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Preventative co-ordinated low-level support for adults with high-functioning autism: systematic review and service mapping

What do we want to know?

People with autism spectrum disorder without learning disability (‘high-functioning’ autism or HFA) often experience social isolation, difficulties with activities of daily living, unemployment, and mental and physical health problems. Current guidance in England recommends that local authorities provide preventative ‘low-level’ support for adults with HFA, including social support, practical assistance and access to services. This project evaluated the effects of all forms of supportive intervention for adults with HFA. It also involved mapping current practice to provide an overview of services for adults with HFA in England.

Who wants to know?

This project was commissioned by the Department of Health in England, and will be of interest to policymakers and practitioners involved in delivering services, and to people with HFA.

What did we find?

We included 37 studies (27 effectiveness studies, three economic studies, and eight qualitative studies (with one overlapping)) in our systematic review. The quality of the studies was mixed. We found evidence that social skills training can improve social skills, and that employment interventions (supported employment and job interview training) can improve outcomes relating to employment, but little evidence of effectiveness on outcomes such as health or wellbeing. There is some evidence that multi-disciplinary teams may be cost-saving. The evidence on other interventions, such as social support, peer support or advocacy, is very limited and inconclusive.

The service mapping found that most services for adults with HFA offer a range of types of support depending on individual needs. These include: training or education; employment services; individualised one-to-one support; mentoring; information and advice; and advocacy. Many services use a ‘hub’ or ‘one-stop shop’ model to provide flexible, personalised support, and to facilitate collaboration between organisations. Many service providers operate on a small scale and may face challenges in terms of sustainability.

What are the conclusions?

Most organisations working with adults with HFA provide supportive, responsive services. However, there is very little evidence about the effects of this type of intervention. The evidence mainly relates to narrowly focused interventions such as social skills training and employment support, and to skills and employment outcomes. Research is needed to assess longer-term outcomes of supportive services.

How did we get these results?

For the systematic review, comprehensive searching of electronic databases and websites was carried out and a narrative synthesis was conducted. For the service mapping, we drew on the Autism Self-Assessment Exercise returns for 2014 and other data sources, and tabulated information on the services provided. We also interviewed three sets of service providers to gather more in-depth information on service delivery.

This report should be cited as:

Lorenc T, Rodgers M, Rees R, Wright K, Melton H, Sowden A (2016) Preventative co-ordinated low-level support for adults with high-functioning autism: systematic review and service mapping. London: EPPI Centre, Social Science Research Unit, UCL Institute of Education, University College London.
ISBN: 978-1-907345-95-1

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Journal paper

Read article from the Sage journal Autism: Support for adults with autism spectrum disorder without intellectual impairment by Theo Lorenc, Mark Rodgers, David Marshall, Hollie Melton, Rebecca Rees, Kath Wright, Amanda Sowden. Article first published 7 July 2017.

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