St. Margaret of
Castello's House

The Margaretian Model of Adult Care for Neurodivergent Profiles

The adult care matrix

Primary wing — where this care is anchored.

Secondary wing(s) — where it extends into daily life.

Typical dose — what a normal week will look like.

Conditions cared for under the Margaretian Model of Adult Care, with the evidence-based intervention, supporting interventions, responsible wings of the house, delivering disciplines, and typical intensity for each.
Condition Evidence-Based Care We Will Provide Adjunct & Supporting Interventions Primary Wing Secondary Wing(s) Delivering Discipline Typical Dose / Intensity
Autism Spectrum Profiles
Autism Spectrum Disorder Level 1 — including late-diagnosed adults Psychoeducation and identity-affirming self-knowledge work after diagnosis; adapted CBT for co-occurring anxiety and depression; supported employment on the Individual Placement and Support (IPS) model as it is adapted for autistic adults Unmasking coaching; Double Empathy peer groups; structured social opportunities, including the PEERS for Young Adults program where age fits; mentoring roles St. Joseph of Cupertino’s Adult Communication & Processing Center St. Dymphna’s Adult Therapeutic Wellness Wing; St. Joseph the Worker’s Adult Vocational & Life Skills Academy; St. Louise’s Community Integration & Social Fellowship Program Psychologist; speech-language pathologist; vocational specialist Targeted intervention 2–4 hours weekly; employment support ongoing; therapy per co-occurring need
Autism Spectrum Disorder Level 2 Functional Communication Training with augmentative and alternative communication (AAC); structured environments and visual work systems; customized employment through the guilds Visual schedules; video modeling; positive behavior support; sensory accommodation; predictable routines St. Joseph of Cupertino’s Adult Communication & Processing Center St. Joseph the Worker’s Adult Vocational & Life Skills Academy; St. Cajetan’s Adult Artisanal Guilds Wing; St. Dymphna’s Adult Therapeutic Wellness Wing Speech-language pathologist with AAC expertise; behavior analyst practicing assent-based support; occupational therapist Speech-language therapy 2–3× weekly minimum; AAC present every waking hour; daily embedded support
Autism Spectrum Disorder Level 3 Intensive AAC and Functional Communication Training; comprehensive positive behavior support; the highest staff continuity in the house; medical-first screening for pain-driven behavior change Sensory-regulated environments; consistent one-to-one relationships; scheduled low-demand recovery; assent-based pacing St. Joseph of Cupertino’s Adult Communication & Processing Center St. Dymphna’s Adult Therapeutic Wellness Wing (nursing); Domus Margaretae Adult Residential Cottage Speech-language pathologist; behavior analyst; occupational therapist; registered nurse; psychiatrist Continuous; 1:1 or 1:2 staffing during programmed activity
Regulation & Focus
ADHD adult Medication management per adult guidelines, with stimulant medication first-line for most; CBT for adult ADHD — a specifically validated adult protocol with good trial support; organizational-skills coaching Environmental structure; movement-rich guild placement; body-double work companionship; task-chunking systems St. Dymphna’s Adult Therapeutic Wellness Wing St. Joseph the Worker’s Adult Academy (executive-function coaching); St. Cajetan’s Adult Artisanal Guilds Wing; St. Bernadette’s Adult Animal and Ecological Sanctuary Psychiatrist; psychologist; occupational therapist; coach Medication review monthly until stable, then quarterly; CBT in a 12-session course with boosters; coaching weekly
Tourette Syndrome & Chronic Tics adult CBIT — Comprehensive Behavioral Intervention for Tics, first-line at every age per the American Academy of Neurology guideline — delivered to protocol; medication second-line via consulting neurologist A zero-judgment community culture; stress-reduction somatic supports; private retreat with dignified return St. Dymphna’s Adult Therapeutic Wellness Wing St. Cajetan’s Adult Artisanal Guilds Wing (regulation-rich work) Psychologist or occupational therapist with CBIT certification; consulting neurologist 8 sessions over 10 weeks, 1:1, boosters as needed
Learning, Motor & Sensory Profiles
Adult Learning Differences dyslexia · dysgraphia · dyscalculia Compensation-forward support: assistive technology as the primary tool — text-to-speech, speech-to-text, audiobook-first access — with structured literacy instruction for adults who choose remediation goals Functional literacy and numeracy tied to the adult’s own goals — recipes, schedules, wages, devotions; technology training through the St. Genesius Digital Guild St. Joseph the Worker’s Adult Vocational & Life Skills Academy (Continuing Education) St. Cajetan’s Adult Artisanal Guilds Wing (the St. Genesius Digital Guild); St. Joseph of Cupertino’s Adult Communication & Processing Center Adult educator with structured-literacy training; occupational therapist for technology fitting Literacy circles 2–3× weekly by choice; technology support ongoing
Dyspraxia Developmental Coordination Disorder, adult Task-oriented therapy on adult-chosen goals (the CO-OP model); ergonomic engineering of every workstation Weighted and adaptive tools; joint-protective techniques; motor practice embedded in guild craft St. Dymphna’s Adult Therapeutic Wellness Wing (physical & occupational therapy) St. Cajetan’s Adult Artisanal Guilds Wing (adapted stations) Occupational therapist; physical therapist Goal-directed blocks 2× weekly; ergonomic review with each placement
Cerebral Palsy adult Lifelong physical therapy focused on mobility preservation — strength, pain, and energy management against early musculoskeletal aging; spasticity management continued at the adult standard; proactive chronic-pain care; fall prevention; cardiometabolic screening for inactivity-driven risk; equipment and seating for life Hypermobility-safe strengthening, hydrotherapy, ergonomic audits, and orthotics at the Wellness Wing — components that serve cerebral palsy almost verbatim; adapted guild stations; AAC maintained for life; safeguarding and advocacy through the Guardianship Network St. Dymphna’s Adult Therapeutic Wellness Wing (physical therapy) St. Cajetan’s Adult Artisanal Guilds Wing (adapted stations); St. Joseph of Cupertino’s Adult Communication & Processing Center (AAC); The Lifelong Guardianship & Advocacy Network Physical therapist; occupational therapist; consulting physiatrist; nurse PT in goal-directed blocks while an active goal exists; pain and cardiometabolic screening on calendar; equipment and seating reviewed for life
Sensory Processing Differences adult Sensory-adaptive environments campus-wide; individualized sensory plans from standardized adult profiling (the Adolescent/Adult Sensory Profile); full eight-modality assessment Regulation rooms; personal sensory kits; motor-rights protections for stimming; shutdown and meltdown recovery protocols St. Dymphna’s Adult Therapeutic Wellness Wing Domus Margaretae Adult Residential Cottage; St. Bernadette’s Adult Animal and Ecological Sanctuary Occupational therapist; every staff member trained Environmental support continuous; direct occupational therapy where a functional goal exists
Nonverbal Learning Profile NVLD, adult Explicit verbal instruction for spatial and procedural tasks; verbal strength leveraged across work and learning; social frameworks taught as explicit rules Structured layouts; verbal walk-throughs; graph-paper systems; occupational therapy for motor planning St. Joseph the Worker’s Adult Vocational & Life Skills Academy St. Joseph of Cupertino’s Adult Communication & Processing Center; St. Dymphna’s Adult Therapeutic Wellness Wing Psychologist; adult educator; occupational therapist Embedded daily; explicit instruction as needed — and we tell adults plainly that NVLD is not yet a formal DSM diagnosis
Emotional Wellness & Recovery
Anxiety & Social Anxiety adult Cognitive behavioral therapy with graduated exposure — the first-line adult treatment; adapted CBT for autistic adults (concrete language, visual supports, a longer arc); SSRI where indicated and monitored Graded real-world practice via St. Louise’s; animal-assisted adjunct at St. Bernadette’s; skills carried into cottage life St. Dymphna’s Adult Therapeutic Wellness Wing St. Louise’s Community Integration & Social Fellowship Program; St. Bernadette’s Adult Animal and Ecological Sanctuary Licensed psychologist or clinical social worker Weekly 45–60 min, 12–20 sessions; exposure groups of 3–5
Depression & Mood Conditions adult Cognitive behavioral therapy and behavioral activation — with the fellowship program and guilds as the activation engine; medication with minimum-effective-dose stewardship; active screening against diagnostic overshadowing in adults with intellectual disability Structured daily rhythm; light and movement; grief work; peer fellowship St. Dymphna’s Adult Therapeutic Wellness Wing St. Louise’s Community Integration & Social Fellowship Program (activation through belonging); St. Cajetan’s Adult Artisanal Guilds Wing Psychologist; psychiatrist; registered nurse Weekly therapy; psychiatric review per protocol; daily behavioral activation woven into ordinary life
Autistic Burnout Recognition as a real phenomenon per emerging research — an evidence base we honestly rate as emerging; structured demand reduction through the Sabbatical; energy-accounting and pacing skills; unmasking support Sensory rest; reduced obligations with preserved belonging; gradual, adult-paced re-entry St. Dymphna’s Adult Therapeutic Wellness Wing Domus Margaretae Adult Residential Cottage (the Sabbatical lives at home); St. Bernadette’s Adult Animal and Ecological Sanctuary Psychologist; occupational therapist; the whole care team The Sabbatical entered by choice or counsel; duration set by recovery, not calendar
Trauma & Attachment Wounds adult Trauma-focused therapy at the adult standard: EMDR — strongly supported for adult PTSD — and trauma-focused CBT; adapted delivery for communication differences, including AAC-integrated psychotherapy and somatic emotion-mapping Consistent caregivers; predictable environment; life-story work; animal-assisted adjunct; coercive “attachment therapies” categorically banned St. Dymphna’s Adult Therapeutic Wellness Wing Domus Margaretae Adult Residential Cottage; St. Bernadette’s Adult Animal and Ecological Sanctuary Trauma-certified, EMDR-trained therapist Individual, weekly, duration per protocol and person
Genetic Syndromes & Developmental Support
Intellectual Disability adult Systematic instruction with task analysis toward adult-chosen goals; supported decision-making as the default; the Active Support model of engaged daily staffing; customized guild employment Community-based instruction; AAC where needed; self-advocacy formation; annual health checks against diagnostic overshadowing St. Joseph the Worker’s Adult Vocational & Life Skills Academy St. Cajetan’s Adult Artisanal Guilds Wing; Domus Margaretae Adult Residential Cottage; The Lifelong Guardianship & Advocacy Network Adult educator; speech-language pathologist; occupational therapist; psychologist Embedded across the day; skills taught in short high-repetition blocks; decision-making status reviewed annually
Down Syndrome adult The GLOBAL Medical Care Guidelines for Adults with Down Syndrome — the published adult surveillance schedule: thyroid, cardiac, hearing and vision, celiac screening, obstructive sleep apnea evaluation, cervical-spine precautions — plus an annual cognitive baseline and dementia screening from the guideline-specified age, using the National Task Group’s early-detection screen (NTG-EDSD) Continued speech and oral-motor support; physical therapy for tone and joints; full guild, choir, and fellowship life; dementia-capable care planning done early, with the adult St. Dymphna’s Adult Therapeutic Wellness Wing (the medical home) St. Joseph the Worker’s Adult Academy; St. Cajetan’s Adult Artisanal Guilds Wing; St. Louise’s Fellowship Program; Track V when its season comes Physician; registered nurse; speech-language pathologist; physical therapist; psychologist Surveillance per the published schedule; dementia screening annually; supports re-tuned as needs evolve
DiGeorge Syndrome 22q11.2 Deletion, adult Adult consensus-guideline surveillance: endocrine (calcium, thyroid), cardiac, immune — and front-line psychiatric care, because the elevated psychosis risk is realized in adolescence and young adulthood; early-intervention-for-psychosis standards where illness emerges Coordinated specialist care; medication stewardship; cognitive and vocational support tuned to the profile St. Dymphna’s Adult Therapeutic Wellness Wing St. Joseph the Worker’s Adult Academy; St. Joseph of Cupertino’s Adult Communication & Processing Center Psychiatrist; physician; registered nurse; endocrinologist Psychiatric review at least twice yearly in young adulthood; medical surveillance per consensus schedule
Prader-Willi Syndrome adult Lifelong food-secure living — the evidence does not expire at eighteen; endocrine management; diabetes and obesity surveillance; sleep-disordered-breathing monitoring A dietitian–chef partnership; daily physical activity; syndrome-experienced behavioral support; dignified feast-day planning St. Dymphna’s Adult Therapeutic Wellness Wing Domus Margaretae Adult Residential Cottage (the adult food-secure cottage) Endocrinologist; dietitian; physician; psychologist; trained residential staff Environmental management continuous; dietetic review monthly; endocrine review per protocol
Williams Syndrome adult Lifelong cardiac surveillance — blood pressure in both arms, a permanent anesthesia-risk flag; calcium monitoring; anxiety treatment, highly prevalent lifelong; hypertension screening Musical vocation through choir and liturgy; hyperacusis accommodation; explicit financial and social exploitation safeguards — the adult-life form of the stranger-safety risk St. Dymphna’s Adult Therapeutic Wellness Wing St. Louise’s Community Integration & Social Fellowship Program; The Lifelong Guardianship & Advocacy Network (financial protection) Cardiologist; physician; psychologist; music ministry Cardiology per schedule; anxiety care weekly where needed; safeguarding plan reviewed annually
The Elder Years
Aging & Neurocognitive Change all profiles Baseline cognitive documentation for every resident entering later adulthood; structured re-screening at intervals — the NTG-EDSD for adults with intellectual disability; dementia-capable environmental adaptation; palliative and end-of-life care in place, at home Track V rhythms; memory supports built into the cottage; family and Sisters at the bedside; anointing and the sacraments to the last day St. Dymphna’s Adult Therapeutic Wellness Wing (neuro-geriatric & palliative nursing) Domus Margaretae Adult Residential Cottage; the Chapel Registered nurse; physician; palliative specialist; chaplain Screening per protocol; care intensity follows the person, to the end

Our Model of Adult Care

Most systems built for neurodivergent adults are built backwards. They begin from what an adult cannot do, fund what can be billed, and end at the edge of a program year.

The Margaretian Model of Adult Care begins somewhere else entirely: with the conviction that a neurodivergent adult is not an aged-out child or a managed patient, but a man or woman with a vocation — and it commits to them not for a program cycle, but for the entirety of their life, from the threshold of adulthood to its final vespers.

The Three Layers (and Two Overlays)

Our model separates three questions that most institutions wrongly merge into one:

  1. Where does the adult live? (Residential grouping)
  2. Where does the adult learn? (Instructional grouping)
  3. Where does the adult receive therapy? (Therapeutic grouping)

No answer is given from a referral folder. Every arriving adult’s first thirty to ninety days are a Welcome Phase — settling, relationship-building, and full assessment, including occupational preferences in their own words or symbols. Adults crossing from our own children’s program receive a gentler version: same campus, same faces, new front door.

OVERLAY 1 — SUPPORT-INTENSITY TIER universal · targeted · intensive — reviewed quarterly, never a spoken label OVERLAY 2 — DECISION-MAKING STATUS independent · supported decision-making · guardianship — reviewed annually, least restrictive always Residential Occupational Therapeutic where the adult lives where the adult works & learns where the adult receives therapy one adult
Three groupings, decided independently, meeting in one adult — with the two overlays set apart from all three.

Layer 1 — Residential: the cottage is a home, never a unit

Cottages of four to six adults, grouped by regulation profile, personality compatibility, and life-stage rhythm — never by diagnosis, IQ, or support level. The same two or three primary staff on a fixed rota.

No more than two residents requiring intensive night support per cottage. The one deliberate exception continues for life: adults with Prader-Willi syndrome live in a purpose-built food-secure cottage — an architectural protection, never a social separation, because hyperphagia does not retire at eighteen.

Layer 2 — Occupational: work and learning by skill and calling, never by label

The child model grouped instruction by level; the adult model groups occupation by skill, interest, and stamina. An adult may be in the bakery guild at an advanced station, a literacy circle at a foundational level, and a digital guild purely through passion — all of this simultaneously.

Placements re-form on demonstrated skill and the adult’s own stated preference each season. Age-dignity governs everything: adult materials, adult tone, adult respect, at every skill level.

Layer 3 — Therapeutic: the protocol dictates the format

Unchanged, because evidence is evidence: CBIT is one-to-one; exposure groups are small; EMDR is individual; medication is reviewed on schedule. An intervention delivered at half its tested dose is not that intervention.

Overlay 1 — support-intensity tiers

Universal / targeted / intensive: a staffing decision, reviewed quarterly, able to move down as well as up, never a spoken label.

Overlay 2 — decision-making status

Independent / supported decision-making / guardianship: reviewed annually with the Lifelong Guardianship & Advocacy Network, always seeking the least restrictive arrangement the adult’s safety allows — and never treated as a measure of the person’s worth or voice.

And when the weight becomes too much: the Sabbatical

The adult model’s answer to autistic burnout, depressive collapse, or grief — a formally recognized low-demand season, entered by choice or clinical counsel, in which obligations contract to the constants while therapy deepens.

Not a failure state, not a discharge risk: a sabbath, planned for in staffing and honored in culture, from which adults return at their own pace. Burnout care that has to be earned by collapse is not care; ours is on the schedule before it is needed.

Three Signatures Make Our Model Distinct

  • The Spine of Consent

    Everything in our child model that ran on assent now runs on consent. Adults co-author their own care plans; participation in every program is chosen, “based on their own capability and discretion”; and where decision-making needs help, we reach first for supported decision-making — the adult deciding with trusted counsel.

    ‘Nothing about me without me’ is not a slogan here. It is our operating system.

  • The Dignity of Risk

    A life with no possibility of failure is not a protected life — it is a diminished one. Our adults will burn toast, miss buses, overspend allowances, and have awkward first conversations, because that is what living is. We manage danger; we do not manage away adulthood. Every protection in this model is weighed against the freedom it costs.

  • Threshold to Vespers

    The model spans the entire adult arc: the young adult crossing from our children’s program or arriving from the services cliff; the working adult in the fullness of guild life; and the elder whose pace is slowing — including, without flinching, the memory changes and end-of-life care that other systems quietly discharge. No one graduates from a family.

And one continuity from our child care model, unchanged, because the evidence is unchanged: comorbidity is the norm.

The autistic adult with ADHD, anxiety, and a lifetime of undiagnosed dyslexia is not an unusual case — he or she is the expected resident.

So, our model never files an adult under one diagnosis, and our wings are services an adult travels to, never cohorts an adult is sorted into.

The Six Care Tracks: How We Blend an Adult’s Day

No condition is well treated by a single therapy, so no adult at St. Margaret’s receives one. Each adult’s care is a designed blend — movement, learning, therapy, prayer, play, and rest, woven together around their profile. The blend, not any single session, is the treatment.

But a neurodivergent adult’s day is not a pie chart, and we will not pretend it is. Instead, our model has two parts: the constants, which every adult receives every day without exception — and the tracks, which decide where each adult’s day places its emphasis.

The Constants: What Every Adult Receives Every Day

Before any track is assigned, the following five things, at the very minimum, are guaranteed to every adult at St. Margaret’s, automatically woven throughout the entire day rather than scheduled into a corner of it:

  • Communication, all day.

    Every adult’s communication system — voice, sign, text, picture board, or speech device — present, charged, and honored in every building, by every person, from waking to sleep.

  • Movement, before it is needed.

    Bodies in motion regulate minds at fifty as surely as at five. Movement is woven through work, prayer, and leisure — and never withdrawn as a consequence.

  • Prayer and belonging.

    The liturgical rhythm of the house — morning offering, the Angelus, evening prayer — always by invitation, never by requirement, adapted to every body and mind.

  • Meaningful contribution.

    Every adult has real work that matters to someone — a guild bench, a garden row, a kitchen station, a choir part — because contribution is a human need, not a reward for ability.

  • The consent and trauma-informed thread.

    Choices offered all day; no surprise touch; predictable transitions; histories carried gently; and the standing assumption that behavior is communication. It takes no minutes of its own. It changes how every minute is delivered.

The Tracks: Where Each Adult’s Day Places Its Emphasis

Each adult is placed on at least one of six tracks — not by diagnosis alone, but by their dominant support needs right now. The adult’s track(s) sets the day’s emphasis; it is reviewed quarterly and changes as the adult grows.

At St. Margaret’s, we find this practice integral: because most of our adults carry more than one diagnosis, their track(s) answer a simple question: what does this adult need most, most of the time?

We describe emphasis in four honest levels rather than unreliable percentages:

  • Anchor the centerpiece of the day; dedicated blocks, protected time, the largest share of programmed hours
  • Daily dedicated time every day, built into the schedule
  • Woven deliberately embedded inside other activities rather than scheduled separately
  • Constant never scheduled because it never stops (the five constants above)

Track T — Threshold young adults, roughly 18–25

Who: Adults newly arrived — from our own children’s program, from the services cliff, from family homes.
The rule of this track: exploration before settlement; no one’s permanent rhythm is decided in their first years of adulthood.

Track T emphasis by domain
DomainEmphasisWhat it looks like
Vocational discoveryAnchorRotations through guilds and academy modules — finding the work that fits before committing to it
Independence skillsDailyCooking, budgeting, transit, self-advocacy — the Academy’s curriculum at full intensity
Clinical therapyDailyWhatever the profile requires, plus the identity work of becoming an adult
Community & fellowshipWovenSt. Louise’s outings, peer friendships, parish young-adult life
Faith, movement, rest, homeConstant—

A day in Track T: A morning trying the wood shop for the third week — and discovering the sanding station feels like prayer. Lunch cooked in the teaching kitchen, mostly successfully. An afternoon session on bus routes, then coffee in town to prove it. Evening prayer, and a cottage meeting where next month’s guild choice is genuinely his to make.

Track B — Communication & Connection

Who: Autistic adults at Levels 2–3, and every adult whose primary communication runs through AAC. (Continuous with the child Track B — same name, same promises, adult delivery.)

Track B emphasis by domain
DomainEmphasisWhat it looks like
CommunicationAnchorDaily named intervention at Cupertino’s Adult Center — and the device present every waking hour besides
Guild work & contributionDailyStations built around the adult’s communication system, where “more clay” on a device gets more clay
Clinical therapyDailySLP 2–3× weekly minimum; OT; scheduled low-demand recovery
Independence skillsWovenTaught through the adult’s modality, at the adult’s pace
Faith, movement, rest, homeConstant—

Track C — Regulation & Focus

Who: Adults with ADHD, tic disorders, dyspraxia, and sensory regulation needs — every adult whose dominant need is a well-regulated body in a demanding world.

Track C emphasis by domain
DomainEmphasisWhat it looks like
Movement & regulationAnchorMovement before demands, heavy work through the guilds, sensory resets on schedule
Guild workDailyPhysically engaged stations chosen deliberately — regulation disguised as honorable work
Clinical therapyDailyCBT for adult ADHD; CBIT; medication management on calendar
Executive-function coachingWovenPlanning systems, time-mapping, decision supports at the Academy
Faith, communication, rest, homeConstant—

Track D — Vocation & Independence

Who: Adults with intellectual disability, Down syndrome, and Williams syndrome whose dominant need is adaptive growth and meaningful work. The largest track in the adult program.

Track D emphasis by domain
DomainEmphasisWhat it looks like
Guild vocationAnchorA real craft, a real station, real output — identity built on what I make, not what I lack
Independence skillsDailyAcademy modules in high-repetition blocks; community-based practice with transport
Communication & self-determinationDailySLP support; choice-making; supported decision-making practice
Clinical therapyWovenPT for tone and joints folded into daily routine; counseling as needed
Faith, movement, rest, homeConstant—

Track E — Medically Complex

Who: Adults with 22q11.2 deletion, Prader-Willi syndrome, complex epilepsy, and significant multi-system needs (including the POTS/EDS/GI cluster common in neurodivergent adults).
The rule: the schedule flexes around medical reality without the adult ever losing community life.

Track E emphasis by domain
DomainEmphasisWhat it looks like
Clinical & medical careAnchorNursing, surveillance, specialist coordination — medicine serving the day, never consuming it
Guild work & contributionDailyShaped to stamina — a shorter shift is still a real shift
Rest & recoveryDaily (protected)Non-negotiable, defended against every competing demand
Therapy & movementWovenPrescribed and paced by the clinical team
Faith, communication, homeConstant—

Track V — Vespers elder years

Who: Adults whose pace is slowing with age — including adults with Down syndrome entering the years of elevated dementia risk, and any resident approaching the end of life.
The rule of this track: the evening of a life is lived, not managed.

Track V emphasis by domain
DomainEmphasisWhat it looks like
Gentle rhythm & presenceAnchorSlower mornings, shorter engagements, familiar faces, beloved routines kept sacred
Health & comfort careDailyNeuro-geriatric nursing, memory support, pain vigilance, palliative care when its time comes
Legacy & storytellingWovenElder roles at storytelling nights, guild mentorship at whatever scale remains, life-story completion
Community & fellowshipWovenNever withdrawn — an elder who naps through half the feast still belongs at the feast
Faith, communication, rest, homeConstantAnointing, the Rosary at the bedside, and a community that does not leave

A day in Track V: A late breakfast, unhurried. An hour in the garden — supervising now, mostly, and glad to. A nap that no schedule interrupts. The children’s choir rehearsing within earshot, on purpose. Evening prayer by the window, the same psalm as fifty years of evenings, and the same people saying it with him.

Where Anxiety, Trauma, Depression & Burnout Live

Not in tracks — alongside them, exactly as in our child model. Every track carries a clinical-therapy block; the adult receives their CBT, EMDR, or grief work inside their track, without leaving their cottage, guild, or friends. When the weight becomes dominant, the Sabbatical opens — and closes only when the adult is ready.

How an Adult Is Placed — and Re-Placed

Placement and re-placement are decided by the adult with their clinical team — the adult’s own voice first, in whatever modality it comes — on dominant support need this season, reviewed quarterly, movable in any direction. The goal of every track is the lightest track that still serves.

Condition by Condition, In Full

Autism Spectrum Disorder — Level 1, Including Late-Diagnosed Adults

St. Joseph of Cupertino’s Adult Communication & Processing Center

Home wing: St. Joseph of Cupertino’s Adult Communication & Processing Center · Also supported at: St. Dymphna’s Adult Therapeutic Wellness Wing; St. Joseph the Worker’s Adult Academy; St. Louise’s Fellowship Program

The care we will provide. For the adult diagnosed at six or at sixty: psychoeducation and identity-affirming self-knowledge work after diagnosis — the careful re-reading of a whole life through a truer lens — with properly adapted CBT where anxiety or depression co-occur, and supported employment on the Individual Placement and Support model as it is adapted for autistic adults. Targeted intervention runs two to four hours weekly; employment support is ongoing.

Supporting the whole adult. Unmasking coaching, Double Empathy peer groups, structured social opportunities — including the PEERS for Young Adults program where age fits — and mentoring roles, because an adult who has navigated this world has something to teach it.

Honestly stated. We will never train an adult to perform neurotypicality. Many of our residents arrive having masked for decades, at documented cost to their mental health. Here, the mask is finally allowed to come off.

Faith alongside. Catechesis and spiritual direction that honor deep interests as a real route to God.

Autism Spectrum Disorder — Level 2

St. Joseph of Cupertino’s Adult Communication & Processing Center

Home wing: St. Joseph of Cupertino’s Adult Communication & Processing Center · Also supported at: St. Joseph the Worker’s Adult Academy; St. Cajetan’s Adult Artisanal Guilds Wing; St. Dymphna’s Adult Therapeutic Wellness Wing

The care we will provide. Functional Communication Training with full-spectrum AAC — fitted, repaired, upgraded, and re-assessed across the decades by AAC-specialized speech-language pathologists, at minimum two to three sessions weekly, with the device present every waking hour. Structured environments and visual work systems at every guild placement, and customized employment through the guilds.

Supporting the whole adult. Visual schedules, video modeling, positive behavior support, sensory accommodation, and predictable routines throughout the campus.

Honestly stated. An adult’s communication system is never taken away, never made contingent on behavior, and never outgrown — it is maintained the way the world maintains everyone else’s voice without ever thinking about it.

Faith alongside. AAC integrated into liturgy, Reconciliation, and spiritual direction — prayers programmed onto devices, responses honored in every modality.

Autism Spectrum Disorder — Level 3

St. Joseph of Cupertino’s Adult Communication & Processing Center

Home wing: St. Joseph of Cupertino’s Adult Communication & Processing Center · Also supported at: St. Dymphna’s Adult Therapeutic Wellness Wing (nursing); Domus Margaretae Adult Residential Cottage

The care we will provide. Intensive AAC and Functional Communication Training, comprehensive positive behavior support built on assent-based pacing, and one-to-one or one-to-two staffing during programmed activity from the same familiar faces, deliberately protected from rotation, across years — the highest staff continuity in the house.

Supporting the whole adult. Sensory-regulated environments, scheduled low-demand recovery, and the medical-first rule at every age: when behavior changes suddenly, a medical workup precedes any behavioral response — dental pain, reflux, constipation, and seizures all speak through behavior in adults who cannot report them.

Faith alongside. Presence-based spirituality — the chapel, music, tactile sacramentals — with participation individually discerned. No adult’s place before God will ever depend on words.

ADHD

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: St. Joseph the Worker’s Adult Academy (executive-function coaching); St. Cajetan’s Adult Artisanal Guilds Wing; St. Bernadette’s Adult Animal and Ecological Sanctuary

The care we will provide. Medication management per adult guidelines — stimulant medication first-line for most, reviewed monthly until stable and quarterly thereafter — alongside CBT for adult ADHD, a specifically validated adult protocol with good trial support, delivered in a twelve-session course with boosters, and weekly organizational-skills coaching.

Supporting the whole adult. Environmental structure, movement-rich guild placement, body-double work companionship — the quiet power of working beside someone — and task-chunking systems carried into every corner of the day.

Honestly stated. Movement is never withdrawn as a consequence, and we will not offer brain-training as primary treatment; the evidence does not support it in that role.

Faith alongside. Prayer built for moving bodies — the walking Rosary, processions, active service roles — rather than demanding long stillness.

Tourette Syndrome & Chronic Tic Disorders

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: St. Cajetan’s Adult Artisanal Guilds Wing (regulation-rich work)

The care we will provide. CBIT — Comprehensive Behavioral Intervention for Tics, first-line at every age per the American Academy of Neurology guideline — delivered to protocol: one-to-one, eight sessions over ten weeks, with boosters as needed. Medication is second-line, via a consulting neurologist, only if CBIT proves insufficient.

Supporting the whole adult. A zero-judgment community culture in which staff, Sisters, and residents alike are trained to not react to tics at all; stress-reduction somatic supports; and private retreat with dignified return when tics flare with fatigue.

Honestly stated. We will never ask an adult to simply suppress tics without CBIT’s actual techniques — suppression without training increases distress. And because most adults with Tourette also carry OCD or ADHD, we screen for both, always.

Faith alongside. Full participation in liturgy with a quiet retreat always available — stepping out never means losing your place.

Adult Learning Differences — Dyslexia, Dysgraphia & Dyscalculia

St. Joseph the Worker’s Adult Academy

Home wing: St. Joseph the Worker’s Adult Vocational & Life Skills Academy (Continuing Education) · Also supported at: St. Cajetan’s Adult Artisanal Guilds Wing (the St. Genesius Digital Guild); St. Joseph of Cupertino’s Adult Communication & Processing Center

The care we will provide. For many of our adults, these differences were never named in school — only felt. Our support is compensation-forward: assistive technology as the primary tool — text-to-speech, speech-to-text, audiobook-first access — with structured literacy instruction for adults who choose remediation goals, in literacy circles two to three times weekly, by choice, always adult in tone and never remedial in spirit.

Supporting the whole adult. Functional literacy and numeracy tied to the adult’s own goals — recipes, schedules, wages, devotions — and technology training through the St. Genesius Digital Guild, so the tools genuinely belong to the person using them.

Honestly stated. An adult who chooses audiobooks over decoding has chosen a legitimate, complete way to read. And we will not use colored overlays, tinted lenses, or vision therapy — the professional bodies have rejected them.

Faith alongside. Scripture and the day’s prayers in audio and pictorial form, and prayer journals kept by voice or keyboard — so neither reading nor writing ever stands between an adult and God.

Dyspraxia / Developmental Coordination Disorder

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing (physical & occupational therapy) · Also supported at: St. Cajetan’s Adult Artisanal Guilds Wing (adapted stations)

The care we will provide. Task-oriented therapy on adult-chosen goals — the bus route, the kitchen, a guild craft — on the CO-OP model, in goal-directed blocks twice weekly, with ergonomic engineering of every workstation and an ergonomic review at each new placement.

Supporting the whole adult. Weighted and adaptive tools, joint-protective techniques, and motor practice embedded in guild craft that means something — kneading, planting, carving — never drills for their own sake.

Faith alongside. Liturgical roles chosen deliberately as motor practice with genuine purpose and genuine dignity — carrying, processing, serving.

Cerebral Palsy

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing (physical therapy) · Also supported at: St. Cajetan’s Adult Artisanal Guilds Wing (adapted stations); St. Joseph of Cupertino’s Adult Communication & Processing Center (AAC); The Lifelong Guardianship & Advocacy Network

The care we will provide. The services cliff is notoriously brutal for cerebral palsy: adults with CP face early musculoskeletal aging — pain, fatigue, and walking loss often beginning in the twenties and thirties — precisely when pediatric services vanish. So we provide lifelong physical therapy focused on mobility preservation: strength, pain, and energy management against that early aging, spasticity management continued at the adult standard, proactive chronic-pain care, fall prevention, cardiometabolic screening for inactivity-driven risk, and equipment and seating for life.

Supporting the whole adult. The Wellness Wing’s hypermobility-safe strengthening, hydrotherapy, ergonomic audits, and orthotics serve cerebral palsy almost verbatim — alongside adapted guild stations, AAC maintained for life, and safeguarding and advocacy through the Guardianship Network.

Honestly stated. Most systems retire from CP care at eighteen, exactly when the body’s needs begin to grow. We do not.

Faith alongside. Full, integrated-seating participation in the chapel our foundress’s own bent body inspired — at every liturgy, never apart.

Sensory Processing Differences

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: Domus Margaretae Adult Residential Cottage; St. Bernadette’s Adult Animal and Ecological Sanctuary

The care we will provide. The building itself is the intervention, and it never clocks out: sensory-adaptive environments campus-wide, with individualized sensory plans drawn from standardized adult profiling — the Adolescent/Adult Sensory Profile — and full eight-modality assessment by occupational therapists.

Supporting the whole adult. Regulation rooms, personal sensory kits, shutdown and meltdown recovery protocols — and protected motor rights: rocking, pacing, and humming affirmed as essential, dignified self-regulation.

Honestly stated. Sensory supports are what the evidence shows them to be: powerful supports for comfort and participation — not a cure, and we will never claim otherwise.

Faith alongside. Sensory-adapted liturgy: quiet zones with a sightline to the altar, incense-free options, tactile sacramentals.

Nonverbal Learning Profile (NVLD)

St. Joseph the Worker’s Adult Academy

Home wing: St. Joseph the Worker’s Adult Vocational & Life Skills Academy · Also supported at: St. Joseph of Cupertino’s Adult Communication & Processing Center; St. Dymphna’s Adult Therapeutic Wellness Wing

The care we will provide. These adults often carry remarkable verbal strength beside real difficulty with spatial, procedural, and unspoken social demands — so we teach through the strength: explicit verbal instruction for spatial and procedural tasks, verbal strength leveraged across work and learning, and social frameworks taught as explicit rules rather than left to inference.

Supporting the whole adult. Structured layouts, verbal walk-throughs, graph-paper systems, and occupational therapy for motor planning.

Honestly stated. NVLD is not yet a formal DSM diagnosis, and we tell adults so plainly — while fully supporting the very real profile it describes.

Faith alongside. Verbal, Socratic, conversational formation — playing directly to these adults’ deepest strength.

Anxiety & Social Anxiety

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: St. Louise’s Fellowship Program (graded real-world practice); St. Bernadette’s Adult Animal and Ecological Sanctuary

The care we will provide. Cognitive behavioral therapy with graduated exposure — the first-line adult treatment — in weekly 45–60 minute sessions across 12–20 session courses, with exposure groups of three to five. For autistic adults, CBT properly adapted — concrete language, visual supports, a longer arc — because they deserve the version that works. SSRI medication where indicated and monitored.

Supporting the whole adult. The skills leave the therapy room: graded real-world practice through St. Louise’s outings, the animal-assisted calm of St. Bernadette’s Sanctuary, and skills carried into cottage life by trained staff.

Faith alongside. Scrupulosity — the anxious conscience — recognized and answered pastorally rather than dismissed.

Depression & Mood Conditions

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: St. Louise’s Fellowship Program (activation through belonging); St. Cajetan’s Adult Artisanal Guilds Wing

The care we will provide. Cognitive behavioral therapy and behavioral activation — with the fellowship program and the guilds as the activation engine, because a reason to get up in the morning is not a metaphor here; it is a bench with your name on it. Medication with minimum-effective-dose stewardship, reviewed per protocol, and active screening against diagnostic overshadowing in adults with intellectual disability, so depression is never dismissed as “behavior.”

Supporting the whole adult. Structured daily rhythm, light and movement, grief work, and peer fellowship — the ordinary architecture of a life worth waking for.

Faith alongside. The house keeps praying with those who cannot pray — presence, music, and the psalms carried for the adult until they can carry them again.

Autistic Burnout

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: Domus Margaretae Adult Residential Cottage (the Sabbatical lives at home); St. Bernadette’s Adult Animal and Ecological Sanctuary

The care we will provide. Recognition, first — autistic burnout is a real phenomenon, described by autistic adults for decades and now documented in emerging research. Then structured demand reduction through the Sabbatical: a formally recognized low-demand season, entered by choice or clinical counsel, in which obligations contract to the constants while therapy deepens. Alongside it, energy-accounting and pacing skills, and unmasking support.

Supporting the whole adult. Sensory rest, reduced obligations with preserved belonging — the adult steps back from demands, never from the family — and gradual, adult-paced re-entry, with duration set by recovery, not by a calendar.

Honestly stated. The research base for autistic burnout is emerging rather than established, and we say so plainly — while refusing to make adults wait for the literature to catch up with what they are living. Burnout care that has to be earned by collapse is not care; ours is on the schedule before it is needed.

Faith alongside. A sabbath is not an absence. The chapel stays open, the community stays near, and rest itself is honored as holy.

Trauma & Attachment Wounds

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: Domus Margaretae Adult Residential Cottage; St. Bernadette’s Adult Animal and Ecological Sanctuary

The care we will provide. Trauma-focused therapy at the adult standard: EMDR — strongly supported for adult PTSD — and trauma-focused CBT, individual and weekly, with duration set by protocol and person. Delivery is adapted for communication differences: AAC-integrated psychotherapy and somatic emotion-mapping, so no adult’s history stays locked behind speech.

Supporting the whole adult. Consistent caregivers, a predictable environment, life-story work done gently over time, and the quiet companionship of animals for those not yet ready to trust people.

Honestly stated. Coercive “attachment therapies” involving holding, restraint, or forced regression are condemned by the professional bodies and categorically banned at St. Margaret’s, without exception.

Faith alongside. A theology of belonging expressed less in words than in permanence: you are wanted here, and no one is sending you away.

Intellectual Disability

St. Joseph the Worker’s Adult Academy

Home wing: St. Joseph the Worker’s Adult Vocational & Life Skills Academy · Also supported at: St. Cajetan’s Adult Artisanal Guilds Wing; Domus Margaretae Adult Residential Cottage; The Lifelong Guardianship & Advocacy Network

The care we will provide. Systematic instruction with task analysis toward adult-chosen goals — every skill broken into learnable steps, taught in short high-repetition blocks and practiced in real kitchens, real laundries, real markets. Supported decision-making as the default, with decision-making status reviewed annually. The Active Support model of engaged daily staffing, so no one sits idle while life happens around them. And customized guild employment, because contribution is a human need, not a reward for ability.

Supporting the whole adult. Community-based instruction with transport, AAC wherever communication needs exist, self-advocacy formation, and annual health checks run deliberately against diagnostic overshadowing.

Honestly stated. The greatest clinical danger these adults face is diagnostic overshadowing — pain and mental illness misread as “behavior.” Our nurses screen for both actively and separately, always.

Faith alongside. The Eucharist is not withheld for want of verbal articulation.

Down Syndrome

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing (the medical home) · Also supported at: St. Joseph the Worker’s Adult Academy; St. Cajetan’s Adult Artisanal Guilds Wing; St. Louise’s Fellowship Program

The care we will provide. The GLOBAL Medical Care Guidelines for Adults with Down Syndrome — the published adult surveillance schedule, run proactively on calendar: thyroid, cardiac, hearing and vision, celiac screening, obstructive sleep apnea evaluation, and cervical-spine precautions. Plus an annual cognitive baseline and dementia screening from the guideline-specified age, using the National Task Group’s early-detection screen (NTG-EDSD) — because early change deserves early answers.

Supporting the whole adult. Continued speech and oral-motor support, physical therapy for tone and joints, full guild, choir, and fellowship life — and dementia-capable care planning done early, with the adult, while their own voice can lead it.

Faith alongside. Full sacramental life and real liturgical roles — choir, greeting, procession. Not accommodated into the parish. Belonging to it.

DiGeorge Syndrome (22q11.2 Deletion)

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: St. Joseph the Worker’s Adult Academy; St. Joseph of Cupertino’s Adult Communication & Processing Center

The care we will provide. Adult consensus-guideline surveillance — endocrine (calcium, thyroid), cardiac, immune — and front-line psychiatric care, with review at least twice yearly in young adulthood, because the elevated psychosis risk of 22q11.2 is realized in adolescence and young adulthood and watching for it is not optional. Where illness emerges, care follows early-intervention-for-psychosis standards.

Supporting the whole adult. Coordinated specialist care with hospital bedside advocacy, careful medication stewardship, and cognitive and vocational support tuned to the profile.

Faith alongside. Ordinary, full participation. Medical fragility will never translate into spiritual exclusion.

Prader-Willi Syndrome

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: Domus Margaretae Adult Residential Cottage (the adult food-secure cottage)

The care we will provide. Lifelong food-secure living — the evidence does not expire at eighteen — in a purpose-built cottage with secured storage designed into the architecture itself, so that no adult is ever publicly restricted, conspicuously supervised at the table, or shamed. Alongside it: endocrine management, diabetes and obesity surveillance, and sleep-disordered-breathing monitoring.

Supporting the whole adult. A dietitian–chef partnership planning nutrition monthly, daily physical activity, syndrome-experienced behavioral support, and dignified feast-day planning.

Honestly stated. Hyperphagia — the relentless hunger of Prader-Willi — is a neurological drive, not disobedience, and it does not retire at eighteen. No adult will ever be treated as though it were a moral failing.

Faith alongside. Feast days and fellowship meals planned deliberately in advance, so the adult with Prader-Willi celebrates with everyone, never apart from them.

Williams Syndrome

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing · Also supported at: St. Louise’s Fellowship Program; The Lifelong Guardianship & Advocacy Network (financial protection)

The care we will provide. Lifelong cardiac surveillance — the central medical priority in Williams syndrome, with blood pressure taken in both arms and a permanent anesthesia-risk flag on every medical record — plus calcium monitoring, hypertension screening, and anxiety treatment weekly where needed, because anxiety is highly prevalent and lifelong in these warm, deeply feeling adults.

Supporting the whole adult. Musical vocation through choir and liturgy, hyperacusis accommodation — sound sensitivity is real distress, not preference — and explicit financial and social exploitation safeguards, the adult-life form of the stranger-safety risk, with the safeguarding plan reviewed annually.

Honestly stated. The exceptional warmth of Williams syndrome is one of its gifts — and a genuine vulnerability. We build protective planning around every adult without ever teaching them their warmth is wrong.

Faith alongside. Real musical vocation in the liturgy, for adults whose gift for music is often extraordinary.

Aging & Neurocognitive Change — All Profiles

St. Dymphna’s Adult Therapeutic Wellness Wing

Home wing: St. Dymphna’s Adult Therapeutic Wellness Wing (neuro-geriatric & palliative nursing) · Also supported at: Domus Margaretae Adult Residential Cottage; the Chapel

The care we will provide. Baseline cognitive documentation for every resident entering later adulthood, with structured re-screening at intervals — the NTG-EDSD for adults with intellectual disability — and dementia-capable environmental adaptation as needs change. And when its time comes, palliative and end-of-life care in place, at home: in the adult’s own cottage, among the people who know them.

Supporting the whole adult. Track V’s gentle rhythm, memory supports built into the cottage, and family and Sisters at the bedside — with care intensity that follows the person, to the end.

Honestly stated. Other systems quietly discharge the resident whose needs grow heavy at the end. We do not. No one graduates from a family.

Faith alongside. Anointing and the sacraments to the last day, the Rosary at the bedside, and a community that does not leave.

The Christ’s Most Forgotten Initiative

All eight programmes