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Monday, January 20, 2020

Transition Planning, Implementation, and Outcomes

In The Politics of Autism, I write:
When disabled people reach their 22d birthday, they no longer qualify for services under IDEA. ... People in the disability community refer to this point in life as “the cliff.” Once autistic people go over the cliff, they have a hard time getting services such as job placement, vocational training, and assistive technology. IDEA entitles students to transition planning services during high school, but afterwards, they have to apply as adults and establish eligibility for state and federal help. One study found that 39 percent of young autistic adults received no service at all, and most of the rest got severely limited services.
Claire Snell-Rood and colleagues have an article at Autism titled "Stakeholder Perspectives on Transition Planning, Implementation, and Outcomes for Students with Autism Spectrum Disorder."  The abstract:
Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by the Exploration, Preparation, Implementation, and Sustainment implementation science framework, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was characterized by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services stipulated in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder.

Service fragmentation is a big problem. From the article:
Respondents noted that schools were good at setting the goals, but implementation was often the challenge, commented one parent: “I was looking [at the goals] and I was like ‘Wow, these are great IEP objectives. If only they would have done them!’” At present, schools are not accountable to reach the IEP goals— leading some school administrators and policymakers to wonder if a standard of measurement could influence the planning process. In addition, many parents and policymakers hoped for resources that could provide a map of the options available to young adults with ASD that would “guide you through the next ten years.” Such a resource could inform parents and individuals to be better prepared before IEP meetings, and could also enable networking and advocacy among families.
As outlined by EPIS, an EBP [evidence-based practice] requires identification and involvement of the key critical players acting conjointly within a set of interdisciplinary collaborative relationships to provide effective services. In contrast, as noted consistently by several participants above, transition planning lacked an inter-organizational structure to support and sustain collaborative planning and implementation of services. Key players tended to operate within separate and usually different organizational policies, goals, and priorities that supported their unique mandates (employment, academic achievement) with no clear process for creating and sustaining the kind of integrative planning and goals needed for successful transition.