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ALEX GARVEY, PhD
Chief Sponsorship Officer for Markets and Shared Services at Bon Secours Mercy Health

JESSICA WEINGARTNER, MA
Director of Mission at Bon Secours St. Francis Health System

Illustration by Nathan Hackett

Access to employment that is both meaningful and productive is a key concept of Catholic social teaching. However, there is a recognized gap for young people who have cognitive impairment. While several programs assist this group to transition from school to work, many fall short. Project SEARCH is a school-to-work transition program designed to bridge this gap. It challenges the health care system, school districts and state supportive agencies to join forces to create an arena where human dignity flourishes, communities prosper and the hospital workforce experiences benefits. Participants are provided with the opportunity not just to live life, but to live life in abundance.

Through an effort to bring Project SEARCH to its Greenville, South Carolina, market more than five years ago, Bon Secours St. Francis Health
System — through collaboration with community partners — provides an on-the-job hospital training program for high school-aged students with disabilities.

HOPE FOR AN UNCERTAIN FUTURE
For a parent of a child who has disabilities, one of their greatest fears is the thought of, "What will happen to my child when I am gone?" This is certainly not an unfounded worry. Young people with disabilities have a more difficult time securing employment following high school graduation than their peers without disabilities. This is especially true for young adults with autism spectrum disorder and intellectual and developmental disabilities. Students on the autism spectrum have some of the lowest employment rates in the years following high school, even among their peers with other types of disabilities.¹

In Catholic health care ministry, we are called to "bring alive the Gospel vision of justice and peace" through a commitment to the principles of Catholic social teaching, including human dignity, justice and the common good.² One of the core themes of Catholic social teaching is the dignity of work and rights of workers. In the Catholic social tradition, work is not just a means of obtaining the money required to support oneself and one's family but is a way in which a person achieves fulfillment as a human being.³ One area where the Catholic health care ministry can contribute to "the dignity of the individual and the demands of justice"⁴ is through promoting avenues for meaningful employment for people with disabilities. This allows them new ways to be productive, flourishing and participating in the life of their community.

Each year, between 70,700 and 111,600 teens on the autism spectrum will transition from school-based supportive services into adulthood.⁵ A.J. Drexel Autism Institute's 2017 National Autism Indicators Report found that only 14% of surveyed adults on the autism spectrum held a paying job in the community, and 15% worked in sheltered workshops, typically for less pay than community-based jobs.⁶ The students with the worst outcomes often have compounding vulnerabilities in addition to their diagnosis, including lower household income, difficult family situations and a family history of behavioral health conditions.⁷

Bon Secours St. Francis Health System

Project SEARCH-Bon Secours St. Francis program interns Marques Hughey, left, and Caitlin Kelly, right, take part in a team-building activity to learn what they have in common with each other.

The typical model of transition services for students with cognitive limitations involves a combination of special education classes with either simulated work environments or short-term community employment; however, the simulated work environment fails to help students meaningfully connect learned skills to the context of real, community-based employment.⁸ Improving poor employment outcomes requires providing ways to connect students with opportunities to have integrated, community-based work experiences, discover their passions and develop employment skills. One such program, integrated within the hospital setting, provides Catholic health care ministries the opportunity to live out our Gospel calling to promote the dignity and human flourishing of these young individuals.

In 1996, a program called Project SEARCH was developed at Cincinnati Children's Hospital Medical Center that would not only enable young adults with autism and other disabilities to successfully transition from school to adult life, but would improve the hospital's workforce as well. Project SEARCH is a high school-to-work transition program for young adults with disabilities, with the goal of achieving competitive employment. Competitive employment is understood as part- or full-time employment, integrated within the community (for example, not in a sheltered workplace), with compensation at the same rate as other workers without disabilities. Students involved in the program have varying physical, intellectual and developmental disabilities, including autism spectrum disorder, intellectual and developmental disabilities, Down syndrome, hearing and visual impairments, and traumatic brain injury, among others. The program combines classroom training in employability, independent living and immersive job skills, which empower the students to develop both the hard and soft skills necessary for attaining and maintaining competitive employment.

PROJECT SEARCH AT BON SECOURS ST. FRANCIS
Bon Secours St. Francis Health System brought Project SEARCH to the Greenville market in 2016, joining the health system's other programs in the Richmond and Hampton Roads regions in Virginia. Pope Saint John Paul II reminds us in Laborem Exercens that it is the responsibility of the entire community to "pool their ideas and resources" to achieve a critically important goal "that disabled people may be offered work according to their capabilities," for this is demanded by their dignity as persons and as subjects of work."⁹ With that call in mind, Bon Secours St. Francis began to seek out willing community partners. We quickly formed meaningful ministerial relationships with the Greenville County School District and the South Carolina Vocational Rehabilitation Department — which prepares and assists eligible South Carolinians with disabilities to achieve and maintain competitive employment — to introduce this program to our hospital and the Greenville community. Both agencies were familiar with the program and delighted to join our health system in this venture. Program participants are either high school seniors or recent graduates from Greenville County School District, and most are or were followed by South Carolina Vocational Rehabilitation Department throughout their school careers. The program is also supported by the South Carolina Department of Disabilities and Special Needs, Able SC and Goodwill Industries. The collaboration between these agencies is the hallmark of the program's success.

The program's operating expenses are covered through Bon Secours St. Francis' mission department budget. It is housed in the hospital where a workforce coordinator arranges unpaid internships. However, after the young people have the needed job skills and are hired, they earn the same pay as their peers. The Greenville County School District provides a full-time special education teacher and a skills coach, and South Carolina Vocational Rehabilitation Department provides a full-time skills coach and ongoing professional counseling as needed. Together, this core team provides immersive on-the-job training for students. Such placement is crucial to train interns to fill essential, high-turnover, entry-level positions within the hospital. Over the course of the school year, the students rotate through three 10-week internships in various departments throughout the hospital, such as linens, central sterile processing, patient transport, endoscopy and food services.

Candidates with potential to succeed in the program are nominated by special education teachers with the school district. Accompanied by a parent or family member, the candidates come to our site to undergo a skills test. The test is not designed to exclude candidates, rather, it is to identify skill sets, create an entry point for placement, and best indicate which candidates will excel in the program. After the selection is completed, the candidates are notified by a letter sent to their home. One parent of a candidate recalled the excitement of receiving the letter of acceptance by explaining, "When I opened the letter, I felt like I was opening the golden ticket to Willy Wonka's Chocolate Factory." The feeling of joy is shared across the community through social media posts, school system announcements and often a letter of praise from elected officials. The success of the program has had an incredible impact on the lives of the students, their families and the community we serve.

This model is successful because it provides not only on-the-job training, but a multitude of other tools for success — which go far beyond the necessary physical skills — required to achieve and maintain competitive employment. Through classroom instruction, the students learn independent living skills, how to manage their personal finances and essential self-advocacy skills. The graduates can understand and advocate for their rights in the workplace, articulate their skills and limitations, and request appropriate job accommodations. In addition to general and specific job skills, the students learn how to navigate the employment process. The students leave the program having created resumes, completed job applications and interviewed for their positions. The internships are not just assigned to each student, but the students must apply and interview for each rotation. As a result, students learn not only marketable job skills, but also how to look for a job, know what types of jobs they are qualified for, and come away equipped with the tools needed to be a successful employee.

UNDERSTANDING THE HUMAN ELEMENT
Perhaps the greatest impact on interns is to their self-confidence and personal growth. Unfortunately, many students come from a school environment where they are marginalized at best, and actively bullied at worst. Therefore, often their ability to relate to another is lacking as the trust factor has been fractured. Work, as in life, is really all about developing soft skills, which often is a difficult — yet vital — part of securing their employment. Soft skills are best learned through working in an integrated setting with other hospital employees. This is one key component to provide interns insight into gaining an understanding of workplace culture, helping them not just to keep their jobs, but to thrive in them. The integrated workplace experience allows for the development of communication skills, attitudes and professional workplace behaviors that employers desire.¹⁰

The following is an example of where God's love for God's people shines through the creativity of the teaching team. Last year, Liam, an intern on the autism spectrum, was doing an excellent job in the linens department but did not speak to his coworkers. The teachers compiled a list of questions for Liam to ask and set the timer for every 20 minutes on his phone. Liam's instructions were simple, noted as: When the timer goes off, look at your phone and turn to the person on your right and ask the question. Often, the questions were: How was your weekend? What is your favorite football team? Why do you love this job? This simple exercise helped Liam to break out of his shell and become comfortable communicating with and relating to his coworkers. Enacting such simple practices in the environment allows the intern to flourish and builds the trust needed for success.

The second component of success is twofold, one in how the interns both develop in a caring work environment and the other in how they change the entire culture of the organization. It is easy to witness how our interns are accepted and integrated with our frontline staff. The presence of the interns throughout the hospital is a hard-wired part of the organization. Once the interns are ingrained in their roles, they become part of this team. Often high-reliability, high-functioning departments that welcome an intern express the greatest associate satisfaction scores. They are welcomed in birthday parties, invited to staff lunches and fully integrated with their coworkers. For many interns, outside of their families, this is the first time they have ever functioned in a highly inclusive culture. Working alongside other hospital employees as equals provides a safe environment to learn and develop the soft skills required to flourish in community-based, integrated employment.

At first, some leaders found it difficult to envision a role for interns within their department. In the past five years, the experience of seeing the interns working and flourishing in their work led to the interns being valued and loved members of the St. Francis team. We now have 25 departments with opportunities to place interns — more than the number of interns we have in a given year — and our staff are disappointed if an intern is not assigned to their department for a rotation.

Bon Secours St. Francis Health System

Bon Secours St. Francis Health System Intern Class of 2023 for the Project SEARCH-Bon Secours St. Francis program in Greenville, South Carolina.

Another great example of this impact is Justin, an intern on the autism spectrum who was nonverbal for most of his life. Justin had been provided with supportive services throughout his schooling, but interning in the hospital really allowed him to flourish. Thanks to supportive coaching and associates who truly included and valued him as a member of the team, Justin slowly began to allow his voice to be heard. His mother recounted one day at the end of the school year when Justin came home after interning. He told his parents, "Hey guys, I got a job." It was the first time they had heard his voice in years. Justin's mother says this is the only time she has ever seen her husband cry.

COMMUNITY AND THE COMMON GOOD
Meaningful ministerial relationships occur when the community's greatest needs or desires intersect with the passion of a health care system. The dynamic partnership between Bon Secours St. Francis, Greenville County School District and South Carolina Vocational Rehabilitation Department created media attention, which led to further goodwill and a promise of hope within our community.

The community partnerships that formed to make this work possible represent the principle of the common good in action. The hallmark of the principle is understanding human beings as essentially social beings and that, in the words of Pope John XXIII, "individual human beings are the foundation, the cause, and the end of every social institution."¹¹ Striving for the common good unites people of goodwill towards a common purpose. The common good, says America magazine contributing editor Bill McCormick, SJ, "orders us in reason toward justice, creating social bonds that can be strengthened by charity."¹²

The philanthropic community stood with Bon Secours St. Francis in helping to bring the Project SEARCH vision to fruition. The monumental success of the program in its first few years led to incredible generosity from businesses and individuals in the community. This generosity allowed us to purchase Chromebooks for every intern. In 2021, we expanded the Project SEARCH classroom — thanks to a generous donor and our foundation, which secured a $750,000 donation — into an entire training center able to accommodate up to 18 interns at a time. The training center features a classroom with state-of-the-art technological capabilities, offices for the staff and skills trainers, mock hospital rooms where the students can practice skills before applying them in their internship rotations, and conference space for meetings and interviews.

CONCLUSION
The program is as beneficial to the hospital as it is to the students it serves and allows us to live out our mission. The internships are designed to train the students to fill real, essential support positions within the hospital — they are not merely invented for the sake of a diversity job hire, but are important and needed positions. The roles that the graduates often fill are high-repetition, high-turnover, entry-level positions that hospitals usually have a difficult time recruiting and maintaining with qualified candidates. The partnerships with support services such as vocational rehabilitation — which often continue after the student has graduated and achieved competitive employment — help the student to be successful in maintaining their job. Therefore, hiring our graduates is incredibly beneficial to the hospital by filling essential roles and reducing turnover.¹³

The joy which a family experiences in understanding that their loved one works in an environment where they are respected, appreciated and allowed to work to the maximum of their potential cannot be underestimated. Competitive, integrated employment provides not only essential income and benefits that will support these individuals throughout the continuum of life, but allows their human dignity to flourish through meaningful work and radical inclusion.

ALEX GARVEY is chief sponsorship officer for markets and shared services at Bon Secours Mercy Health. He is also the scholar in residence at Duquesne University Center for Global Health Ethics. JESSICA WEINGARTNER is director of mission for Bon Secours St. Francis Health System in Greenville, South Carolina, and system ethics lead for Bon Secours Mercy Health.

NOTES

1. Paul T. Shattuck, "Postsecondary Education and Employment among Youth with an Autism Spectrum Disorder," Pediatrics 129, no. 6 (June 2012): 1042-49, http://doi.org/10.1542/peds.2011-2864.
2. "A Shared Statement of Identity for the Catholic Health Ministry," Catholic Health Association, https://www.chausa.org/docs/default-source/mission/shared-statement-flyer_english.pdf?sfvrsn=34ba02f2_4.
3. Pope Francis, Laudato Si', paragraph 128, https://www.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20150524_enciclica-laudato-si.html.
4. Pope Benedict XVI, Caritas in Veritate, paragraph 32, https://www.vatican.va/content/benedict-xvi/en/encyclicals/documents/hf_ben-xvi_enc_20090629_caritas-in-veritate.html.
5. "Autism Statistics and Facts," Autism Speaks, https://www.autismspeaks.org/autism-statistics-asd.
6. Anne M. Roux et al., "National Autism Indicators Report: Developmental Disability Services and Outcomes in Adulthood," A.J. Drexel Autism Institute, Drexel University, 2017, https://drexel.edu/~/media/Files/autismoutcomes/publications/Natl%20Autism%20Indicators%20Report%202017_Final.ashx; "Subminimum Wage," U.S. Department of Labor, https://www.dol.gov/general/topic/wages/subminimumwage.
7. Holly N. Whittenburg et al., "Helping High School-Aged Military Dependents with Autism Gain Employment through Project SEARCH + ASD Supports," Military Medicine 185, no. 1 (January/February 2020): 663-68, https://doi.org/10.1093/milmed/usz224.
8. Susie Rutkowski, "Project SEARCH: A Demand-Side Model of High School Transition," Journal of Vocational Rehabilitation 25, no. 2 (November 2006): 85-96.
9. Pope John Paul II, Laborem Exercens, paragraph 22, https://www.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_14091981_laborem-exercens.html.
10. Paul Wehman et al., "Competitive Employment for Transition-Aged Youth with Significant Impact from Autism: A Multi-Site Randomized Clinical Trial," Journal of Autism and Developmental Disorders 50, no. 6 (June 2020): 1882-97, https://doi.org/10.1007/s10803-019-03940-2.
11. Pope John XXIII, Mater et Magistra, paragraph 219, https://www.vatican.va/content/john-xxiii/en/encyclicals/documents/hf_j-xxiii_enc_15051961_mater.html.
12. Bill McCormick, SJ, "We Need to Make the Common Good More than Just a Slogan," America, February 17, 2022, https://www.americamagazine.org/faith/2022/02/17/common-good-arturo-sosa-pope-francis-242385.
13. Bonnie O'Day, "Project SEARCH: Opening Doors to Employment for Young People with Disabilities," Mathematica, December 30, 2009, https://www.mathematica.org/publications/project-search-opening-doors-to-employment-for-young-people-with-disabilities.