ABSTRACT There is a need and opportunity to improve the supports, transitions, and life outcomes of people with autism spectrum disorder (ASD). Compared to their neurotypical peers, autistic teenagers and adults report poorer mental health and quality of life (QOL), and have higher rates of unemployment or underemployment and low participation in post-secondary education. Nearly 40% spend little or no time with friends. Although autism awareness has grown considerably in recent decades, much more can be done to improve the life outcomes for people with autism. Cost-effective, affordable and scalable support systems are needed as well as ongoing assessments and personalized treatment plans that focus on individual strengths and challenges in different contexts (college, work, community life) across the life span. This requires adaptive interventions and regular consultation with and between stakeholders. It also requires a rigorous approach to measuring outcomes that are not one-size-fits-all and do not expect everyone to reach, or have, the same goals. To meet these needs, the applicant organization, care.coach corporation (care.coach, Millbrae, CA), proposes to leverage its already successful conversational and relational avatar technology platform to be a virtual companion and coach to autistic people without intellectual disability in early adulthood (AYA, ages 18 to 35 years). Furthermore, we propose to use this technology platform to scale a strong theoretical and conceptual approach that has proven successful in meeting the individual needs and personalized outcomes of autistic students through a collabora- tive consultation model for promoting competence and success (COMPASS) combined with Goal Attainment Scaling (GAS). To deliver personalized coaching, empathy, and outcomes at scale, care.coach will translate GAS/COMPASS into software-driven evidence-based protocols in collaboration with clinical, academic, and community partners (Aim 1). Using the care.coach platform, the digital program is executed with the help of cutting-edge conversational artificial intelligence (AI) and a team of human staff that oversee and can remotely control the avatars and conversations as well as coordinate with AYA and clinical professionals as needed. Barriers to the acceptance of this virtual health assistant by AYA will be assessed and removed (Aim 2). The optimized digital intervention will be piloted tested in a small feasibility trial (Aim 3), after which the technology platform and all intervention and research protocols are finalized. The efficacy of the digital intervention com- pared to standard practice using traditional coaching methods (in-person clinic visits, all-human care coordina- tion, paper-and-pencil assessments and adherence monitoring) is tested in a properly-powered randomized control trial (RCT) with AYA (Aim 4). Effects on mental health, QOL, and self-directed, individualized functional goals and outcomes will be assessed. If successful, the deliverable of this Fast-Track SBIR is an effective, meaningful, and ready-to-be-commercialized digital health intervention that adapts to the needs, preferences and goals of transition-age autistic adults to support and benefit their health, functioning, and outcomes in life.

NARRATIVE This research and development with the care.coach avatar and conversational agent will deliver an effective, meaningful, and ready-to-be-commercialized digital health intervention that adapts to the needs, preferences and goals of autistic young adults to support and benefit their health, functioning, and quality of life. The prod- uct and platform have the potential to improve the health and wellbeing of millions of Americans, including those with autism.