Table_2_An individual-supported program to enhance placement in a sheltered work environment of autistic individuals mostly with intellectual disability: a prospective observational case series in an Italian community service.docx

IntroductionAutism spectrum disorder is a lifelong neurodevelopmental disorder. The profile of functioning in autistic people is very heterogeneous, and it is necessary to take into account individual characteristics to better support integration in the workplace. However, unemployment rates are higher for autistic people than for other types of disabilities. We present a prospective case series to explore the feasibility and efficacy of an individual-supported program to enhance placement in a sheltered work environment delivered by an Italian community day care center.
MethodsAutistic subjects, aged from 12 to 31 years, participated in an individual-supported program regarding employment in sheltered art workshops, integrated into the regular activity of a semi-residential center three times a week for 1 year. Their feasibility retention rate and time worked per session were registered; moreover, working methods efficacy and self-organization improvement were tracked by the Likert-based rating system. Secondary outcome measures span functional levels, challenge behaviors, and sensory problems.
ResultsAll the individuals presented a good adaptation to the environment, with a significant increase in time worked per session. After 1 year, the intervention allowed an increase in tasks completed in an assigned complex job and an improvement in self-organization within the work schedule in a group of subjects consisting mainly of severe-to-moderate levels of autism severity (86.6%). Finally, we observed a significant increase in independent functioning areas of the TEACCH transitional assessment profile. Challenge behaviors and sensory problems were also recorded.
ConclusionThis case series supports the idea that individual-supported programs for placement in sheltered job environments delivered by community day care centers could be feasible and effective for ASD with higher levels of severity and co-occurring intellectual disability. Further targeted studies based on community models and accessible methods need to be planned to define the effectiveness of the intervention and promote improved practice at the community level with a better social impact.

引言
自闭症谱系障碍（Autism Spectrum Disorder, ASD）是一种终身性神经发育障碍。自闭症患者的功能表现异质性极强，需结合个体特征以更好地促进其职场融入。然而，自闭症患者的失业率高于其他类型残障人群。本研究介绍一项前瞻性病例系列研究，旨在探讨由意大利某社区日间照料中心开展的、用于提升庇护性工作岗位（sheltered work environment）安置的个体化支持项目的可行性与有效性。

方法
招募年龄介于12至31岁的自闭症受试者，参与一项针对庇护性艺术工坊就业的个体化支持项目。该项目融入半寄宿中心的日常活动，每周开展三次，持续一年。研究记录了受试者的项目参与保留率及每次工作时段的时长；此外，通过李克特评分量表（Likert-based Rating Scale）追踪工作方法有效性与自我组织能力的改善情况。次要结局指标涵盖功能水平、挑战行为及感觉问题。

结果
所有受试者均对环境展现出良好适应，且每次工作时段的时长显著提升。一年后，干预措施使以中重度自闭症（占比86.6%）为主的受试者群体，在指定复杂工作任务的完成量上有所增加，且工作排班内的自我组织能力得到改善。此外，我们观察到TEACCH过渡评估量表（TEACCH Transitional Assessment Profile）所涵盖的独立功能领域得分显著提升。研究同时记录了挑战行为与感觉问题的变化情况。

结论
本病例系列研究表明，由社区日间照料中心开展的、用于庇护性工作岗位安置的个体化支持项目，对自闭症谱系障碍且自闭症严重程度较高、伴随共患智力障碍的患者而言，具备可行性与有效性。未来需开展基于社区模式的针对性研究与可及性干预方法，以明确该干预措施的有效性，并推动社区层面实践优化，进而产生更优的社会影响。