Supporting Students with Mental Health Disabilities Valerie R. Cherry, Ph.D. Principal Mental Health Consultant San Francisco Region Health and Wellness Conference May 10, 2006

2 Mental Health and Wellness Program Yesterday and Today Clinical Staff Development TEAP Support File Reviews Disability Team and Accommodations CDSS Support Work is Recovery

Mental Health Scenarios Real Life Cases

4 SCENARIO 1 Michael age 20, is requesting admission to Job Corps, he provides the following information to the AC:  Diagnosed with schizophrenia and over the past year has been stable and able to manage his own medications  Recent evaluation from therapist to support entry to Job Corps. Evaluation indicates that Michael will need to remain on medication, consider low stress trade, and have access to mental health support  Michael was an A/B student in high school and actually took some advanced courses -Applicant is assigned to a center Center Process: Applicant met with CMHC for a face to face interview as part of IDT CMHCs evaluation indicated that while the applicant was not actively psychotic, he did not feel the applicant could function socially in Job Corps due to his severe diagnosis, the negative symptoms associated with the diagnosis (flat affect and mood), and the risk for future decompensation AGREE OR DISAGREE?

5 SCENARIO 1 Types of Barriers and Accommodations Barriers  Interacting Socially  Difficulty reading social cues  Fitting in and maintaining interpersonal relationships Accommodations  Schedule flexibility – allow to leave class a few minutes early to avoid crowded hallways  Assign a Peer buddy  Assign a Mentor  Participation in Counseling Support Groups  Participation in local community counseling

6 SCENARIO 2 Brittany age 19, is requesting admission to Job Corps, she provides the following information to the admissions counselor (AC):  History of depression, currently in treatment with a community psychologist  Hospitalized 3 months ago for suicidal behavior  Letter from the psychologist stating that she is stable to join Job Corps, but needs to continue medications and therapy  Applicant is assigned to a center Center Process: The center IDT received the applicant’s file and due to the mental health history the CMHC reviewed the file. The CMHC recommended a denial due to the recent hospitalization and the need for continued therapy The file was forwarded to the Regional Office Regional Process: RMHC reviewed the file and indicated that admission should be delayed until therapy could be completed Applicant’s admission to Job Corps was disapproved until treatment could be completed Notification given to applicant by AC AGREE OR DISAGREE?

7 SCENARIO 3 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.

8 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 & 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.

9 SCENARIO 4 Applicant has Asperger's syndrome or is Autistic, and has difficulty with normal group or social discourse.

10 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?

11 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.

12 SCENARIO 5 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?

13 SCENARIO 6 18 year old male wants to study computer repair. He has a chronic history of psychosis with multiple hospitalizations, 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. IEP of 2002 indicates applicant reads and writes at the 5th grade level. Criminal Hx: None

14 SCENARIO 6 (continued) Records indicate applicant not compliant with appointments and is therefore frequently in need of urgent appointments. Therapist letter of indicates diagnosed with psychotic disorder NOS and indicates NON compliance with medication and medications will be necessary for completion of JC. He is also diagnosed with polysubstance abuse with multiple hospitalizations. History of suicide attempts: 7/2002, 4/2002, 5/2003, 6/2003 and described as “frequently suicidal and homicidal ideation.

15 SCENARIO 6 (continued) 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 psych meds after leaving the hospital in May of However, there is no description by the CMHC of any current inappropriate or psychotic or manic behavior. NEXT STEPS?

Students with Mental Health Disabilities Potential Barriers and Types of Accommodations

17 Potential Barriers and Types of Accommodations BARRIERS Unable to Ignore Environmental Stimuli Sustaining Concentration ACCOMMODATIONS Reduce distractions in the immediate area (avoid seating near doorway, high traffic areas, etc.) 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

18 Potential Barriers and Types of Accommodations BARRIERS Managing Deadlines and Multiple Tasks ACCOMMODATIONS Make daily TO-DO lists and check items off as they are completed Use calendars & checklists as reminders Use electronic organizers Divide large assignments into smaller tasks and goals

19 Potential Barriers and Types of Accommodations BARRIERS Dealing with Change ACCOMMODATIONS 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.) and orient the new instructor to student’s needs

20 Potential Barriers and Types of Accommodations BARRIERS Medication Side Effects Inconsistent Attendance Increase in Fatigue/Reduced Endurance Difficulty Taking Notes Difficulty with Memory, Retention & Recall Reduced Attention ACCOMMODATIONS 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

21 Supporting Students with Mental Health Disabilities What We Shared and Learned Today!