Project Search partners with businesses, schools and community agencies to run nine-month skills training programs for high school students with intellectual disabilities. In 2013, the project, which began at Cincinnati Children's Hospital 18 years ago, had grown to include 285 business sites worldwide and 69 per cent of graduates that year got jobs. The project trains students in complex but routine jobs from sterilizing surgical equipment and making defibrillators to working on a carpet-making production line. BLOOM interviewed Erin Riehle (photo centre), director of disability services and Project Search at Cincinnati Children’s.
BLOOM: How did you get the idea for this project?
Erin Riehle: I’m a critical-care nurse and I used to be the director of the emergency department here at Cincinnati Children’s. One day I was sitting in my office, right off the waiting area, and I looked out and noticed that a lot of the people sitting there waiting were people with developmental disabilities. I’d seen a young man with disability bagging groceries in a grocery store and I thought gosh, how many people with intellectual disabilities do we train and hire here?
I called our chief financial officer and I asked how much money do we make by serving people with developmental disabilities? I learned it’s a substantial part of our revenue at the hospital. Then I called our head education officer and asked how many training programs we had. It’s over 60, but not a single one is about training people with disabilities.
I checked with HR and learned we hadn’t intentionally hired a person with an intellectual disability to do any of our jobs. We had lots of volunteers who had developmental disabilities but no employees. It didn’t seem right.
I had some open jobs and I was willing to see if a person with a disability could do them. I invited the head of special education from our school district and someone from our county board of developmental disability to visit with an idea of starting a training program.
BLOOM: You said in a video that you felt children with disabilities who received services at the hospital deserved to see staff with disabilities working there?
Erin Riehle: I think if we’re going to make a lot of money by providing their medical care and our mission statement is to ‘change the outcome,’ then for people with disabilities we should be training and hiring them just as we train and hire other people. It turns out that our families love it and we get so much positive feedback about how much it means to them to see folks working at the hospital who look like their kids with disabilities.
BLOOM: How many people with disabilities are employed through Project Search today?
Erin Riehle: We have 58 people with significant intellectual disabilities working here at Cincinnati Children’s and they’re in a wide variety of jobs. We also have another six programs in the Cincinnati community we manage and each trains about 12 young people a year. Not all kids with disabilities want to work in hospitals so we partner with businesses to offer other programs in a university, a bank, a retirement centre and the sheriff’s office.
BLOOM: And the program has been modelled around the world?
Erin Riehle: Today we have about 285 programs. About 250 of them are in the U.S. and the other 35 are in England, Ireland, Scotland, Canada and Australia. The one in Canada is in Winnipeg. Overall we serve about 2,750 young people a year and 69 per cent go on to get jobs. Every day we get interest from other cities and countries who want us to teach them how to replicate our model.
BLOOM: How old are Project Search students?
Erin Riehle: We have two versions of the program. In one, we partner with local high schools, so it’s a high-school transition program and those students are aged 18 to 21. But we also run the same program as an adult model and typically those students are aged 18 to 30.
BLOOM: How does the program work?
Erin Riehle: The students are here for a school year of nine months. We break it into three 12-week rotations, and each young person goes to a department by themselves, depending on what they’re interested in, and they begin to learn skills, not jobs. We might teach a skill using a video, or doing a picture board and being there with the student until they’ve mastered it. We took all of the manuals used by departments for orienting staff and added pictures to them, because many of our students don’t read or write. So anyone who gets trained in that department, whether or not they have a disability, uses the same books. It’s one of many examples of a modification made to help a person with a disability that helps everyone.
BLOOM: What are some of the hospital jobs students learn?
Erin Riehle: Hospitals are a microcosm of the working world and anything you want to learn you can do in the hospital and then take back out into the community. We have people doing sterilizing of the trays used in surgery, stocking all of the materials used in patient rooms and departments, and transporting patients. We even have a guy who works in pathology in the morgue, changing chemicals in tanks and doing tissue slides. In general, we find people with intellectual disabilities tend to excel at jobs that are very hard, very complex, but also routine.
BLOOM: In your video there’s a participant who sterilizes surgical trays. Can you explain what her day would look like?
Erin Riehle: That’s Jill. She comes in, puts on her scrubs and safety gear and goes to her station, just like everyone else in that department. She has to do at least 30 trays a day, and each tray has 100 to 200 instruments that have to be put in the exact order used by the surgeon, from first to last. I’ll be honest with you, if Jill had left high school without any skills and applied for that position without knowing how to do it, there’s no way in the world she ever would have gotten that job. But if we bring her in while she’s still a high school student and have nine months to teach her the parts of a skill, she can do it as well as anyone else.
BLOOM: If the student is hired when the program ends, do they make minimum wage?
Eric Riehle: They're hired at whatever the customary wage is for a position. They have the same job description and make the same salary as anyone else doing that work. We know that for 2013, 69 per cent of our grads were hired, about 40 per cent by the host business, and 60 per cent elsewhere in the community. It's better than most transition programs, but we're still failing 31 per cent of the time.
BLOOM: Is it challenging to get regular staff to buy into the program?
Erin Riehle: We go out to businesses and explain what we’re trying to do and almost never do we have a business that says no. Our model works and businesses really like it. We do tons of education and talk to the staff during brown bag lunches and we rarely have problems with staff.
BLOOM: So what is the greatest challenge?
Erin Riehle: At Cincinnati Children’s and at every other business site we have several partners who work together to make the program happen. This includes the school district; a community rehab agency; Vocational Rehabilitation, which is a federally-run funding program; and an agency for people with developmental disabilities.
The biggest challenge is getting the partners to work together. We require the teams to braid their funding and expertise and resources. We prescribe the role that each will play. But even though they all have the same goal of helping people with disabilities find jobs, they have their own bureaucracies with their own rules and measures of success. It’s very difficult to get them to collaborate.
BLOOM: What kind of impact have you seen on Project Search graduates?
Erin Riehle: To get up every morning and come in to a workplace and have a purpose and be responsible for something that is not just made-up work, that if you don’t do it it’s going to have a ripple effect, these are powerful things. It is life changing.
We have at least eight folks here at Cincinnati Children’s that have gone on to get married. We have a ton of people who, because of their paycheck, are living on their own and have bought a condo or are living with someone they work with. We have lots of folks spending money and paying taxes and they have friends.
One thing we see, which is a concern and deserves further study, is that in 18 years we’ve had 10 deaths among people with developmental disabilities who work here at the hospital and that’s way out of proportion to our general work population. That has really jumped out at us. Something is getting missed in their health care.
BLOOM: What is the impact on staff?
Erin Riehle: It’s massive. It changes the minds and hearts of doctors and nurses. Instead of a doctor seeing every kid with cerebral palsy as a person that just needs to be seen, he or she starts thinking ‘This kid really could work. I need to make sure I link him up with the right services.’
At least once a week we get a call from a nurse on a unit who says ‘I’ve got a patient up here and I talked to the parents about Project Search and they’ve never heard of it. Can I send them to you to talk?’
So nurses, instead of seeing kids with disabilities as patients, and impersonal objects, they begin to see every kid with a disability as a person who could work, as a valuable person. It really changes the whole care experience of patients with disabilities and their families.
And I hear from doctors all the time that if you’re the head of the autism or Down syndrome clinic and you have some of your patients working here and they’re seen by other families, that makes those families think you’re a better doctor.
It makes them feel more confident in the care they’re getting and it makes them see themselves differently and have higher expectations for their sons and daughters.
The doctor who runs our clinic for cerebral palsy said there was a woman with a child with cerebral palsy who was working on a project here at the hospital. And one day, she said, ‘I saw Matt again, he must be really sick.’ Matt is someone who has cerebral palsy and she made the assumption that he was there because he was sick. But he was here because he was working.
BLOOM: Are you funded federally?
Erin Riehle: We don’t get any federal funding. I still work for the hospital and we have a team of people who go out to set up programs. The way we get funding when a group wants to start a program is that they sign a license agreeing to our rules and outcomes, and they pay for technical assistance to replicate the program. We charge $15,000 per site, which covers all of our expenses and salaries and time going in to work with teams.