The Science and Practice of Peer-Facilitated Interventions for Autistic Adults

Background and Purpose

Autistic people report high rates of unmet support needs. Some autistic adults find it difficult to connect with non-autistic supporters, who may have little education about or hold stigmatizing views of autism. Several studies suggest that autistic people learn well from other autistic people and benefit from hearing their experiences reflected and sharing information and solutions to common issues. Peer-facilitated, peer support, or peer specialist services are provided by a person with lived experience with a condition and can include outreach, skill building, health coaching, case management, system navigation, or psychoeducation. Peer facilitated interventions could be a promising innovation for addressing the support needs of autistic people.

There is a large body of evidence for the effectiveness of peer-facilitated interventions for people in recovery from substance use disorder or mental health challenges. They are widely used across the mental health and veterans’ health systems and considered an essential mental health service by the World Health Organization. Peer-facilitated interventions have been shown to reduce inpatient hospitalization, substance use, social isolation, model community living, enhance social networks, and improve adherence and participation in treatment for non-autistic people. To date, it is not clear whether peer-facilitated interventions are feasible, acceptable, or effective for autistic people, and some providers have expressed uncertainty about whether this approach could be effective for autistic people. The aim of this study is to critically review the state-of-the evidence on peer support interventions for autism and make recommendations for future research and practice.

Methods

Using PRISMA guidelines, we conducted a scoping review of the English-language, peer-reviewed published articles on peer facilitated interventions for autistic adults using PubMed. Peer support was defined as autistic people being involved in delivering the intervention. Articles where autistic people learned from each other in groups moderated only by non-autistic people were excluded (n=4). Both interventions and formative research were included. Terms were peer support, peer specialist, peer-facilitated, co-facilitated, co-taught, and autistic-led. We reviewed the reference lists of included articles to identify additional articles.

Results

We identified 57 articles, including 2 duplicates. Of the articles reviewed, 9 met criteria for inclusion. 5 were pilot evaluations of interventions and four were qualitative studies gathering formative data on the acceptability of peer support interventions. Intervention targets were diverse, including making progress on self-identified goals (n=2), supporting newly diagnosed autistic adults (n=1), successful transition to college (n=1), and developing healthier relationships (n=1). The intervention studies reported preliminary evidence of feasibility and efficacy. Both intervention studies and formative research reported a high degree of acceptability of these interventions.

Conclusions and Implications

Peer-facilitated interventions are a promising approach for meeting the needs of autistic people in a cost-effective, accessible, and acceptable manner and can be eligible for Medicaid reimbursement. Autistic people report high interest in this approach and satisfaction when provided with peer support. Research gaps include stronger trial methods using comparison groups, the best methods for training and supervision of peer support specialists, and how best to implement peer interventions across different settings.