There is a lack of research on gender differences in adults’ with autism participation in social activities (i.e., activities that provide interactions with others in the community). Using a large statewide sample (N = 775, 217 females and 558 males), we examined gender differences in the social participation of adults with autism while considering the presence of an intellectual disability (ID). No gender differences were found in total participation days. However, women with autism without ID reported participating in lower percentages of social activities that were important to them and perceiving sufficient participation in lower percentages of these important social activities than their male counterparts. They also reported lower satisfaction with participation level (i.e., perceived sufficiency in participation in important social activities) in social activities that were important to them than women with autism with ID. Implications of findings for understanding gender differences in autism across the life course are discussed.

Community participation is critical for health, particularly during young adulthood. Coordinated Specialty Care (CSC) programs for young adults with early psychosis aim to promote community participation; however, research on practices beyond those focused on employment, education, and family relationships is limited. This qualitative study explored CSC programs' community participation practices across a broad range of areas and the factors influencing their implementation. Following a national survey, individual semi-structured interviews were conducted with 11 CSC program leaders to examine ten specific practices. Recorded responses were transcribed and qualitatively analyzed using an integrated thematic analysis approach. Findings revealed that programs implemented a range of practices, including outreach to mainstream organizations, fostering mutual support among clients, facilitating independent community participation, and providing targeted support in spirituality/religion, intimate relationships, and civic engagement activities. Effective leadership, organizational culture, and staff factors (e.g., knowledge, skills, supportive attitudes and behaviors) emerged as key facilitators, while primary barriers included limited resources, staff challenges (e.g., lack of training), and environmental challenges (e.g., stigma, rural settings). Client-level factors, such as motivation and interference from symptoms, and the perceived effectiveness and acceptability of various practices, also impacted implementation. Recommendations include enhancing leadership buy-in, staff training, and creative resource use to overcome barriers and sustain community participation efforts. This study highlights variability across CSC programs and provides actionable strategies to strengthen community participation practices for young adults with early psychosis.

Young adults with early psychosis often disengage from essential early intervention services (i.e., Coordinated Specialty Care or CSC in the United States). While decision support interventions improve service engagement, their use in this population is underexplored. This study evaluated the feasibility, acceptability, fidelity, and potential impact of a decision coaching intervention for young adults with early psychosis in CSC services. Using a mixed-method, longitudinal, collective case study design, we assessed the intervention's impact on decision-making needs through the Decisional Conflict Scale and qualitative interviews. We also evaluated feasibility, fidelity, and acceptability through observations and feedback from interventionists and participants. Eight young adults from three CSC programs participated, showing variable engagement, with generally favorable fidelity and acceptability ratings. The Decisional Conflict Scale revealed mixed findings, while four themes from qualitative interviews emerged: Perspective and Information Seeking, Motivation and Prioritization, Empowerment and Confidence, and Critical Thinking and Evaluation. The findings suggest that training CSC providers—including peer specialists and clinicians—to deliver decision coaching with fidelity is feasible, well-received by young adults, and potentially impactful on decision-making. Replication in a larger controlled trial, addressing observed study limitations, is warranted. This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034) on August 28, 2020, as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis (https://clinicaltrials.gov/ct2/show/NCT04532034?term=NCT04532034 draw=2 rank=1).

Objective: A cohort of certified peer specialists (CPSs) was surveyed to investigate factors affecting postcertification employment and retention. Methods: Survey data were collected in 2020, 2021, and 2022 from 591 CPSs in four states (North Carolina, Oregon, Pennsylvania, and Texas). The data were analyzed via percentages, means, and multilevel regression models. Results: Postcertification employment remained high: 76% (N=448 of 591) in 2020, 73% (N=329 of 448) in 2021, and 77% (N=279 of 364) in 2022. However, the proportion working in peer support positions declined significantly-from 73% (N=325 of 448) in 2020 to 63% (N=175 of 279) in 2022-despite the significantly higher job satisfaction, greater access to job benefits, and longer average job tenure reported by those working in peer support versus nonpeer jobs. Conclusions: Although the individuals who completed certification appeared to remain employed, a significant proportion appeared to leave peer support for other work. These trends should be monitored to evaluate investments in peer certification and service capacity. Psychiatric Services 2025; 76:497-501; doi: 10.1176/appi.ps.20240166

OBJECTIVE:Although certification can raise the status of peer support work, certified peer specialists (CPSs) may continue to face financial hardship that affects their employment choices. This study aimed to explore how wages and financial well-being changed for CPSs over a 3-year postcertification period. METHODS:This study examined wages, job characteristics, and financial well-being for a cohort of 448 employed CPSs working in peer support (PS) or other, nonpeer (NP) jobs during the study period. Self-report survey data were collected on current jobs, hours worked, and job tenure. Financial well-being was assessed by using the Consumer Financial Protection Bureau's Financial Well-Being Scale. Differences in job characteristics over time were described by using chi-square and t tests, and mixed-effects logistic regression models were used to model job attributes and financial well-being. RESULTS:Hourly wages for both PS and NP jobs increased significantly between 2020 and 2022, with smaller increases for PS than for NP positions. Individuals with PS jobs were significantly more likely to have longer job tenures than those with NP jobs. Higher hourly wages were associated with a greater likelihood of longer job tenure. Financial well-being did not improve significantly over time. CONCLUSIONS:The larger wage increases and shorter tenures characteristic of NP jobs, relative to PS positions, suggest that workers may have switched from PS jobs to other jobs to improve their financial and career mobility opportunities. CPSs are part of a trend in the general U.S. adult population of declining financial well-being, despite increased wages.

Purpose This study explores the relationship between different modes of transportation and community participation among individuals with serious mental illnesses. Methods This study reports on data from 283 individuals with serious mental illnesses recruited from community mental health centers in 15 states. Participants responded to self-report items about the types of transportation used and participation in the community. Data were analyzed using Classification and Regression Trees to determine which modes of transportation were predictive of community participation. Results Individuals with serious mental illnesses reported walking as the most frequently used form of transportation followed by using public transportation. Biking and driving one's own car, were the strongest predictors of amount and breadth of community participation. Walking was the only predictor of community participation sufficiency. Conclusions Lack of transportation is an often-cited barrier to community participation for individuals with mental illnesses. Independent modes of transportation (Biking, driving one's own car, and walking) appear to facilitate participation. Future research should develop and test interventions that aim to promote transportation access and usage in order to facilitate diverse participation in the community.

Background: Individuals with autism often experience transportation challenges as primary barriers to essential community services such as health care and employment. Research of travel training interventions has identified evidence -based techniques for improving specific transportationrelated competencies. Peer -mediated interventions are recognized as effective and when provided in natural social contexts. This study evaluated a peer -mediated travel training approach with adults with autism to provide and improve specific skills necessary for independent travel on public transportation. Purpose: This study aimed to evaluate the efficacy and feasibility of a systematic peer -mediated travel training to improve public transportation travel independence for autistic adults to increase their access to the community. Method: A randomized control trial (RCT) was used to determine the effectiveness of a peer -mediated travel training program on travel skills, community mobility goals, community participation, and self -efficacy for individuals with ASD. Measures including self -report, observational measures, and GPS data were collected at baseline and two weeks after the intervention. Data on community participation and self -efficacy was collected again 4 months post -intervention. Analysis: Analyses to compare group differences over time were completed. Pearson correlations were used to examine the associations between different constructs at baseline. Results: Seventy-five individuals were enrolled in the study, with 38 individuals in the control group and 37 in the experimental group. The group receiving peer -mediated intervention significantly improved the travel skills necessary for public transportation and community mobility (p < 0.0001), although there were no significant differences between groups in community participation or self -efficacy. Results identified that peermediated travel training was feasible for adults with autism. Conclusion: The results of the current study identify promise for a comprehensive peer -mediated travel training intervention to improve travels skills and community mobility. Future research is needed that examines the implementation and effectiveness of different service delivery models such as peer versus staff -delivered interventions.

Community brief Why is this an important issue?Employment is important for income, quality of life, and the ability to get the supports or services a person needs. Autistic adults are more likely to be unemployed or underemployed when compared with neurotypical adults and people with other disabilities. There are many environmental barriers to participating in adult activities in the community, but issues with transportation are a primary barrier. In previous research, a high number of autistic adults (72%) reported that they had missed some of their desired activities due to lack of transportation. It is important to understand the relationship between transportation and employment to know how to overcome barriers and improve employment options for autistic adults who want to work. What was the purpose of this research?The purpose of this research was to look at transportation and employment status (i.e., employed or unemployed). Specifically, this study compared types of transportation used and perceived barriers to transportation between autistic adults who were employed and those who were unemployed. What did the researchers do?Information was collected from 1120 autistic adults through a large statewide survey, which included questions about employment and transportation. Information from autistic adults who were employed and those who were not employed was compared. What were the results of the study?Results of this comparison showed that participants who were employed were more likely to drive themselves and less likely to take rides from other people or to use service transportation. Those who were employed also reported fewer barriers to public transportation. Barriers such as crime, planning a trip, treatment by fellow passengers, cost, knowledge on how to use public transportation, and sensory overload were identified by more people who were unemployed than by people who were employed. How will these findings help autistic adults now or in the future?The study identified specific barriers to transportation for autistic adults who are unemployed. This information can help to guide supports and policies to reduce barriers for travel needed for employment. In addition, results of this study can help guide future research to develop or identify the transportation skills needed for travel to work for autistic adults. Background: Autistic adults are significantly unemployed or underemployed even compared with other disability groups. Employment is a social determinant that, when satisfied, closely influences health-related quality of life. For autistic adults, environmental barriers to transportation can impact the ability to get to employment resulting in limited employment opportunities. This study provides a closer examination of the association between transportation use and employment status.Objective: To examine the use of different types of transportation and barriers to public transit by employed and unemployed autistic adults.Method: The data were from a large statewide study conducted between May 2017 and June 2018 using the Pennsylvania Autism Needs Assessment (PANA), in which information about employment and transportation use was obtained from autistic adults who were residents of Pennsylvania. The study sample included 1120 autistic adults (M-age = 28.03 years, standard deviation = 9.84; 70% men; 82% non-Hispanic White).Results: Participants who were employed were more likely to drive themselves than those who were unemployed (45% vs. 21%, p < 0.001), while they were less likely to take rides from others (62% vs. 75%, p < 0.001) or use service transportation (11% vs. 18%, p = 0.001). For barriers to public transit, the results identified that employed participants reported fewer barriers to public transportation than unemployed participants with a small effect size (1.98 vs. 2.54, d = 0.22).Conclusion: Employed autistic adults exercise more transportation independence. Unemployed autistic adults report more barriers to participation and lower ability to independently use public transportation. Future transportation and employment studies are necessary.

BACKGROUND:This study examines the extent of exposure to verbal violence experienced by people with intellectual disabilities and whether it differs based on their housing situation: living in the community, with family, or in a residential facility.METHOD:One hundred and eighty-nine people with intellectual disabilities were interviewed about their experience with verbal violence.RESULTS:Eighty-six percent reported experiencing verbal violence in their lifetime and approximately 77% experienced it the past week. Participants were most likely to be yelled at, and friends were the most common perpetrators. While there were few differences by setting, people living with their families were more likely to be laughed at and marginally more likely to experience rude comments.CONCLUSIONS:Verbal violence is prevalent in the lives of people with intellectual disabilities in Israel. Interventions are necessary to assist people with intellectual disabilities to deal with such incidents, with possible additional supports needed for those living with family.

Objective: Campus engagement, including participation in student organizations and groups, is important for both academic and health outcomes. Yet, college students with serious mental illnesses demonstrate lower levels of campus engagement compared to peers without mental illnesses. To inform psychiatric rehabilitation approaches that might enhance this outcome, the purpose of this study was to test an integrated model of self-determination and self-efficacy theories to predict campus engagement within this student population. Methods: Sixty-seven college students with serious mental illnesses completed measures assessing self-determination constructs (autonomy, competence, and relatedness), college self-efficacy, and campus engagement. Correlational and path analytic models examined relationships among these variables. Results: Bivariate and multivariate analyses supported the interrelationships among the variables. Specifically, the theory-driven path model demonstrated that autonomy (but not competence or relatedness) was a significant predictor of college self-efficacy, which in turn was associated with campus engagement. Conclusions and Implications for Practice: Findings particularly highlight the importance of autonomy and self-efficacy for promoting campus engagement among college students with serious mental illnesses. As such, they may be relevant targets for psychiatric rehabilitation interventions, such as supported education, that are designed to enhance student success.

Individuals with serious mental illnesses (SMI) living in rural areas face unique challenges to community inclusion and participation. The purpose of this study is to evaluate barriers to participation in rural areas and discuss potential strategies to mitigate them. We conducted a qualitative analysis of responses from 87 individuals attending the Pennsylvania Association of Psychiatric Rehabilitation Services annual conference. Participants were randomly assigned to groups and asked to provide written answers to the questions: (1) What are the barriers to participation in rural areas? and (2) What are the facilitators to participation in rural areas? The barriers cited by participants corresponded with those most cited in the literature, such as transportation, a lack of resources, and stigma. While some might believe nothing can be done to address these issues, participants were able to suggest several strategies to overcome barriers and promote participation at the policy, program, and practice level. The implementation of these will require concerted efforts among individuals with SMI, providers, policymakers, and others in the community, such as local businesses and advocacy groups, to bring them to fruition.

Objective: Promoting leisure participation requires a collaborative approach that emphasizes personal interests, strengths, and motivations. The purpose of this article was to test the effectiveness of the Independence through Community Access and Navigation (ICAN) intervention on community participation, recreation participation, and positive emotions among individuals with schizophrenia spectrum disorders. Using motivational interviewing and an individualized placements and support framework, the ICAN intervention focuses on working with participants to identify and participate in personally meaningful leisure activities by connecting with personal motivations and mainstream community opportunities. Method: This randomized controlled trial was conducted with 74 participants diagnosed with schizophrenia with assessments conducted at baseline and posttreatment. Intervention effects were examined with repeated-measures analysis of variance (ANOVA). Multiple regression analysis was also performed using a change score as an outcome variable and baseline negative symptoms score, condition, and interaction as predictors. Results: There was no significant main effect of ICAN on positive emotions, recreation participation, or community participation; however, among those in the experimental group, those with impairments in motivation and pleasure experienced improvements in community participation. Conclusions and Implications for Practice: For individuals experiencing greater negative symptoms, a supported leisure intervention may be an effective strategy to explore personal motivations and increase leisure participation. Future research should test the intervention effectiveness specifically targeting a larger sample of individuals with more severe negative symptoms.

According to William Anthony’s “Recovery from mental illness: the guiding vision of the mental health service system in the 1990s,” mental health recovery means “changing one’s attitudes, values, feelings, goals, and skills in order to live a satisfying life within the limitations caused by illness.” This seminal work served as an overarching goal, a call to action, and a roadmap for the enhancement of psychiatric recovery. Unfortunately, from many viewpoints, the goals encouraged by Anthony have not been achieved. Through semi-structured interviews with psychiatry clinicians and senior faculty members, this article aims to elucidate the current status of psychiatric recovery, how the movement progressed to this point, and where we could go from here. The development of the recovery movement will be discussed, along with its assumptions and explicit goals. The interviews focus on the extent to which these goals have been achieved, barriers to progress, whether goals should be revised, and how to achieve these goals.

Background: The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverseCOVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but researchhas yet to document this population's perceptions and acceptance of COVID-19 boosters. Objective: This study aims to identify person-level and community characteristics associated with COVID-19 vaccination andbooster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding thisinformation is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the publichealth emergency for the COVID-19 pandemic. Methods: Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics,COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analysesand 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrencewas identified using phi coefficient correlation plots. Results: Most autistic adults (193/266, 72.6%) intended to receive or received the vaccine and booster, 15% (40/266) did notreceive or intend to receive any vaccine, and 12.4% (33/266) received or intended to receive the initial dose but were hesitant toaccept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences.The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort withothers not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the countythat voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasonsfor accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those whoaccepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereasthose who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someonethey trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would makethem feel unwell were the most often reported reasons Conclusions: Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults thanthe population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others,while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public healthopportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to bettersupport the already strained autism services and support system landscape. Vaccination uptake could be improved by leveragingpassive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 informationto better alleviate safety concerns

Background The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population’s perceptions and acceptance of COVID-19 boosters. Objective This study aims to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the public health emergency for the COVID-19 pandemic. Methods Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi coefficient correlation plots. Results Most autistic adults (193/266, 72.6%) intended to receive or received the vaccine and booster, 15% (40/266) did not receive or intend to receive any vaccine, and 12.4% (33/266) received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the county that voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereas those who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were the most often reported reasons. Conclusions Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults than the population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others, while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information to better alleviate safety concerns.

Community inclusion and participation are social determinants of physical and mental health. This study examines activity preferences, barriers to engagement, and potential strategies for facilitating community participation for individuals with serious mental illness living in rural communities. Data for this qualitative study were collected in a series of focus groups with a stakeholders in rural Pennsylvania. Written responses to questions on activities, barriers, facilitators, and solutions were analyzed by members of the research team. The activities that are important to our participants included both those readily accessible in rural areas and those only accessible in more urban areas. Many of the barriers identified aligned with prior research (e.g., poverty, community mobility issues). A number of novel and feasible solutions to overcome barriers were provided at the policy, program, and practice levels, some of which that can be implemented immediately, to increase participation, and improve overall health of people with mental illnesses.

Date Presented 03/23/24 Community mobility is often associated with participation in important life activities. This study used global positioning system (GPS) technology to track various dimensions of community mobility and community participation in a sample of autistic adults. Primary Author and Speaker: Elizabeth Pfeiffer Contributing Authors: Eugene Bruisilovskiy, Mark Salzer, Amber Davidson Pomponio

Peer support has been an undeveloped pathway for filling the service gap and to generate employment opportunities for autistic individuals. Peer supports have been deployed widely in mental health and among veterans and understanding the utility of this service modality among autistic individuals illuminates opportunities for research, policy, and practice. This study examined characteristics of participants in an autistic-delivered peer support program and reports on use of and satisfaction with the program. Half of autistic participants had a co-occurring mental health diagnosis. Participants reported multiple areas of unmet needs and participant satisfaction with the program was high (90%). The findings of this study point toward autistic-delivered peer support as a promising avenue for future development.

Recovery is real and has had a transformative impact on mental health policies and services, including shifting the focus from chronicity and symptom management to the realization that individuals with mental health issues can lead meaningful lives. However, recovery has been defined, described, understood, and measured in a wide variety of ways that may account for misuses and abuses in its application and possible stagnation in its impact. It is argued that the mental health field must now build upon the strong foundations of recovery by integrating a well-established rights-oriented framework. While recovery emphasizes personal growth and hope, a rights-based perspective underscores inherent dignity, autonomy, and opportunities for acceptance and embrace in engaging in valued social roles. The addition of a rights-based framework - community inclusion, to conversations involving recovery, is aligned with the origins of recovery and how it is commonly understood, and also connects the mental health field to the dramatic positive impacts that have emerged from the longstanding centrality of this concept in the broader disability community.

Inclusion can be defined as valuing each individual’s uniqueness and talent, providing equal access to opportunities, and supporting people to meet their potential. Recently, applied behavior analysis (ABA) has been criticized for targeting client behaviors that differ from the majority (e.g., stereotypy). We conducted a survey with 170 behavior analysts to evaluate the degree to which they focus on changing client behavior relative to changing the behavior of others for a behavior of concern that was harmful, disruptive but not harmful, or merely different. Respondents reported that they were more likely to focus on changing client behavior for a harmful behavior than they were for a behavior that was different, although the differences were marginal. The most common response across all questions was to focus equally on both the client’s and others’ behavior. The implications of inclusionary practices related to interventions in ABA services are discussed.