Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Group interventions have been shown to improve soft skills, a common barrier to employment for individuals with autism. Although telehealth shows promise as a service delivery method, published research on telehealth soft-skills interventions for this population is lacking. Thus, this study explored differences between face-to-face and hybrid delivery of a group soft-skills intervention for young adults with autism. Results detail potential benefits of telehealth-delivered OT.
Primary Author and Speaker: Annemarie Connor
Contributing Authors: Sanja Dizdarevic, Isayda Gonzalez, Zoey Knece, and Hannah Koedam
PURPOSE: Individuals with autism have disproportionately high rates of unemployment (Seaman & Cannella-Malone, 2016). Group interventions have been shown to improve soft skills, a common barrier to employment (Connor et al., 2019). The use of telehealth with the autism population has been rising and has potential to reduce barriers to care; yet, evidence is lacking regarding its use directly with individuals with autism (Hepburn et al., 2016) or as a soft skills training platform. Thus, the current study aims to explore the feasibility and preliminary efficacy of hybrid (50% synchronous online) delivery of a manualized group softs skills intervention as compared to face-to-face delivery of the same program. Constructs explored were theoretically-derived and include social skills, self-efficacy and overall satisfaction.
DESIGN: In this two-group pre-experimental pretest-posttest design, a convenience sample of two groups of seven individuals with autism completed a 13-session soft skills training program (Connor et al., 2019); the first group received face-to-face delivery, while the other received a hybrid delivery. Sixteen individuals were screened and 14 (88%) were eligible to participate. Retention rate was 100%. The face-to-face group had a mean age of 19.86 (SD = 3.02) and consisted of six males (86%) and one female (14%); the hybrid group, 23.29 (SD = 3.40), four males (57%) and three females (43%). Selection criteria: 17-28 years; diagnosis of autism; fluent verbal communication, able to read and comprehend questionnaires.
METHOD: Self-report instruments were used to measure program effects before and immediately after intervention. Social skills were assessed using the Social Responsiveness Scale-2. Self-efficacy was examined across three domains using the General Self-Efficacy Scale (GSE), Perceived Empathic Self-Efficacy Scale (PESE) and Perceived Social Self-Efficacy Scale (PSSE). Following intervention, satisfaction/soft skills confidence/improvement was measured with a program-specific user rating profile (Sung et al., 2019). Independent samples t-tests and Mann-Whitney U were used to compare change and group outcomes.
RESULTS: Change in social dysfunction between the face-to-face and hybrid groups, -4.57, was not statistically significant, t(10) = -0.43, p = .68. All three measures of change in self-efficacy indicated non-significant differences in change scores between groups: GSE, -0.18, t(12) = -0.64, p = .53; PSSE, -0.26, t(12) = -0.58, p = .57; and PESE, -0.33, t(12) = -0.53, p = .42. Soft skills confidence among the hybrid group (Mdn = 5.00) was significantly greater than the face-to-face group (Mdn = 3.83), U = 1.00, z = -3.06, p = .001, representing a large effect (r = .82). Improvement in the hybrid group (Mdn = 4.00) was significantly greater than in the face-to-face group (Mdn = 3.14), U = 1.00, z = -3.05, p = .001, representing a large effect (r = .82). On average, the hybrid group reported higher satisfaction (M = 4.71, SE = 0.02) than the face-to-face group (M = 4.19, SE = 0.13). This difference, 0.51, was statistically significant, t(6.34) = -3.94, p = .007 and represented a very large effect (g = 2.03).
CONCLUSION: Results revealed no significant difference in gains between groups, indicating similar efficacy between hybrid and face-to-face delivery. However, average satisfaction, soft skills confidence, and perceived improvement were significantly higher in the hybrid group. These findings suggest that hybrid delivery was efficacious, feasible, acceptable, and perhaps preferred among our small sample. Due to limitations in study design and sampling, further research is needed before generalizing findings.
References
Connor, A., Sung, C., Strain, A., Zeng, S., & Fabrizi, S. (2019). Building skills, confidence, and wellness: Psychosocial effects of soft skills training for young adults with autism. Journal of Autism and Developmental Disorders 50, 2064–2076 (2020). https://doi.org/10.1007/s10803-019-03962-w
Hepburn, S. L., Blakeley-Smith, A., Wolff, B., & Reaven, J. A. (2016). Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. Autism 20(2), 207–218. https://doi.org/10.1177/1362361315575164
Seaman, R. L., & Cannella-Malone, H. I. (2016). Vocational skills interventions for adults with autism spectrum disorder: A review of the literature. Journal of Developmental and Physical Disabilities, 28(3), 479-494. https://doi.org/10.1007/s10882-016-9479-z
Sung, C., Connor, A., Chen, J., Lin, C.-C., Kuo, H.-J., & Chun, J. (2019). Development, feasibility, and preliminary efficacy of an employment-related social skills intervention for young adults with high-functioning autism. Autism: The International Journal of Research and Practice 23(6), 1542–1553. https://doi.org/10.1177/1362361318801345
