A Systematic Review of the Comparative Benefits and Costs of Models of Providing Residential and Vocational Supports to Adults with Autistic Spectrum Disorder

The specific aim of this review was to summarise existing research evidence that may be of value to those responsible for commissioning or providing residential or vocational services for adults with autistic spectrum disorders. The broader aim of the review was to support the development of evidence-based commissioning and practice in the social care of adults with autistic spectrum disorders. We attempted to identify all research published in the last 25 years that that addressed the comparative benefits and/or costs of different ways of providing community-based residential and vocational supports to adults with autistic spectrum disorders. We did this by searching key electronic databases and contacting active researchers. Given that commissioning decisions are inherently comparative, we excluded studies that only described or evaluated one approach to providing support. Given that institutionalisation is no longer a policy option, we also excluded studies of the impact of deinstitutionalisation on adults with autistic spectrum disorders. Residential Supports Within the field of intellectual disabilities generally there is a sizeable body of research on the comparative outcomes and costs of models of supported accommodation. For example, a recent systematic review (Emerson, Lobb, Hatton et al., in press) identified 86 papers published since 1995 that reported the comparative benefits and/or costs of models of supported accommodation for people with intellectual disabilities. In contrast, comparative research on the benefits and costs of models of residential supports for people with autistic spectrum disorders is remarkably scarce. Indeed, we were only able to identify three studies that had addressed this issue in the last 25 years. The three studies that have been conducted were undertaken in the US, employing small sample sizes, contain a limited range of outcome measures, and contain no information on the cost of supports received. As such, they cannot be considered of any real value to commissioning decisions in the UK. A similar picture is evident when we looked at vocational supports. While there is a substantial literature on superior cost-benefit of supported employment programmes (when compared to sheltered workshops or other day service options) for people with intellectual disability, there is little information available on whether such benefits are also apparent for adults with autistic spectrum disorders. 2 Most of the available evidence comes from a series of studies undertaken in the UK by Professor Pat Howlin and colleagues. The results of which suggest that supported employment for more able people with autistic spectrum …