Impact case study database

The findings of López and her team have directly led to a fundamental shift in local authority employment strategic provision across Hampshire. As the Commissioning Lead for Adult Health and Social Care at HCC states: ‘ The research and expertise of Dr Beatriz López has been instrumental to the success of the implementation of the employment strand of the [Adult Autism] strategy’ ( S1). The ACRE team, in partnership with the four Hampshire local authorities (HCC, SCC, PCC and IoWC) and Autism Hampshire (AH), have co-developed a suite of freely-available, evidence-based employment Profiling Assessment (PA^©) tools that allow, for the first time, the systematic provision of individually-tailored recommendations for employers on the adjustments they need to make for their autistic employees without learning disabilities (LD). The PA^© tools assess: a) employability profiles to facilitate matching the person to a suitable job; and b) cognitive profiles to identify strengths and potential adjustments required in the workplace. The demonstrated cost-effectiveness of the PA^© tools in a series of employment programmes in Hampshire has subsequently led to policy and practice changes at national levels in the UK and Spain.

The ACRE team has also developed training packages aimed at changing attitudes towards autism, rather than merely increasing autism knowledge. Between 2015 and December 2020, ACRE staff have used these packages to train over 400 job advisors and autism ambassadors, responsible for raising employers’ autism awareness in Hampshire (PCC, SCC, IoWC, HCC, AH, approximately 180 delegates), elsewhere in the UK (Worcester County Council 2018, 2019; Surrey County Council 2015 approximately 70 delegates) and in Spain (e.g. Autismo España 2019, AETAPI 2017, approximately 150 delegates).

Improved employment strategic provision in Hampshire

Since 2015, the PA^© tools have been used across three employment programmes delivered in Hampshire: the ACE programme (15 participants) ( G1, S2); the Solent Job Programme delivered by SCC and PCC (75 participants) ( G3, S3a,b); and one programme delivered by Autism Hampshire (47 participants) ( G2, G4, S4). To date, these programmes combined have benefitted 137 out of the approximate 150 autistic adults without LD known to local services in Hampshire at the time ( S2, S3b, S4).

The inclusion of the PA^© tools in these programmes have:

• Increased employment rates and work experience: A preliminary report from the Solent Jobs Programme (SJP) demonstrated that 53% of 75 autistic participants gained paid long-term employment suitable to their qualifications, compared with 29% for all other participants in the programme who did not receive a PA^© assessment ( S3a). Of the 15 participants completing a work placement in the ACE programme, 10 secured paid (n=3) or unpaid (n=7) long-term positions at the end of the programme, and 7 have now gained permanent employment suitable to their qualifications. In addition, the 2 programmes delivered by Autism Hampshire, which supported 47 autistic job seekers who were not ready for work, used the PA^© tools to identify potential career pathways and training needs to achieve their goals ( S4).

• Enhanced employers’ ability to make adjustments in the workplace and improved attitudes: The ACE programme demonstrated that the PA^© tools are effective in helping employers design individually tailored adjustments for their employees. Employees reported higher satisfaction rates (83%) ( S2) with the adjustments made by their employers compared with those reported in R2 (25%). There was also a significant increase in employers’ reported likelihood to employ autistic adults, from 17% (n=2) before the programme to 58% (n=7) after the programme ( S2).

• Reduced on-job support and assessments costs: The main cost associated with the employment programmes delivered at the time came from on-job support by mentors in the workplace. By providing employers with the necessary information to support their autistic employee, thanks to the use of the PA^© tools in the ACRE programme, the need for on-job mentoring was significantly reduced to an average of 2 hours a week ( S2). Specifically, a comparative cost simulation showed a cost saving of GBP6.86 per participant per hour worked relative to published costings of a previous employment programme ( S2). Crucially, the reduced costs do not result in reduced satisfaction; only one client (out of 15) reported that they would have liked more hours of support ( S2). The use of the PA^© tools also reduces the time mentors spend on assessing their clients’ needs. In the SJP, employer advisors reported that the PA^© tools are “ robust” and “ very valuable” and confirmed that ‘ providing the assessment online was more cost-effective and quicker than other methods’ ( S3a).

• Increased wellbeing of autistic people: All programme evaluations revealed significant improvements in self-esteem and wellbeing ( S2, S3a, S4). For instance, in the SJP, the 75 participants who received PA^© assessments showed an average increase of 4.47 points on wellbeing scores (6.8% of the maximum possible score) compared to an average increase of 2.125 points in participants with other conditions who did not receive a PA^© assessment (3% of the maximum possible score) ( S3a). In turn, the ACE programme reported a statistically significant increase of 1.88 point change (6.2% of the maximum possible score) in self-esteem scores and a significant reduction of 8.4 point change (16.9% of the maximum possible score) in negative mood scores (S2).

The ACE programme, led by the ACRE team, was awarded the 2016 National Autistic Society prize for the Outstanding Adult Services category. Dr Adam Feinstein, who has served as a judge in five consecutive years stated that ‘ the ACE employment programme […] , stood out as a rare example of innovation combined with the genuine integration of research and practice. The originality of the ACE programme lies in the fact that it focuses on the provision of support towards the employer, rather than on the autistic employees’ ( S5). The programme also received a special mention in the Think Autism (2016) report (Department of Health, UK) detailing progress on the implementation of the UK Adult Autism Strategy ( S6, p.61).

The significant benefits that the use of the PA^© assessment tools have had on autistic people are probably best exemplified by a 54-year-old autistic adult who had been unemployed for over 3 years after a breakdown. For him, the PA^© tools helped his ‘ employer understand fully the kind of problems I may face’. He also says, ‘ I have learned that I can work again. I have learned that in the right circumstances, I can be utterly professional and crack on with the job. I have had self-doubt about whether I would be able to go back to work again. This has shown me that I still can contribute to society, that I can work, and that I can feel worthy again’ ( S7).

The PA^© assessment tools will continue to benefit autistic adults in Hampshire in future as ‘ the positive contribution of ACRE profiling services and Dr López’s expertise is clear both in terms of employment outcomes and mental health’, and hence , ‘we have incorporated these assessments to the continuation of the SJP programme, also funded by the European Union, […] until June 2023’ (Service Manager, Employment skills, SCC, S8).

Broadening the benefits to the UK and Spain

The PA^© tools were first developed as a solution to local demand; however, funding to ACRE from Research Autism in 2016 ( G2) allowed the development of an online version of the PA^© tools. The online format and its cost-efficiency have led to changes in policy and practice in the UK and Spain. Specifically:

• Changes in policy and practice UK: ACRE was approached in October 2020 by the [text removed for publication] to include the PA^© tools in the revised version of the UK Autism Adult Strategy, to be published in Spring 2021 by the Department of Health and Social Care. In this communication, [text removed for publication] also confirmed the plans to launch the PA^© tools across all 638 UK Job Centres as part of the standard provision delivered by Disability Employment Advisors supporting autistic job seekers without LD ( S9).

• Changes in employment provision in Spain: The PA^© tools have been translated by the Spanish National Society for Autism Professionals (AETAPI) and have been incorporated as a core element to the employment provision across the country. AETAPI is the largest organization of professionals supporting autistic people in Spain with a membership of 950 autism professionals ( S10).

The PA^© tools were due to be launched both by the [text removed for publication] in the UK and by AETAPI in Spain during International Autism Awareness Week (April 2020). However, as a result of the COVID-19 pandemic, the [text removed for publication] had to deploy resources to support the significant rise in unemployment ( S9). Consequently, launch of the PA^© tools was delayed to 6^th November 2020. For similar reasons, AETAPI delayed the launch of the tools until October 2020 ( S10).

Finally, and to reach English-speaking autistic adults unknown to services, in April 2019, ACRE launched the Autism & Employment online toolkit, developed in collaboration with Leeds Beckett University (GBP2,000 from PCC). This toolkit provides guidance regarding employment and includes activities and self-reflective questions to empower autistic people and their families in their journey to prepare, look for and stay in work. The use of the toolkit is one of only 3 autism toolkits recommended by the DWP (UK) in their Guidance for employing people with disabilities and people with health conditions, published in March 2020 ( S11). To date, the site has received over 2,500 visitors from 9 countries.