Mental Health Disabilities

1. Mental Health Disabilities Accommodations and Supports Dr. Valerie Cherry, Humanitas Debbie Jones, Humanitas

2. Reasonable Accommodation Committee (RAC) Considerations Preparing to accommodate

3. Accommodation Considerations? • How do we know what accommodations an applicant or student needs to access the Job Corps program? • Remember that many applicants/students will not know much about the types of accommodations they previously received in school and they may not specifically know what to ask for in the Job Corps program. • So, what do you do? • What do you do if there are accommodations requested or needed that are not on an IEP?

4. Examples of Accommodation Documentation Sources • IEPs • 504 plans • Medical records • Psycho-educational evaluations • Neuro-psychological evaluations • Psychological evaluations • Center staff and clinician recommendations • Interviews and review of history/documentation • Applicant and/or family

5. Testing Guidance • Providing educational and psychological testing is NOT considered part of the routine tasks of the CMHC and is NOT accounted for in the 5 hours per 100 students. • Students who need educational and psychological testing to document a suspected disability should be referred to vocational rehab or other appropriate agency. • If appropriately licensed and trained CMHCs are involved in testing, they must conduct an evaluation to document the disability that can be used to secure accommodations and/or services in and outside of Job Corps. • The following is based on community practice standards and the GED Accommodation Guidelines.

6. Learning and Other Cognitive Disabilities • Primarily CMHCs who are Psychologists • Measure of Intelligence • IQ screening measures (e.g., WASI, K-BIT, etc.) and older editions of the WAIS are NOT acceptable • Measures of Academic Achievement • At least 2 measures • Additional Neuropsychological tests, if appropriate • Language • Perceptual-motor skills • Coordination • Attention • Memory

7. ADHD • Primarily CMHCs or Center Physicians with special training in ADHD assessment • Meets ADHD Criteria in DSM-IV TR • Rating Scales • Results from Specific Objective Tests • Attention-related functioning (e.g., the Test of Variables of Attention or Connors’ Continuous Performance Tests) • Attention-related tasks (e.g., Delis-Kaplan Executive Function System or Stroop Color-Word Test) • Functional impact of attention deficits on timed or untimed achievement tests (e.g., Woodcock-Johnson PsychoeducationalBattery-III)

8. Emotional/Psychological/Psychiatric Disability • Primarily CMHCs or Center Physicians with special training in psychological and/or psychiatric assessments • Documentation and assessment tests must: • Include a clear diagnosis based on DSM-IV TR • Document the history of impairment • Provide information on current functional limitations • Confirm that the symptoms are not due to another disorder, such as a learning disability or ADHD

9. Sample Scenario • 18 year old applicant has a history of conflict with peers which has resulted in verbal altercations in the past. • No history of physical aggression, but has demonstrated dramatic and impulsive behavior with one hospitalization for suicidal attempt about 2 years ago. • Currently applicant is unemployed, but has worked at two jobs in the past year – Burger King and WalMart.

10. Sample Scenario • Applicant reports that the people at the jobs were not fair and treated employees badly. Applicant quit both jobs after about 3-4 months each. • Has a therapist who reports present behavior as stable on medication. • Medication side effects of morning grogginess, dry mouth • Therapist also indicates that applicant can function in a residential group setting, but needs to continue in outpatient treatment to work on managing anger and improving self-esteem. • Applicant has a diagnosis of borderline personality.

11. What accommodations might you suggest?

12. Definitions and Types Mental Health impairments and Functional Limitations

13. Mental? Mental Illness? Mental Disorder? Mental Disease? Mental Disability? Mental Impairments? 13

14. Mental Health Impairments • Mental health impairments, refer collectively to all diagnosable mental health disorders characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. 1 1Goldman, H.H., Rye, P., & Sirovatka, P. (Eds.) (1999). Mental health: A report of the surgeon general.

15. Common Mental Health Impairments • ADHD • Anxiety Disorders • Generalized Anxiety • Post Traumatic Stress Disorder • Obsessive Compulsive Disorder • Bipolar Disorder • Depression • Asperger’s Syndrome

16. Common Mental Health Impairments (cont’d) • Personality Disorders • Cluster A: Odd or eccentric behavior • Schizoid Personality Disorder • Paranoid Personality Disorder • Cluster B: Dramatic, emotional or impulsive behavior • Antisocial Personality Disorder • Borderline Personality Disorder • Cluster C: Anxious fearful behavior • Obsessive-Compulsive Personality Disorder • Schizophrenia

17. Functional Limitations Definition: The inability to perform an action or a set of actions, either physical or mental, because of physical or emotional restriction2 • Time Management • Organization and Prioritization • Social Skills • Concentration • Memory • Communication • Stamina • Responding to Change • Screening Out Environmental Stimuli • Managing Stress 2Brodwin, M., Tellez, F., Brodwin, S. (1993). Medical, Psychosocial and Vocational Aspects of Disability. Athens, GA: Elliott and Fitzpatrick, Inc.

18. Mental Health Impairments and Functional Limitations • Screening Out Environmental Stimuli • An applicant with ADHD reports being easily distracted may not be able to work in a large group. • Concentration • An applicant reports having Depression and has trouble focusing on tasks for extended periods. • Stamina • Student with a diagnosis of Schizophrenia reports not having energy to do residential chores in the morning and combating drowsiness in the afternoon due to medications.

19. Mental Health Impairments and Functional Limitations • Change • A student with Anxiety Disorder may take longer to learn new routines, or feel stressed when new students arrive in the dorm. • Managing Stress • An applicant with a personality disorder indicates that when stressed by deadlines and workload has a hard time managing emotions and sometimes gets into verbal conflicts with peers. • Social Skills • A student with Asperger’s does not talk much with other students during down time in the dorm and has trouble reading subtle social cues in a group setting.

20. Accommodations and Supports How Can we help Outside the classroom

21. Accommodations:Screening Out Environmental Stimuli • Help arrange the student's environment • Redesign space • Minimize auditory/visual distractions • Reduce clutter

22. Accommodations: Maintaining Concentration • Help arrange the student’s schedule • Prioritize tasks/activities/assignments • By day, week, month, etc. • Identify student’s patterns in activity • Example: “you do this 3 times each week” • Emphasize due dates on calendars • Develop a color-coded system (each color represents a task, or event, or level of importance) • Ensure accuracy of entries on calendar or I-Phone

23. Accommodations: Maintaining Stamina • Arrange for longer/more frequent breaks between activities • Help student pace their workload and social activities • Develop substitution strategies (for times when a student cannot keep their obligation to the event or activity)

24. Accommodations: Managing Change (Transition) • Recognize that change can be difficult (physically/mentally) • Maintain special channels of communication during transition period (hotline, on-call personnel) • When appropriate, share your own experiences with transition • Re-fresh skills learned in orientation (such as directions through the building, doing laundry, etc.) • Offer peer mentorship

25. Accommodations: Managing Stress • Reinforce time management techniques • Identify support personnel • Teach money management skills • Invite therapy animals organization onto site for visit

26. Accommodations: Exhibiting Appropriate Social Skills • Develop simple and appropriate code of conduct for environment: • Acceptable verbal language or gestures • Engaging in debate or discussion • Acceptable student interaction • Environments might require different codes of conduct: • Classroom/career technical • Lunchroom • Dorms or common areas • Recreation • Out in the community

27. Accommodations: Exhibiting Appropriate Social Skills • Practice appropriate social skills • Role play • Video demonstration • Encourage all students to model appropriate social skills • Use a peer, tutor, and/or mentor to reinforce appropriate social skills • Reward/praise student engaging in appropriate behavior

28. Accommodations: Exhibiting Appropriate Social Skills • Identify the “out” for those times when the student cannot demonstrate appropriate skills • Hand gesture, word, or signal • Where to go to regain composure • How to return/re-engage in environment

29. Accommodations: Communicating with Others • Adjust method of communication • One-on-one • Face-to-face • In the presence of another • Teach/model appropriate communication skills • Addressing person by name or title • Waiting to speak (not interrupting others) • How to enter another group’s conversation

30. Sample Scenario • 18 year old applicant has a history of conflict with peers which has resulted in verbal altercations in the past. • No history of physical aggression, but has demonstrated dramatic and impulsive behavior with one hospitalization for suicidal attempt about 2 years ago. • Currently applicant is unemployed, but has worked at two jobs in the past year – Burger King and WalMart.

31. Sample Scenario • Applicant reports that the people at the jobs were not fair and treated employees badly. Applicant quit both jobs after about 3-4 months each. • Has a therapist who reports present behavior as stable on medication. • Medication side effects of morning grogginess, dry mouth • Therapist also indicates that applicant can function in a residential group setting, but needs to continue in outpatient treatment to work on managing anger and improving self-esteem. • Applicant has a diagnosis of borderline personality.

32. What accommodations might you suggest?

33. Accommodation Suggestions • What accommodations might be indicated? • REMEMBER: You must consider accommodation needs throughout the center environment. • Water bottle in class, in testing, and in dorm. • What could you do if refillable water bottles are prohibited for drug/alcohol use concerns? • Schedule adjustments • For therapy appointments, later start to class day, change in time medication is taken so adjustment to dorm schedule • Frequent breaks (for movement and to re-organize self) • Positive Peer Mentor (particularly during meal times) • Chunking assignments - why?

34. Resources

35. Contact the Job Accommodation Network! (800) 526-7234 (V) (877) 781-9403 (TTY) www.askjan.org

36. Job Corps Disability Website

37. Additional Resources • Health and Wellness Website (Citrix) • CMHC Desk Reference Guide • Attachment I - Sample Accommodations for Students with Mental Health Disabilities • Attachment P -Mental Health Chronic Care Management Plans • APA Guidelines for Assessment of and Intervention with Persons with Disabilities • http://www.apa.org/pi/disability/resources/assessment-disabilities.aspx • GED Test Accommodations for Candidates with Disabilities • http://www.acenet.edu/Content/NavigationMenu/ged/test/take/Accommodations_Disab.htm

38. Regional Mental Health Specialists • Region 1 Dave Kraft, MD, MPH dkraft@external.umass.edu Maria Acevedo, PhD mmacevedo@onelinkpr.net • Region 2/Lead Valerie Cherry, PhD vcherryphd@aol.com • Region 3 Suzanne Martin, PsyD, MPH SUZANNEM@aol.com • Regions 4 and 6 Andrew Berger, PhD headoc@aol.com Vicki Boyd, PhD vdelboyd@aol.com • Region 5 Helena MacKenzie, PhD helena.mackenzie530@gmail.com

39. Regional Disability Coordinators • Lisa Kosh – Boston Region • lisa.kosh@humanitas.com • Nikki Jackson – Atlanta and Philadelphia Regions • nikki.jackson@humanitas.com • Sylvia Domagalski – Dallas Region • sylvia.domagalski@humanitas.com • Kim Jones – Chicago and San Francisco Regions • kim.jones@humanitas.com

40. Questions?