficult for the individual to cope with, and how to problem solve before the event occurs. For instance, if the employment site needs building renovations for a few days and there is the expectation of loud noises, what can be done to lessen the impact of the noise? Can the employee listen to music with headphones? Can a white noise machine play in the background? These are the type of options that should be discussed and implemented. Finally, we work to improve each participant’s own problem-solving skills, reducing the need to rely on others to identify and solve problems as they arise.

Maggie: How can professionals prepare and support the employer to support their worker with autism? What type of education have you and your team provided to community partners to ensure buy-in?

Todd and Amanda: When approaching employers on behalf of our participants, we strive to outline the individual’s strengths and abilities. While we are often focusing on supporting our participants, there also needs to be a focus on educating and transferring skills to the employer so that support can continue in the absence of a job coach or employment specialist. It’s important to start by having a quick “Autism 101” at your fingertips. Assess what will be important for the employer to know about individuals with autism that may be helpful in the long run, but also what might be relevant to the particular job site. Having a quick information sheet to share with employers that clearly and efficiently outlines the potential benefits of hiring individuals with disabilities (e.g., tax incentives) is also an important tool. Include resources for the employer to learn more or who they can contact with questions.

In 2012, we developed a short web-based training for employers in partnership with Pennsylvania’s Bureau of Autism Services. The training informed supervisors and co-workers about autism and some basic strategies that have been shown to be helpful in supporting individuals with autism in the workplace. These strategies included providing visual information related to schedules and expectations; how to best address introducing changes in workplace routines and/or new work tasks; how to create a comfortable and positive work environment; and various environmental and sensory strategies that can be used. We have found this type of training to be highly beneficial, especially when it is adapted to audience characteristics and the length of time available for training.

Maggie: We have all had jobs that haven’t worked out for a variety of reasons. How do you help an individual with autism determine if their current job is a good fit for them if they are having difficulty, and how do you assess when it may be time to begin looking for an alternative job?

Todd and Amanda: Regular check-ins are incredibly important. If a job isn’t a good fit, it may be a small adjustment that is needed – but we need to learn about it early before it creates bigger issues. Helping participants identify what is going well in a job and what they wish they could change is a good starting point when job satisfaction begins to wane. Something as simple as listing likes and dislikes about a job can lead to identifying issues that can improve the workplace experience.

This process of evaluation also creates an opportunity to teach problem-solving and social skills. For example, if a participant lists that he is sitting too much at work, we problem-solve with that individual to see if more active tasks can be added to the routine. Once those active tasks are identified, we will strategize on how to get to that change, beginning with scheduling a time to meet with the supervisor. Through role-play and practice, we can review how that conversation with the supervisor might go, and how to best react to the supervisor’s response.

However, as with anybody, sometimes there isn’t a compromise that would make the job a good fit. If the job cannot be modified in a meaningful way, it is important to begin seeking alternatives without a sense of blame or shame for either the participant or the employer. Sometimes, it just isn’t a good fit.

Maggie: What are the biggest barriers to ongoing, successful competitive employment for adults with autism in your experience?

Todd and Amanda: One of our biggest challenges is teaching participants the social skills that are needed to be successful in community-based employment sites. For most of their lives, our participants are in very structured environments and surrounded by trained staff. So, they learn social skills within those types of contexts.

Learning appropriate social skills in environments that are significantly less structured and predictable, and being around co-workers who often have received no or very little training, creates some instructional challenges. And social rules vary between settings, so we must continuously evaluate and prioritize what skills are the most important to teach that can be generalized across a variety of situations and settings.

Having multiple community-based job training experiences during the transition years provides an opportunity to teach these critical skills in the natural environment and to also teach flexibility with rules as new job training sites are introduced. Unfortunately, many of our participants may not have had these opportunities in their earlier years. This requires us to prioritize skills to work on, as not all skill areas can be addressed at one time.

Maggie: What advice do you have for employers who may be hesitant to hire an employee with autism?

Todd and Amanda: First and foremost, we believe that this is not only an opportunity for the individual seeking employment to be a contributing member of our community, but an equally important opportunity for employers to demonstrate their commitment to the community. Realistically, we know that there are barriers – some that are perceptions and some that are very real. The best way to overcome barriers is to personalize the process. We make sure that the employer has an opportunity to get to know the individual they are considering hiring. Along with face-to-face meetings, we have found that digital and/or paper-based portfolios can also serve to achieve this goal. The digital portfolios can be particularly helpful since it allows the potential employer to see the individual at a past worksite and recognize their capabilities. Video references or letters of reference from past employers or supervisors at training sites can also be very valuable. Having a past supervisor describe work habits, punctuality and attendance, attention to detail, stamina, and other relevant information is helpful in bridging doubts about including an individual with autism in the workplace. These references frequently emphasize how much participants have taught their co-workers and how they have improved the social elements of the workplace.

Secondly, clearly communicating our role is critical in building an employment opportunity. We have found that employers are put at ease when we explain that we will be onsite to support the new employee in learning the related job tasks and routines before we gradually fade support. We also emphasize our continued partnership with the participant and employer to address work related issues, both small and large.

On a broader level, our goal is not only to find meaningful employment for the individuals we serve but to educate employers on a larger scale about the potential of those we serve and how employers can get involved. Some employers may not be ready to hire, but are open to allowing participants to come observe the work setting, ask questions, and possibly practice skills onsite for assessment and teaching purposes. We have a small business that initially offered participants the opportunity to practice work skills on site. Not only did this open doors for participants to get much needed experience, but the opportunity to have participants observe and practice skills has led businesses to be interested in hiring people with disabilities too!

For anyone, finding a job can be a daunting task. For those we serve, it’s often a bigger climb. But the rewards are equally magnified – both for the individual and the employer. Individuals with autism sharing their lives with co-workers and supervisors ultimately leads to a more inclusive and diverse workforce and stronger communities.

Maggie: Based on our interview, it sounds like training and education for employers is just as important as it is for the individuals supported at work. Dr. Harris and Amanda, thank you very much for your thoughtful and informative answers to my questions about this important topic.

Citation for this article:

Haag, M. (2018). Interview with Dr. Todd Harris and Amanda Duffy. Science in Autism Treatment, 15(4), 23-26.

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