Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A.

Meet Jill

Jill is one of the pioneers of Project SEARCH; she joined the original pro- gram site at Cincinnati Children’s Hospital Medical Center in the very early days—even before the structure of the High School Transition Program was formalized. She came to the program from her home school—a K through 12 school operated by the Hamilton County Board of Developmental Disabilities. Jill trained in the Sterile Processing department for about 5 months be- fore she was offered a job in that area. She worked with a job coach to learn how to assemble surgical trays (kits including the specifi c instruments needed for a given operation) and how to prepare them for the sterilization process. For each tray that Jill learned, her job coach, along with the Project SEARCH team, created a notebook showing photographs of each instrument in that tray. These notebooks took the place of the text-only checklists of surgical instruments that were typically used. Initially, the Project SEARCH team had Jill focus on learning the trays that had the highest utilization rates and the fewest instruments such as ear tube, tonsillectomy, and laceration trays. Over time, she kept learning and increasing the complexity of the trays that she could prepare such that she is now able to do 30 or 40 different trays—some with more than 150 different instruments. According to her supervisor, Timo- thy Lyons, “Jill is excellent on trays. She’s very thorough, she enjoys putting up trays, and she’s really focused when she does it.” Jill’s parents played an important supportive role in her success. While she was learning her job, they did homework with her every night—quizzing her on the names of instruments and discussing the subtle but important differences among them. To help her with the diffi cult “sterile fi eld” concept, Jill’s parents made the extra effort to train at the hospital in the process of maintaining a sterile area. They learned how to “suit up” to enter a sterile area, as well as the dos and don’ts of working in such areas, and used this knowledge to reinforce the procedures with Jill at home. Jill and her dad still do homework once a week to help keep her skills sharp. Jill is continuously progressing in her job. At fi rst, she worked part time but later changed to a full-time schedule. In addition, she continues to add new trays to her repertoire. Jill uses a photo book each time she learns a new tray but quickly memorizes the trays and no longer needs the book. In addi- tion to her own personal progress, Jill has also been able to keep up with the constant changes that are inherent in the work she does—newly designed surgical instruments, changes based on doctors’ preferences, and changes in policy and procedures. For example, the department instituted a system of bar codes so that each step in the sterilization process could be traced back to the responsible individual, and Jill seamlessly incorporated this change

(continued)

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The Project SEARCH Model: A Business-Driven Approach

into all her work. Jill no longer needs a job coach to help her retrain in response to such changes. Instead, she goes through departmental in-service trainings along with her colleagues. She eats lunch with her co-workers every day, has an identical workspace to any other employee, and enjoys the same salary and benefi ts. Jill recently celebrated her 10-year anniversary with Cincinnati Children’s. When you ask Jill about her work at the hospital, she simply says, “I love my job!”

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Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A.

The Project SEARCH

High School Transition Program

While freedom of choice is given, the right to work is earned.

Stephen Simon, 1998

hen Jim D. fi nished high school, he knew he wanted a career, but like most teen- agers, he didn’t feel ready to start navigating the vast and confusing world of work. Because Jim has autism, he was on an individualized education program

W(IEP) and, thus, eligible for 3 years of transition services through his school dis-

trict, which he and his family hoped would help him in defi ning his goals. But it didn’t turn out quite as they had expected. His fi rst year consisted of 5-day weeks in the transition pro- gram, and in the second year, the program was offered 2 days a week. At the end of the fi rst 2 years of transition, he wasn’t any closer to knowing what he wanted to do or to having a real career plan in place. He had spent his mornings taking a class at a community college, and by mid-morning, he and the other students were bused back to the transition program where they spent the rest of the day in seminar classes on a variety of topics such as dating, social skills, and resume writing. The program was strongly focused on independent living skills, with the expectation that the students would independently fi nd employment so that they could prac- tice their job skills. Jim’s teachers showed him how to look for jobs in the newspaper and on the internet, and vocational rehabilitation (VR) services were available to him, but the job search and application process were pretty much left up to him. This was confusing for the students and their families. In some instances, the students were treated as if they had limited abilities, but at other times, the transition staff had expectations that seemed unrealistically high. The way Jim’s mother, Sandy, described it, “They acted as if the transition students were capable, but just needed to be pushed.” But she knew that her son needed more than just a push. He was trying his hardest to meet the goals put before him. After 2 years of working on his independent living skills in a large group setting, it was time to see what else was out there. Jim needed a smaller setting in which he could build upon his skills and develop and practice them in order to reach his employment goals. It was in this context that Jim and his family learned about the Project SEARCH ® program starting up at Medtronic, Inc., an international medical technology company in Minneapolis. From their fi rst contact with the program at the Project SEARCH Open House, the family was impressed with

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Daston, Riehle, and Rutkowski

the philosophy and atmosphere that was so positive and focused on the students’ strengths. Sandy D. could see right away the effect it had on the participants, “It’s building them up and helping them feel good about themselves—helping them feel capable and confi dent.” And in that environment, with plenty of support coupled with high expectations, she could see that the students were thriving and surprising themselves and everyone around them with what they were capable of. Jim and his family knew right away that this was where they wanted Jim to be. Jim applied for Project SEARCH at Medtronic and was accepted. He began Project SEARCH in the fall of his third year of transition, and his experience in the program was what he and his family had hoped for. Now that Jim has been able to train in several different types of jobs, his confi dence has increased, he’s gained new skills, and he has a good idea of the kind of work he wants to do. Moreover, he and his family have found that the way the school, the business, and VR all work together in Project SEARCH has made Jim’s relationship with his VR counselor much more productive. Jim had been linked with VR at the end of high school, but although his VR counselor was equipped to help him prepare for and fi nd a specifi c type of job, the counselor was lacking the resources to help Jim decide what sort of job interested him. There seemed to be a mismatch in the information that VR expected to get from the family and what the family was actually prepared to tell them. Without the opportunity for job explora- tion, Jim and his parents didn’t know what he would enjoy or be good at—they didn’t even know the names of the jobs. But after his time in Project SEARCH, Jim had three internships under his belt and knew exactly what sort of work he wanted to do, and he had the language and terminology to name those jobs in a way that his VR counselor could understand. In ad- dition, he was able to tell his counselor exactly what skills he had that qualifi ed him for those jobs. Jim’s experience in Project SEARCH gave him new, marketable skills and helped him to defi ne his career path. At the same time, it’s helped him to get more out of his interaction with VR so that, shortly after he graduated from the program, he was offered and accepted a job in the human resources department of a local clinic. As his mother Sandy said, “This is what transition services should be!” Project SEARCH is primarily focused on young people with disabilities, like Jim, as they transition from high school to adult life. We emphasize this age group because of the copious research and practical experience showing that this is a critical juncture for establishing lifelong patterns. For a young person with a disability, an unsuccessful transition can lead to lower self-esteem, diminished engagement in social activities, decreased life satisfaction, and lower income. On a societal level, unsuccessful transitions to adulthood are associated with reduced productivity, lower tax revenues, and higher rates of criminal activity and incarceration (Fraker & Rangarajan, 2009). Conversely, when young people are prepared to enter the work force, they gain a number of personal benefi ts as well as an increased likelihood that they will achieve fi-nancial independence and, thus, become less dependent on their families and on social services. Because of the high stakes, and the considerable costs of unsuccessful transition—to the young people themselves, to their families, and for society as a whole—interventions that target this transitional period are particularly effective in combating the chronic problems of unemploy- ment and underemployment for people with intellectual and developmental disabilities (IDD). The change from high school to adult life is a demanding time for everyone, and any young person can benefi t from the guidance that an experienced adult can offer at this stage. But young people with intellectual and developmental disabilities face particular challenges that heighten that need for assistance. Disability research has provided decades of data documenting persist- ent low rates of participation in employment, postsecondary education, and other indicators of productive engagement for young people with disabilities in the years after they exit high school (Benz, Lindstrom, & Yovanoff, 2000; Peraino, 1992; Wagner, Blackorby, Cameto, Hebeler, & Newman, 1993; Wagner, Cameto, & Newman, 2003). Recognizing this problem, federal law now mandates transition assistance for students receiving special education services under the Individuals with Disabilities Education Act (IDEA, PL 108-446). However, although excellent

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Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A.

The Project SEARCH High School Transition Program

Table 3.1. Differences between a traditional school environment and a Project SEARCHfi classroom/host business

Traditional school environment Project SEARCH Social environment Many social activities are available to students Students have team-building activities, staff meet- such as dances, plays, and clubswith the goal ings, and other work-related activities that are of developing more well-rounded people. social but have work-specifi c purposes. Performance Many schools reward effort. They will look for alter-Employers reward results. They will look for native methods when a student is not learning or alternative ways to give employees the skills to exhibits a bad attitude. perform the job. Employers are looking for per- formance, ability, and a positive attitude. Dress code A more casual dress code is tolerated. More leni-Employers will have specifi c, formal, and uniform ent dress standards are acceptabletattoos, dress requirements, with strict rules about foot- extreme hairstyles, and facial piercings are often wear, jewelry, and tattoos. In a business, the cus- tolerated. tomers perceptions are of extreme importance. Support personnel Various individualssuch as counselors, special Most employers do not have a nurse or any oth- needs coordinators, and nursesare available er coordinator to help the employee with daily on a daily basis to handle personal problems struggles. Project SEARCH partners can fi ll this that may occur. need, but not always in person or on a daily ba- sis. Job coaches are on site to teach the essen- tial job functions and core skills. Discipline A principal or other administrator is available to ad-Managers and supervisors handle any discipline dress and enforce concerns that could lead to items. Documentation, performance improve- detentions, suspensions, or any other deterrent. ment plans, or possible termination may result. Environment Loud voices, talking in the hallways, running, and In a professional environment, there is no running bells indicating where one should be are all typi-or shouting, and there are no bells or other in- cal in school. dicators to help students know when to take a break, go to lunch, return from break, or return from lunch.

services are available in many regions, there is no consistency in the quality or availability of such assistance throughout the United States (Larson, Goldberg, McDonald, Leuchovius, Rich- ardson, & Lakin, 2011). Moreover, when transition services are available, they are often deliv- ered with good intentions but in an unfocused manner with no clear pathway to employment. Consequently, youth with disabilities often miss out on opportunities to develop the specifi c competencies, work habits, communication skills, and attitudes that employers look for when making hiring decisions and that are critical to maintaining employment once hired.

OVERVIEW OF CONCEPTS IN TRANSITION

IDEA is the special education law mandating free and appropriate public education for eligi- ble infants, toddlers, children, and youth with disabilities. It was originally enacted in 1975 and most recently amended in 2004. The law specifi es how states, school districts, and pub- lic agencies are to provide early intervention, special education, and related services. With regard to transition, IDEA states that services should be based on the individual student’s needs and interests [34 CFR 300.43 (a)] [20 U.S.C. 1401(34)]. Section 602 (30)(C) of the act speci- fi es that transition services include “instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and, when appro- priate, acquisition of daily living skills and functional vocational evaluation.” This is an all- encompassing mandate and effectively delivering on all seven of these broadly stated priori- ties is a lot to expect of the schools. Schools do a lot of things well, but considering that they are trying to incorporate so many elements, it’s not surprising that transition programs some- times lack focus. Some schools respond to this mandate by trying to cover all seven aspects of transition at once with no clear progression. But, in many cases, schools make an effort to break down the goals and address them in a logical sequence in their transition programs or in traditional career technical training.

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Daston, Riehle, and Rutkowski

FEDERAL DEFINITION OF TRANSITION SERVICES UNDER THE INDIVIDUALS WITH DISABILITIES EDUCATION ACT (IDEA, PL 108-446)

The term transition services means a coordinated set of activities for a child with a disability that

• **** Is designed to be within a results-oriented process, that is focused on improving the academic and func- tional achievement of the child with a disability to facilitate the childs movement from school to postschool activities, including postsecondary education; vocational education; integrated employment (including supported employment); continuing and adult education; adult services; independent living; or community participation
• **** Is based on the individual childs needs, taking into account the childs strengths, preferences, and inter- ests
• **** Includes instruction, related services, community experiences, the development of employment and other postschool adult living objectives, and if appropriate, acquisition of daily living skills and functional voca- tional evaluation Schools have developed different programs and practices to meet IDEA requirements and prepare students for employment. In traditional classroom models, employability training takes place strictly in a school setting with students in segregated special education classrooms. Work- study models combine classroom instruction with actual work experience, but usually, time at a community work setting is limited to a few hours a day or week. Students might participate in job-shadowing or tour worksites in groups. Many programs include a transition-to-community component that emphasizes social skills and independent living skills. Other programs use an adapted career and technical model in which job skills are taught in a laboratory environment with simulated or actual worksites that model different business sectors such as restaurants, hotels, or horticulture operations. Among the factors that distinguish the different options, the degree to which students are exposed to real work environments is one that seems to make the biggest difference in work readiness (Carter et al., 2011; National Alliance for Secondary Educa- tion and Transition, 2005; Test, Fowler, Richter, White, Mazzotti, Walker, et al., 2009).

Table 3.2. Project SEARCHfi High School Transition contributes to Individuals with Disabilities Education Act performance indicators

IDEA indicator Performance measure Relevant Project SEARCH features

1. Graduation* Percentage of youth with IEPs gradu- State-approved curriculum and lesson plans are used. ating from high school Formal assessments are performed. All goals are focused on training and employment. Students have completed high school graduation requi- rements before entering program.

2. Least restrictive envi-Percentage of children with IEPs Immersion in host business is 100% of time. ronment served inside the regular classroom Ample opportunity exists to model work environment less than 40% of the school day and culture in integrated environment. Internships teach competitive, marketable work skills. Curriculum reinforces business culture.

3. Parent involvement Percentage of parents with a child re- Parents/families are an integral part of students team ceiving special education services and are expected to attend monthly progress meetings. who report that schools facilitated Parents/families receive training in transition topics and parent involvement guidance on how best to support students. Parents/families are active participants in the job devel- opment process.

4. Quality of IEPs and tran-Percentage of youth ages 16 and old- Teachers receive training on quality transition goals. sition goals er with an IEP that includes coordi- Assessments measure career readiness and employnated, measurable, and annual IEP ability skills. goals and transition services that Regular meetings with team are designed to monitor will reasonably enable the student progress toward goals. to meet the postsecondary goals (continued)

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Table 3.2. (continued)

into the program. Program fi delity is ensured through licensing agreement and audits. Note: Through IDEA and its specifi c recommendations regarding transition, schools have been given more responsibility for employment outcomes. State departments of education and local education agencies (LEAs) are held accountable to signifi cantly improve their outcomes tied to federal IDEA indicators, with an emphasis on attaining higher outcomes as it relates to IDEA indicator 14, postschool outcomes. Schools benefi t from their involvement in Project SEARCH because it helps them to satisfy 5 of the 14 federal student outcome−related performance indicators that show compliance with IDEA. Project SEARCH has a strong track record of working effi ciently with LEAs to signifi cantly increase their outcomes tied to federal IDEA indicators 1, 5, 8, 13, and

track record of working effi ciently with LEAs to signifi cantly increase their outcomes tied to federal IDEA indicators 1, 5, 8, 13, and 14. That is, whereas the ultimate objective for Project SEARCH is to secure competitive employment for its student graduates, the programs core model components and curriculum focus on the least restrictive environment, the development and implementation of IEPs with quality transition goals, family involvement, employment outcomes, and graduation. *Participating in Project SEARCH, or any other transition program, promotes progress toward graduation but requires stu-

*Participating in Project SEARCH, or any other transition program, promotes progress toward graduation but requires students to stay in high school longer than the traditional 4 years. Currently there are federal school performance measures that confl ict with IDEA indicators in that they emphasize graduation in 4 years. However, IDEA and the need for students with disabilities

Key: IDEA, Individuals with Disabilities Education Act, PL 108-446; IEPs, individualized education programs. OVERVIEW OF THE PROJECT SEARCH HIGH SCHOOL TRANSITION PROGRAM

strongly believe and have the expectation that each student can achieve the goal of competitive employment. As the inventor and philanthropist Charles Kettering put it, we “believe and act as if it is impossible to fail.” The Project SEARCH program works best when it is offered as part of a continuum of transition services. In general, the most successful students are those who come to Project SEARCH after spending 1 or 2 years in more traditional career and technical education programs that al-

low for maturation, functional skill development, and career exploration. In this way, students can use the fi rst part of their transition process to focus on the softer aspects of the section 602

Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A.

Daston, Riehle, and Rutkowski

defi nition of transition such as community experiences, adult living objectives, and daily liv- ing skills. Project SEARCH continues to reinforce those skills, but the context clearly shifts to a laser-like focus on the development of work skills and getting a job. The Project SEARCH approach can be applied to supported employment for adults; this has been done successfully in several contexts. However, when working with prospective Project SEARCH sites, we strongly recommend that they initiate their program by introducing a High School Transition Program. There are two reasons for this: the fi rst relates to the impor- tance of reaching youth at this juncture, and the second relates to the powerful impact that the High School Transition Program has on business culture. As Erin Riehle put it,

Instead of having a High School Transition Program, Cincinnati Children’s could hire three adults with signifi cant disabilities tomorrow. Those new employees could do fabulous work, but the dif- ference is that they’d be scattered throughout the hospital and they wouldn’t create a big enough presence to drive institutional culture change. In contrast, when you take 12 student interns and, over the course of a year, move each one of them through two or three departments where they are learning real skills—by the end of the school year you could potentially have 20 department heads that, for the fi rst time in their lives, have worked with people with disabilities. And they now see those individuals through different eyes—as capable adults. You also have 20 or more groups of staff who now see people with disabilities as inherently capable people who are able to learn and perform complex tasks. Suddenly, you’re not worried about them or afraid of them, but you see them as people who fi t into your mix and you can see them as colleagues. The extensive pres- ence that comes with a High School Transition Program makes a signifi cant impact and, with that change, it becomes easier for everyone to envision a person with a signifi cant disability becoming a permanent part of that environment.

This scenario has been played out time and again at Project SEARCH sites: Skeptical managers and co-workers become transformed by their experiences with young people with disabilities. And this transformation is possible because of the duration and extent of their interactions with

PROJECT SEARCH AND SPECIAL EDUCATION: DIFFERENT FOCUS, DIFFERENT RULES

To participate in a Project SEARCH program, students have to apply and be accepted. Part of the purpose of this application is to demonstrate an awareness of the Project SEARCH process and a willingness to move be- yond the protections and entitlements of special education. Because we are an application-only program, and not the sole option for transitioning students, we have the fl exibility to vary from some of the standard special education procedures when they are at odds with our goals of employment and independence. For example, independent travel is not just encouraged, but rather, it is required by Project SEARCH programs in most are- as. That is, there is no school bus or van involved in transporting the young people to the worksite. Each young adult must complete travel training during the summer before entering the program or during the fi rst intern- ship. The goal is for each young adult to learn to travel as independently as possible. In some circumstances, this might mean that they are driven by a friend or family member, but ideally, the family and the young adult will begin to take advantage of the best options available in the community. This could mean public transporta- tion, a taxi, ride sharing, or a variety of other options. Another example in which Project SEARCH differs from school-based special education is in the approach to special services such as speech therapy, psychological services, or mobility training. We are supportive of students receiving the services that they need; however, we require that they have those needs met in the same way as others who are functioning in an adult world. That is, appointments must be scheduled so that they do not interrupt the skills training that is the raison dŒtre of Project SEARCH. For example, occupational therapy will be provided as a consultation rather than an ongoing service and occurs at the internship site to integrate recommendations directly into the work environment. With each internship, the providers of special services (such as occupational therapists) can return to the new internship, consult with the staff, and deter- mine the scope of services. These specialists could also attend the monthly employment-planning meeting, consult with the team, address issues, and help solve problems.

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The Project SEARCH High School Transition Program

the student interns. It would happen much more slowly, or not at all, in a business following the typical model of supported employment. First of all, in a typical job application process, an applicant with a disability would be less likely to get a job in the fi rst place because they would be a complete unknown to the business and, without the internships, wouldn’t have re- ceived the training or the opportunity to demonstrate their capabilities. Moreover, even if the applicant is successful in getting the job, the hiring of individuals with disabilities would be an isolated event. In these circumstances, the individuals with disabilities are likely to be scattered too widely to make an impact beyond their immediate surroundings, and they may not have received suffi cient orientation or training to allow them to perform to their highest potential. In contrast, with the Project SEARCH model, students enter the business with the support of a job coach and a special education teacher, which ensures that students receive the guidance that they need to succeed. And it makes a powerful impression on managers and co-workers to observe the students as they grow in maturity, improve in accuracy and effi ciency, and acquire new skills.

Target Population

The Project SEARCH High School Transition Program serves students with signifi cant intel- lectual and developmental disabilities who are transitioning from high school to adult life. Most fall in the age range of 18 to 22 years, but more importantly, these are students who are on an IEP, have completed all of their high school credits and graduation or certifi cation requirements, and have deferred graduation status. The most important eligibility criterion is a personal and family desire to achieve competitive employment.

FEDERAL DEFINITION OF DEVELOPMENTAL DISABILITIES

According to the Developmental Disabilities Act, section 102(8), the term developmental disability means a severe, chronic disability of an individual 5 years of age or older that

1. Is attributable to a mental or physical impairment or combination of mental and physical impairments;
2. Is manifested before the individual attains age 22;
3. Is likely to continue indefi nitely;
4. Results in substantial functional limitations in three or more of the following areas of major life activity: i. Self-care; ii. Receptive and expressive language; iii. Learning; iv. Mobility; v. Self-direction; vi. Capacity for independent living; and vii. Economic self-suffi ciency.
5. Refl ects the individuals need for a combination and sequence of special, interdisciplinary, or generic services, supports, or other assistance that is of lifelong or extended duration and is individually planned and coordinated, except that such term, when applied to infants and young children, means individuals from birth to age 5, inclusive, who have substantial developmental delay or specifi c congenital or acquired conditions with a high probability of resulting in developmental disabilities if services are not provided. From the web site Real People, Real Jobs: Stories from the Front Lines (http://www.realworkstories.org/dev-disability-defi nition)

DEFINITION OF INTELLECTUAL DISABILITY

“Intellectual disability is a disability characterized by signifi cant limitations both in intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18. From the web site of the American Association on Intellectual and Developmental Disabilities (http://www.aaidd.org/content_100.cfm?navID=21)

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PROJECT SEARCH HIGH SCHOOL TRANSITION PROGRAM ENTRANCE CRITERIA

Is at least 18 years of age Has completed high school credits necessary for graduation or certifi cate Agrees that this will be the last year of student services and will accept diploma or certifi cate at the end of Project SEARCH Meets eligibility requirements for vocational rehabilitation Meets eligibility requirements for developmental disabilities services and other service providers as neces- sary for follow-along services (This is preferred but not necessary.) Has independent personal hygiene and grooming skills Has independent daily living skills Is able to maintain appropriate behavior and social skills in the workplace Is able to take direction from supervisors and modify performance or change behavior, as requested Is able to communicate effectively Can utilize public transportation when available and participate in travel training to maximize independence in travel Has previous experience in a work environment (including school, volunteer, or paid work) Is able to pass drug screen and felony check and have immunizations up to date Desires and plans to work competitively in the community at the conclusion of the Project SEARCH program

Deferred graduation is an IDEA provision that allows for education and transition serv- ices for young people with disabilities to continue until the age of 22. It is a policy that is implemented locally such that the specifi c structure varies regionally. But, regardless of the lo- cale, the legislation provides students with disabilities the opportunity to gain additional skills training. This eligibility ends once a student accepts a regular high school diploma or special education certifi cate. Leveraging the option of deferred graduation is a key concept in fund- ing the Project SEARCH High School Transition Program. Before entering Project SEARCH, students complete their academic requirements but do not accept their diploma until after completing the program. Alternatively, a student might participate with his or her peers in the important social ritual of the high school graduation ceremony. However, the student would receive a blank diploma and, thus, remain eligible for per-student education dollars from a combination of federal, state, and local sources, as well as special education-weighted fund- ing. In the Project SEARCH High School Transition Model, those education dollars are used to support the special education teacher who has responsibility for supervising students in the program and planning and delivering the Project SEARCH curriculum in the worksite-based classroom. Under certain circumstances, young adults who have already received a high school di- ploma or certifi cate of completion can also participate in the Project SEARCH High School Transition Program. Young adults who have aged out of high school can fi ll vacant slots in a Project SEARCH program if the recruiting team cannot identify enough eligible high school– aged students to fi ll a classroom or if a space opens up mid-year because a student intern is hired and leaves the program for regular employment. Either way, inclusion of these young adults can present certain challenges. First of all, if a young person is no longer school-eligible, she or he will not be accompanied by the per-pupil education dollars that helps to pay the instructor’s salary, which can leave the program with a gap in funding that could be fi lled through funding from an adult disability employment agency, such as VR. The other chal- lenge is that a large age difference among the students can disrupt the dynamics of the Project SEARCH experience. An important part of Project SEARCH’s formula for success is the forma- tion of a supportive cohort of similarly aged peers, and a student who is at a different life stage

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The Project SEARCH High School Transition Program

and mind-set may not identify with or interact well with high school students. We recommend that eligibility guidelines be set around age, typically limiting participation in the program to young adults ages 26 and younger. Adult candidates must be eligible for services from VR and, ideally, the local DD agency as well. Also, the young adults must go through the same applica- tion procedure as the high school students. That is, they should submit an application along with all supporting documentation; take part in an interview; and participate in a program site tour or hands-on assessment, or both. All or part of the selection committee should meet to interview and assess the young adult candidate and accept or decline the application. Another way to include young adults in Project SEARCH is to create a program that is strictly for high school graduates. In this model, no school system would be involved and the instructor would not necessarily be a special education teacher. An experienced and strong rehabilitation professional, or possibly a community college instructor with special education training, could fi ll this role (many of our U.K. Project SEARCH sites follow this model). How- ever, because there would be no school system involved in the program, arrangements would have to be made for a supported employment agency to cover the cost of instruction. Funding is a challenge for this type of program; some agencies have utilized “Day Rehab,” Medicaid, and/or VR as funding sources. We continue to recommend the high school program as the best model for implementing Project SEARCH. If a “young adult–only” program is implemented, all other aspects of the typical structure and model should be maintained.

Program Overview

Students attend the Project SEARCH High School Transition Program for a full school year (see

Figure 3.4). Each program site is based in a place of business. The host business provides an on-

site classroom that can accommodate approximately 12 students. The specifi c number will vary from site to site from as few as 6 to as many as 15, based on the local minimum requirements for a full classroom (i.e., the number of students required to cover the expense of staffi ng the classroom with a teacher) and the capacity of the host business. Each site is staffed by a teacher and job coaches (a suffi cient number to achieve a 4:1 student-to-coach ratio). The required credentials for teachers will vary from state to state, but in Ohio (where Project SEARCH origi- nated), the requirements include a special education or vocational education certifi cate and a state-licensed transition-to-work endorsement. For continuity in the program, it is critical that each Project SEARCH site is staffed by a single teacher and that 100% of that teacher’s work time is devoted to facilitating and coordinating the Project SEARCH program. Likewise, the job coaches should be consistent at a given site. Figures 3.1 and 3.2 show how the teacher’s and the job coach‘s specifi c duties shift throughout the school year. After an initial orientation period of 3 to 4 weeks, the students’ day consists of a 1-hour morning classroom session in which they participate in activities designed to enhance employ- ability and independent living skills, as shown in Table 3.3. The rest of the day is devoted to learning specifi c, relevant, and transferable job skills in an internship. Students rotate through two to three different worksite internships throughout the business over the course of the year. Throughout the week, the students participate in a minimum of 20 hours at their internship to learn work skills as well as social and communication skills. As they experience the culture and learn to function with support and guidance, they utilize classroom time at the end of the day to review their work and experiences, discuss different options, and plan for the next day.

Figure 3.3 shows how the specifi c roles and responsibilities of the students evolve as they move

from their last year of high school (the Project SEARCH planning year) into Project SEARCH and as they progress through the program year. Each program site is guided by an Advisory Board that includes Project SEARCH teach- ers and job coaches, an additional special education administrator, VR counselors, employer representatives, family members, and Project SEARCH students or alumni with disabilities.

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32 Daston, Riehle, and Rutkowski Role: Teacher Student recruitment: organize school presentations, information sessions, tours, skills assessment days, student interviews, selection process and perform, associated tasks such as application process selection rubric and eligibility determination Internships: identify and analyze potential internship locations, develop task designs for internship areas, provide job coaching, monitor and evaluate intern progress, provide education and communicate with internship site staff, and create job accommodations Job development: analyze employment climate, connect with community employers, build vocational profi les for interns, provide individual job search activities, and facilitate supports for competitive employment Meetings and marketing: develop and utilize marketing tools and facilitate Business Advisory Committee, intern employmentplanning meetings, individualized education program (IEP) meetings, and other problem-solving team meetings Teaching and curriculum: orientation to host business, individual, and group classroom instruction Training and staff development: participate in Project SEARCHfisponsored training, prepare and deliver family involvement curriculum, and prepare and deliver program information to internal and external partners Technical assistance: work with the internal Project SEARCH team on program development and continuous improvement Paperwork: process licensing agreement, intern attendance sheets, Commission on Accreditation of Rehabilitation

5% 5% 5% Program Phase: Year 1, 1st QuarterSeptember, October, and November Assumption: The program year begins in late August and the interns are in the classroom for the majority of the day through

Assumption: The program year begins in late August and the interns are in the classroom for the majority of the day through early September for orientation activities. Job development activities, such as analyzing local employment needs, begin early in the year.

Program Phase: Year 1, 2nd Quarter—December, January, and February

5% 5% Program Phase: Year 1, 2nd QuarterDecember, January, and February Assumption: A focus on teaching the curriculum remains strong, but it shifts from general employability skills to lessons directed

Program Phase: Year 1, 3rd QuarterMarch, April, and May

40%40% Program Phase: Year 1, 3rd QuarterMarch, April, and May Assumption: Activities for the current class shifts to job placement. If a community placement service is part of the team, the

Program Phase: Year 1, 4th Quarter-June, July, and August

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5% 30% 30% 5% Program Phase: Year 1, 4th QuarterJune, July, and August Assumption: The teacher will need to have 20 contracted days between June and August to fi nalize job placement activities for

5% 5% Program Phase: Planning Year, 4th QuarterJune, July, and August Assumption: The job coach will need to be hired by July or early August and have 1015 contracted days during this quarter. Some days will be needed before the program begins so that the Job Coach can complete the host business orientation, receive training

Assumption: The interns are placed in their fi rst rotation (department worksite) by early to middle September. Job coaches use a majority of their time in late August and early September to prepare standard work (task designs) for internship departments.

Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A.

The Project SEARCH High School Transition Program

5% 5%

10% 10% 15% 15% **5%**5%

15% 15% **50%**50%

Program Phase: Year 1, 2nd QuarterDecember, January, and February Assumption: The job coach remains focused on internships and teaching job skills, including task designs, task analysis, and job accommodations. Other activities include assisting with job development and recruitment activities.

**5%**5% 5% 5%

10% 10%

20% 20%

60% 60%

Program Phase: Year 1, 3rd QuarterMarch, April, and May Assumption: Activities related to successful internships continue. It is critical to identify teaching/coaching strategies for the intern as the job placement phase intensifi es. Coaches also will assist with new student recruitment activities and job placement planning.

10% 10% 10% 10% **5%**5% 60% 60% 5% 5% 10% 10%

Program Phase: Year 1, 4th QuarterJune, July, and August Assumption: The job coach for the program may also be the coach assigned to the community job. If so, that will be the focus of the work. The coach will need contracted days during this quarter to participate in Project SEARCH training and review internship task designs in August.

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Table 3.3. A typical day for a Project SEARCH student

Time* Activity Comments

8:00 a.m.9:00 a.m. In the class-Students sign in. Lessons are based on an approved Project SEARCHfi curriculum room: employ-that focuses on daily living/employability skills (i.e., team building, workplace navi- ability skills gation, safety, technology, social skills, communication, interviewing skills, money class management, health and wellness, resume and career passport, job search skills, and keeping a job). Instruction follows an approved Project SEARCH curriculum. 9:00 a.m.11:30 a.m. At internship Students participate in nonpaid job internships in departments throughout the host sites: morning business. They rotate through three different internships throughout the school session year and learn the core skills of entry-level jobs. 11:30 a.m.12:00 p.m. Lunch Students may purchase a lunch or pack their own. Students are encouraged to eat with their co-workers and peers at the internship sites. 12:00 p.m.2:00 p.m. At internship Students return to sponsoring department to continue learning job-specifi c and em- sites: afternoon ployability skills. session 2:00 p.m.2:30 p.m. Reconvene in At the end of the day, students have time in the classroom for refl ection on the days the classroom events, planning, and working on communication skills (journaling, group discussion). Students sign out at 2:30 p.m. and, if available, take public transportation home.

*Project SEARCH follows the yearly calendar and daily start and dismissal schedule of the local school district. Make the host business aware of any holiday breaks, staff professional development days, and weather-related closures or days the students will be absent. This schedule can be fl exible and responsive to the businesss needs. For example, the curriculum could be taught at the end of the day if an earlier start time is needed to accom- modate worksites at which mornings are particularly busy, as is often the case in hospitals and other health care settings. The bookend class times allow for maximum and immediate teaching opportunities. If one of the students has an issue with another co-worker or supervisor or a question arises regarding protocol or following the code of contact, the class can review the situation and have a discussion, role play, develop a T-chart, or use some other strategy to problem solve and address the new issue. The time spent on internships should equal 20 to 25 hours per week, which builds skills and stamina for a part- to full-time position.

Role: Student

Competetive employment: this includes all of the tasks associated with being an employee, which vary depending on the employer and the specifi c job Student recruitment: organize school presentations, information sessions, tours, skills assessment days, student interviews, selection process and perform associated tasks such as application process selection rubric and eligibility determination Internships: identify and analyze potential internship locations, develop task designs for internship areas, provide job coach- ing, monitor and evaluate intern progress, provide education and communicate with internship site staff, and create job accommodations Job development: analyze employment climate, connect with community employers, build vocational profi les for interns, provide individual job search activities, and facilitate supports for competitive employment Meetings and marketing: develop and utilize marketing tools and facilitate Business Advisory Committee, intern employment- planning meetings, individualized education program (IEP) meetings, and other problem-solving team meetings Teaching and curriculum: orientation to host business, individual, and group classroom instruction Training and staff development: participate in Project SEARCHfisponsored training, prepare and deliver family involvement curriculum, and prepare and deliver program information to internal and external partners Technical assistance: work with the internal Project SEARCH team on program development and continuous improvement Paperwork: process licensing agreement, intern attendance sheets, Commission on Accreditation of Rehabilitation Facili- ties (CARF) reports, intern progress reports, billing to funders, grant-related reports; create materials for interns and busi- nesses

Figure 3.3. Student responsibilities. Pie charts at left indicate time spent on regular school-related tasks (gray) versus Project

SEARCH tasks (black); charts at right break down the Project SEARCH tasks (see key above).

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The Project SEARCH High School Transition Program

10% 10% 10% 10%

Regular school-

**related tasks vs.50%**50% Project SEARCH tasks Project SEARCH 40% 40% 90% 90% tasks

Program Phase: Preentry Year (when the student applies for entry into Project SEARCH), 1st QuarterSeptember, October, and November Assumption: Potential students for Project SEARCHfi are completing their academic credit requirements for graduation. Individu- alized education program (IEP) planning should include transition to work activities such as job shadowing, paid or unpaid work experiences, and career counseling. Students should have a vocational rehabilitation (VR) counselor in place and apply for devel- opmental disabilities (DD) services. There are often work study, career tech or transition opportunities for students to prepare for a Project SEARCH program.

10% 10% **10%**10%

Regular school-

20% 20% **related tasks vs.60%**60% Project SEARCH tasks Project SEARCH 90% 90% tasks 10% 10%

Program Phase: Preentry Year, 2nd QuarterDecember, January, and February Assumption: Students will receive information about Project SEARCH from teachers or vocational rehabilitation (VR) counselor and have access to the application process.

10% 10%

30% 30% Regular school- related tasks vs. 50%50%Project SEARCH tasks Project SEARCH 90% 90% tasks 20% 20%

Program Phase: Preentry Year, 3rd QuarterMarch, April, and May Assumption: Students will complete the individualized education program (IEP) process and vocational rehabilitation (VR) plan- ning process for participating in Project SEARCH in the fall.

(continued)

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38

Regular schoolrelated tasks vs.

Project SEARCH tasks

Program Phase: Preentry Year, 4th Quarter—June, July, and August

Program Phase: Preentry Year, 4th QuarterJune, July, and August Assumption: Students will complete the host site entrance requirements, such as updated immunizations and background checks,

5% 5%

5% Program Phase: Program Year, 1st QuarterSeptember, October, and November

Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A.

The Project SEARCH High School Transition Program

5% 5% 10% 10%

45% 45%

40% 40%

Program Phase: Program Year, 3rd QuarterMarch, April, and May Assumption: The students complete their fi nal internship, which should be targeted to potential employment opportunities either in the host site or in a community business. The students work toward maximizing their skills and making the transition from intern to employee.

5% 5% **5%**5%

90% 90%

Program Phase: Program Year, 4th QuarterJune, July, and August Assumption: The student completes processes for employment and works with a job coach to meet and exceed employer expec- tations. The student learns self-monitoring techniques to ensure maximum sustained performance. The student can be a useful team member for evaluating and improving the Project SEARCH program. If the student is not yet employed, job development replaces employment on the chart.

Monitoring Student Progress

Each student is carefully monitored throughout his or her time in the Project SEARCH pro- gram. This is achieved on a daily basis, through the student’s regular contact with the teacher, job coaches, and worksite supervisors, co-workers, and mentors. In addition, the student’s progress is tracked by a team that includes the student, family members, the teacher, the stu- dent’s job coach, the student’s VR counselor, the employment specialist, and others as ap- propriate. By interacting with this team, the student builds a network of people and resources to help in defi ning and reaching employment goals. Starting with an initial employment- planning meeting at the beginning of the school year, each student’s team meets monthly or at least twice during each internship. At the meetings, the team reviews the student’s progress on skill acquisition, discusses any challenges he or she may be encountering, and helps to plan for future internships. These meetings keep the focus on the goal of employment and ensure that each student has established realistic goals and that he or she is making steady progress toward those goals. The meetings also teach the students self-advocacy skills because they are expected to take over leadership of their team, invite the attendees, plan the agenda, present their progress, and facilitate the meetings as the year progresses.

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Daston, Riehle, and Rutkowski

THE ANNUAL TIMELINE FOR THE PROJECT SEARCH HIGH SCHOOL TRANSITION PROGRAM Recruitment and Admissions

Each Project SEARCH site carries out its own independent recruitment program. One of the fi rst methods of outreach is an information session for prospective students, families, and school special education staff. Other stakeholders who should be invited include the host business personnel involved in the program, VR staff, DD and supported employment agency staff, and representatives from any other agencies that might be involved or inter- ested in becoming involved. Currently enrolled students should take part in the information session where they can act as greeters and, along with their internship manager or mentor, give fi rsthand information about their internships and other aspects of participating in Project SEARCH. This is a rewarding experience for the students, a way to engage the business depart- ments, and a very effective way to communicate the value of the program. Typically, students are referred to Project SEARCH through their schools, but they can also enter through other routes. Sometimes, parents learn about Project SEARCH through word of mouth and contact the Project SEARCH site directly. Alternately, VR counselors or other serv- ice providers might be the source of a referral. Student applications are submitted in the winter and spring in the year prior to enter- ing the program. The selection process is overseen by the local Project SEARCH teacher with extensive input from the Advisory Board or an ad hoc student-selection committee that rep- resents all Project SEARCH partners including the host business. After the initial review of the applications, eligible candidates are invited to tour the program individually or in groups and participate in hands-on assessments. The students are then interviewed and scored by the members of the selection team using an eligibility rubric. A sample showing 2 of the 17 strands of the rubric are in Figure 3.5. The complete Project SEARCH Student Selection Rubric Guide is available in Appendix 3.1. At this stage of selection, the process to determine VR eligibility should begin for pro- spective students. Once the applications are complete, the selection committee reviews the candidates and makes their selections based on the application, the tour, on-site assessment information, the interview, the rubric score, their VR eligibility status, and other pertinent ob- servations. The rubric is not a tool to screen students out of the program but, rather, a vehicle for conversation about each applicant. Indeed, candidates with perfect scores generally do not need the program to gain skills and employment. However, to gauge the likelihood of success for a given candidate, teams should also consider important criteria such as prior work experi-

Summer August Internships June

Begin PS 1st 2nd 3rd Graduate and program internship internship internship begin work (10 weeks) (10 weeks) at site or in community Orientation Student recruitment For next year

Job search For current students

Figure 3.4. Time line of Project SEARCH® (PS) year.

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The Project SEARCH High School Transition Program

TOTAL SCORE (out of a possible 85):

Figure 3.5. Project SEARCH $ ^{\circ} $ Student Selection Rubric Guide High School Transition Program (excerpt).

Figure 3.5. Project SEARCHfi Student Selection Rubric Guide High School Transition Program (excerpt).

ence, communication skills, attendance, family support, and most importantly, the desire to work competitively. Like many other Project SEARCH tools, the Eligibility Rubric can be adapted for individual programs, states, and teams. The template has 17 components or strands and the student is scored on a scale of 1 to 5 for each of these, such that the highest possible score is 85. Most transition-age students with developmental disabilities (or even a typical youth) will not score an 85. If they did, it is likely that they could transition successfully from school to work on their

who have motivation and basic transition skills that can be developed during the program year. Several things infl uence how the rubric might be adapted:

an 85. If they did, it is likely that they could transition successfully from school to work on their own. Many Project SEARCH teams are looking for candidates who score in the 50 to 70 range and

teams, after a year of operating a Project SEARCH program, will choose in the second year to give double weight to items that proved problematic in the fi rst year. For example, an inner-city

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Daston, Riehle, and Rutkowski

program that grappled with poor attendance in the fi rst year gave double weight to this factor in the second year. Other groups have developed ways to evaluate certain skills through a hands-on assessment session at the host business. This eliminates the need for estimating the correspond- ing score on the rubric and allows the team to reduce the number of strands to include only those components that they did not directly observe during the hands-on assessments. One example of a team using the rubric in tandem with other evaluation tools involved a new program at Grady Memorial Hospital in Delaware, Ohio. There were over 25 applicants for 9 Project SEARCH slots in Year 1 of the program. The program planning team, which dou- bled as the student-selection team, scheduled a skills assessment day in March, approximately 5 months before the program start date. Before that day, part of the group met to narrow the applicant pool from 25 to 16 candidates through a prescreening system based on age, work ex- perience, and school attendance. The 16 candidates then came to the hospital for 3 hours (eight students in the morning and eight students in the afternoon) for the assessment day. During each 3-hour block, students participated in skills that mirrored tasks they might be doing as part of the internships. These skills were designed by one of the business liaisons. The students were coached and observed by half of the members of the planning team. Another business liaison from the human resources department led the other half of the team in interviewing the candidates individually. The hospital created a very welcoming environment with snacks and greetings from various staff members for all the students. After all the students left the hospital, the entire planning team convened and utilized an adapted rubric with 10 strands to rank the students. The resulting scores were combined with information gained from the skills assess- ments and interviews. By the end of the day, the team had identifi ed a slate of students and two alternates. When students are not accepted into a local Project SEARCH program, families can ask for an appeal. We recommended that implementation teams establish a formalized process for such appeals. First, the selection committee should establish a separate, objective appeal committee. It can be small, with as few as 3 members, and should consist of people who were not part of the original selection process or who are not familiar with the applicant in question. The following are some individuals who might be appropriate for the appeals committee:

• **** A guidance counselor or special education staff member from the high school sponsoring the Project SEARCH program site
• A VR counselor who is not presently serving the Project SEARCH program involved in the appeal
• A staff member from the local DD agency who is familiar with transition services The appeals committee should receive information from the selection committee on the student applicant and the reasons she or he was not accepted into the program. The family involved with the appeal should then be scheduled to appear in front of the appeals commit- tee at a time convenient for all involved. The next step is for the committee to interview the student and ask questions that address topics such as prior work experience, school activities, community involvement, and commitment to competitive employment. The parent or other family member should then have the opportunity to speak to the committee and address why the Project SEARCH program would be benefi cial for his or her young adult. The commit- tee can then ask the family members questions that may clarify issues that may be barriers to success in the program. Directly after these two interviews, the appeals committee should discuss the information and make a recommendation for acceptance or denial into the pro- gram. This recommendation, along with the documentation on which the recommendation is based, should be given to the selection committee so they can use it to make a fi nal decision. If the fi nal recommendation is to not accept the student into the Project SEARCH program, the members should list the reasons along with other transition options for the family to consider. FOR MORE INFORMATION OR TO ORDER, VISIT WWW.BROOKESPUBLISHING.COM/PROJECT-SEARCH

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The Project SEARCH High School Transition Program

Summer

The Project SEARCH

The selection process should be completed in time for

Family Involvement Curriculum

new students to be notifi ed of their acceptance into the program in the spring, allowing time to develop an IEP Because parents and other caregivers play such a critical role in a students success, Project and ensure VR eligibility. This schedule also allows the SEARCH developed a Family Involvement summer before program entry to be used for prepara-Curriculum to accompany the High School tion, orientation, assessment activities, and a Benefi ts Transition Program. The Project SEARCH Family Analysis (a tool usually provided through the local So-Involvement Curriculum involves several sessions cial Security Administration or DD organization to help to be delivered throughout the school year. They are facilitated by a designated parent partner clarify the positive impact of competitive work and pro- or team of designated parents (and often the vide very specifi c information to each family about howProject SEARCH teacher). The parent partners their government benefi ts will be affected. could be alumni parents who have children who Summer orientation activities could include ahave completed the Project SEARCH program. home visit or meeting in which the teacher discusses These sessions should be attended by all parents or caregivers of students currently enrolled in the scope and goals of the program with the student the Project SEARCH High School Transition and the family members. In turn, the teacher gets aProgram. sense of the student’s home life through these visits. The Project SEARCH Family Involvement Curriculum Session 1: Family Involvement

should be introduced in the spring or summer before Introduction

the program begins. This program gives transitionFamilies are prepared to understand the shared information, helps families develop goals related to commitment and responsibility of the Project SEARCH program and their involvement in the achieving employment, sets the tone, and establishes employment process. the expectation that families will be a critical part of each student intern’s success in the program. The spe-Session 2: Social Security Benefi ts cifi c roles and responsibilities of the families duringLocal experts provide information on topics such the application process and throughout the Projectas Supplemental Security Income, Social Secu- SEARCH program year are outlined in Figure 3.6. rity Disability Income, Medicaid, Medicare, Plan to Achieve Self-Support (PASS), impairment- Summertime family engagement activities, such related work expenses (IRWE), and work incen- as picnics or other informal gatherings, are impor-tives planning and assistance (WIPA). tant for team building and developing camaraderie among the cohort of students and their families. Session 3: Expectations of Employment

These get-togethers can also be opportunities to share This session involves a discussion of family and student responsibilities in regard to seeking job expectations such as independent travel, attendance, opportunities. The goal is 100% employment for behavior, dress, the goal of employment, the fam-Project SEARCH interns so families and interns ily’s role in student progress meetings, and so on and are encouraged to clarify their expectations in to provide information such as advice on managingregard to job selection. Social Security issues. Session 4: Family Involvement Beyond Transportation to the program site is an important Project SEARCH issue that is addressed in the summer. The student’s This session can be customized to the current home school is ultimately responsible for facilitating cohort to address their specifi c issues and travel training or making other arrangements if inde-circumstances. For example, some topics might pendent travel is not possible. Students are strongly be parenting, recreation options, and fi nancial encouraged to travel independently, and the teacherplanning. often will work with the student and family to begin travel training over the summer. VR is often involved and may fi nancially support this activity in partnership with the school and supported em- ployment agency. Part of an incoming student’s summer preparations will be to fulfi ll the host busi- ness’s requirements for access to the worksite. These will vary with the specifi c busi- ness and industry sector but often include a criminal background check, updated immu- nizations and tuberculosis test (especially relevant in a health care environment), and a drug screen. Most businesses will also require that the Project SEARCH students wear an

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44

Role: Family Members

Role: Family Members Competetive employment: this includes all of the tasks associated with being an employee, which vary depending on the employer and the specifi c job

employer and the specifi c job Student recruitment: organize school presentations, information sessions, tours, skills assessment days, student interviews, selection process; perform associated tasks such as application process selection rubric and eligibility determination

Internships: identify and analyze potential internship locations, develop task designs for internship areas, provide job coaching, monitor and evaluate intern progress, provide education and communicate with internship site staff, and create job accommodations

accommodations Job development: analyze employment climate, connect with community employers, build vocational profi les for interns, provide individual job search activities, and facilitate supports for competitive employment

provide individual job search activities, and facilitate supports for competitive employment Meetings and marketing: develop and utilize marketing tools and facilitate Business Advisory Committee, intern employment-

Meetings and marketing: develop and utilize marketing tools and facilitate Business Advisory Committee, intern employmentplanning meetings, individualized education program (IEP) meetings, and other problem-solving team meetings Teaching and curriculum: orientation to host business, individual, and group classroom instruction

Teaching and curriculum: orientation to host business, individual, and group classroom instruction Training and staff development: participate in Project SEARCHfisponsored training, prepare and deliver family involvement

Training and staff development: participate in Project SEARCHfisponsored training, prepare and deliver family involvement curriculum, and prepare and deliver program information to internal and external partners Technical assistance: work with the internal Project SEARCH team on program development and continuous improvement Paperwork: process licensing agreement, intern attendance sheets, Commission on Accreditation of Rehabilitation

Regular schoolsupported tasks

Project SEARCH tasks

Assumption: Families will receive program and application information from teachers, vocational rehabilitation, and developmental disabilities agencies.

Program Phase: Year: Preentry Year, 1st and 2nd QuartersSeptember through February Assumption: Family members of students who are interested in the Project SEARCHfi program should make sure the student is

Regular schoolsupported tasks

Program Phase: Preentry Year, 4th Quarter-June, July, and August

Program Phase: Preentry Year, 4th QuarterJune, July, and August

Program Phase: Program Year 1, 1st Quarter—September, October, and November

Program Phase: Program Year 1, 1st QuarterSeptember, October, and November Assumption: Families are valuable partners as the program develops an individual training and employment plan for the intern.

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Program Phase: Program Year, 2nd QuarterDecember, January, and February

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Daston, Riehle, and Rutkowski

Figure 3.6. (continued)

40% 40%

60% 60%

Program Phase: Program Year, 3rd QuarterMarch, April, and May Assumption: Families are vital to the job placement process. They provide job leads and work with the team to support the job goals.

5% 5%

20% 20%

75% 75%

Program Phase: Program Year, 4th QuarterJune, July, and August Assumption: As interns gain employment, families continue to be their strongest support. Their focus will be on activities to help the intern transition from intern to employee. If the intern is not employed, the focus will remain on job development activities.

PITFALLS IN OBTAINING THE BUSINESS IDENTIFICATION BADGE

Worksite immersion is critical to the Project SEARCH model, and it is the biggest factor in our success. How- ever, there are logistical challenges that come along with having school transition take place in a business. For example, to issue an identifi cation badge, most hospitals require a two-step tuberculosis test. This means scheduling four visits for each student over the course of 9 days. The timing is highly structured, and if any of the four visits are missed, the entire process must be started over from the beginning. Another common point of stress is drug screening. Urinalysis for drug screening can be an invasive and uncomfortable procedure for anyone, and especially so for someone with a cognitive disability who may not understand the reasons for the strict rules and lack of privacy. Another common barrier for students in gaining the business identifi cation (ID) badge is the lack of a state-issued picture ID. Many Project SEARCH students do not drive and, therefore, dont have drivers licenses. If their families or teachers havent worked with them to make sure that they have a state-issued ID, they wont be able to even initiate the process of gaining access to the worksite. Clearly, its diffi cult to get all of these things done for all of the students, and it becomes even more diffi cult once the students are out of school and have gone their separate ways for the summer. But, with some advance planning, we have found that many things can be done to help things go more smoothly. It takes some coordina- tion on the part of the teacher and job coaches, but it can make all the difference in terms of reducing stress and achieving an on-time start for all the students. Project SEARCH teachers should encourage and facilitate taking care of many of these items in the spring after students are accepted into the program but are still in school and, thus, are still a captive audience. Another strategy is for the teacher or a job coach to arrange times for the students to come in and take care of these requirements as a group over the summer before the program begins. This is helpful with regard to simplifying the scheduling and also can reduce stress by allowing for some prepara- tion and explanation for the young people as well as for the person who is administering these tests.

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The Project SEARCH High School Transition Program

identifi cation badge at the workplace. The badging process may be completed during the summer so that the student will have full access as soon as the program starts. The Project SEARCH Annual International Conference takes place in a different U.S. city every summer. This is where the professionals and families involved in Project SEARCH sites around the country come together to share their successes, lessons learned, and insights gained through their work in administrating and participating in Project SEARCH programs. Although it is by no means necessary for incoming students and their families to attend, for those who are able to get there, it’s an excellent venue for gaining a deeper understanding of Project SEARCH and networking with other families and disability professionals. The summer is also a time of preparation for the Project SEARCH staff. The teacher, job coaches, and business liaison can use this time to identify new internship sites and develop job and task analyses for those internships and to think about potential adaptations that might be useful at those sites. It is also a convenient time to provide education to the host business about Project SEARCH on topics such as disability issues, supervision strategies, and the goal of in- ternships. During the summer, the teacher might also choose to work with the Advisory Board to review the Project SEARCH classroom curriculum and to discuss how it can be customized for the host business.

Orientation and Assessment

The annual schedule of the Project SEARCH school year is governed by the local school cal- endar, but the students do not spend any time at the home school. At most sites, the program start date is mid-August or early September, and once the school year starts, the students come to the business every weekday for a full school day. The fi rst few weeks of the program are focused on student assessment and orientation to the work environment. Students undergo a specially designed vocational assessment with their teacher. The assessment explores functional math and reading skills that relate to the individual internships as well as basic job skills. The specifi c job skills will vary depending on the nature of the host business; however, certain core skills—such as fi ling, computer skills, telephone use, materials handling, and the ability to follow instructions and solve problems— are important in nearly any business setting. To become oriented to the host business facilities and culture, the students participate in “way-fi nding” exercises; review the business’s employee code of conduct; hear presenta- tions by representatives of the host business on the mission and core values of the business and how the students contribute; learn about and practice communication protocols in use at the business; and complete any mandatory employee education, such as safety and confi den- tiality training. After this more general orientation, the students become involved in activities that specifi-cally prepare them for their internships, which will take place over three 10-week rotations at worksites throughout the business. These include touring the potential internship sites, creat- ing a resume and cover letter, and practicing interviewing skills.

Classroom Activities

A typical day at a Project SEARCH High School Transition program site begins with a 1-hour classroom session. During this time, students work on lessons from a functional curriculum that stresses employability and independent-living skills. Classroom activities are designed around 12 major focus areas: team building, workplace navigation, workplace safety, tech- nology, social skills, presentation skills, interviewing skills, money management, health and wellness, resume development, job search skills, and job retention skills. Some examples of specifi c lesson topics include beginning and more advanced computer skills; effective verbal, nonverbal, written, and electronic communication; and personal budgeting. In the beginning of the year, lessons are focused on general skills needed to function in the workplace, such as learning to navigate and get around within the business, making good choices in the cafeteria, FOR MORE INFORMATION OR TO ORDER, VISIT WWW.BROOKESPUBLISHING.COM/PROJECT-SEARCH

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Daston, Riehle, and Rutkowski

and appropriate dress and grooming. The curriculum is fl exible so that, as the year goes on and the teacher gets to know the students better, the teacher can customize the curriculum to accommodate the specifi c needs and interests of the students and the business as they arise. This fl exibility helps to ensure a meaningful and successful experience for participants, as well as to provide responsiveness to the business. Even though we have an entire academic year with the students, the time goes quickly. In order to reach our goal of competitive employment for each intern, we must ensure that every activity, every lesson, and every skill gained contrib- utes to reaching this important objective.

Linkages

In the Project SEARCH High School Transition model, linkages to adult services are estab- lished before high school eligibility ends and, ideally, before the students begin the program. This is important because young people with disabilities run the risk of “falling through the cracks” as they move from the consolidated support system of the school environment to the more fragmented world of adult services (Certo, Mautz, Pumpian, Sax, Smiley, Wade, et al., 2003; Certo & Luecking 2006). A relationship with a VR counselor is usually among the fi rst linkages made for a Project SEARCH student because VR eligibility is typically a requirement for entry into the program. Moreover, Project SEARCH teachers are familiar with other com- munity resources and are able to assist students in accessing those services as the need arises. These might include DD services; psychological services; or specifi c services related to hearing, speech, or visual impairments. Linkages to appropriate services in the community are particularly important as students prepare to graduate from the program to ensure a successful transition to employment and adult life. Specifi c availability of services varies with the locale, but in most cases, assistance with necessary adaptations required to perform a specifi c job, job coaching, as well as job development and long-term follow-along can be arranged through the local VR Services Commission, the Administration on DD, or both. Locally based and disability-specifi c organi- zations are additional sources of needed services. The array of services and the way they are delivered can vary from state to state and often use a regional or county approach. In many states, VR does not provide direct services but instead vends with supported employment or community rehabilitation partners (CRPs). The vendor (CRP) provides consistent personnel in accordance with the provision of the Project SEARCH model concerning the need for “consist- ent, on-site staff.”

Worksite Internships

The hallmark of the Project SEARCH model of high school transition is a series of supervised internships through which students build communication and problem-solving skills, as well as job-specifi c skills (for more detail, see Chapter 4). These are unpaid student internships— analogous to the clinical rotations that are part of every medical school curriculum and the internships that are often used to incorporate career-specifi c training and experience for un- dergraduate college students. The internships should be chosen strategically to ensure that the students learn marketable, competitive, transferable skills. Potential internship sites are identifi ed through a continuous collaborative process involv- ing the teacher, the job coach, the business liaison, and specifi c worksite supervisors. For the students, work rotations begin after the orientation period, with staggered start dates so that each student has access to individualized attention from the teacher and a job coach on her or his fi rst day of a new internship and beyond, as needed. Students usually participate in three different internships over the course of the program. The student and teacher work together to choose worksites based on that student’s previous work experience, interests, specifi c career goals, and skills assessment.

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The Project SEARCH High School Transition Program

Monthly Employment-Planning Meetings Monthly employment planning meetings are an important aspect of the Project SEARCH High School Transition Program through which the core members of each student’s team convene monthly to discuss the student’s progress. In the beginning of the year, the focus is on the internships and the skills the student is acquiring. By the second internship, the focus should shift to employment goals and job development. Students should lead the meetings and could utilize tech-

demonstrate their progress.

Transition Weeks Between each of the three 10-week rotations in internships, the students spend a week in the classroom. The names for these intervals vary from site to site, but they are often called “workshop” or “transition” weeks. These weeks fi ll a scheduling need by facilitating the staggering of internship rotation start dates. In addition, they give students the opportunity to regroup, review the skills they learned on their previous internships, update their resumes, add samples of their work to their portfolios, and start preparing for the next internship as the cycle begins again. These weeks also afford the time to present additional curriculum topics or to reinforce those that need to be revisited. It’s also a good opportunity to host guest speakers to broaden the students’ perspectives on topics related to employment or independent-living skills. This can be likened to the ongoing professional development and training

Job Development and Employment Starting in the second half of the school year, the emphasis shifts to refi ning skills, fi nalizing the career goal, and carrying out an individualized job search. The provision of job development services vary from site to site and state to state. Because most supported employment agencies vend their services with VR, they can negotiate a rate and service delivery method on an individual basis. In some places, the job coach and job developer are the same person and share these duties. In other places, the job coach and job developer are separate people. In any case, each Project SEARCH team should design their job development plan in

The Project SEARCH High School Transition Program 49

that any employee might engage in to enhance job success and career advancement.

The Project SEARCH High School Transition Program 49 Monthly Employment-Planning Meetings Monthly employment planning meetings are an The monthly employment-planning meetings are important aspect of the Project SEARCH High School a critical feature of the Project SEARCH model of high school transitions. They offer a level of com- Transition Program through which the core members

high school transitions. They offer a level of com- Transition Program through which the core members munication, planning, and strategic thinking that of each student’s team convene monthly to discuss the is highly unusual among transition programs. The student’s progress. In the beginning of the year, the fo-purpose is for each students team members to cus is on the internships and the skills the student is exchange information regarding the internships, acquiring. By the second internship, the focus should skill acquisition, and the job search process. They are meant to be short (3045 minutes) and shift to employment goals and job development. Stustudent-led. These individual meetings keep all dents should lead the meetings and could utilize techteam members on the same page and identify nology, such as a PowerPoint presentation or a video, to

high school transitions. They offer a level of communication, planning, and strategic thinking that is highly unusual among transition programs. The purpose is for each students team members to exchange information regarding the internships, skill acquisition, and the job search process. They are meant to be short (3045 minutes) and student-led. These individual meetings keep all team members on the same page and identify

team members on the same page and identify nology, such as a PowerPoint presentation or a video, to ways to support the intern to reach his or her end goal of competitive employment. Some Project

ways to support the intern to reach his or her end goal of competitive employment. Some Project SEARCH programs have the meetings during 1 day each month; others schedule them during an entire week after school so that the job coaches can attend once the daily internships Between each of the three 10-week rotations in intern-are fi nished. Every effort should be made to accommodate the parents/familys schedule. ships, the students spend a week in the classroom. Getting all the meetings on the calendar at the The names for these intervals vary from site to site, but beginning of the school year will make it easier

ways to support the intern to reach his or her end goal of competitive employment. Some Project SEARCH programs have the meetings during 1 day each month; others schedule them during an entire week after school so that the job coaches can attend once the daily internships are fi nished. Every effort should be made to accommodate the parents/familys schedule. Getting all the meetings on the calendar at the beginning of the school year will make it easier

The names for these intervals vary from site to site, but beginning of the school year will make it easier they are often called “workshop” or “transition” weeks. to have the meetings at the same time each These weeks fi ll a scheduling need by facilitating the month, which is one way to ensure attendance staggering of internship rotation start dates. In addi-of all team members. The job search process should be determined before the beginning of the tion, they give students the opportunity to regroup,

staggering of internship rotation start dates. In addishould be determined before the beginning of the tion, they give students the opportunity to regroup, Project SEARCH program to ensure that the right review the skills they learned on their previous internpeople are at the meetings. ships, update their resumes, add samples of their work Students should begin leading the meeting as to their portfolios, and start preparing for the next early in the school year as possible (with the goal internship as the cycle begins again. These weeks also of starting this practice by the second meeting). Many sites encourage students to utilize afford the time to present additional curriculum topics technology to share their information, e.g. with a or to reinforce those that need to be revisited. It’s also PowerPoint or iPad presentation. There are many a good opportunity to host guest speakers to broaden

or to reinforce those that need to be revisited. It’s also PowerPoint or iPad presentation. There are many a good opportunity to host guest speakers to broaden tools the interns can utilize to share the informa-

a good opportunity to host guest speakers to broaden tools the interns can utilize to share the informathe students’ perspectives on topics related to employ-tion at the monthly meetings: ment or independent-living skills. This can be likened Internship evaluations to the ongoing professional development and training Electronic and paper portfolio documents

Internship evaluations to the ongoing professional development and training Electronic and paper portfolio documents that any employee might engage in to enhance job suc-Training matrix forms that document progress in skill acquisition

emphasis shifts to refi ning skills, fi nalizing the career Review skill acquisition during the current goal, and carrying out an individualized job search. internships. The provision of job development services vary from

that any employee might engage in to enhance job suc-Training matrix forms that document progress in skill acquisition Low- and high-technology accommodations and adaptations

Starting in the second half of the school year, the Purpose/Agenda emphasis shifts to refi ning skills, fi nalizing the career

plan for employment) Starting in the second half of the school year, the Purpose/Agenda

(continued)

Monthly Meeting Members

(continued)

Monthly Meeting Members

Monthly Meeting Members Student intern*

Student intern* Project SEARCH instructor*

Student intern* Project SEARCH instructor* Job coach (if possible)

Project SEARCH instructor, job coach, or student can get the information from the internship man-

Project SEARCH instructor* Job coach (if possible) Family member* Vocational rehabilitation counselor*

Daston, Riehle, and Rutkowski development can begin smoothly. The employment specialist from the supported employment agency takes the lead in the job search for a given student, but all the members of a student’s team should be involved. Family members and other team members are excellent sources for information on possible job opportunities. Job development is based on the student’s experiences, strengths, preferences, and skills. It is important that the job developer attends the student’s monthly employment- Job developer* (if different from the job coach planning meetings so that he or she can bring to bear all availthis person should be attending the meeting at able information about the student, such as individual inter- If necessary, support personnel such as case ests, skills, work behavior, adaptations, and preferences with managers, occupational therapists, physical regard to locale, as the job search progresses. The job developer’s role and how it evolves throughout program planning and

er’s role and how it evolves throughout program planning and Internship managers and business liaisons (these implementation, and throughout the program year, is depicted in are always welcome but not necessary. The Project SEARCH instructor, job coach, or student Figure 3.7. can get the information from the internship man-Project SEARCH programs are increasingly integrating tech-

*Denotes team member whose attendance is essential.

Role: Job Developer

95% 95%

Role: Job Developer Student recruitment: organize school presentations, information sessions, tours, skills assessment days, student interviews, selection process and perform associated tasks such as application process selection rubric and eligibility determination Internships: identify and analyze potential internship locations, develop task designs for internship areas, provide job coaching,

modations Job development: analyze employment climate, connect with community employers, build vocational profi les for interns, provide individual job search activities, and facilitate supports for competitive employment

Program Phase: Planning Year, 1st Quarter through 4th Quarter Assumption: A Project SEARCHfi job developer may be from a community rehabilitation agency or the educational system. The

vide individual job search activities, and facilitate supports for competitive employment Meetings and marketing: develop and utilize marketing tools and facilitate Business Advisory Committee, intern employment-

roles for the job developer in the planning process may be to learn about the program, assist the planning team to identify a host business, and assist the staff to identify quality internships that can match jobs in the community.

Figure 3.7. Job developer responsibilities. Pie charts at left indicate time spent on primary job tasks (gray) versus Project SEARCH tasks (black); charts at right break down the Project SEARCH tasks (see key above).

Primary job

Teaching and curriculum: orientation to host business, individual, and group classroom instruction Training and staff development: participate in Project SEARCHfisponsored training, prepare and deliver family involvement curriculum, and prepare and deliver program information to internal and external partners Technical assistance: work with the internal Project SEARCH team on program development and continuous improvement

Project SEARCH tasks

Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A.

The Project SEARCH High School Transition Program

5% 5% 10% 10% 10% 10% **10%**10% Primary job **tasks vs. Project15%**15% Project SEARCH tasks SEARCH tasks 90% 90% **60%**60%

Program Phase: Year 1, 1st QuarterSeptember, October, and November Assumption: A job developer is a valuable resource for the teacher and staff because he or she develops quality internships that build the skills necessary for jobs in the community. Although the job developer may not be directly involved in the program plan- ning or the fi rst half of the program year, the developer typically has knowledge and experience that may be useful for teacher and job coach training.

10% 10%

20% 20%

Primary job

tasks vs. Project 50%

50% Project SEARCH tasks SEARCH tasks 90%**30%**30% 90%

Program Phase: Year 1, 2nd QuarterDecember, January, and February Assumption: The job developer becomes more involved in the program activities during this quarter. He or she should attend monthly meetings and be part of the job planning process. Also, he or she continues to a consult for the staff in developing quality internships. 5% 5%

15% 15%

80% 80%

Program Phase: Year 1, 3rd QuarterMarch, April, and May Assumption: The job developer provides intense individualized job development during this quarter. The percentage of time for primary job versus Project SEARCH tasks depends upon how many consumers the job developer serves.

(continued)

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Daston, Riehle, and Rutkowski

Figure 3.7. (continued)

5% 5%

15% 15%

80% 80%

Program Phase: Year 1, 4th QuarterJune, July, and August Assumption: The job developer continues intense individualized job development during this quarter. The percentage of time for primary job versus Project SEARCH tasks depends upon how many consumers the job developer serves.

ing their resumes and doing virtual job searches, and using iPads for picture task lists, social stories, and other accommodations. They are also developing ePortfolios, which will improve their overall technology skills while enhancing the job search process. It is important that our students are able to compete with any other peers without disabilities in the use of both main- stream and assistive technology.

Program Completion and Graduation

Upon satisfactory completion of the program (95% or better attendance, good attitude, success- ful skill acquisition at each job site), many students receive a “Career Passport.” The contents of this packet will vary among Project SEARCH program sites but will usually include a resume, letters of recommendation, a competency profi le, any awards or special recognition received while in the program, and a certifi cate from the education partner. The Career Passport gives a prospective employer a thorough and accurate picture of the capabilities and experience of the student and, as such, has proven to be very helpful in guiding hiring decisions. Project SEARCH defi nes a successful outcome as competitive employment in the com- munity with a work schedule of at least 20 hours per week and pay at the prevailing wage. The program lasts for a full school year, and the goal is to achieve competitive employment for each student within 3 months after the end of the school year. Sometimes, a situation arises in which a student excels in an internship and the host business wants to hire a Project SEARCH intern into an open position before the school year ends. This practice is encouraged if it is de- termined that the job is a good fi t for the student and that it meets the Project SEARCH criteria for a successful employment outcome. If a student is hired during the school year, she or he can retain student status for school funding and insurance purposes. If having the diploma is a criterion for accepting the position, the student can accept the diploma at this point. When hired, the student should assume the schedule and persona of a young worker in that business with support and assistance from the Project SEARCH team. At the end of the school year, each Project SEARCH site plans and implements a com- pletion ceremony or graduation, which is usually held at the host business. This event is an important way to recognize the accomplishments of the student interns and to highlight employment outcomes. It is also an excellent opportunity to publicly thank the host business, internship managers, the families, and the Project SEARCH partner agencies. It’s a good idea to involve all partners in the event as speakers, planners, or recognized guests. Giving stu- dents an active role in planning and implementing the event makes it especially rewarding for them and provides another opportunity for learning teamwork, organizational skills, and good communication.

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Project | SEARCH

Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® year of eligibility and has all

may vary each day. business, dress code, and weather.

APPENDIX 3.1 (continued)

APPENDIX 3.1 (continued)

and has 2 or more years of Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH®

High School Transition That Works: Lessons Learned from Project SEARCH $ ^{\circ} $ by Maryellen Daston, J. Erin Riehle, and Susan Rutkowski. Copyright $ \textcircled{c} $ 2012 Cincinnati Children's Hospital Medical Center. All rights reserved. Baltimore, MD: Paul H. Brookes Publishing Co., Inc.

Excerpted from High School Transition that Works: Lessons Learned from Project SEARCH® by Maryellen Daston Ph.D., J. Erin Riehle M.S.N., & Susie Rutkowski M.A. APPENDIX 9.3

Meet Matthew

Matthew (Matt) was a member of the Project SEARCH class of 20052006 at the Clinton Memorial Hospital Regional Health System in rural southwest Ohio. Matt chose to participate in the Project SEARCH program after com- pleting his educational requirements at Lynchburg-Clay School District, a small district in a town of 1,300 people. Once in the program, Matt proved to be a remarkable intern. His excellent memory and attention to detail were well suited for internship sites such as the sterile processing area and materials supply. These traits were helpful in the classroom, too; each day, Matt would calculate the number of days of the school year the class had completed and the number they had yet to go. He was so dependable and precise, his teach- er and job coaches came to rely on him much as one might rely on a calendar. Matt was also a stickler for facts. After reading that a person is more likely to get injured if riding in the front seat of a car, Matt always chose to ride in the back seat. This made it highly unlikely that he would be willing to work toward getting a drivers license. And because there was very limited public transportation in the rural area where he lived, when it came time to fi nd Matt a job, the only choice was his small home town. Fortunately, small companies are everywhere and, often, they are looking for the perfect employee. Within walking distance of Matts home is Mirac, Inc., a small but growing electronics assembly and fabrication company that has been in business since 1992. Matts attention to detail was a skill that was highly valued by this company because of the necessity for precision in the work that they do. The president and CEO, Ralph Captain, reviewed Matts application and offered him employment. Recently, Ralph stated that Matt is an exceptional young man. According to Matt, the best part about his job is the being with his co-workers and ordering lunch in on Fridays. As an activity in the Project SEARCH program, the interns identifi ed their favorite quotes to live by. The Project SEARCH instructor for Matts class, Linda Emery, still remembers Matts favorite quote: It is nice to be important, but more important to be nice. To this day, she is thankful to Matt for that important reminder!

High School Transition That Works: Lessons Learned from Project SEARCH® FOR MORE INFORMATION OR TO ORDER, VISIT WWW.BROOKESPUBLISHING.COM/PROJECT-SEARCH by Maryellen Daston, J. Erin Riehle, and Susan Rutkowski. Copyright ' 2012 Cincinnati Childrens Hospital Medical Center. All rights reserved. Baltimore, MD: Paul H. Brookes Publishing Co., Inc. page x of y Brookes Publishing | www.brookespublishing.com | 1-800-638-3775 © 2012 | All rights reserved

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