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1
Understanding and Accommodating Students Who
Have Mental Health Disabilities That Include a
Behavioral Component
Kellie L. Miller, LCSWLoring Job Corps Center
andDiane Fairchild, MS
SiatechNational Health and Wellness Conference 2011
2
Identify common mental health impairments and associated symptoms
Describe behavioral indicators associated with mental health disabilities
List functional limitations among students identified with mental health disabilities
Name accommodations to increase positive student behavioral responses
Describe and practice use of the Success Management Plans in a case management approach to improve outcomes for students with mental health disabilities
Objectives
3
Disability Program-PRH 6.11, R7
“Because it is a federally funded training program, Job Corps is required to ensure its program and facilities are accessible and provide reasonable accommodation to individuals with disabilities to prevent discrimination on the basis of disability.”
(Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010. pg. 20)
4
Common Mental Health Impairments
5
Schizophrenia and psychotic disorders Mood disorders Anxiety disorders Attention deficit hyperactivity disorders Oppositional defiant disorder Autism spectrum disorders (Asperger’s
Syndrome) Personality disorders
Common Mental Health Impairments
6
Schizophrenia Schizoaffective
Disorder Delusional Disorder Substance-Induced
Psychotic Disorder Psychotic Disorder,
NOS
Psychotic Disorders
7
Delusions Hallucinations False ideas or beliefs (believes someone is
spying on him/her) Experiencing something that does not exist
through one or more of the five senses
Symptoms of Psychosis
(Mental Health America: Schizophrenia: What You Need To Know)
8
Disorganized thinking & speech Grossly disorganized behavior Negative or deficit symptoms Moving from one topic to another in a way
that does not make sense. Individual may make up words or sounds.
Withdrawing socially, Lacks motivation, inappropriate or lack of affect
Symptoms of Psychosis
(Mental Health America: Schizophrenia: What You Need To Know)
9
Major Depressive Disorder
Dysthymic Disorder Depressive Disorder,
NOS Bipolar Disorder Cyclothymic Disorder Substance Induced
Mood Disorders Mood Disorder, NOS
Mood Disorders
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Symptoms of Mood Disorders–Depressive
Feels sad or empty Tearful Loss of interest in
activities Increase or decrease
in appetite Insomnia or
Hypersomnia Restlessness
Restlessness Loss of energy or
chronic fatigue Feeling hopeless,
worthless, or guilty Difficulty
concentrating Recurrent thoughts
of death or suicidal ideation
(American Psychiatric Association, 2000)
11
Symptoms of Mood Disorders–Manic
Abnormally elevated mood
Excessive irritability Inflated self esteem Decreased need for
sleep More talkative than
usual
(American Psychiatric Association, 2000)
More talkative than usual
Racing thoughts Distractibility Increased goal
directed activity (school or work)
Risk taking behaviors
12
Panic Disorders Phobias Obsessive-Compulsive
Disorder Acute Stress Disorder Post Traumatic Stress
Disorder Generalized Anxiety
Disorder Anxiety Disorder, NOS Substance Induced
Anxiety Disorder
Anxiety Disorders
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Excessive anxiety and worry
Difficulty controlling worry
Restlessness or seems “on edge”
Easily fatigued Difficulty
concentrating Irritability Muscle tension Sleep disturbance
Symptoms of Generalized Anxiety Disorder
(American Psychiatric Association, 2000)
14
Symptoms of ADHD–Inattentive
Difficulty paying attention
Makes careless mistakes
Does not seem to listen when spoken to directly
Organizational problems
(American Psychiatric Association, 2000)
Easily distracted Forgetful Reluctant or
avoidant to do school work
Often loses things
15
Symptoms of ADHD–Hyperactive/Impulsive
Talks excessively Blurts out answers
before question is completed
Difficulty waiting turn
Interrupts or intrudes on others
(American Psychiatric Association, 2000)
Fidgets with hands or feet
Often leaves seat Restless energy Difficulty with quiet
play activities Often appears “on
the go” or “driven by a motor”
16
Often loses temper Often argues with
adults Often refuses to follow
rules Often deliberately
annoys others Often blames other for
his or her behaviors Often angry or resentful Often spiteful or
vindictive
Symptoms of Oppositional Defiant Disorder
(American Psychiatric Association, 2000)
17
Inflexible adherence to specific, nonfunctional routines or rituals
Hand or finger flapping or twisting
Preoccupation with parts of objects
Impairments in nonverbal behaviors
Failure to develop age-appropriate peer relationships
Repetitive and stereotyped patterns of behaviors
Symptoms of Asperger’s Syndrome
(Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2000. pg 103)
18
Pattern of inner experiences and behavior that is very different from expectations of culture
At least two of the following areas are impacted:◦ Perception of self or others◦ Intensity of emotional
responses◦ Functioning in relationships◦ Poor impulse control
Symptoms of Personality Disorders
(American Psychiatric Association, 2000)
19
Behavioral Indicators
20
Internalizing behaviors (alcohol/substance abuse, self injury, eating too much or too little, risk taking)
Refusing to do chores Not adhering to curfew Failure to clear from dormitory in
the morning
Behavioral Indicators Associated with Mental Health Disabilities
21
Chronic absences or tardiness for class
Sleeping in class Lack of productivity Challenging authority Disruptive behaviors Use of profanity Social withdrawal or isolation
Behavioral Indicators Associated with Mental Health Disabilities
22
Behavioral Indicators Associated with Mental Health Disabilities
Bullying & Harassment of other students
Frequently getting up from seat or leaving class without a pass
Lack of commitment to personal hygiene and appearance
23
Resistant to feedback and efforts of assistance
Ignoring prompts Not adhering to center standards of conduct
Lacks personal accountability for behavioral choices or blames others
Behavioral Indicators Associated with Mental Health Disabilities
24
Functional Limitations
25
Screening Out Environmental Stimuli
Maintaining Stamina Managing Deadlines
and Multiple Tasks Difficulty with
Medication Side Effects
Interacting Socially Responding to
Negative Feedback Dealing with
Change Meeting Self Care
Needs Sustaining
Concentration
Functional Limitations
26
Sounds Sights Odors Interferes with focusing on tasks
Limited ability to tolerate noise and crowds
Screening Out Environmental Stimuli
27
Difficulty sustaining energy to spend whole day in classes on center
Drowsy due to medications
Slower pace
Maintaining Stamina
(Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010. Attachment A)
28
Prioritizing tasks Time management Meeting deadlines Organization Difficulty
managing assignments
Inability to multi-task
Managing Deadlines and Multiple Tasks
(Mental Health Disabilities: Reasonable Accommodation)
29
◦ Drowsiness◦ Fatigue◦ Dry mouth & thirst◦ Blurred vision◦ Hand tremors◦ Slowed response time◦ Difficulty initiating
interpersonal contact
Difficulty with Medication Side Effects
(Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010. Attachment A)
Side effects of psychiatric medications that affect academic and training performance such as…
30
Interacting Socially Reading social cues Contributing to group
work Fitting in Getting along with
others Dealing with difficult
people Effective communication Maintaining
interpersonal relationships
(Mental Health Disabilities: Reasonable Accommodation)
31
Difficulty understanding and correctly interpreting feedback or poor grades
Tolerating distress Emotion regulation Low self esteem Personalization Defensiveness
Responding to Negative Feedback
(Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010. Attachment A)
32
Difficulty coping with unexpected changes in coursework or training, such as changes in the assignments, due dates, or instructors
Transitional periods Holidays and breaks Limited ability to
tolerate interruptions
Dealing with Change
(Mental Health Disabilities: Reasonable Accommodation)
33
Problems with hygiene or grooming
Difficulty managing stress
Meeting Self Care Needs
(Mental Health Disabilities: Reasonable Accommodation)
34
Restless Shortened
attention span Easily distracted Difficulty
remembering verbal instructions
Sustaining Concentration
(Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010. Attachment A)
35
Accommodations to Increase Positive Student
Behavioral Responses
36
Exhibit appropriate social behavior Communicating with others Maintaining concentration Managing stress Medication side effects Prepare students for change
Accommodations to Increase Positive Student Behavioral
Responses
37
Develop and post simple, clear, and consistent code of conduct◦Acceptable verbal and nonverbal language◦Acceptable ways to engage in discussion or
debate◦Acceptable student interactions
Verify student’s understanding of expectations, rules, consequences, & assignments
Exhibit Appropriate Social Behavior
Slides 34-39 taken from (Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010. pgs 76-77)
38
Ask student’s perspective of personal performance including strengths & areas for improvement
Practice appropriate social skills such as role playing
Encourage all students to model appropriate social skills
Use of a tutor, peer buddy, or staff mentor to reinforce appropriate skills especially during unstructured time
Exhibit Appropriate Social Behavior
39
Reward and praise student engaging in appropriate behavior often
Allow brief time-out or break as needed Identify the “out” for those times when the
student is unable to demonstrate appropriate skills◦Hand gesture, word, or signal◦Where to go to regain composure◦How to return/re-engage in class
Exhibit Appropriate Social Behavior
40
Adjust the method of communication to best suit the student’s individualized needs◦One-on-one◦Face-to-face◦In the presence of another
Communicating with Others
41
Teach/model appropriate verbal communication skills◦Address person by name or title◦Wait to speak, avoid interruptions◦How to enter another group’s conversations
Encourage students to move personal conversation away from classroom and common area
Communicating with Others
42
Prioritize tasks, activities, and assignments for the student◦Divide assignments into smaller tasks
Provide movement breaks Increase natural lighting in classroom
Maintaining Concentration
43
Help arrange the student’s environment◦Redesign space Minimize auditory and visual
distractions (ear plugs/headset) Tennis balls on the bottom of chairs and
tables Reduce clutter Private room for testing
◦Preferential seating
Maintaining Concentration
44
Frequent breaks (for movement and to re-organize self
Reinforce time management/organizational techniques◦ Emphasize due dates on calendars◦ Help students add entries on their own calendar
and double check entries to ensure accuracy◦ Encourage use of “To Do” lists and checklists as
reminders◦ Develop a color coded system (each color
represents a task, or event, or level of importance)◦ Provide students with list of supplies & equipment
Managing Stress
45
Identify support personnel Role Model and Encourage Students to…
◦ Take one thing at a time◦ Be realistic◦ Avoid Superman or Superwoman Syndrome◦ Guided visualization◦ Pray or Meditate◦ Get physical exercise◦ Have fun with hobbies & interests
Managing Stress
(Mental Health America: Coping with Stress Checklist)
46
Role Model and Encourage Students to (cont’d)
◦ Eat healthy◦ Drink enough water◦ Get enough sleep◦ Limit alcohol, sugar, smoking, & caffeine◦ Share their feelings with someone they trust◦ Be flexible◦ Avoid being overly critical or judgmental
Managing Stress
(Mental Health America: Coping with Stress Checklist)
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Allow the student use of water bottle in class, testing, and in dormitory
Adjust student’s schedule◦For therapy appointments, later start of
class day, change in time medication is taken, adjustment to chore schedule
Assign a staff mentor or peer buddy Use medication contracts to help with
compliance and accountability
Medication Side Effects
(Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010. pg 77)
48
Talk with students regarding changes in advance
Prepare students for summer and winter breaks away from center
Support students during times of adjustment & transition (Career Preparation Period and Career Transition)
Prepare Students for Change
49
Allow for student input and ideas when possible
Introduce new staff Make sure new staff are aware of student needs
Be sensitive to stressors such as deaths of family or friends and changes in roommates
Prepare Students for Change
50
Be encouraging Use appropriate humor
(avoid teasing or making fun of students)
Believe each student is capable of meeting his or her goals!
Positive relationships increase retention & successful outcomes
Remember to catch them being good”! Focus on the positive behaviors
Attitude is a Little Thing, But it Makes a BIG Difference!
51
Success Management Plans/Case Management
52
Case Management Approach
Career Counselor makes ideal Case
Manager
Coordinate and facilitate
interdisciplinary core team meetings
Team members: Student, Parent,
Career Counselor, TEAP, Vocational,
Education, RA, Disability
Coordinator, CMHC, CSIO, etc.
Case Manager monitors non-
health staff involvement in the plan to evaluate
student’s progress and performance
Document in the health and
wellness file
53
•Two part written system
•Referrals preferably from career counselor
•Written response from CMHC back to referral source to indicate follow up
Referral and Feedback
•Reason for referral
•Presenting problem
•Mental status
•Diagnostic impression
•Management plan
Mental Health Intake
•Relevant to Job Corps Program
•Identifies specific non-health care staff
•Keep it short and sweet (one page)
Success Management
Plan
CMHC Role in Case Management Approach
54
What are the stressors, triggers, and issues impacting employability?
What are the current behaviors and barriers to employability?
What are the student’s perceived consequences of continued difficulty and failure to complete Job Corps?
Developing a Success Management Plan
55
What are student’s goals in relation to the current stressor or issue as well as relevant academic, vocational, and personal goals)?
What are students strengths and resources? What has been helpful in the past?
What on-center support activities are now being used?
Developing a Success Management Plan
56
What accommodations and actions will support student success?
Who will be the staff responsible for following through with identified accommodations?
How and when will the accommodations be re-evaluated for effectiveness?
Developing a Success Management Plan
57
Case Studies
58
A 22 year old male student has been presenting as increasingly irritable and intolerant of peers and staff over the last 2 weeks. He has not been sleeping well at night. He seems angry and complains about the center rules.
He talks in a loud tone of voice and challenges his instructors when they are providing feedback. Many staff members have mentioned they want to avoid confrontation with the student due to his intimidating nature.
Case Study #1
59
A 16 year old female student is in class. Suddenly her heart begins to pound, she starts to sweat profusely, and finds it difficult to catch her breath. She is feeling dizzy and is unable to concentrate in class. She has no known medical conditions. The next day she is so worried the feeling of panic will happen again, she avoids going to class and begins to isolate herself from others.
Case Study #2
60
An 18 year old male student finds it very difficult to concentrate in class. His instructors are feeling increasingly frustrated due to a number of behavioral concerns. The student often seems to not pay attention when spoken too.
He arrives to class without the necessary equipment despite being informed several times. He states he forgot or lost the items. He does not complete his assignments in a timely manner. The student is disruptive by acting like the class clown, getting up frequently from his seat, and tapping his pencil.
Case Study #3
61
A 20 year old male student has been cited several times for failure to clear the dormitory in the morning. He is complaining of feeling very tired and wants to sleep most of the day. He is increasingly tardy for class. His instructors have complained he keeps his head down and appears to be sleeping in class. The student has not been showing up at the wellness center in the morning to take his prescription antidepressant medication.
Case Study #4
62
A 17 year old male student is observed to be sitting by himself everyday at the cafeteria. He does not appear to have any social friendships on the Center. He comes across as less mature than many of the other students. He seems to lack confidence. The student has been complaining of other students teasing him and wants to leave the center to return home.
Case Study #5
63
A 23 year old female student with a history of sexual trauma, has been engaging in increasingly high risk behaviors. She was caught for an alcohol violation. There have been rumors from others students she is engaging in multiple promiscuous sexual relationships.
She has superficial red scratch marks on her forearms. She appears to attach herself to certain staff members and presents as dependent on their support to the point of missing vocational instruction.
Case Study #6
64
Resources
65
Teacher’s Edition to Behavioral Interventions: Intervention Strategies for Behavior Problems in the Educational Environment, Kathy Cummins Wunderlich, Hawthorne educational Services, Inc.
Pre-Referral Intervention Manual 3rd Edition: The Most Common Learning and Behavior Problems Encountered in the Educational Environment, Stephen B. McCarney, Hawthorne Educational Services, Inc.
Resources
66
Job Accommodation Network (JAN) http://www.jan.wvu.edu/soar/
National Mental Health Association Website http://www.nami.org/ Desk Reference Guide: Job Corps Center
Mental Health Consultant◦ Chronic Care Management Plans
Job Corps Disability Website Supporting Students with Learning Disabilities
Website Desk Reference Guide: Disability Coordinator
Resources
67
Boston Region – Lisa Koshlisa.kosh@humanitas.com
Philadelphia and Atlanta Regions– Nikki Jackson
nikki.jackson@humantias.com Dallas Region– Laura Kuhn
Laura.kuhn@humanitas.com Chicago and San Francisco Regions – Kim
Jones kim.jones@humanitas.com
Regional Disability Coordinators
68
American Psychiatric Association. (2000). Diagnostic Criteria From DSM-IV-TR. Arlington, VA.
Case Management Approach-Job Corps Health. http://jchealth-jobcorps.gov/healthtopics/mhd/bvmr/
Desk Reference Guide: Job Corps Center Mental Health Consultant. October 2010.
Mental Health America: Coping With Stress Checklist. http://wwwmentalhealthamerica.net/go/information/get-info/stress/coping-with-stress-checklist
References
69
Mental Health America: Schizophrenia: What You Need to Know http://www.mentalhealthamerica.net/go/information/get-info/schizophrenia
Mental Health Disabilities: Reasonable Accommodation http://jcweb.jobcorps.org/health/Pages/MHDReasonableAccommodation.aspx
Reasonable Accommodation-Job Corps Health http://jchealth.jovcorps.gov/healthtopics/mhd/ra
References
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