improving accommodation support for students with mental health disabilities

IMPROVING ACCOMMODATION

SUPPORT FOR STUDENTS WITH MENTAL HEALTH

DISABILITIES

Valerie Cherry, PhD

Lead Mental Health Specialist

Humanitas, Inc.

EMPLOYMENT WORKS! Why encourage

people with disabilities to work?

Sense of identity other than a “diagnosis”

Using skills and talents

Personal satisfaction Community inclusion Social Integration Reduces “double

stigma” – disability and lack of occupation

Employment should be the expectation not the exception!

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WHO IS A PERSON WITH A DISABILITY? A person has a disability if he/she has a physical

or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment

Remember – being regarded as having an impairment does not entitle one to positive actions (i.e. accommodations) but it does protect the individual from being discriminated against for having a disability

1EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011)

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AMERICAN DISABILITIES ACT2008 AMENDMENT

Expanded inclusion of medical and mental health conditions that do not require extensive scientific, medical, or statistical analysis

Specifically, determining whether an impairment substantially limits a major life activity should not demand extensive analysis nor consider mitigating measures

Accommodation and Compliance Series: The ADA Amendments Act of 2008" http://askjan.org/bulletins/adaaa1.htm

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AMERICAN DISABILITIES ACT2008 AMENDMENT

Examples that will always be found to result in substantial limitation in performing certain major life activities :

Diabetes substantially limits endocrine function

Epilepsy substantially limits neurological function

Accommodation and Compliance Series: The ADA Amendments Act of 2008" http://askjan.org/bulletins/adaaa1.htm

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WHICH MENTAL HEALTH CONDITIONS ARE LISTED IN ADAAA?

Major Depressive Disorder Bipolar Disorder Post-Traumatic Stress Disorder (PTSD) Obsessive Compulsive Disorder (OCD) Schizophrenia

Substantially Limits Brain Function

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WHO SHOULD BE CONSIDERED AS HAVING A MENTAL HEALTH DISABILITY IN JOB CORPS?

Applicant/student on psych meds Documentation in file of diagnosis and past treatment

for major depression 2 years ago, currently not on meds

Reports being diagnosed as bipolar at age 12, remembers being in special group in school for behavior, saw therapist 5 years ago, no IEP or documentation in file, no meds

Student referred to CMHC who conducts clinical assessment and confirms first time diagnosis of anxiety disorder

Student reports feeling depressed after loss of sibling Student has history of chronic adjustment disorder

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NEXT STEP? Convene Reasonable Accommodation

Committee (RAC) Disability Coordinator, CMHC, and

Applicant/Student Review information in file with

applicant/student and let them know they are entitled to reasonable accommodations while in Job Corps

Ask applicant/student about current functioning related to mental health condition and what areas they may need assistance with in the classroom, in the dorm, or in other social settings like recreation, cafeteria, etc.

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NEXT STEP? Specific Questions to Consider:

What limitations (symptoms or behaviors) does the applicant/student experience?

How do these limitations affect the applicant’s/ student's ability to perform in the classroom or participate in Job Corps activities?

What accommodations are already available to help reduce or eliminate the problems caused by the applicant’s/ student's limitations?

Are all possible resources being used to determine accommodations?

Can the applicant/student provide information on possible accommodation solutions?

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NEXT STEP? In collaboration with the DC, be prepared to offer

suggested accommodations based on what has been used in the past (IEP) and new ones that may be appropriate in the Job Corps setting paying close attention to needs outside of the classroom.

Where can you find sample accommodations for specific mental health conditions? Mental Health Chronic Care Management Plans CMHC Desk Reference Guide Job Corps Disability Website Job Accommodation Network—SOAR Accommodation Drop List in CIS

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askjan.org/soar/

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CIS POSSIBLE ACCOMMODATIONS

INSTRUCTIONAL/ASSIGNMENTS

01 - Verification of understanding of instructions, rules, assignments

02 - Movement breaks

03 - Break large projects/assignments into smaller sections

04 - Instructional supports

05 - Reduced content

06 - Increased wait time for responses

08 - Study guides

09 - Copies of notes

10 - Extended time for assignment completion

BEHAVIORAL

01 - Rules/expectations in accessible format

02 - Verification of understanding of expectations, rules, consequences.

03 - Student/staff cues for need of time-out or break

04 - Time-out/break area

05 - Positive behavior supports

06 - Feedback on progress

PERSONAL SUPPORTS

01 - Buddy/Mentor

99 - Other

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NEXT STEP? Applicant/student can accept all or some, decline or suggest other

accommodations Accepts – DC enters student in disability data and creates

accommodation plan in CIS. Declines – DC enters student in disability data and documents student's

refusal of accommodations.  There is no specific policy requirement on how to document the refusal.  Options include: SHR

Document the decline on the Reasonable Accommodation Request Form (RARF) found within Appendix 605 and store in SHR

Make an entry documenting the decline in the SHR Disability folder- this folder is created for students who have a disability, but

decline accommodation.  It contains the documentation of the disability (if non medical) and the initial decline (usually the RARF).  It becomes the acc folder should the student decide to receive accommodations later.  The disability folders are usually stored in same area as acc folder, but is somehow differentiated within the file cabinet.

Log-some DCs keep a log to document their phone calls or face to face meetings with the applicant/student, the interactive accommodation process, and that the applicant/student declined accommodation

RAC meeting note-Some centers document the decline in the RAC minutes The key is to consistently document if a student declines

accommodations!The Reasonable Accommodation Request Form (RARF)

will be available for download after webinar

IDENTIFYING ACCOMMODATIONS VERSUS CARE MANAGEMENT FOR STUDENTS WITH MENTAL

HEALTH DISABILITIES

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DAILY ACCOMMODATION SERVINGS

The goal is removal of barriers to participation

The emphasis is on ACCESS, NOT on outcome

Not all students with mental health disabilities will need accommodations in Job Corps and many may only need a few accommodations

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COMMON MENTAL HEALTH DISABILITIES Anxiety Bipolar Disorder Major Depression Obsessive Compulsive Disorder (OCD) Panic Disorder Post-Traumatic Stress Disorder (PTSD) Schizophrenia **Autism Spectrum Disorder

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COMMON FUNCTIONAL LIMITATIONSAREAS IMPACTED BY BEHAVIOR OR SYMPTOMS

Attendance Concentration Emotions Fatigue Memory Organization Stress Panic Attacks

Social Skills Sensory and

Environmental Triggers

Communication Panic Attacks Sleep Disturbances Responding to

Change

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CMHC THOUGHT PROCESS

Mental Health Disability

Individual’s Symptoms and Behaviors

Functional Limitations

Accommodations

Mental Health DisabilityMajor Depression

Individual’s Symptoms and BehaviorsDepressed Mood, Low Energy ,Fatigue, Irritability, and Sleep Difficulties

Functional LimitationsLow Energy , Fatigue and Emotions (Irritability)

AccommodationsFrequent/longer breaks and additional time to complete class work and dorm choresAllowed “quiet space” in dorm area

Care ManagementMedication ReviewEmotion Regulation Session/Group

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Mental Health DisabilityBipolar Disorder I

Functional LimitationsConcentration and Handling Emotions

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SCENARIO

Applicant has diagnosis of Generalized Anxiety Disorder and ADHD and is compliant with meds. Reports still sometimes feels nervous around very large groups for too long and at times becomes disorganized, and forgets to complete things when stressed out. Also reports that medicine sometimes makes her groggy in the morning and mouth feels dry. There is an IEP in the file.

Mental Health Disability

Functional Limitations

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Mental Health DisabilityGAD and ADHD

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AREAS/EXAMPLES OF POTENTIAL IMPACT FOR MENTAL HEALTH DISABILITIES

Attendance Concentration Emotions Fatigue Memory Organization Stress Panic Attacks

Social Skills Sensory and

Environmental Triggers

Communication Sleep

Disturbances Responding to

Change

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ATTENDANCE Modified schedule to permit:

Attending counseling appointments in the community.

Attending group meeting(s) on center or in community.

Provide special pass to see CMHC or other designated staff person when feeling overwhelmed.

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CONCENTRATION

Divide large assignments and chores into smaller tasks and goals

Use auditory or written cues as appropriate

Provide memory aids such as schedulers, calendars, email add-ons, or apps

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EMOTIONS Allow student to be excused to go to a

quiet area to use relaxation app on phone

Allow passes during training hours to HWC and others for needed support

Allow flexible breaks

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MANAGING STRESS Allow telephone calls or passes during work

hours to doctors and others for needed support Positive praise and reinforcement Allow flexible work environment:

Flexible scheduling Modified break schedule Leave for counseling

Modify sensory and environmental triggers Adjusted meal times when fewer students and lower

noise level in cafeteria Use of a calming aromatherapy necklace or

bracelet that would allow access to the scent when needed.

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PANIC ATTACKS Allow the student to take a break and go

to a place where s/he feels comfortable to use relaxation techniques or contact a support person

Identify and remove environmental triggers such as particular smells or noises

Peer support person

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COMMUNICATION/SOCIAL SKILLS Allow the student to be exempt from

oral presentations and/or only in small groups

Allow student to email questions and/or concerns and get responses back via email

Peer support person

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TEST YOUR KNOWLEDGEQuick Quiz

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TEST YOUR KNOWLEDGE What are some functional limitations a

person with a mental health disability might experience?

What are some possible accommodations for the examples you identified in the previous question?

What are some possible care management examples for a person with a mental health disability?

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MENTAL HEALTH RELATED RESOURCES National Alliance for the Mentally ill (NAMI)

(http://www.nami.org) National Institute of Mental Health

(http://www.nimh.nih.gov/) Anxiety Disorder Association of America (

http://www.adaa.org/) The Substance Abuse and Mental Health

Services Administration (SAMHSA) — Improves the quality and availability of prevention, treatment, and rehabilitation services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses. (http://www.samhsa.gov/)

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(800) 526-7234 (V)

(877) 781-9403 (TTY)

www.askjan.org

REGIONAL MENTAL HEALTH SPECIALISTS Region 1

David Kraft, MD, MPH dkraft@external.umass

.edu Maria Acevedo, PhD

mmacevedo@onelinkpr.net

Region 2 Valerie Cherry, PhD

vcherryphd@gmail.com

Region 3 Suzanne Martin,

PsyD, MPH suzannempsyd@gmail.

com

Regions 4 Lydia Santiago, PhD

lydia.v.santiago@att.net

Region 5 Helena MacKenzie,

PhD helena.mackenzie53

0@gmail.com

Region 6 Vicki Boyd, PhD

vdelboyd@aol.com

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REGIONAL DISABILITY COORDINATORS Laura Kuhn – Boston and Dallas Region

laura.kuhn@humanitas.com Nikki Jackson – Atlanta and Philadelphia

Regionsnikki.jackson@humanitas.com

Kim Jones – Chicago and San Francisco Regionskim.jones@humanitas.com