White paper

The results of the think tank were summarized in a white paper and shared with the Massachusetts Autism Commission.

The full text is available here.

An executive summary is available here.

The white paper included both implications and recommendations:

• There is a small core of housing models that could be collectively adapted to the needs of a wide variety of residents:
  • Individual apartments and condos
  • Shared living
  • Inclusive small footprint units (such as micro-units and single room occupancy)
  • Inclusive co-housing
  • Transitional housing
• There is still a role for congregate housing for some individuals with extreme maladaptive behaviors, but even this model can be re-imagined to create greater self-direction and privacy.
• Drop-in services for cueing are needed.
• Affordability, the shortage of vouchers, staff training and quality, and transportation are systemic problems. Beyond these, most barriers to housing are more individualized.
• Incorporating Braddock and Rowell’s “Six Most Common Home Modifications”, plus soundproofing, into new housing for people with autism, and into a percentage of new housing generally, would meet the needs of a majority of people with autism, while more significant modifications would be needed for about a quarter of autistics.
• Technology can improve people’s ability to live independently, but they will need options to pay forassessments and the technology (including apps), whether through MassHealth, DDS, or other insurance.
• Good communication, education about housing options, and a person-centered holistic approach that starts early is conducive to a good outcome. This approach should be embedded into a beefed up transition process that incorporates applying for housing vouchers and improving independent living skills.
• The housing sector needs to better understand autism. The housing committee of the Autism Commission should consider expanding its membership to include more representation from the housing sector. Training for housing professionals in autism should be explored.
• Data collection should be undertaken to answer questions about overall housing demand, demand for the models discussed, and homelessness in the autism community. These data can be the basis for establishing housing production targets.

1. DESE recognize its Independent Living mandate under IDEA by insuring cities and towns incorporate into the transition process applying for housing vouchers, improving independent living skills, and education about housing options.
2. DDS/DESE partner with the state university system to offer an expanded transitional housing program aimed at college-aged students, utilizing technology options to increase independence, and considering design modifications as necessary. Vermont’s SUCCEED and Safety Connection should be considered as models.
3. DDS consider options to increase consumer choice, control, and privacy in in its community-based residences, including
   • Combining individual suites with shared common space, and
   • Separating ownership of housing from the provision of services through methods including allowing residents and/or their families to buy shares in existing homes, or having a third party own the property and rent directly to residents. Any third party should have experience with tenants with disabilities and training in autism; one option might be one provider acting as a landlord, while supports are provided by other agencies, as occurs in Delaware.
4. DDS would pay special attention to co-housing by reviewing property density restrictions to allow for individuals/families to live together on the same street or complex with and without people with disabilities.
5. Increase self-direction as a percentage of the DDS budget to allow people with autism and their families to access a full range of housing models.
6. DDS/DHCD consider joint RFRs for inclusive small footprint units and for transitional housing for adults, using technology options to increase independence and incorporating Braddock and Rowell’s design principles, plus sound proofing. Options would need to be available for those with forensic issues.
7. DHCD/MassHousing consider incorporating Braddock and Rowell’s design principles, plus sound proofing, into 5% of dwelling units or one unit, whichever is greater, into new multi-family dwellings of ten or more units receiving DHCD or MassHousing funding or financing.
8. MassHealth consider options to cover technology that permits more independent living (and technology assessments), as housing is a social determinant of health.
9. Drop-in services for cueing should be an option through MassHealth, either through a re-definition of PCA, or through expanding the settings where GAFC may be used.
10. Steps be taken to facilitate the creation by families of sustainable shared living situations, including: deferred or low interest loan options, by right zoning, and a system for repeatedly finding support providers for a defined period. (In this instance, shared living refers to DDS Shared Living, living with an Adult Foster Care provider, or some other arrangement where a support provider lives with an individual with disabilities in property controlled by the individual or their family.)
11. An information clearing house on autism and housing be developed, including online trainings, to serve individuals, families, providers, housing professionals, and homelessness professionals.
12. Person-centered planning be considered for individuals determining housing options/transitioning into housing, since barriers to housing implementation are highly individualized.
13. Data collection in the following ways is needed:

• Voluntary data be collected on possible incidence of autism among the homeless, including both information on individuals with a diagnosis, and through utilization of the AQ-10 screening tool.
• A survey be conducted to identify existing supported housing serving individuals with ASD, and the types of supports provided.
• Autistics served by DDS, DMH, MRC, the Centers for Independent Living, ASAN, and their families (as appropriate), be surveyed on their housing needs, preferences, and independent living skills, including the need for environmental modifications and assistive technology.
• The level of independent living skills (defined as ADLs, IADLs, and ability to initiate) be measured and recorded for students served by DESE in their last year before exiting.