National Center on Secondary Education and Transition
In Their Own Words: Employer Perspectives on Youth with Disabilities in
Searching for a Reliable Workforce:
Cincinnati Children’s Hospital Medical Center
by J. Erin Riehle
Cincinnati Children’s Hospital Medical Center is dedicated to serving
the health care needs of infants, children, and adolescents and to providing
research and teaching programs that ensure delivery of the highest quality
pediatric care to our community, the nation, and the world.
High Quality Care Requires High Quality Staff
In a typical hospital, 70% of the staff members are professionals such
as doctors, nurses, therapists, and other personnel who are highly trained
and educated. For the most part, the rest are support staff who receive
the greater portion of their training on the job. At all levels, however,
hospitals need people who are committed and well prepared. Hospitals also
need to connect directly with their communities, both as healthcare providers
and as employers. Therefore, beginning in the mid-1990s, Cincinnati Children’s
Hospital Medical Center began a significant diversity initiative to attract
and retain the entire spectrum of the community’s potential workforce.
This initiative especially targeted people with disabilities. The reasons
- We were experiencing a particular problem attracting and keeping good
entry-level support staff. We needed to upgrade and expand our recruitment
approaches to include the large segment of job seekers who have disabilities,
want to work, and, as we learned, who are often represented by a variety
of organizations that assist them in job preparation and job search.
- We needed to bolster the quality and intensiveness of our on-the-job
education of new staff so that they were prepared well, performed better,
and stayed on the job longer. Some of these employment organizations
offered assistance to the hospital in designing ways of improving job
training and support for people with disabilities.
- We had adopted as a guiding principle a 1995 policy of the American
College of Healthcare Executives, which states: “Healthcare organizations
must lead their communities in increasing employment opportunities for
qualified persons with disabilities and advocate on behalf of their
employment to other organizations.”
As we quickly learned, hospitals can be very good at providing medical
services to people with disabilities who are in their care, but they are
not always so good at recognizing the productivity that is possible for
people with disabilities when they have the right kinds of opportunity
and support. We had to take some baby steps before we were able to develop
what is now a well-designed partnership with outside schools and organizations
that enabled us to eventually hire more than 100 people with disabilities
in a wide range of jobs.
Search for Assistance Begins
As the head of the hospital’s Emergency Room in the mid-1990s with
hiring and firing authority, I decided to look into this recruitment avenue.
Not knowing exactly where to start, I used the phone book to locate such
resources. After a few dead ends, I found the Great Oaks Institute of
Technology and Career Development, a special needs vocational school,
and the Hamilton County Board of MR/DD, a government agency serving people
with mental retardation and other developmental disabilities. After many
planning meetings, we initiated a training experience where youth and
adults with disabilities were taught to stock supplies for the Emergency
The arrangement worked so well that other departments wanted to try a
similar approach. We soon identified another area of opportunity—the
hospital needed reliable couriers to deliver mail, packages, and materials
to labs and locations throughout our nine-building campus. Before long,
13 people were hired as lab couriers. We formalized the relationship with
Great Oaks and the Board of MR/DD with a legal contract specifying the
roles of all partners, and I soon found myself out of the ER and directing
this new effort, now known as Project SEARCH.
Experience Leads to Adjustments in our Approach
The initiative worked so well that we decided to significantly expand
it. We put out a call to a number of agencies that serve job seekers with
disabilities, resulting eventually in the involvement of six different
agencies that provided a total of 13 different job coaches at any given
time. Unfortunately, this turned out to be a very unwieldy—and ultimately
unworkable—arrangement. We found ourselves dealing with multiple
organizations whose staff had little direct knowledge of our needs. We
had to train them and the employees with disabilities. We also
had no control over who was hired to be a job coach (and if they were
late or tardy, we were at their mercy). If they were not of the caliber
we desired, we had little influence over improving their selection, training,
or development. Overall, this was not a very employer-friendly arrangement.
So we changed the model. Through a contract with Hamilton County Board
of MR/DD, we now hire our own job coaches. We have developed our own support
program for individuals with disabilities whom we hire. In this way we
can make sure that the performance of both the coaches and the employees
meets our standards. The job coaches become thoroughly acquainted with
the hospital’s needs, and consequently are better able to train
and support the people with disabilities we hire. And we can more rapidly
and conveniently address any performance or accommodation issues that
We have made Project SEARCH a single point of entry, so that it is easier
for us to make contacts with schools and agencies representing people
with disabilities. We coordinate referrals, the application process, all
hiring decisions, and manage on-the-job support, such as job coaching,
adaptations, accommodations, final task definitions for specific jobs,
and travel training. We also maintain employment status through on-site
follow-along service and provide opportunities for career advancement.
Project SEARCH now provides employment and educational opportunities for
more than 75 individuals with disabilities who have a range of disabilities
and accommodation needs. They are employed in a range of positions, with
almost all of the positions at full-time status.
Project SEARCH Targets Youth
Participants in Project SEARCH learn through demonstration, outreach,
and education, combined with technical assistance, in several distinct
programs. One of these programs is called the High School Transition Program,
now in its sixth year of operation. This program offers a one-year transition
program for students with disabilities who are in their last year of school.
The program is geared toward students whose main goal is employment and
who are interested in career exploration in a healthcare setting. It is
a major vehicle for preparing and recruiting new hospital employees, although
a number of the participants go on to work in other places.
During the first half of the school year, up to 12 students spend the
day at Cincinnati Children’s or at Clinton Memorial Hospital and
rotate through three to four work site experiences. These site rotations
allow participants to build various skills, including communication, problem
solving, and specific job duties as they become ready for competitive
work environments. During the second half of the school year, individualized
job development and placement occurs based on the student’s experiences,
strengths, and skills. Students are given support with accommodations,
adaptations, and on-the-job coaching by on-site staff. As the school year
ends, linkages are made to appropriate community services in order to
ensure a successful transition to work as well as retention and career
advancement. Many stay on and become permanent employees of Cincinnati
What Makes it Work
In the past, our human resources department was typically approached
by many different education and job placement professionals. We had no
way of understanding all the organizations and people they represented.
It also seemed that the approaches they used were based on sympathy, so
that we would consider hiring a person with a disability. It is not a
model that works for business. It is too complicated and confusing, too
inconvenient, and too out-of-touch with our real human-resource needs.
Most often, applications from such sources ended up in the circular file.
We have been able to develop a viable alternative that is very effective
in meeting our needs. The keys to making it work to our benefit are:
- There is a single point of entry (Project SEARCH). We post jobs and
make them known to schools and organizations representing people with
disabilities who access one place for job information and through which
the various hospital departments can screen applicants.
- Our internal position in the hospital allows us to constantly evaluate
job opportunities and determine options, such as job restructuring,
that meet our needs and that also offer unique opportunities for job
- On-site staff, employed by the hospital, facilitate direct coaching
and the support necessary for many of our employees with disabilities
to perform well.
- A clear cooperative agreement with selected school and disability
service partners gives us a direct connection with special educators
and rehabilitation professionals for expertise in accommodations and
training methodology when we need it. We no longer have to use the phone
book to find resources for expertise in disabilities and employment.
- We strongly believe in the policy statement of the American College
of Healthcare Executives on increasing employment of people with disabilities.
Our approach creates internal advocates for disability employment.
Our project, which has received local and national awards, has now expanded
beyond our own hospital complex. In addition to linking our efforts with
other healthcare facilities, we are now negotiating with a prominent bank
and two retail stores to organize similar opportunities for people with
disabilities. Every industry has the need for a well prepared, highly
functioning workforce. We want to equip companies in other industries
to develop internal structures that will enable them to successfully recruit,
hire, and manage employees with disabilities. Our experience with an employer-driven
approach clearly illustrates very effective ways to both meet company
human-resource needs and to increase the employment options for people
J. Erin Riehle, M.S.N., R.N., is Director of the Division of Disability
Services at the Convalescent Hospital for Children, an affiliate of Cincinnati
Children’s Medical Center. A long-time healthcare professional and
former Emergency Room administrator, she founded Project SEARCH. Project
SEARCH and the Division of Disability Services at Cincinnati Children’s
now encompass eight programs, including the High School Transition Program,
Adult Employment Program, Healthcare Training Program, Vocational-Education
Clinic, Intern Program, Virtual Academy, Incumbent Worker Program, and
SEARCH for Fitness. For additional information, go to http://www.projectsearch.us/
598K, 40 pages
Citation: Luecking, R., Ed. (2004).
Essential tools: In their own words: Employer perspectives on youth
with disabilities in the workplace. Minneapolis, MN: University of
Minnesota, Institute on Community Integration, National Center on Secondary
Education and Transition.
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This document was published by the National
Center on Secondary Education and Transition (NCSET). NCSET is supported
through a cooperative agreement #H326J000005 with the U.S. Department
of Education, Office of Special Education Programs. Opinions expressed
herein do not necessarily reflect the policy or position of the U.S. Department
of Education Programs, and no official endorsement should be inferred.
The University of Minnesota, the U.S. Department of Education, and the
National Center on Secondary Education and Transition are equal opportunity
employers and educators.