Pilot trial of a community-based transition support program for autistic adults
Authors: Brewe Alexis M , White Susan W 
Published: February 2025

For autistic individuals, the transition to adulthood is marked by unique challenges including unemployment/underemployment, social isolation, and difficulties living independently. This pilot trial tests feasibility, acceptability, and preliminary clinical impact of an existing transition support program, STEPS (Stepped Transition to Employment and Postsecondary Success program), as delivered in the community. STEPS was piloted with 12 autistic individuals aged 16–35 in a local community agency. Participants provided ratings on several domains including readiness to transition to adulthood, self-efficacy, mechanisms targeted in STEPS (i.e. self-knowledge, self-determination, and self-regulation), and satisfaction with STEPS. Results supported STEPS feasibility, evidenced by high treatment fidelity and moderately strong alliance. Results also suggest high acceptability, evidenced by low attrition, high session attendance, moderate homework completion, and high program satisfaction. Results partially support preliminary clinical impact of STEPS by showing improvement in the primary outcomes (transition readiness and self-efficacy) for some participants. Given the goal of this pilot was to provide an initial examination of feasibility and acceptability to prepare for a larger implementation trial, challenges and strategies for future implementation are discussed. Future research could utilize innovative implementation approaches to test strategies that might promote adoption and long-term sustainability of STEPS when delivered by community providers.

Lay abstract

Autistic adults are less likely to be employed, attend college, and live independently compared to nonautistic peers. Programs for autistic adults that address skills necessary for these domains exist, although they are often not research-tested or readily available in the community. Stepped Transition to Employment and Postsecondary Success program (STEPS) is a research-tested program that seems beneficial and well-liked by autistic adults, although it has not been tested since STEPS was expanded to focus on goals in employment and independent living, in addition to college. To prepare for a larger study looking at the clinical impact and implementation, we ran this pilot trial to provide preliminary data. We ran STEPS with 12 autistic teenagers and adults in a local community organization. We asked them to complete forms before and after on their preparedness to transition to adulthood, confidence in themselves, ability to set goals, problem-solve, and regulate themselves, and their satisfaction with STEPS. We found mixed results on improvement. Several adults reported feeling more prepared to meet their goals in adulthood and more confidence in dealing with stressful situations, whereas others reported no change or feeling less prepared and confident. Some adults also reported being able to set goals, problem-solve challenges, and speak up for themselves more often. Participants and their caregivers liked STEPS, found it beneficial for their goals, and would recommend it to others. The therapist was able to run STEPS sessions, as intended, within the community organization. These findings suggest that STEPS can be helpful for autistic adults. These findings also suggest that STEPS can be delivered in community organizations, although more research is needed to test whether STEPS is as effective and do-able when delivered by clinicians who work in other organizations and who may have less autism training. This pilot trial was to prepare for implementing STEPS in the community with a larger sample of autistic adults, so we also consider challenges and suggest ways to strengthen future implementation.