• We know autistic people are over-represented in the homeless population
• We also know that autistic people are at increased vulnerability to abuse and other forms of victimisation
• It follows that homeless autistic people may be doubly vulnerable
• Understanding what factors increase an autistic person's risk of becoming homeless will make it possible to identify those who are at risk before they become homeless
• The preemptive identification of autistic people at risk of homelessness will allow research that tests preventative measures, which if successful, would reduce the incidence of homelessness among autistic people
• Collecting the accounts of autistic people who have experienced homelessness and achieved good outcomes will help us design and evaluate the effectiveness of supports for autistic people who experience homelessness

• Ask autistic people who previously experienced periods of homelessness or of inappropriate housing about their experiences
• Try to establish if there are either disability-specific or autism-specific reasons that contributed to their homelessness – for example, falling behind on rent and bills or inability to access welfare payments because of cognitive difficulties, difficulties resolving interpersonal conflicts with cohabitants, unstable employment, greater risk of experiencing domestic violence or abuse or a differential risk to substance misuse
• Ask those who have overcome homelessness what helped them or what they think would have helped had it been available

• Autistic people
• Those with experience of homelessness
• Researchers
• Social workers
• Social care providers
• Department of Work and Pensions
• Homelessness representative organisations
• Family members or friends of autistic people with experiences of homelessness

• There are likely many undiagnosed autistic people in the homeless community
• There are also likely many people with multiple co-occurring conditions in the homeless community, research should consider how these interact
• The causes of homelessness are multifaceted – research must take an inter-sectional approach

• Some theoretical accounts of autism suggest that non-autistic people struggle to empathise with autistic people's experiences and that, by extension, autistic people are best placed to empathise with other autistic people
• A consequence of this suggestion is that autistic people may be able to provide some therapeutic effects unavailable to non-autistic supporters
• Non-autistic care staff often misunderstand the needs and desires of autistic people they work with and this could lead to inappropriate goals being imposed on autistic people
• There are many anecdotal accounts that suggest autistic-led peer support and spaces reserved only for autistic people may be beneficial
• There are also anecdotal accounts that autistic-led peer support can be challenging or harmful
• Empirical evidence about possible benefits or pitfalls of autistic-led peer support is sparse
• If a robust evidence base can be established and it demonstrates that, on balance, autistic-led peer support is beneficial, this can be used to commission services

• Establish a peer-support hub with a group of trained autistic peer supporters
• Recruit autistic adults who would like to access peer support to the hub
• Randomise new hub members to receiving peer support or to a waitlist control
• Determine if there is a change between baseline and follow-up measures in wellbeing of participants and the extent of this change differs between groups
• Explore the perceived usefulness and overall experience among autistic adults who received peer support

• Personnel to run a hub
• Peer support facilitators
• Autistic adults who join the autism hub
• An advisory group with and without experience of peer-support
• Researchers who specialise in randomised experiments

• A study of this kind would need to assess for possible negative outcomes that could come about from an autistic-led peer-support intervention
• The belief that autistic-led activities or autistic spaces are beneficial are deeply entrenched for many in the autistic community and so a study of this nature would need to carefully control for this, especially if outcome measures are unblinded

• Decisions are regularly taken to change the way in which care is provided based on an assumption the new approach will improve something (e.g., experience of person receiving support, re-admission into acute health settings, access to services) but these assumptions are rarely supported by evidence
• Understanding the relative impact of different models of care on set outcome measure and the resource implications of each would allow for better decision making about local offers

• There is huge regional variability in models of social care provided – one reason for this is that, in the absence in robust evidence, decisions are often made based on a small number of people’s opinions about what constitutes best practice
• To improve the availability of evidence to inform decisions about care models, quasi-experiments should be run to compare regions with a specific characteristic (e.g., strengths-based assessment or a multi-disciplinary team) to areas that differ on the characteristic of interest

• Researchers with expertise in running quasi-experiments
• Researchers with expertise running controlled trials
• Social care commissioners
• Social care managers
• Multi-disciplinary social care team
• Autistic people from the region of interest and the comparison region

• The selection of comparison groups will be challenging because of the amount of variability across many different factors (e.g., rural vs urban, high SES vs low SES, historical commissioning legacy)
• Without randomly allocating people to different models of care the interpretation of the results will always be limited

• Identify regions where a particularly high and low proportions of people are aware of their right to an assessment and, when appropriate are offered and receive an assessment
• Facilitate areas that are performing well to share their learning with areas that are doing less well – this could lead to service improvements
• Demonstrating a high degree of variability, if this is found, could be used to advocate for increased investment for quality improvements in certain areas

• Review the relevant legislation (Autism Act, 2009; Care Act, 2014; NICE guidelines, 2011) to more fully understand autistic adults’ rights to an assessment of need
• Conduct an online survey asking autistic adults who were recently diagnosed (e.g., 1-3 years ago) and live in specific regions if they (a) knew they had a right to an assessment of need, (b) if they were offered one, (c) if they received one and (d) if not, why they believe they didn’t
• Provide an independent assessment to determine the proportion of people who were wrongfully refused an assessment

• Researchers
• Practitioners
• Autistic people and their supporters
• Autism policy experts
• Independent social workers to conduct assessments
• Researchers with expertise in survey design and sampling

To understand the results from a study such as this one it would also be necessary to map which services are available in the local areas being surveyed that could impact on results, for example, to know if somebody lives in an area with a specialist national service.

• To increase employment of autistic adults
• To reduce policy barriers to employment
• Identify strategies that successfully make workplaces more accessible to neurodivergent people
• Offer wider variety of employment opportunities to autistic people
• Identify barriers to maintaining employment for those who secure a job

• Survey retired autistic people to ask them to reflect on what they learned during their careers that could help others
• Review employment policy
• Seek the input of both employed and unemployed autistic people
• Write case studies of success stories and case studies about people who struggled to gain and maintain employment
• Seek input from employers about barriers, best practice, what improves recruitment and retention, the benefits of a diverse workforce
• Create a resource helping people decide when and how to disclose their diagnosis at work

• Autistic adults and their family members
• Employers
• Representatives from the Department for Work and Pensions
• Researchers
• Employment trainers and mentors

• Important to gain input from lawyers who specialise in employment law
• Important to consider employment experiences of both autistic people with and without learning disabilities

• Build on existing studies and current practice
• Develop a clear and specific offer of support for adults undergoing diagnostic assessment
• Further our understanding of what support is acceptable and effective
• Assess the cost of providing this support in order to provide this information to commissioners

• Synthesise the literature about pre- and post-diagnostic support
• Conduct analysis of existing datasets (e.g., an adult autism diagnosis survey)
• Conduct interviews and focus groups with autistic adults and social care providers about current practice and their desired support
• Pilot test a novel package of support for adults undergoing the diagnostic process
• Conduct a feasibility trial of this package of support to assess its acceptability
• Conduct an economic analysis of models of support

• Social workers
• Autistic people
• Public and private health and social care professionals
• Researchers with quantitative and qualitative expertise
• Economists
• Commissioners

International collaboration with stakeholders who have experience of systems in which pre- and post-diagnostic support has been offered for some time now would allow lessons to be learned from other approaches.

• Historically autism was under-recognised, this has resulted in generations of autistic people who only receive a diagnosis in adulthood and are more likely to undergo a private assessment.
• The result of this could be that many of these people are not known to the relevant professionals and so services are not commissioned or provided in a way that meets their needs.
• Understanding the reasons why people report positive and negative experiences will allow services to improve the experience of accessing services in future.

• Run a qualitative interview study for autistic people who were diagnosed as adults to ask if they have had an opportunity to speak with any professionals about their needs and individual circumstances
• Identify barriers and difficulties that are commonly reported and recommend strategies to minimise the occurrence of such barriers in future
• Establish factors that lead to people giving positive accounts of their experiences and make recommendations about how to emulate these experiences for other people with similar needs

• Experienced qualitative researchers
• Care commissioners and care staff
• Autistic people who do not have a learning disability and who received their diagnosis in adulthood
• Local authority and private care providers
• Autistic people to consult researchers about study design

• Interviews should be designed to allow input from people with a wide variety of communication needs
• Important to include those from groups traditionally under-represented in research

• Understanding transition from child to adult services will help providers understand how best to support people during this period
• Understanding the true cost of providing this support will allow for more appropriate budget allocation for transition planning
• Managing transitions well should result in more successful placements which will lead to better outcomes for individuals and reduce the need for people to go through further transitions, which would in turn reduce costs

• Conduct interviews with autistic people and their family members/carers about their recent experience
• Ask people if the process was valuable, the extent to which their plan was implemented, what worked and what did not work, whether they had an advocate who helped and if they incurred costs during the process
• Audit a sample of transition plans and the extent to which they were implemented
• Compare people’s experiences as described by their interviews and transition plans against NICE guidelines

• Experienced qualitative researchers
• Autistic people and their family members or carers who have had a recent experience of transitioning from child to adult services
• Autistic people with and without a learning disability
• Those who were ineligible for adult services should be included as well as those who were eligible
• Those who had access to transition plans and those who did not should be included
• Health economists should also assess the cost implications of good or poor transition planning

Studies about transition planning will need to consider not only whether a transition plan was created or implemented but also other relevant details that could impact the implementation of a plan (e.g., insufficient budget, lack of staff availability, lack of suitable transport or too little time allowed).

• There is a shortage of staff in care settings with specialist autism knowledge and often high turnover so there is a lack of staff consistency
• Regular monitoring, supervision and learning could boost the quality of peer-support being offered
• This could boost the self-esteem, employability and resilience of peer-supporters
• It could reduce dependency on benefits
• It provides a good opportunity for upskilling through the apprenticeship scheme
• It achieves aims of the personalisation agenda in the Care Act (2014)
• It builds a community

• Review models of low-level support demonstrated to be effective and determine the likelihood that findings from existing research will generalise to autistic people and across settings
• Conduct a study to assess the feasibility and efficacy of a peer-support intervention at improving the quality of life of autistic adults
• Peer supporters could be employed through the apprenticeship scheme
• Enablement approaches, advocacy and befriending services could be assessed in the same way

• Researchers
• Peer-supporters
• Autistic people and families
• Service managers
• Employment and benefit advisors
• Commissioners

• It will be important to build in safeguards to ensure the peer-support is not biased toward interests or challenges of the peer supporter
• It is important to consider the amount of low-level support that would be needed to generate a real effect

Improve knowledge among social care staff

Improve social care staff attitudes toward the autistic people they work with
Change practice to accommodate autistic adults’ needs
Reduce the high levels of staff turnover and, in turn, the cost (financial and to the quality of care) of recruiting and training new staff
Increase care staff’s self-efficacy
Change attitudes towards care work away from the idea it is unskilled labour

Conduct a pilot study to assess the effectiveness of training social care staff about best practice when working with autistic adults

Compare the following three conditions: 1) usual practice, 2) autism training and 3) autism training with ongoing learning component
Training could be co-produced with autistic people
The training need not be novel, it could be online or a model of training that already exists – the project would assess the effect it has and if sustained support improves its effectiveness

• All staff in social care settings where autistic adults are cared for
• Social care managers
• Autism trainers
• Qualitative and quantitative researchers

There are many national and regional training initiatives underway but we do not know if they generate any change in practice, studies should be generated that are informative about existing training schemes

• If successful, this could lead to improved quality of life, mental health and a greater sense of autonomy among autistic adults
• Reduce the incidence where staff impose inappropriate goals on people

• Would the development of a system in which goal setting was individualised improve a person’s sense of autonomy, expectation management, rapport with staff working with them and make their goals more realistic?
• Compare a system using self-generated goals with treatment as usual condition with structured observation, surveys and focus groups
• Conduct a scoping review of the literature about individualised goal setting

• Qualitative and quantitative researchers
• Autistic people and family members
• Social care manager
• Social care professionals
• Normalisation process theorists

A study such as this would need to consider and record the possible negative outcomes of engaging in this sort of approach.