IMPROVING ACCOMMODATION SUPPORT FOR STUDENTS WITH MENTAL HEALTH DISABILITIES

1. IMPROVING ACCOMMODATION SUPPORT FOR STUDENTS WITH MENTAL HEALTH DISABILITIES Valerie Cherry, PhD Lead Mental Health Specialist Humanitas, Inc.

2. 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!

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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?

10. 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

12. askjan.org/soar/‎

16. CIS Possible Accommodations

17. 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

18. identifying accommodations versus care management for students with mental health disabilities

19. 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

20. Common Mental Health Disabilities • Anxiety • Bipolar Disorder • Major Depression • Obsessive Compulsive Disorder (OCD) • Panic Disorder • Post-Traumatic Stress Disorder (PTSD) • Schizophrenia • **Autism Spectrum Disorder

21. 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

22. CMHC Thought Process

25. 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.

28. 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

29. 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.

30. 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

31. 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

32. 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.

33. 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

34. 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

35. Test Your Knowledge Quick Quiz

36. 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?

37. 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/)

40. (800) 526-7234 (V) (877) 781-9403 (TTY) www.askjan.org

41. 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.mackenzie530@gmail.com • Region 6 • Vicki Boyd, PhD • vdelboyd@aol.com

42. Regional Disability Coordinators • Laura Kuhn – Boston and Dallas Region • laura.kuhn@humanitas.com • Nikki Jackson – Atlanta and Philadelphia Regions • nikki.jackson@humanitas.com • Kim Jones – Chicago and San Francisco Regions • kim.jones@humanitas.com