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Provision of Alternative Care for Autistic Adults: A Multi-Stakeholder Qualitative Study in China

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Title: Provision of Alternative Care for Autistic Adults: A Multi-Stakeholder Qualitative Study in China
Language: English
Authors: Xi Wang (ORCID 0000-0003-0363-0473), Xiaoli Guo
Source: Autism: The International Journal of Research and Practice. 2026 30(5):1305-1316.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 12
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Adults, Autism Spectrum Disorders, Foreign Countries, Group Homes, Needs, Social Services, Institutionalized Persons, Residential Programs, Private Agencies, Public Agencies, Family (Sociological Unit), Place of Residence, Services
Geographic Terms: China
DOI: 10.1177/13623613261434406
ISSN: 1362-3613
1461-7005
Abstract: Providing alternative care for autistic adults unable to live with their biological families remains a low priority, particularly for those requiring high support. This population often receives inadequate attention despite its significant and long-term developmental needs. Using an exploratory qualitative design with ethnographic methods, this study conducted directed content analysis on data collected through 4 months of participant observation and 36 semi-structured interviews across four Chinese cities. The findings reveal that small-group alternative care emphasizes the physical and psychological development of autistic adults. However, charitable expectations among alternative care institutions and charitable donors lag behind the actual care needs of autistic adults with high support needs, limiting resource efficiency. The "present bias" diminishes recognition of the long-term societal benefits of developmental care. In developing contexts, achieving cohesive and sustainable nursing strategies led by non-state actors is crucial. A misalignment between charitable motivations and developmental priorities creates a "care sustainability gap" that threatens the continuity and effectiveness of alternative care for autistic adults.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1503257
Database: ERIC
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  Value: <anid>AN0193059431;f9d01may.26;2026Apr20.02:44;v2.2.500</anid> <title id="AN0193059431-1">Provision of Alternative Care for Autistic Adults: A Multi-Stakeholder Qualitative Study in China </title> <p>Providing alternative care for autistic adults unable to live with their biological families remains a low priority, particularly for those requiring high support. This population often receives inadequate attention despite its significant and long-term developmental needs. Using an exploratory qualitative design with ethnographic methods, this study conducted directed content analysis on data collected through 4 months of participant observation and 36 semi-structured interviews across four Chinese cities. The findings reveal that small-group alternative care emphasizes the physical and psychological development of autistic adults. However, charitable expectations among alternative care institutions and charitable donors lag behind the actual care needs of autistic adults with high support needs, limiting resource efficiency. The "present bias" diminishes recognition of the long-term societal benefits of developmental care. In developing contexts, achieving cohesive and sustainable nursing strategies led by non-state actors is crucial. A misalignment between charitable motivations and developmental priorities creates a "care sustainability gap" that threatens the continuity and effectiveness of alternative care for autistic adults. Many autistic adults in China cannot live independently, yet non-family alternative care for this group is poorly supported and understudied. This study explored alternative care for autistic adults in four Chinese cities through participant observation and semi-structured interviews with private enterprises, charitable organizations, care providers, and autistic adults' families. We found that charitable organizations and private enterprises mostly focus on short-term, visible support (like donating daily supplies or facility equipment) for autistic adults' care, while ignoring their long-term needs for independent living skills and social integration. Social stigma that mislabels autistic adults as mentally ill also leads to overemphasis on safety in care, limiting their growth. In addition, many alternative care institutions lack clear long-term plans, making it hard to sustain development-focused care. This study highlights a gap between donors' expectations and autistic adults' actual care needs. A misalignment between charitable motivations and developmental priorities creates a "care sustainability gap" that threatens the continuity and effectiveness of alternative care for autistic adults.</p> <p>Keywords: alternative care; autistic adults; charitable expectations</p> <hd id="AN0193059431-2">Introduction</hd> <p>Although there are approximately 10 million autistic individuals in China ([<reflink idref="bib24" id="ref1">24</reflink>]), research on alternative care for autistic adults who cannot be cared for within their biological families remains scarce. Autistic adults often have high support needs ([<reflink idref="bib13" id="ref2">13</reflink>]), including constant supervision and assistance from adult caregivers ([<reflink idref="bib11" id="ref3">11</reflink>], [<reflink idref="bib12" id="ref4">12</reflink>]).</p> <p>Compared with Western countries, the situation of alternative care for autistic adults in China shows notable differences. Recent research reports that among Chinese autistic adults aged 18–30 years (<emph>n</emph> = 99), 93% live with their parents ([<reflink idref="bib11" id="ref5">11</reflink>]), while a smaller proportion are placed in alternative care institutions. In contrast, 41.9% of autistic adults in the Netherlands reside in such institutions ([<reflink idref="bib17" id="ref6">17</reflink>]). This disparity indicates that alternative care for autistic adults is not yet a social priority in China. Key contributing factors include limited policy support (e.g., absence of community-based and alternative care frameworks for autistic adults), inadequate service provision (most rehabilitation institutions cater primarily to children), and persistent social stigma, whereby autistic adults are often misidentified as mentally ill and discouraged from independent public engagement. It means that they should not go out without the company of a guardian. Surprisingly, whether institutional or deinstitutionalized, research on the factors influencing the life expectancy and quality of life of autistic adults in charity-supported alternative care in China remains almost nonexistent. This includes gaps in understanding how charitable support and policy affect autistic adults' access to services.</p> <hd id="AN0193059431-3">Alternative Care Options for Autistic Adults in China</hd> <p>Alternative care options (see Supplementary 1) in China include alternative care provided within the family (e.g., care within extended family), institutional alternative care (provided by government, non-profit, or commercial institutions), and deinstitutionalized alternative care. Government support is generally available only when no family members can assume caregiving responsibilities ([<reflink idref="bib4" id="ref7">4</reflink>]).</p> <p>For autistic adults unable to receive care within their biological families, institutional alternative care is most common. However, such care remains severely limited: nursing homes consider autistic adults too young; orphanages view them as too old; rehabilitation institutions primarily serve children; and mental hospitals are inappropriate settings. Recent research suggests that institutional care is suboptimal for young adults genuinely requiring sustained support ([<reflink idref="bib21" id="ref8">21</reflink>]). This may reflect the restrictive nature of residential facilities, which often limit residents' freedom of movement and social engagement ([<reflink idref="bib22" id="ref9">22</reflink>]).</p> <p>Furthermore, amid the global shift toward deinstitutionalization, a hybrid alternative care model—distinct from both institutional and care provided within the family—has emerged and evolved ([<reflink idref="bib18" id="ref10">18</reflink>]). In China, as the children of the first generation of parents who established alternative care institutions for their own children reached adulthood, these institutions, together with those founded by parents of autistic adults, began to explore adult development-focused care models. This emerging model prioritizes the cultivation of independent living skills (such as grocery shopping and self-care) and social integration, rather than focusing solely on basic survival support.</p> <p>Charitable organizations and private enterprises have become the main supplementary supporters of both deinstitutionalized and institutionalized alternative care models (see Diagram 1). However, research examining the enabling and constraining factors influencing the improvement of alternative care for Chinese autistic adults supported by these charitable organizations and private enterprises remains virtually absent. This lack of evidence hinders efforts to enhance the overall welfare and holistic development of autistic adults who cannot be cared for within their biological families.</p> <p>Graph: Diagram 1. Care Systems Relationship Diagram.</p> <p>This study addresses two interrelated research questions:</p> <p></p> <ulist> <item> <bold> Research Question 1 (RQ1): </bold> How do charitable organizations' and private enterprises' priorities influence the design and sustainability of alternative care models for autistic adults in China?</item> <p></p> <item> <bold> Research Question 2 (RQ2): </bold> To what extent do cross-stakeholder (private enterprises, charitable organizations, alternative care providers, parents) conflicts in donor expectations undermine high-quality alternative care outcomes, and how might these dynamics generalize to contexts with limited state welfare support?</item> </ulist> <p>This study focuses on autistic adults aged 18–45 years for two main reasons. First, to ensure consistency with existing literature ([<reflink idref="bib11" id="ref11">11</reflink>]), this age range captures early adulthood, a stage of transition from dependence to social and economic independence ([<reflink idref="bib20" id="ref12">20</reflink>]). Assessing whether alternative care meets these developmental needs is therefore crucial. Second, parents of autistic adults in mid-adulthood may experience declining caregiving capacity as they age (⩾60 years), which increases the need for alternative care. In current care settings, autistic adults above 45 years are extremely rare—only two cases were identified during preliminary fieldwork, rendering sampling infeasible.</p> <p>This study offers several contributions. First, to the best of our knowledge, it is the first research to explore how donor expectations shape the experiences of alternative care of autistic adults in China who cannot be cared for within their biological families, thereby addressing a critical research gap. Second, using empirical evidence, the study analyzes how the priorities of charitable organizations and private enterprises influence the structure, quality, and sustainability of alternative care for autistic adults. These insights may also be applicable to contexts with limited state welfare support.</p> <hd id="AN0193059431-4">Method</hd> <p></p> <hd id="AN0193059431-5">Study Design</hd> <p>Given the absence of comprehensive national and regional statistics, this study adopted an exploratory qualitative design ([<reflink idref="bib14" id="ref13">14</reflink>]) combined with ethnographic methods ([<reflink idref="bib5" id="ref14">5</reflink>]). This approach emphasizes in-depth participant observation and contextual understanding of social practices. It enables the examination of policymakers' and implementers' perspectives in setting priorities for charitable resource allocation, as well as the identification of situational mechanisms and influencing factors ([<reflink idref="bib7" id="ref15">7</reflink>]). Data were collected through 4 months of participant observation and 36 semi-structured interviews across four Chinese cities and analyzed using directed content analysis framed by the Expectation-Confirmation Model (ECM) and Hyperbolic Discounting Theory (HDT). Figure 1 illustrates the modes of data collection—defined as the distinct phases and corresponding methods of data gathering employed throughout the study, including preliminary observation (pre-interview), mid-stage intensive observation, and late-stage supplementary observation.</p> <p>Graph: Figure 1. Data Collection Modes and Phases.</p> <p>To capture diverse perspectives, maximum variation sampling was employed across four cities—Beijing, Guangzhou, Xi'an, and Changchun—representing differing economic levels, care infrastructures, and positions along China's urban welfare gradient (megacity: >10 million residents; metropolis: 5–10 million; large city: 1–5 million). These cities were also chosen because they were among the earliest to adopt alternative care programs for autistic adults, ensuring the data's representativeness and relevance.</p> <hd id="AN0193059431-6">Inclusion Criteria and Recruitment</hd> <p>Purposeful sampling was used to identify participants. All alternative care institutions were selected based on recommendations from the municipal Civil Affairs Bureau or the Municipal Disabled Persons' Federation. Private enterprises and charitable organizations were similarly recruited through nominations by municipal authorities and alternative care institutions.</p> <p>Across the four cities, participants included three categories of institutional leaders and decision-makers: (<reflink idref="bib1" id="ref16">1</reflink>) government officials and quasi-government officials (Civil Affairs Bureaus/Disabled Persons' Federation); (<reflink idref="bib2" id="ref17">2</reflink>) representatives of charitable donations (including private enterprises and charitable organizations); and (<reflink idref="bib3" id="ref18">3</reflink>) the founders or person in charge of institutions providing alternative care (alternative care institutions founded by parents of autistic adults/children and by non-parents). In addition, parents of autistic adults were recruited as a separate, independent participant group. They were nominated by alternative care institutions but were not affiliated with any care organization or charitable enterprise. These parents were treated as a distinct stakeholder group, as their perspectives on alternative care (e.g., care expectations, economic burden, trust in institutions) differ from those of care providers, donors, or government officials.</p> <hd id="AN0193059431-7">Researcher Positionality</hd> <p>The first author has 3 years of experience collaborating with institutions founded by parents of autistic adults and children, including weekly volunteer activities that involved accompanying parents and autistic adults during hiking and social integration events. This background facilitated trust-building with participants and also posed potential risks of subjective bias. To minimize such bias: (<reflink idref="bib1" id="ref19">1</reflink>) team discussions were held to review coding decisions and ensure neutrality; (<reflink idref="bib2" id="ref20">2</reflink>) we invited a qualitative researcher unfamiliar with autistic adults' care to conduct a peer review of interview transcripts; and (<reflink idref="bib3" id="ref21">3</reflink>) we performed member checking (two participants verified the accuracy of their interview summaries).</p> <hd id="AN0193059431-8">Data Collection</hd> <p>Data were collected through a mixed qualitative approach combining participant observation and semi-structured interviews. The study employed the "participant-as-observer" framework ([<reflink idref="bib6" id="ref22">6</reflink>]), which allowed the researcher to maintain engagement while preserving reflective distance from participants.</p> <hd id="AN0193059431-9">Participant Observation</hd> <p>Participant observation was conducted across multiple settings. Researchers' early field involvement before initiating interviews formed part of the research data, influencing both question development and contextual interpretation. For instance, initial observations revealed that parents frequently emphasized respite needs, prompting the inclusion of related questions in the interview guide. These reflections were documented in a research diary to ensure procedural transparency.</p> <p>Before formal data collection, the first author actively participated in crowdfunding meetings for charitable projects supporting autistic adult care, observing the goals and priorities of charitable organizations and private enterprises willing to donate. The first author also attended field visits and donation planning meetings involving enterprise representatives, alternative care institutions, and a provincial rehabilitation hospital. Observation data were recorded systematically through a structured research log (see Supplementary 2).</p> <p>This approach enabled observation of both formal and informal communication among private enterprises, charitable organizations, and alternative care institutions, providing a preliminary understanding of the alternative care ecosystem for autistic adults.</p> <hd id="AN0193059431-10">Semi-Structured Interviews</hd> <p>Between 2021 and 2024, semi-structured interviews were conducted in Beijing, Guangzhou, Xi'an, and Changchun with key stakeholders to facilitate the co-construction of knowledge. The interview guide was developed into a series of general and open-ended questions (see Table 1). In total, 36 semi-structured interviews were conducted, each lasting between 60 and 120 min. This method allowed in-depth exploration of participants' perceptions, experiences, and behaviors that could not be fully captured through observation alone. Interviews continued until data saturation was achieved. When necessary, follow-up interviews were conducted, and all sessions were transcribed verbatim.</p> <p>Table 1. Information of Interview Participants.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Participant type</th><th align="left"><italic>N</italic></th><th align="left">Interview length</th><th align="left">Core topics</th></tr></thead><tbody><tr><td>Corporate representatives</td><td>5</td><td>50-120 min</td><td>Donation motives, expectations, risk concerns, understanding of alternative care for autistic adults, perceived usefulness, satisfaction, criteria for sustained support, and barriers to cross-sector donations.</td></tr><tr><td>Charity leaders (founders/secretaries-general)</td><td>6</td><td>90-120 min</td><td>Expectations, risk concerns, supportive design of care models, understanding of alternative care, donation coordination, donation intentions, perceived usefulness, satisfaction, criteria for sustained support, and barriers to cross-sector donations.</td></tr><tr><td>Directors of alternative care institutions</td><td>10</td><td>80-110 min</td><td>Models and practices of alternative care, directions requiring fundraising or support, understanding of alternative care for autistic adults, and resource requirements.</td></tr><tr><td>Government officials and quasi-government officials (civil affairs/Disabled Persons' Federation)</td><td>2</td><td>90-100 min</td><td>Understanding of alternative care, relevant policies, and cross-sector coordination obstacles.</td></tr><tr><td>Provincial rehabilitation hospital physicians</td><td>1</td><td>85 min</td><td>Understanding of alternative care, deficiencies in institutional care, and future directions.</td></tr><tr><td>Parents of autistic adults</td><td>6</td><td>100-120 min</td><td>Current gaps in alternative care, understanding of alternative care, care expectations, economic burden, and trust in institutions.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0193059431-11">Ethics</hd> <p>Ethical approval was obtained from the College of International Trade and Economics (Approval Number: 20211030), Changchun University of Finance and Economics. Prior to participation, all interviewees received detailed research information via WeChat, including the study's purpose, data collection procedures, data usage, confidentiality measures, and their right to withdraw at any time. Participants were given 72 hr to review the information and could raise questions through WeChat or phone calls. Verbal informed consent was obtained from all participants before data collection. Anonymity was strictly maintained, and no identifying information was recorded throughout the study.</p> <hd id="AN0193059431-12">Data Analysis</hd> <p>Directed content analysis was employed ([<reflink idref="bib9" id="ref23">9</reflink>]) because it is suitable for contexts where relevant theories or prior research exist but require further clarification or contextual application. Although limited research has examined alternative care for autistic adults supported by charitable actors in China, this study draws on well-established cross-disciplinary frameworks, namely, the ECM and HDT—alongside preliminary fieldwork findings. These theories provided conceptual guidance for examining charity–subject interactions and sustainability mechanisms, while 4 months of participant observation helped refine and contextualize the coding scheme for the Chinese setting.</p> <p>According to [<reflink idref="bib9" id="ref24">9</reflink>], when existing theory or research on a phenomenon is incomplete yet conceptually informative, directed content analysis allows researchers to initiate coding with predetermined categories derived from theoretical constructs. This strategy enables systematic linkage between empirical data and conceptual models, ensuring theoretical coherence and contextual adaptability. The analytical process involved identifying categories derived from the research questions and existing theoretical frameworks. Deductive codes were developed in advance based on the ECM and HDT. These codes were generated collaboratively by the interdisciplinary research team to ensure a balanced integration of theoretical rigor and contextual applicability.</p> <hd id="AN0193059431-13">Theoretical Approach</hd> <p>This study's theoretical framework integrates the ECM and HDT. The Theory of Planned Behavior ([<reflink idref="bib1" id="ref25">1</reflink>]) was excluded because it emphasizes donation intention rather than sustained donation behavior.</p> <p>[<reflink idref="bib2" id="ref26">2</reflink>] proposed the ECM to explain how individuals' continued participation in a service depends on the degree of expectation confirmation—the alignment between initial expectations and actual experiences. The ECM comprises four key constructs: expectation confirmation, perceived usefulness, satisfaction, and continued intention. In this study, donors' expectations are shaped by both prior beliefs (e.g., donations will improve autistic adults' safety) and social norms. Following donation, donors evaluate actual performance through feedback mechanisms such as financial and activity reports. Their subsequent satisfaction and intention to continue donating depend on whether perceived outcomes align with original expectations. This model is particularly relevant for analyzing how charitable donors' expectations interact with the evolving care needs of autistic adults in alternative care.</p> <p>The HDT ([<reflink idref="bib16" id="ref27">16</reflink>]) provides a behavioral economics lens for understanding the sustainability of altruistic behavior. [<reflink idref="bib16" id="ref28">16</reflink>] argued that decision-makers tend to overvalue immediate benefits while undervaluing future ones. This framework is particularly useful for analyzing public welfare initiatives, as it explains why donors often prioritize short-term, tangible outcomes (e.g., infrastructure or equipment donations) over long-term developmental support for autistic adults (e.g., training for independent living).</p> <p>Predetermined codes were defined as core category labels derived from existing theories prior to data analysis to guide initial categorization. These codes were developed collaboratively by an interdisciplinary research team of two members, following a dual approach that combined top-down theoretical guidance and bottom-up empirical induction—addressing the concern of uncodable data and avoiding over-reliance on theoretical frameworks. The predetermined codes development process included three steps: (<reflink idref="bib1" id="ref29">1</reflink>) breaking down the ECM model into donor expectations, perceived usefulness of donation, and satisfaction with outcomes. Breaking down hyperbolic discounting into preference for immediate outcomes, neglect of long-term value and risk perception. (<reflink idref="bib2" id="ref30">2</reflink>) Refining theoretical variables into operational codes using 4 months of observation data (e.g., crowdfunding meetings, parent mutual-aid activities) (e.g., refining preference for immediate outcomes into preference for hardware donations and preference for short-term projects). (<reflink idref="bib3" id="ref31">3</reflink>) Conducting a pre-coding test using interview transcripts to adjust code boundaries and add subcategories (e.g., splitting institutionalized alternative care into official institutionalized alternative care and non-profit institutionalized alternative care, as their funding sources and service scopes differ significantly in practice). The decision to use predetermined codes instead of open coding was made to maintain theoretical alignment and analytical focus. This approach ensured that data interpretation remained consistent with the study's objective, to assess the adaptability of existing theories to alternative care contexts—and preserved coherence around the core analytic logic of charity–subject–demand (i.e., the interaction between donors, care recipients, and care demands). The decision to integrate predetermined codes with inductive empirical codes (rather than using only predetermined codes or open coding) was made to maintain theoretical alignment while ensuring empirical relevance—avoiding the risk that themes would merely replicate theoretical constructs.</p> <p>The unit of analysis was defined as meaningful text segments drawn from interview transcripts and research logs. Examples include a corporate representative's remark, "We only donate hardware because short-term results are visible," which fully represents a donation preference, and a research diary note stating, "The parents mentioned during a farm activity that it is enough for children to buy groceries on their own," which captures caregiving objectives. The process of progressing from codes to themes involved clustering conceptually similar codes into broader analytical categories.</p> <p>The code-to-theme transformation followed four sequential steps: (<reflink idref="bib1" id="ref32">1</reflink>) First-round coding: We directly applied the predetermined codes (derived from ECM and HDT) to code all meaningful text segments in interview transcripts and research logs and explicitly marked uncodable data—defined as text segments that could not be matched to any predetermined code and had no corresponding theoretical dimension (e.g., parents' repeated concern about potential abuse of autistic adults in closed care institutions, which was not covered by ECM- or HDT-related codes); (<reflink idref="bib2" id="ref33">2</reflink>) Conducting secondary analysis on uncodable data to determine whether it constitutes a new code (e.g., anxiety about care safety); (<reflink idref="bib3" id="ref34">3</reflink>) Coding clustering into categories: Based on semantic relevance and theoretical dimensions, we grouped conceptually similar codes into a single category—codes with consistent core meanings and belonging to the same theoretical dimension were clustered together, and each category was named to reflect its core connotation (e.g., preference for safety and preference for short-term projects were both aligned with the immediate orientation of HDT, so they were grouped into the Divergence Between Short-Term Safety Priorities and Long-Term Developmental Goals category); and (<reflink idref="bib4" id="ref35">4</reflink>) Category integration into themes: We identified the common logical connection across all categories, integrated these categories to form the core theme, and ensured that the theme directly responded to the two central research questions of the study. The final core theme was confirmed as follows: Charitable organizations and private enterprises influence the development and sustainability of alternative care for autistic adults through differences in their expectations and priorities. No data analysis software was used.</p> <hd id="AN0193059431-14">Results</hd> <p>Following data analysis, 30 initial codes were extracted from semi-structured interviews and participant observations. These were subsequently consolidated into one overarching theme, three categories, and 16 refined codes. The results are reported in Table 2.</p> <p>Table 2. Categories and Codes.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th align="left">Categories</th><th align="left">Codes</th></tr></thead><tbody><tr><td>1. Differing expectations of what care systems should deliver</td><td>1. Provide a safe environment to ensure survival2. Special adult care resembling nursing-home care3. Care that only meets basic food and lodging needs4. Care that is safe but isolating5. Care that promotes holistic physical and mental development</td></tr><tr><td>2. Divergence Between Short-Term Safety Priorities and Long-Term Developmental Goals</td><td>1. Prevent disruption to public order2. Secure basic survival (location of care irrelevant)3. Rely on institutions to provide safe housing for more autistic adults4. Deliver professional care (institutional or not) for developmental goals5. Prioritize respite for parents over adults' developmental needs6. Avoid negative public judgment or incidents</td></tr><tr><td>3. Unsustainability of Charity Expectations</td><td>1. Charities and corporations expect high security2. Charities and corporations expect visible donation outcomes and short-term project3. Care institutions and parents expect safety & basic survival4. Parents expect short-/long-term placement of adult children5. Parents desire adult children's development but cannot bear high costs</td></tr></tbody></table> </ephtml> </p> <hd id="AN0193059431-15">Differing Expectations of What Care Systems Should Deliver</hd> <p>This category encapsulates the differing perspectives among stakeholders regarding the primary objectives of alternative care—whether it should emphasize survival or development. Key differences in expectation include two aspects: (<reflink idref="bib1" id="ref36">1</reflink>) utilitarian welfare-cost considerations (e.g., private enterprises prioritize low-cost hardware donations over high-cost developmental training) and (<reflink idref="bib2" id="ref37">2</reflink>) need prioritization (some stakeholders focus on basic survival needs, others on developmental needs, which shaped whether they viewed the goal of care as basic survival or high-level development).</p> <p>Some charitable organizations view closed nursing institutions as barriers to social integration for autistic adults, a concern shared by many parents. These organizations consider both social development and basic survival needs when designing care. A Guangzhou charity representative offering daycare reported,</p> <p>We are China's first institution offering alternative care for autistic adults. We focus on teaching independent living skills. Initially, as a closed facility, limited funds restricted development opportunities. We established our charitable foundation to fund development-oriented alternative care. In recent years, we have raised funds through charity to set up a life farm. About eight autistic adults are living and working here.</p> <p>One parent observed, "Short-term institutional stays noticeably reduce my children's communication and response abilities. Confined inside, they lack interaction with people. While basic needs are met, their normal functions deteriorate." Another mother stated, "I will not send my children to an alternative care institution. If I die, I'll kill him rather than leave him in an alternative care institution."</p> <p>Conversely, some private enterprises focus primarily on survival-level care, guided by social welfare obligations and market demands. One entrepreneur described their expectations for improving living conditions in care facilities through tangible contributions such as donating air purifiers. They acknowledged that low-input charitable activities satisfy their expectations of generating visible, positive outcomes while fulfilling corporate social responsibility.</p> <p>For parents facing financial hardship, expectations for high-quality alternative care remain modest. One mother explained, "For respite, I accept basic institutional care that provides food and warmth. The cost of high-level alternative care is very high. My child's father and I are divorced, and I can't afford it."</p> <p>Most heads of alternative care institutions for autistic adults also emphasized that it is common for parents to leave their children in care facilities for extended periods, with safety remaining the central concern. The founder of a charity organization, herself a mother of autistic adults, reflected,</p> <p>I established this institution for my own children. At that time, he was still young, and the center mainly cared for children. As my children grew up, our institution began to provide long-term care for autistic adults. Half of the adults here rarely see their parents, sometimes only a few times a year. Their parents often remarry and form new families, making it inconvenient to continue caregiving within the household. If we do not accept these adults, they may have nowhere else to go. At the beginning, we were particularly afraid they might leave the facility without permission. Autistic adults sometimes exit unsupervised, risking getting lost or injured, which could lead to serious safety incidents, institutional closure, and difficulties explaining the situation to their families. Safety was therefore the top priority. As a mother of an autistic adult, my expectation of providing high-level care is constrained by financial limitations.</p> <p>This category addresses conflicting priorities between different groups (between stakeholders and donors).</p> <hd id="AN0193059431-16">Divergence Between Short-Term Safety Priorities and Long-Term Developmental Goals</hd> <p>This category differs from the previous category (mismatch between stakeholder and donor priorities) in its focus: while the first category addresses conflicting priorities between different groups, this category focuses on the internal divergence within alternative care provision itself—specifically, the tension between short-term safety priorities (market logic: e.g., preventing wandering, ensuring basic living conditions) and long-term developmental goals (social logic: e.g., cultivating independent living skills, promoting social integration). Market logic is characterized by utilitarian considerations, focusing on visible short-term outcomes, accountability to donors or boards of directors, and minimizing potential risks. In contrast, social logic is centered on the long-term physical and psychological development and social integration of autistic adults, emphasizing their right to independent living and holistic well-being. Representatives of charitable organizations and private enterprises generally prioritize enhancing care quality within the framework of public welfare. According to their accounts, alternative care for autistic adults comprises three fundamental components: (<reflink idref="bib1" id="ref38">1</reflink>) preventing safety incidents (e.g., wandering, injuries); (<reflink idref="bib2" id="ref39">2</reflink>) guaranteeing basic living conditions; and (<reflink idref="bib3" id="ref40">3</reflink>) promoting overall physical and mental development.</p> <p>Private enterprise representatives stated at crowdfunding conferences that donation projects needed to avoid negative business impact. This makes alternative care prioritize Components (<reflink idref="bib1" id="ref41">1</reflink>) and (<reflink idref="bib2" id="ref42">2</reflink>), as improving overall development means expanding life scope, bringing risks unacceptable to donors.</p> <p>Charitable organizations' priorities often differ depending on their founders' backgrounds. Those established by parents of autistic adults or children tend to emphasize cultivating independence among autistic adults within alternative care. Two organizations in Beijing and Guangzhou highlighted this approach. The leader of the Guangzhou charity explained, "It is wrong to wait forever to be cared for, as this hinders the development of autistic adults." Although they require substantial support, this does not mean they cannot learn to care for themselves in daily life. The foundation of alternative care is to treat them as ordinary people—to help them develop skills for living, communication, and employment. The tension between short-term safety priorities and long-term developmental goals reflects the conflict between market logic and social logic.</p> <hd id="AN0193059431-17">Unsustainability of Charity Expectations</hd> <p>This category reveals how misaligned donor expectations undermine the long-term sustainability of high-quality alternative care. Participants repeatedly emphasized the decisive role of donor expectations.</p> <p>From the perspective of alternative care institutions, it remains uncertain whether charitable organizations and private enterprises will renew contracts supporting advanced care programs. Typically, these contracts are project-based and short-term, lasting only 6 months to a year. Such arrangements reflect the utilitarian balance between welfare costs and donor demand management.</p> <p>One institutional leader explained,</p> <p>Private enterprises and charitable organizations are more willing to donate materials, such as food. Our expectations are higher—we want to help autistic adults achieve independent living. For safety reasons, we often approach charitable organizations and private enterprises to provide free farms or villas in the suburbs where our adults can live and work. However, few donors are willing to support us on a yearly basis. They prefer visible outcomes, like purchasing listed materials. These are usually one-time donations.</p> <p>However, many representatives from private enterprises and charitable organizations observed that alternative care institutions often lacked continuity and systematic planning in project design. This inconsistency created considerable uncertainty about the long-term effectiveness of donations. One private representative explained,</p> <p>This charity project aims to improve the environmental conditions of care institutions, such as air purification. While that is a basic requirement, the project plan lacks coherence. We visited several institutions, and none had a systematic development plan. Some small groups of six people seemed better organized, but their leaders could not demonstrate progress or stage results after receiving donations. We could not see tangible outcomes. Ultimately, such institutions risk becoming small and closed systems—the very model they criticize—which diverges from the high-level care they promised when seeking donations.</p> <p>The influence of donor expectations on the sustainability of development-oriented care models reflects structural weaknesses of alternative care.</p> <hd id="AN0193059431-18">Discussion</hd> <p>This study aimed to address two interrelated research questions: RQ1 and RQ2. Methodologically, an exploratory qualitative design was employed, incorporating ethnographic methods that included 4 months of participant observation and 36 semi-structured interviews with 30 stakeholders across Chinese cities. Data were analyzed using directed content analysis ([<reflink idref="bib9" id="ref43">9</reflink>]), framed by the ECM and HDT to interpret the dynamics of charitable behavior and care sustainability.</p> <p>The divergent expectations of alternative care for autistic adults identified in this study can be partially explained through two theoretical lenses—the ECM and HDT—although neither theory alone nor their combination is sufficiently comprehensive to account for all dimensions of these expectations. The ECM elucidates how stakeholders' sustained engagement with a service depends on expectation confirmation—the alignment between anticipated and actual outcomes. In this context, ECM highlights the tension between charitable donors' expectations (e.g., "hardware donations deliver visible safety outcomes") and the actual developmental needs of autistic adults (e.g., "training for independent living"). These expectations reflect utilitarian welfare-cost calculations that seek to confirm perceived returns on charitable investment. This mechanism produces a form of confirmation bias, whereby charitable actors selectively attend to evidence that validates their short-term expectations while disregarding unmet developmental needs such as social integration. This pattern aligns with [<reflink idref="bib8" id="ref44">8</reflink>] argument that selective reasoning enables individuals to rationalize the information that reinforces their preferred beliefs. Conversely, alternative care providers—particularly parent-founded institutions—prioritized holistic development but faced external pressure from donors to emphasize safety and risk avoidance. This tension led to institutional decoupling, wherein formal organizational goals diverged from informal caregiving practices, resulting in a "safety-first" care approach that limited developmental progress. Notably, during the pre-coding test, a small proportion of data related to social stigma and cultural biases toward autistic adults initially fell outside the predetermined codes derived from ECM and HDT, requiring the development of supplementary sub-codes to capture these contextual factors—further indicating that the two theories, while valuable, are not fully sufficient to explain the complexity of divergent expectations.</p> <p>The HDT ([<reflink idref="bib16" id="ref45">16</reflink>]) posits that decision-makers discount the value of future benefits, prioritizing immediate, tangible rewards over delayed, intangible gains. This present bias helps explain why charitable actors often emphasize short-term safety measures rather than long-term developmental care for autistic adults. For instance, approximately 80% of enterprise donations consisted of tangible goods such as beds and air purifiers, rather than intangible services like training or community integration programs. Similarly, most charities signed short-term project contracts (6–12 months) instead of multi-year commitments, citing that "long-term outcomes are too uncertain to report." In Guangzhou, for example, the farm-based care model, designed to promote self-reliance through crop sales, requires sustained financial support. Yet, donors often undervalue these delayed benefits in favor of immediate, visible interventions related to safety.</p> <p>Although situated within China's hybrid welfare regime, these findings align with institutional theory predictions ([<reflink idref="bib3" id="ref46">3</reflink>]) concerning the dominance of non-state actors in fragmented welfare systems. In contexts where state support is minimal, non-state actors such as private enterprises and charitable organizations inevitably shape service design. However, their risk-averse priorities, focused on immediate accountability and visible outcomes, frequently conflict with beneficiaries' developmental needs. This tension manifests in alternative care institutions that favor closed facilities to meet physical safety expectations at the expense of developmental engagement. It is important to note that neither the ECM nor the HDT explicitly accounts for the role of social stigma and cultural contexts in shaping donor expectations and alternative care practices—this represents a notable weakness of these theoretical frameworks when applied to contexts with deep-rooted cognitive biases toward disability. The ECM focuses on the alignment between expectations and outcomes, while the HDT emphasizes present bias in decision-making; neither theory incorporates social stigma as a key variable influencing stakeholder behaviors and care priorities. The implications extend beyond China to other fragmented welfare contexts. For example, similar contradictions between charitable intentions and systemic needs are seen in Cambodia's health infrastructure ([<reflink idref="bib10" id="ref47">10</reflink>]), while Ghana's health sector has faced funding gaps, care interruptions, and the marginalization of vulnerable populations following the withdrawal of donor support ([<reflink idref="bib15" id="ref48">15</reflink>]). The tension between charitable actors' short-term project cycles, reflecting market logic, and alternative care providers' long-term integration goals, reflecting social logic, illustrates a global phenomenon of institutional decoupling, where formal objectives diverge from informal caregiving practices. We conceptualize this as a charitable sustainability paradox: a structural contradiction in which private enterprises' and charities' short-term, visible contributions unintentionally undermine the long-term sustainability of alternative care focused on physical and psychological developments.</p> <p>Globally, the prioritization of alternative care for autistic adults remains insufficient. Current international policy and legislative frameworks addressing out-of-family caregiving are limited and fragmented ([<reflink idref="bib19" id="ref49">19</reflink>]). Furthermore, little is known about how existing and emerging alternative care models influence the physical and psychological development and overall well-being of adults who transition from biological family care to institutional or community-based settings.</p> <p>Our findings contribute two key advances. First, by redefining core concepts and examining the competition among priorities, this study foregrounds the perspectives of charitable organizations, private enterprises, and both parent- and non-parent-founded alternative care institutions. It explores how these actors' allocation of charitable resources shapes divergent models of alternative care for autistic adults. Participants consistently emphasized that safety remains the central expectation and dominant priority in providing care for autistic adults—particularly under the banner of charitable support. This emphasis, however, reflects a deeper social stigma shared by some charitable actors and care institutions toward the independent living capacities of autistic adults. Many assume that autistic adults are unable to manage community integration and, therefore, require constant protection. Social stigma toward autistic adults was identified as a distinct core code during the pre-coding test, as it emerged repeatedly in participants' narratives and could not be fully encapsulated by the predetermined codes derived from ECM and HDT. This code captures the widespread cognitive biases, discriminatory attitudes, and misconceptions about autism in social and cultural contexts—factors that significantly shape alternative care practices and stakeholder expectations. Notably, approximately half of the founders of alternative care institutions reported that, in prevailing public consciousness, mental hospitals are still regarded as appropriate placements for autistic adults—revealing persistent cognitive biases toward disability. In China, labeling someone as "mentally ill" in everyday contexts is often used pejoratively, carrying connotations of insult and discrimination. Consequently, all parents of autistic adults in this study firmly rejected such classification and refused to send their children to what they described as "terrifying" mental hospitals. In addition, most participants noted that preventing safety incidents involving autistic adults was a primary institutional priority. This discourse implicitly reinforces a widespread public perception that autistic adults are less capable of controlling their behavior, perpetuating both overprotection and social exclusion. Such incidents can lead to the closure of care institutions and damage the social reputation of donors. Several participants noted that some members of the public equate autism with mental illness that threatens social stability or citizen safety, believing autistic adults lack self-control. As a result, the social integration component of alternative care has been confined largely within institutions rather than extended to community settings. In other words, widespread misconceptions persist among Chinese citizens regarding the symptoms, causes, and long-term implications of autism spectrum disorder (ASD) ([<reflink idref="bib23" id="ref50">23</reflink>]).</p> <p>The second research contribution focuses on conflicts in donor expectations. The donor expectations held by both charitable actors and alternative care institutions jointly shape the unsustainability of care models that emphasize developmental outcomes. This partly stems from the perceived social risk associated with the potential negative consequences of "good deeds." Charitable organizations must remain accountable to donors, corporations to their boards of directors, and alternative care institutions to their own operational survival. These layered accountabilities drive donor expectations toward the lowest functional threshold, where "effectiveness" is measured primarily by safety assurance rather than developmental impact.</p> <p>Importantly, the influence of donor expectations on the sustainability of development-oriented care models reflects structural weaknesses of alternative care. An important finding challenges the initial theoretical expectation derived from HDT: private enterprise donors' reluctance to commit to long-term funding for alternative care is not only due to present bias (prioritizing short-term, tangible outcomes over long-term developmental benefits) but also due to concerns about the operational capacity and performance of alternative care institutions. Private enterprise representatives repeatedly mentioned that many care institutions lack systematic development plans, cannot demonstrate clear progress or phased results after receiving donations, and often operate as small, closed systems—these structural weaknesses create significant uncertainty about the long-term effectiveness of donor funding. The implication of this finding is profound: to improve the sustainability of development-oriented alternative care, it is not enough to encourage donors to adopt a long-term perspective; it is also necessary to strengthen the operational capacity of alternative care institutions, including improving their systematic planning, establishing clear performance evaluation mechanisms, and enhancing transparency in the use of donated funds. This dual approach—addressing both donor-present bias and care institution structural weaknesses—is crucial for bridging the gap between donor expectations and the developmental needs of autistic adults.</p> <hd id="AN0193059431-19">Limitations</hd> <p>Participants were drawn from economically developed urban regions of China, representing only a subset of the broader autistic adults' population and excluding those from rural or less developed areas. The study focused on cities with the most established experience in providing alternative care and conducted multiple interviews with decision-makers from representative charities and alternative care institutions, following a triangulation approach. By recruiting participants across different locations and systematically comparing their narratives, the study aimed to achieve data convergence, thereby enhancing the credibility of qualitative findings and minimizing potential researcher or participant bias.</p> <hd id="AN0193059431-20">Conclusion</hd> <p>This study identifies an institutional sustainability gap arising from the misalignment between charitable organizations' and private enterprises' market logic and the social logic of autistic adults' developmental needs. Using a dual-theoretical framework, the findings demonstrate that the sustainability crisis of charity-based care represents a global challenge rather than a localized phenomenon. Two core contradictions underlie this gap. First, there is a cross-cultural cognitive bias: the public stigmatization of autism—illustrated in China by associating autism with "mental illness" and the resultant overemphasis on safety—mirrors similar patterns worldwide. Such bias reduces developmental objectives to mere protection, simplifying care goals and limiting autonomy. Second, there exists an institutional gap in intergenerational equity: present-oriented decision-making, explained by hyperbolic discounting, systematically deprives future beneficiaries—such as autistic adults—of sustained developmental resources. A challenge with urgent relevance as aging autistic populations worldwide strain existing care systems.</p> <hd id="AN0193059431-21">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-aut-10.1177_13623613261434406 for Provision of Alternative Care for Autistic Adults: A Multi-Stakeholder Qualitative Study in China by Xi Wang and Xiaoli Guo in Autism</p> <hd id="AN0193059431-22">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-2-aut-10.1177_13623613261434406 for Provision of Alternative Care for Autistic Adults: A Multi-Stakeholder Qualitative Study in China by Xi Wang and Xiaoli Guo in Autism</p> <ref id="AN0193059431-23"> <title> References </title> <blist> <bibl id="bib1" idref="ref16" type="bt">1</bibl> <bibtext> Ahmad W., Kim W. G., Anwer Z., Zhuang W. (2020). Schwartz personal values, theory of planned behavior, and environmental consciousness: How tourists' visiting intentions toward eco-friendly destinations are shaped? Journal of Business Research, 110, 228–236. https://doi.org/10.1016/j.jbusres.2020.01.040</bibtext> </blist> <blist> <bibl id="bib2" idref="ref17" type="bt">2</bibl> <bibtext> Bhattacherjee A. (2001). Understanding information systems continuance: An expectation-confirmation model. MIS Quarterly, 25(3), 351–370. https://doi.org/10.2307/3250921</bibtext> </blist> <blist> <bibl id="bib3" idref="ref18" type="bt">3</bibl> <bibtext> Campbell J. L. (2007). Why would corporations behave in socially responsible ways? An institutional theory of corporate social responsibility. Academy of Management Review, 32(3), 946–967. https://doi.org/10.5465/amr.2007.25275684</bibtext> </blist> <blist> <bibl id="bib4" idref="ref7" type="bt">4</bibl> <bibtext> Fisher K., Jing L. (2008). Chinese disability independent living policy. Disability & Society, 23(2), 171–185. https://doi.org/10.1080/09687590701841216</bibtext> </blist> <blist> <bibl id="bib5" idref="ref14" type="bt">5</bibl> <bibtext> Gertner A. K., Franklin J., Roth I., Cruden G. H., Haley A. D., Finley E. P., Hamilton A. B., Palinkas L. A., Powell B. J. (2021). A scoping review of the use of ethnographic approaches in implementation research and recommendations for reporting. Implementation Research and Practice, 2, 1–17. https://doi.org/10.1177/2633489521992743</bibtext> </blist> <blist> <bibl id="bib6" idref="ref22" type="bt">6</bibl> <bibtext> Gold R. L. (1958). Roles in sociological field observations. Social Forces, 36(3), 217–223. https://doi.org/10.2307/2573808</bibtext> </blist> <blist> <bibl id="bib7" idref="ref15" type="bt">7</bibl> <bibtext> Green J., Hanckel B., Petticrew M., Paparini S., Shaw S. (2022). Case study research and causal inference. BMC Medical Research Methodology, 22(1), Article 307. https://doi.org/10.1186/s12874-022-01728-2</bibtext> </blist> <blist> <bibl id="bib8" idref="ref44" type="bt">8</bibl> <bibtext> Greenwald A. G. (2012). There is nothing so theoretical as a good method. Perspectives on Psychological Science, 7(2), 99–108. https://doi.org/10.1177/1745691611434210</bibtext> </blist> <blist> <bibl id="bib9" idref="ref23" type="bt">9</bibl> <bibtext> Hsieh H.-F., Shannon S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687</bibtext> </blist> <blist> <bibtext> Lee S., Park E. Y. (2024). Examining aid fragmentation and collaboration opportunities in Cambodia's health sector. Globalization and Health, 20(1), 62. https://doi.org/10.1186/s12992-024-01063-7</bibtext> </blist> <blist> <bibtext> Liu F., Begeer S., Hoekstra R. A., Wang C., Scheeren A. M. (2024a). Autistic adults in China and the Netherlands: Proxy-reported community integration and life satisfaction. Autism: The International Journal of Research and Practice, 28(12), 3186–3200. https://doi.org/10.1177/13623613241258182</bibtext> </blist> <blist> <bibtext> Liu F., Begeer S., Hoekstra R. A., Wang C., Scheeren A. M. (2024b). Self-reported psychosocial outcomes of autistic adults living in China and the Netherlands. Autism in Adulthood. Advance online publication. https://doi.org/10.1089/aut.2024.0073</bibtext> </blist> <blist> <bibtext> Lord C., Charman T., Havdahl A., Carbone P., Anagnostou E., Boyd B., Carr T., de Vries P. J., Dissanayake C., Divan G., Freitag C. M., Gotelli M. M., Kasari C., Knapp M., Mundy P., Plank A., Scahill L., Servili C., Shattuck P...McCauley J. B. (2022). The Lancet Commission on the future of care and clinical research in autism. The Lancet, 399(10321), 271–334. https://doi.org/10.1016/S0140-6736(21)01541-5</bibtext> </blist> <blist> <bibtext> Mansourian Y. (2008). Exploratory nature of and uncertainty tolerance in qualitative research. New Library World, 109(5/6), 273–286. https://doi.org/10.1108/03074800810873614</bibtext> </blist> <blist> <bibtext> Mao W., McDade K. K., Huffstetler H. E., Dodoo J., Abankwah D. N. Y., Coleman N., Riviere J., Zhang J., Nonvignon J., Bharali I., Bandara S., Ogbuoji O., Yamey G. (2021). Transitioning from donor aid for health: Perspectives of national stakeholders in Ghana. BMJ Global Health, 6(1), Article e003896. https://doi.org/10.1136/bmjgh-2020-003896</bibtext> </blist> <blist> <bibtext> Saez-Marti M., Weibull J. W. (2005). Discounting and altruism to future decision-makers. Journal of Economic Theory, 122(2), 254–266. https://doi.org/10.1016/j.jet.2004.06.003</bibtext> </blist> <blist> <bibtext> Scheeren A. M., Howlin P., Bartels M., Krabbendam L., Begeer S. (2022). The importance of home: Satisfaction with accommodation, neighborhood, and life in adults with autism. Autism Research, 15(3), 519–530. https://doi.org/10.1002/aur.2653</bibtext> </blist> <blist> <bibtext> Sindi I., Strömpl J., Toros K. (2018). The Estonian way of deinstitutionalisation: Experiences from ethnographic research in SOS Children's Village. Child & Youth Services, 39(4), 305–332. https://doi.org/10.1080/0145935x.2018.1511975</bibtext> </blist> <blist> <bibtext> Strahl B., Du Plessis van Breda A., Mann-Feder V., Schröer W. (2021). A multinational comparison of care-leaving policy and legislation. Journal of International and Comparative Social Policy, 37(1), 34–49. https://doi.org/10.1017/ics.2020.26</bibtext> </blist> <blist> <bibtext> Winpenny E. M., Winkler M. R., Stochl J., van Sluijs E. M. F., Larson N., Neumark-Sztainer D. (2020). Associations of early adulthood life transitions with changes in fast-food intake: A latent trajectory analysis. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 130. https://doi.org/10.1186/s12966-020-01024-4</bibtext> </blist> <blist> <bibtext> Yin S. (2024). Risks and challenges of living in institutions: Voices from young people with care experience in China. Children and Youth Services Review, 163, 107776. https://doi.org/10.1016/j.childyouth.2024.107776</bibtext> </blist> <blist> <bibtext> Yin S. (2025). How does living in an institution impact young lives? Insights from young people in Ci'aiyuan. Children & Society. Advance online publication. https://doi.org/10.1111/chso.12942</bibtext> </blist> <blist> <bibtext> Yu L., Stronach S., Harrison A. J. (2020). Public knowledge and stigma of autism spectrum disorder: Comparing China with the United States. Autism, 24(6), 1531–1545. https://doi.org/10.1177/1362361319900839</bibtext> </blist> <blist> <bibtext> Zhou H., Xu X., Yan W., Zou X., Wu L., Luo X., Li T., Huang Y., Guan H., Chen X. (2020). Prevalence of autism spectrum disorder in China: A nationwide multi-centre population-based study among children aged 6 to 12 years. Neuroscience Bulletin, 36(9), 961–971. https://doi.org/10.1007/s12264-020-00530-6re</bibtext> </blist> </ref> <ref id="AN0193059431-24"> <title> Footnotes </title> <blist> <bibtext> Xi Wang</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0003-0363-0473</bibtext> </blist> <blist> <bibtext> Ethical approval was obtained from the College of International Trade and Economics, Changchun University of Finance and Economics (Approval Number: 20211030).</bibtext> </blist> <blist> <bibtext> Verbal informed consent was obtained from all participants before data collection. Anonymity was strictly maintained, and no identifying information was recorded throughout the study.</bibtext> </blist> <blist> <bibtext> Xi Wang: Conceptualization; Formal analysis; Investigation; Methodology; Writing—original draft; Writing—review & editing.Xiaoli Guo: Conceptualization; Formal analysis; Resources; Writing—original draft.</bibtext> </blist> <blist> <bibtext> The authors received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The data analyzed during the current study are not publicly available, as the data contain potentially sensitive participant information. Relevant supporting materials can be provided upon reasonable request to the corresponding author.</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> </ref> <aug> <p>By Xi Wang and Xiaoli Guo</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib24" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib13" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib11" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib12" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib17" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib21" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib22" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib20" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib14" firstref="ref13"></nolink> <nolink nlid="nl11" bibid="bib16" firstref="ref27"></nolink> <nolink nlid="nl12" bibid="bib10" firstref="ref47"></nolink> <nolink nlid="nl13" bibid="bib15" firstref="ref48"></nolink> <nolink nlid="nl14" bibid="bib19" firstref="ref49"></nolink> <nolink nlid="nl15" bibid="bib23" firstref="ref50"></nolink>
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  Data: Provision of Alternative Care for Autistic Adults: A Multi-Stakeholder Qualitative Study in China
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  Data: <searchLink fieldCode="AR" term="%22Xi+Wang%22">Xi Wang</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0363-0473">0000-0003-0363-0473</externalLink>)<br /><searchLink fieldCode="AR" term="%22Xiaoli+Guo%22">Xiaoli Guo</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2026 30(5):1305-1316.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: <searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Group+Homes%22">Group Homes</searchLink><br /><searchLink fieldCode="DE" term="%22Needs%22">Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Services%22">Social Services</searchLink><br /><searchLink fieldCode="DE" term="%22Institutionalized+Persons%22">Institutionalized Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Residential+Programs%22">Residential Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Private+Agencies%22">Private Agencies</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Agencies%22">Public Agencies</searchLink><br /><searchLink fieldCode="DE" term="%22Family+%28Sociological+Unit%29%22">Family (Sociological Unit)</searchLink><br /><searchLink fieldCode="DE" term="%22Place+of+Residence%22">Place of Residence</searchLink><br /><searchLink fieldCode="DE" term="%22Services%22">Services</searchLink>
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  Data: 10.1177/13623613261434406
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  Data: 1362-3613<br />1461-7005
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  Data: Providing alternative care for autistic adults unable to live with their biological families remains a low priority, particularly for those requiring high support. This population often receives inadequate attention despite its significant and long-term developmental needs. Using an exploratory qualitative design with ethnographic methods, this study conducted directed content analysis on data collected through 4 months of participant observation and 36 semi-structured interviews across four Chinese cities. The findings reveal that small-group alternative care emphasizes the physical and psychological development of autistic adults. However, charitable expectations among alternative care institutions and charitable donors lag behind the actual care needs of autistic adults with high support needs, limiting resource efficiency. The "present bias" diminishes recognition of the long-term societal benefits of developmental care. In developing contexts, achieving cohesive and sustainable nursing strategies led by non-state actors is crucial. A misalignment between charitable motivations and developmental priorities creates a "care sustainability gap" that threatens the continuity and effectiveness of alternative care for autistic adults.
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    Identifiers:
      – Type: doi
        Value: 10.1177/13623613261434406
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 1305
    Subjects:
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Group Homes
        Type: general
      – SubjectFull: Needs
        Type: general
      – SubjectFull: Social Services
        Type: general
      – SubjectFull: Institutionalized Persons
        Type: general
      – SubjectFull: Residential Programs
        Type: general
      – SubjectFull: Private Agencies
        Type: general
      – SubjectFull: Public Agencies
        Type: general
      – SubjectFull: Family (Sociological Unit)
        Type: general
      – SubjectFull: Place of Residence
        Type: general
      – SubjectFull: Services
        Type: general
      – SubjectFull: China
        Type: general
    Titles:
      – TitleFull: Provision of Alternative Care for Autistic Adults: A Multi-Stakeholder Qualitative Study in China
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Xi Wang
      – PersonEntity:
          Name:
            NameFull: Xiaoli Guo
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 05
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1362-3613
            – Type: issn-electronic
              Value: 1461-7005
          Numbering:
            – Type: volume
              Value: 30
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Autism: The International Journal of Research and Practice
              Type: main
ResultId 1