# Presentation: 215080

## Disability Considerations and  Mental Health

- Gwendolyn Childs, PsyD
- Regional Mental Health Consultant
- Atlanta Region Health and Wellness Conference
- September 21, 2006

## Areas to be Addressed

- What is a mental health disability?
- When may a mental health disability constitute a grounds for applicant denial?
- How may a mental health disability be reasonably accommodated?
- Specific center issues/concerns

## Who is a Person with a Disability?

- There are 3 categories of protected individuals:
- An individual with an actual, current disability
- An individual with a record of a past disability
- An individual who has been regarded as having a disability

## Any individual who has a physical or mental impairment that substantially limits one or more of the person’s major life activities MAY be a person with a disability.

**Notes:**
If documentation is available and there is a question as to whether it meets the definition of a disability – error on the side of it being a current disability.

## Major Life Activities Potentially Impacted by Mental Health Disabilities

- Caring for oneself
- Concentrating
- Interacting with others
- Sleeping
- Eating

## Common Mental Health Disabilities

- ADHD
- Learning disabilities
- Mood disorders
- PTSD
- Mental retardation
- Autistic spectrum disorders (e.g., Aspergers’)
- Obsessive compulsive disorder

## What Does Not Qualify as a Mental Health Disability

- A current drug user is not considered a person with a disability
- A person who casually used alcohol or drugs in the past
- Pedophilia
- Compulsive gambling
- Pyromania, kleptomania

## File Review: Factors for Consideration 

- Applicant poses a direct threat to self or others that can not be reasonably accommodated (_requires an individualized threat assessment_)
- Applicant can not be reasonably expected to successfully participate in group situations and activities and is likely to engage in behavior that would prevent other students from receiving the benefit of Job Corps
- Applicant’s education and training needs can not be best met through the Job Corps program _even with accommodation_

## Potential Barriers for Individuals with Mental Health Disabilities

**Meeting Self-Care Needs**—Problems with hygiene or grooming Unable to Ignore Environmental Stimuli (Inability to ignore sounds, sights, or odors that interfere with focusing on tasks)
**Sustaining Concentration**—Restless, shortened attention span, easily distracted, difficulty remembering verbal instructions
**Maintaining Stamina**—Lack of energy, drowsy due to medications, slower pace

## Potential Barriers (continued)

**Managing Deadlines and Multiple Tasks—**Difficulty prioritizing tasks, meeting deadlines, organizing
**Interacting Socially—**Difficulty reading social cues, fitting in, getting along, maintaining interpersonal relationships
**Responding to Negative Feedback—**Trouble accepting and understanding criticism, withdraws because does not know how to change
**Dealing with Change—**Upset by instructor changes, coursework changes, or changes in examination dates

## Medication Side Effects

- Excessive thirst
- Itching
- Restlessness
- Increased frequency of urination
- Drowsiness

## Potential Impact of Medication Side Effects

- Inconsistent attendance
- Increase in fatigue
- Reduced endurance
- Difficulty taking notes
- Difficulty with memory, retention and recall
- Reduced attention and concentration

## Accommodations to Consider

- Schedule modification or restructuring
- Non-spill drink containers
- Copy of notes from instructor/peer
- Use of digital tape recorder
- Study guides, note cards, review of materials via video and audio tapes
- Frequent breaks, variety in types of assignments, vibrating watch for reminders

## Social Relationship Difficulties

- Social relationship difficulties may include:
- Difficulty with properly interpreting nonverbal cues
- Dislike of working in crowds or wanting not to be isolated
- Difficulty with interacting or fitting in with others
- Difficulty responding to negative feedback

## Accommodations to Support Positive Social Interactions

- Schedule flexibility–allow to leave class a few minutes early to avoid crowded hallways
- Assign a peer buddy
- Assign a mentor
- Participation in support groups
- Participation in local or on site counseling opportunities

## Accommodations to Support Difficulty Responding to Negative Feedback

- Use a feedback loop (ask student’s perspective of performance, describe both strengths and weaknesses)
- Suggest specific ways to improve; give student the chance to read written feedback privately, and then discuss
- Make alternative assignments or “extra credit” options available to all students, thus giving them the opportunity to make up for a poor grade; if necessary

## Accommodations to Support Students with Difficulty Responding to Change

- Prepare students when possible for changes that will be happening
- Make a special effort to introduce any new staff (e.g., instructors, teachers, residential advisors, career counselors, etc.)
- Orient the new instructor to student’s needs

## Accommodation to Reduce Distractibility/Attention Difficulties

- Reduce distractions in the immediate area (avoid seating near doorway, high traffic areas, etc.)
- Provide study carrels
- Allow for use of white noise or environmental sound machines (with headsets)
- Increase natural lighting or provide full spectrum lighting
- Allow for frequent breaks
- Divide large assignments into smaller tasks and goals
- Provide alternate testing environment

## Organization Accommodations

- Encourage use of daily to do lists and check items off as they are completed
- Use calendars and checklists as reminders
- Use electronic organizers
- Divide large assignments into smaller tasks and goals

## Accommodations to Enhance Memory

- Provide digital tape recorder
- Provide copy of notes/study guides
- Provide written instructions
- Provide written checklists

## Accommodations to Assist with Stress Management 

- Provide praise and positive reinforcement
- Encourage use of support groups
- Allow access to peer buddy or mentor if needed
- Allow breaks as needed

## Behavior Intervention Plans

- Identify the target behaviors
- Identify the triggers for those behaviors
- Develop strategies to manage responses once symptoms or signs of behavior occurs
- Ensure frequent positive feedback is used.

## Center Case Examples

## Scenario 1

- The applicant has an IQ of 65 and a history of special education. Has good adaptive functioning, but sometimes becomes frustrated and may have behavioral outbursts—however has never targeted outbursts towards another individual. Last outburst was 8 months ago. Teachers report he is well liked, follows directions with minimal prodding, and is eager to please authority figures. May need 1:1 support in educational/vocational training.

## Scenario 1 Tips

- IQ scores should never be considered in isolation.
- Has applicant’s educational history been reviewed to determine if the applicant can work independently on certain tasks and needs 1:1 on others?
- Has an interactive conversation/interview taken place where a better assessment might provide additional information.
- Can the applicant process and comprehend material auditorily?
- Can they follow a visual pictorial guiding them through the sequence of steps.
- There is a difference between needing 1:1 support which JC does provide and needing continuous 1:1 support which we do not provide.

## Scenario 2

- 18 year old male wants to study computer repair.
- He has a chronic history of psychosis with multiple hospitalization, suicidal and homicidal ideation, who is non-compliant with medication or talk treatment.
- IEP dated 12/2/2002 describes applicant as severely emotionally disturbed and requiring accommodations.  2002 IEP indicates applicant reads and writes at the 5th grade level.
- Criminal Hx:  None

## Scenario 2 (continued)

- Records indicate applicant not compliant with appointments and is therefore frequently in need of urgent appointments.
- Therapist letter of 7-11-03 indicates diagnosed with psychotic disorder NOS and indicates non-compliance with medication and medications will be necessary for completion of Job Corps.
- Also diagnosed with polysubstance abuse with multiple hospitalizations.

## Scenario 2 (continued)

- History of suicide attempts:  7/2002, 4/2002, 5/2003, 6/2003 and described as “frequently suicidal and homicidal ideation.
- Applicant requesting accommodations for learning disabilities.  Dropped out of school because he was “ditching and messing around.”  He wants a high school diploma so he can enter the Air Force.
- Interview with CMHC indicates applicant stopped his psychiatric medications after leaving the hospital in 5/2003.  However, there is no description by the CMHC of any current inappropriate, psychotic, or manic behavior.

## Scenario 3

- Applicant has Asperger's syndrome or is autistic, and has difficulty with normal group or social discourse.

## Scenario 3 Tips

- Should a decision to deny be based upon the diagnosis?
- Case by case basis
- What is the individual’s history in the school setting (i.e., included, self-contained)?
- Any corresponding behavioral problems when under stress?

## Reasonable Accommodation Considerations

- Minimize requirements to participate in group activities.
- Provide a quiet place if time out is needed.
- Providing sensitivity training (disability awareness) to all staff and students.
- Using role-play scenarios to demonstrate appropriate behavior in workplace.
- Using training videos to demonstrate appropriate behavior in JC and in workplace.
- If applicant cannot interact with others or significantly struggles with interaction, then this applicant would most       likely not be expected to successfully participate in group situations.

## Scenario 4

- Jane Mars, age 28, is requesting an age waiver to participate in a Job Corps program in Kentucky stating that she has a substance abuse disability.  Jane is a resident of Maryland.  The age waiver was granted conditionally in CIS by the regional office.
- Jane provides the following information to the AC:
- Methadone maintenance for prior drug use
- Physician letter stating that she is progressing and her methadone dosage has decreased during the past year
- Requesting clerical trade
- Applicant's mother will obtain the methadone from the physician and mail it to the center each month
- CAN WE ACCOMMODATE?

## Promote Success!

- Be Supportive
- Be Positive
- Be Encouraging