DOI: 10.3886/e184105v1-139275
title: Enhancing Community Participation for Adults with Autism Spectrum Disorders through Peer-Mediated Transportation Interventions

description: This project was designed to determine the effectiveness of a peer-mediated travel training intervention to increase independent use of public transportation for individuals with ASD. A randomized control trial was implemented to evaluate the effectiveness of the peer delivered travel training program on self-efficacy, participation and community mobility outcomes for individuals with ASD. Participants were randomized to either a control or intervention group. Participants in the control group continued use of prior transportation methods as usual. The intervention group received didactic instruction consisting of direct instruction and role play with a peer interventionist and clinic staff person for 2-3 times a week for 1 – 1 ½ hours over a two week period. Following this, participants received 1-1 individualized travel training instruction over 12 sessions ranging between 1-3 hours with a peer leading the training. Participant demographics and characteristics were collected at pre-test. Measures of self-efficacy (General Self-Efficacy Scale, Transportation Appraisal Scale) and community participation (Temple University Community Participation Scale) were administered at pre-test, post-test 1 (immediately following the intervention) and post-test 2 (3-4 months following the start of intervention). Community mobility, including location and movement of participants, was measured using smart phones and AccuTracking software during a two week pre-test period and a two week post-test period of time. Additionally, transportation skills (Progressive Evaluation of Travel Skills) and community mobility goals (Goal Attainment Scaling) were assessed at pre- and post-test 1 for individuals randomly assigned to the travel training intervention group. Data was collected from March 2019 to November 2021.
description: Response Rates: There were 88 participants screened for the study. Five participants did not meet the study inclusion criteria. 83 participants were enrolled in the study. Eight of these 83 dropped out of the intervention group due to the sudden COVID-19 shut down that occurred during their intervention period. A total of 75 participants completed the pre-test and intervention period. 73 participants completed the first post-test (97%) and 67 completed the second post-test (89%).
description: Presence of Common Scales: <b>Descriptive Data. </b>The research team collected demographic data including age; gender; ethnicity; education; current methods of transportation; travel barriers to transportation; and previous use of public transportation.<br><b></b><b>Inclusionary Measures:<br></b><b>Pre-Screening Travel Assessment. </b>This pre-screening assessment tool identified pre-requisite and foundational skills necessary for travel training. The participant or a person close to the participant (e.g. family member, support staff) completed the assessment. Certain skills on the pre-assessment are deemed essential for safe travel. Participants with scores of 28 or below were not included in the study as they were deemed not ready for travel training based on their score. Response options on the tool included “Never”, “Sometimes” and “Very Often”.<br><b>Ritvo Autism Asperger Diagnostic Scale – Revised. </b>Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-R) is a self-report measure for adults that assesses characteristics of Autism including circumscribed interests, sensory motor, language and social aspects of the condition. There are 80 questions in a Likert format with response options “True now and when I was young”; “True only now”; “True only when I was younger than 16”; and “Never true”.<br><b>Outcome Measures:</b><b>Temple University Community Participation measure (TUCP)</b>. The Temple University Community Participation measure (TUCP) was used to assess self-reports of participation in 26 participation areas. Participants are asked to indicate the number of days in the past 30 days that they participated in each of the 26 areas, whether each participation area was important to them, and whether they felt they participated in each area enough, not enough, or too much.<br><b>Transportation Appraisal Scale. </b>This self-report rating scale measures transportation self-efficacy, the belief that a person can perform tasks needed to travel on public transportation. The scale was developed for the purpose of the study based on guidelines from Bandura’s Guide for Constructing Self-Efficacy Scales (2006), along with the Kennedy Center’s (2012) travel training curriculum identifying the specific skills needed for independent use of public transportation. The TAS has 18 items with a 10-point interval rating scale ranging from 0 to 100. Rating descriptors include cannot do at all (0), moderately can do (50) and highly certain can do (90-100). It provides a total raw score.<br><b>General Self-Efficacy Scale (GSE).</b><b> </b>The GSE measures the belief that a person can perform a novel or difficult task(s) and cope with adversity in various domains of human function. The GSE (Schwarzer & Jerusalem, 1995) has ten items designed to measure successful coping, which implies an internal-stable attribution of success. It is a self-report questionnaire with a rating scale of 1 (not at all true), 2 (hardly true), 3 (moderately true) and 4 (exactly true).<br><b>Progressive Evaluation of Travel Skills</b>. This test was completed by the interventionist and/or supervising clinical staff through observation of the participant using public transportation in the community environment. It was only administered to the participants assigned to the intervention group. It has a total of 28 items with a rating scale of 0 (needs physical prompts/no response or indication of what is going on), 1 (reassurance; knows but looks for approval), 2 (verbal prompts or gesture initiated; needs to be told or led in skills) or 3 (completes skill properly without assistance). A total test raw score is provided.<br><b>GPS.</b><b> </b>Participants were provided with cellular phones that had GPS tracking capacity. The AccuTracking (www.accutracking.com) application installed on the phone was used for tracking the locations and movement of study participants.<br><b></b><b>Daily Transportation and Participation Questions</b><b>. </b>Participants completed questions daily to identify the community-based activities and the modes of transportation that they used get to these activities. Specifically, the total number of community activities performed over a two week period, and 2) the number and percentage of these activities that were reached by public transit were calculated for analysis. A question about the general location of the activity was also included to provide data to validate GPS data.
description: Convenience sample of people with an identified ASD receiving services through local community-based agencies randomly assigned to control and intervention groups in blocks
description: People 18 years of age and older identified with an Autism Spectrum Disorder (ASD).
description: coded on-site observation; face-to-face interview; remote sensing; telephone interview; web-based survey;