Accommodating Students with Emotional Disabilities

1. Accommodating Students with Emotional Disabilities Nicole R. Biggs, M.Ed. Site Principal SiaTech Debbie Jones Disability Program Analyst Humanitas

2. Objectives

3. Objectives • Center staff will be able to: • Identify appropriate examples of accommodations and strategies based upon a student’s manifestations of the disability (i.e. presenting symptoms and behaviors) • Verbalize how the use of appropriate accommodations and strategies assists students with emotional disabilities in improving their educational and daily living outcomes • Identify classroom management techniques that support improved behavioral outcomes by increasing appropriate behaviors and decreasing inappropriate behaviors

4. Documentation Source Examples • IEP serves as documentation of the disability in the Job Corps program • Classification of Emotional Disturbance (ED) in IEPs • Definition and characteristics defined within the Individuals with Disabilities Education Act • Applies to public school/charter partners • Provides accommodation/modification and supports history • Medical Records • Psychological and Neuro-psychological assessments

5. Definitions

6. Emotional Disturbance defined • According to IDEA section 34 CFR 300.8 (c)(4), an emotional disturbance is defined as: • a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: • An inability to learn that cannot be explained by intellectual, sensory, or health factors • An inability to build or maintain satisfactory interpersonal relationships with peers and teachers

7. Emotional Disturbance defined • Inappropriate types of behavior or feelings under normal circumstances • A general pervasive mood of unhappiness or depression • A tendency to develop physical symptoms or fears associated with personal or school problems

8. Determining reasonable accommodation

9. Determining Reasonable Accommodation • How do you know what accommodations an individual with a disability might need? • Did the applicant requestany accommodations? • 6-53 • Accommodation Request Form • Stated in the interactive accommodation process • Documentation of disability shows previous need/history of use of certain supports and accommodations • What are the presenting symptoms/behaviors? • Functional limitations

10. Functional limitations • Time Management • Organization and Prioritization • Social Skills • Concentration • Memory • Communication • Stamina • Responding to Change • Screening Out Environmental Stimuli • Managing Stress Definition: The inability to perform an action or a set of actions, either physical or mental, because of physical or emotional restriction1. 1Brodwin, M., Tellez, F., Brodwin, S. (1993). Medical, Psychosocial and Vocational Aspects of Disability. Athens, GA: Elliott and Fitzpatrick, Inc.

11. Assessing one’s own perceptions • Assess your own perceptions of people with emotional disabilities? • Do you have some misperceptions, fears, questions related to working with students with emotional disabilities? • Be conscientiousness and aware of how your own interaction with student can lead to exacerbating disruptive or concerning behaviors • Your personality, tone, body language • Understand how you interact and react

12. Identifying Behavioral supports

13. Behavior Intervention Plan (BIP) • Unlike the core components of the Job Corps program, our public school or charter partners also have to meet the obligations outlined within IDEA including how a BIP is developed • A BIP is based on the results of a functional behavior assessment which would be conducted to try and determine why the behavior was occurring and then use that information to identify intervention strategies that include positive behavior supports and services to address behavior • In Job Corps, the Reasonable Accommodation Committee (RAC) (inclusive of the student) identifies needed supports or the student may request needed supports. When the type of support needed is unclear, a less formal assessment approach can be used. Dependent upon the specifics of the support, it may need to be added to the student’s accommodation plan

14. Identifying behavioral supports • If a student with a disability is having difficulty managing his or her behavior, then convene the Reasonable Accommodation Committee (RAC), inclusive of the student, to review and discuss • Is the conduct in question caused by or had a direct and substantial relationship to the student’s disability? • Have previously identified and agreed upon accommodations in the student’s Job Corps Accommodation Plan been implemented? • Are they effective? • Did the student’s IEP mention or have attached a behavior intervention plan (BIP)?

15. Assessing The behavior • Identify the specific behavior(s) in question • Attempt to determine why the behavior is occurring • What function does the behavior serve for the student? For example, does it allow the individual to escape the environment to avoid over-stimulation of the senses, to resolve anxiety, to escape demands, etc. • Does the behavior appear to be linked to a skill deficit or a performance deficit? • Skill Deficit - A behavior or academic skill that student does not know how to perform (Ex. A student who hasn't mastered the skill of greeting others appropriately may have a skill deficit in that area) • Performance Deficit - A behavioral or academic skill the student does know, but does not consistently perform (Ex. A student is chronically late for a math class he or she does not enjoy)

17. “Emotional” disorders

18. Anxiety disorders • An umbrella term that encompasses several distinct disorders that share the core characteristic of excessive, irrational fear and dread: • generalized anxiety disorder (GAD) • obsessive-compulsive disorder (OCD) • panic disorder • posttraumatic stress disorder (PTSD) • social anxiety disorder (also called social phobia) • other specific phobias http://nichcy.org/wp-content/uploads/docs/fs5.pdf

19. Post-traumatic stress disorder (PTSD) • PTSD is one of the anxiety disorders that develops after a terrifying ordeal that involved physical harm or the threat of physical harm. People with PTSD may: • startle easily • become emotionally numb • lose interest in things they used to enjoy • have trouble feeling affectionate • be irritable • become more aggressive http://www.nimh.nih.gov/health/publications/anxiety-disorders/post-traumatic-stress-disorder.shtml

20. Eating disorders • Eating disorders are characterized by extremes in eating behavior - either too much or too little - or feelings of extreme distress or concern about body weight or shape • Anorexia nervosa, bulimia nervosa, and binge-eating are common types of eating disorders • Anorexia nervosa is characterized by self-starvation and dramatic loss of weight • Bulimia nervosa involves a cycle of binge eating, then self-induced vomiting or purging • Binge-eating is when the person loses control over his or her eating but they do not purge afterwards http://nichcy.org/wp-content/uploads/docs/fs5.pdf

21. Mood Disorders • Mood disorders refer to a category of mental health problems that include all types of depression and bipolar disorder. Mood disorders are sometimes called affective disorders • Symptoms may include: • persistent feelings of sadness or feeling hopeless or helpless • having low self-esteem • difficulty with relationships • decreased energy and/or difficulty concentrating • frequent physical complaints (i.e. headache, stomach ache, fatigue) http://medicalcenter.osu.edu/patientcare/healthcare_services/mental_health/mental_health_about/mood/Pages/index.aspx

22. Bipolar disorder • Bipolar disorder is a mood disorder, also known as manic-depressive illness, and is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Some symptoms might include: • increased distractibility • restlessness • loss of interest • feelings of jumpiness or agitation http://www.nimh.nih.gov/health/publications/bipolar-disorder/what-is-bipolar-disorder.shtml

23. Personality disorders • Personality disorders are deeply ingrained ways of thinking and behaving that are inflexible and generally lead to impaired relationships with others. Some symptoms may include: • Rigid – unable to respond to the changes and demands of life or inflexible as stated above • Difficulty with or extreme anxiety in social interactions • Difficulty making decisions or in completing tasks http://www.nmha.org/go/information/get-info/personality-disorders

24. Conduct Disorder • Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. This may include some of the following behaviors: • aggression to people and animals • destruction of property • deceitfulness, lying, or stealing • truancy or other serious violations of rules http://nichcy.org/wp-content/uploads/docs/fs5.pdf

25. Psychotic disorders • “Psychotic disorders” is another umbrella term used to refer to mental disorders that cause abnormal thinking and perceptions. Two of the main symptoms are delusions and hallucinations • Delusions are false beliefs, such as thinking that someone is plotting against you • Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there • Schizophrenia is one type of psychotic disorder http://nichcy.org/wp-content/uploads/docs/fs5.pdf

26. Accommodations

27. Staff responsibilities • Each staff person must ensure: • Familiarity with a student’s accommodation plan • That the accommodations related to their specific area are discussed with the student • That the accommodations are implemented • That the accommodations are monitored for effectiveness

28. Individuals with the same diagnosis may and often do have needs that are unique to them; the same disability may manifest itself in different ways in different people • There is no list of accommodations appropriate for a particular condition. Accommodations are determined on a case-by-case basis • Functional limitations • Strengths

29. managing Stress/Anxiety • Allow modifications to schedule to use stress relieving strategies • Exercise • Provide private space to use stress relieving strategies • Provide special pass to see a designated staff person or go to a designated quiet space • Provide peer or staff mentor student can speak with if symptoms are escalating

30. managing Stress/Anxiety • Consider placement in work/living space • For example, a student with PTSD may need to be seated facing doorways not in the classroom but in the dormitory and other environments • Provide additional time to complete certain tasks or assignments • Remove environmental triggers • Smells, noises, etc. • Lighting • Provide frequent feedback, praise, positive reinforcement, etc.

31. Maintaining organization • Provide organizer and assist, as appropriate • 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 iPhone

32. Maintaining attention/concentration • Movement breaks • Redesign space to • Minimize auditory/visual distractions • Reduce clutter • Visual timers or vibrating watches • Break large assignments into smaller segments • Use checklists/charts • Noise cancelling headset • Provide written instructions and notes when giving oral instruction • Verify understanding

33. Memory supports • Provide written information or notes • Provide pictorial or verbal cues • Use check-lists • Use color coding to indicate priority order • Variety of mediums to review content independently • Videos • Audio of content/recorder • Extended time

34. Maintaining stamina • Arrange for longer/less frequent or shorter/more frequent breaks between activities • Help student pace their workload and social activities by using shortened task lists or a timed schedule • Develop substitution strategies (for times when a student cannot keep their obligation to the event or activity)

35. Managing change/Transitions • Assist student in identifying points of transition within organizer • Highlight/color code transitions in schedule • Provide prompts/cues and/or set up alerts via electronic or other means of transition times in schedule • Ensure enough time to process and adapt to the change • Use peer mentorship to model and support individual during times of transition

36. Managing Social interactions • Environments might require different codes of conduct (i.e. classroom, career technical versus the dorm or the cafeteria or out in the community) • Provide written copy or audio version, if needed • Verify understanding • Use a peer, tutor, and/or mentor to reinforce appropriate social skills • Practice appropriate social skills • Role play • Provide video of expected interactions like using “social stories”

37. Managing social interactions • Identify the “out” for those times when the student cannot demonstrate appropriate skills and build into accommodation plan • Hand gesture, word, or signal • Where to go to regain composure • Use headphones with soothing music • Provide information, in an accessible format, as to how the student can return/re-engage in environment

38. Supporting social anxiety • Allow leaving each class a few minutes early to avoid crowded hallways • Sit near an exit during large meetings or assemblies • Allow watching of assembly via electronic means live or via videotape • Allow to provide written response versus an oral one • Use tri-fold boards for in-class testing • Assign seating to the side or the back of the room • Provide a peer mentor • Provide information, in an accessible format, as to how the student can return/re-engage in environment

39. Let’s review • An applicant with a diagnosis of Bipolar reports being easily distracted and may have difficulty working in a large group. • An applicant with a personality disorder indicates that when stressed by deadlines and workload, he has a hard time managing emotions and sometimes gets into verbal conflicts with peers. • A student with a diagnosis of Schizophrenia reports not having energy to do academic work in the morning due to medication side effects. • A student with an Anxiety Disorder is having trouble learning how to do his dorm duties and feels stressed when new students arrive in the dorm.

40. “Classroom" Management

41. Setting expectations • Establish ground rules • Rules are clear and consistent • Keep rules to a minimum of 5 • Clearly post rules • Give copy of rules • Review rules frequently • Ensure understanding of rules • Set limits and boundaries

42. Classroom Managementtechniques & strategies • Ensure classroom instruction and assigned tasks match student’s interests and instructional level; utilizing structured, interactive, fast-paced and directive teaching styles that maximizes students' attention during whole school instruction and individual seat work • Provide a structured and predictable environment. This is often beneficial for students with all types of disabilities but can sometimes be essential for students with emotional disabilities • Establish clear short-term and long-term goals • Use high interest materials when presenting something to the class

43. Classroom Management techniques & strategies • Praise specific behavior • Provide opportunities for the student to use self-control/self monitoring techniques to control behavior • Teach and/or model the techniques • Use the CMHC as a resource • Teach self-talk to relieve stress and anxiety • Use iPhone apps that walk through calming sequence • Provide brief opportunities for movement and down time to participate in an activity of choice • Structure activities to incorporate opportunities for social interaction

44. Classroom Management techniques & strategies • Allow for short breaks between assignments • Cue student to stay on task (non-verbal) • Change tone of voice • Establish a quiet zone or “cool-off” area, if possible • Praise often • Ensure each day has some opportunity for success, preferably at the beginning of a class, task, etc. • Ignoring inappropriate behaviors not drastically outside of classroom limits if not proving disruptive to others • Post Daily/Weekly Schedule

45. Prevention & De-escalation • Take preventative action to avoid behavior escalation whenever possible. • Use humor to diffuse tension • Offer two choices as options (if possible) • Redirect through diversion of attention to something else • Again, allow time for the individual to regroup and regain level of calmness

46. Most Importantly! Treat the student with an emotional disability as someone who is entitled to and deserves a “normal” learning experience!

47. resources

48. References • Center for Effective Collaboration and Practice • http://cecp.air.org/fba/default.asp • United States Department of Commerce • http://www.commerce.gov/blog/2012/07/25/census-report-nearly-1-5-people-have-disability-us-update • National Dissemination Center for Children with Disabilities • http://nichcy.org/disability/specific/emotionaldisturbance • National Institute of Mental Health • http://www.nimh.nih.gov/index.shtml

49. 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

50. Regional mental health specialists • Dave Kraft, MD, MPH - Boston • dkraft@external.umass.edu • Maria Acevedo, PhD - Boston (Puerto Rico Centers) • mmacevedo@onelinkpr.net • Valerie Cherry, PhD - Philadelphia • vcherryphd@aol.com • Suzanne Martin, PsyD, MPH - Atlanta • suzannempsyd@gmail.com • Lydia Santiago - Dallas • lydia.v.santiago@att.net • Helena Mackenzie, PhD - Chicago • helena.mackenzie530@gmail.com • Vicki Boyd, PhD - San Francisco • vdelboyd@aol.com