The purpose of this study is to examine the feasibility and efficacy of a systematic training approach targeting behaviors to increase safety and prevention of airborne diseases such as COVID-19 in the workplace for individuals with Intellectual and Developmental Disabilities (IDD). This project is designed to determine proof of concept and proof of product for a peer support intervention, the SAFE program, to increase knowledge and safe workplace practices. There is an identified immediate need for individuals with IDD to receive training in an accessible format. The SAFE program has been developed in an accessible format for those with IDD. It focuses on education regarding actionable behaviors that reduce the risk of acquiring and transmitting COVID-19 and other airborne diseases. The study will implement a peer-mediated and occupational therapy lead program, SAFE, to identify and address potential implementation issues and further refine the program curriculum. Additionally, the efficacy of the program on perceived safety and well-being, observable preventative behaviors and self-advocacy will be examined.

It is hypothesized that the SAFE program will have a positive effect on perceived well-being and knowledge of the actionable behaviors for the prevention of COVID-19 and other airborne diseases. The program will have a larger effect on outcomes when provided using peer support compared to staff training. Individuals with IDD will demonstrate increased knowledge and safe behaviors after completing the SAFE program. Peer-interventionists will report perceived benefits and limitations of participating in training and providing peer-mediated travel training interventions to identify potential outcomes for future research.

The research intends to answer these questions:

Does participation in the SAFE program increase perceived safety and well-being in the workplace for people with Autism Spectrum Disorder (ASD) and/or Intellectual or Developmental Disabilities (IDD)? Does participation in the SAFE program increase knowledge of actionable behaviors to prevent transmission of airborne diseases (i.e. COVID-19) in the workplace for people with IDD? When implemented through peer support, does the SAFE program have a larger increase in perceived well-being and knowledge of actionable behaviors to prevent transmission of airborne diseases (i.e. COVID-19) than when implemented through staff training and supports?

The research further intends to:

Develop health communication messages related to safe interactions and the prevention of COVID-19 and other infectious airborne diseases for autistic adults

Refine and expand the SAFE program based on stakeholder priorities and input

Evaluate the SAFE program training with Autistic adults Procedures.

The researchers will leverage current relationships with community organizations to recruit 100 participants with ASD and or IDD who are employed 10 hours or more a week and receiving employment services or supports. Organizational administrators will provide information on the study to individuals that meet the inclusion criteria. Interested individuals will contact the project research coordinator to determine inclusion. Eligible participants will be randomized into one of the 3 arms of the study, Control, Peer Interventionist Led, Staff Led.

If the participant is assigned to the staff intervention support staff will be contacted with an email or phone call. Staff members will be required to complete human subjects training. Researchers will obtain informed consent for all participants. During the first contact made with participants, written information will be provided remotely using Zoom/FaceTime or in person to all participants explaining the following in simple terms: 1) the criteria for participation, 2) the purpose of the research and the procedures involved, 3) the subject's right to withdraw at any time without penalty of any sort, 4) potential benefits to the subject, 5) potential risks, 6) assurance of anonymity, and 7) terms of remuneration. All research staff will complete training about the informed consent process prior to consenting subjects. The information described above will be reviewed and any questions answered. Participants will be obtained signed or a printed signature box used for signature when electronic signatures are unable to be obtained for consent either in person or virtually.

The researchers will collect data from young adults or transitional aged-youth with ASD or IDD to determine the efficacy and feasibility of the intervention. Recruitment occurs through the sites identified in the participant recruitment section of this proposal. Participants interested in the study will contact the primary investigator or research staff who will schedule an initial physical or virtual meeting at a place and time convenient for the participant to determine inclusion and obtain consent/assent. Participants are randomly assigned to either peer-support intervention, staff intervention or a control group. The researchers will randomize in blocks of 12 (4 to each group) until the investigators reach the targeted number of 120 or 40 participants in each group. Pre-test and post-test measures will be administered by researcher staff prior to the start of the intervention (Pre-test) and at the end of the intervention 4 weeks (Post-test ). Key stakeholders, including the participants and interventionists (occupational therapists and peer mediators), will complete qualitative interviews at the end of the intervention period for each participant. The information gathered will determine acceptability and feasibility of intervention. Participants will be asked to discuss their experiences during the intervention specific to their assigned intervention group.

A member from the research team will then contact interested individuals to set up a convenient meeting time and place for the SAFE program training. These meetings will occur remotely or in a private location convenient to the participant. The SAFE program course training will occur in small group settings or individually. The course trainings will occur 2-3 times per week for between 45-60 minutes. An appropriate curriculum has been developed by Temple University Researchers and Occupational therapy students based on many qualitative interviews, research of proper education methods, and COVID-19 practices. The curriculum is based on a series of classes designed to create an understanding of best practices and behaviors to prevent the spread of COVID-19 in the workplace. The curriculum will be adapted to meet the needs of this project and study population. The course will provides instruction in the following areas: 1) COVID-19 and how it spreads 2) Personal Protective Equipment (PPE) and How to use it properly 3) Social Distancing 4) Community Participation 5) Employment 6) Self Efficacy.

Participants will complete the SAFE program sessions remotely or in person in a private, quiet and convenient setting.. Participants will be randomized into two treatment arms and a control group. The first treatment arm will receive the SAFE program implemented through a staff training model. The second group will receive the program using a peer support model. The control group will continue to receive their standard vocational rehabilitation supports.

Training of the SAFE program will occur remotely or in person by staff who are trained within our research team or will be implement it in collaboration with staff or a peer specialist remotely as part of their current services. If it is in person it will be implemented at their vocational rehabilitation centers or places of employment. Research staff will be available to support the process after the training is complete.

The researchers will use a questionnaire to assess knowledge of actionable behaviors to prevent COVID-19, which reflect the core components of the SAFE program (social distancing, proper use of PPE, personal hygiene practices, and self-advocacy in the workplace). The researchers will also administer measures to determine the degree of self-advocacy and self-efficacy in the work place reported by staff and self-reported by participants. The researchers will determine how well a participant follows workplace procedures. Data will be collected either in person or virtually both at pre-test and post-test for all outcome measures. Finally, the investigators will assess perceived anxiety.

Inclusion Criteria:

• The researchers anticipate recruiting young adults 18years old and over with ASD or IDD who are currently employed or actively looking for employment to participate in the study. Participants will have a diagnosis of ASD or IDD. Participants will self-report their ASD or IDD diagnosis. Additionally, the community agencies have access to documentation that identifies their consumer's diagnoses. Based on this, the researchers will ask them to only provide information to those individuals who have a diagnosis of IDD. Potentially eligible participants with documented intellectual and developmental disabilities will be recruited through large vocational rehabilitation organizations (Community Integrated Services CIS and Project Search) that together serve over 1200 adults with IDD. Participants must be working a minimum of 10 hours a week outside the home and/or receive vocational rehabilitation services.

Exclusion Criteria:

• under 18 years, do not have a minimum of 10 hours/week of work experience, do not have Autism Spectrum Disorder and/or Intellectual Disability

5 months

The sample is limited to the Philadelphia area, reducing generalizability. Randomization occurred by classroom, not individual, which may have influenced responses due to differences in support needs. One classroom had higher overall support, possibly affecting how lessons were accessed and surveys completed.

The statistician will blindly randomize the three arm groups. The only staff with access to the groups will be the research coordinator. The primary investigators are blinded.