Mary Hanley OTRL
Ramsey County, Minnesota
June 11, 2007

In the last call we discussed Red Flags that might indicate more significant problems.
In this call we’ll discuss how to assess functioning in the areas that Disability Determiners need to decide eligibility for SSI benefits, and ideas for supported work and types of accommodations for those who need extra help, but don’t meet eligibility for SSI benefits.

We started by offering in depth, office based
Vocational-Psychological assessment to those with several red flags.
To Enlist Cooperation:
Allay fears
Debunk stereotypes and stigma
Join with the participant
Vocational strengths and weaknesses
Potential eligibility for other programs and services.

Start with asking participant what they think the results are
Ask if they have ever been accused of being lazy or unmotivated
Tell them there is assistance
- Coping skills
- Reasonable accommodation
- Supported Employment
- SSI for the disabled
* We were startled by the results ourselves and decided to offer in home assessment to find out how participants were functioning in their home environment.
*

In home functional assessments to make the link between diagnosis, symptoms and 4 areas of functional limitation
Ongoing Home visits
Mental Health and CD Diagnosis and Treatment
Case management
Specialized on the job strategies
Connecting with Rehabilitation Services
Supported Employment Options
A. Enclave
B. Supported Competitive Employment
Job Coaches
SSI application/Advocacy

Functional assessment measures one’s ability to perform activities of daily living, social functioning, concentration, pace, and persistence for tasks.
This is the information needed, along with diagnosis and symptoms, to determine eligibility for SSI benefits.
The information can also be used to obtain access to other services or determine reasonable job accommodations.
We chose to do the assessments in the home setting.
Requires a 2 hour time commitment, but this can be done in 2 visits.

Physical Ability
Communication
Orientation
Personal Hx
Personal Hygiene
Dressing Skills
Laundry and Household
Chores
Kitchen Skills
Planning/Decision Making
Social Skills
Time Management
Prevocational Skills
Safety/Prevention
Pace, Persistence,
Concentration
Community Mobility
Money Management

Deficits are neurocognitive
Deficits are hidden
Mislabeled as motivational
Information processing system is compromised:
Medications don’t improve negative symptoms
No primary rehabilitation
Be creative

Assessment should start with activity analysis.
Break each task down into component parts.
Skills training must be highly structured
Be reinforcing - sandwich constructive feedback between validating comments
Don’t rule out reasonable employment options -
Can reasonable accommodations help the person fit the job better? Can another employee complete non-essential job functions?
Accountability - People with MI and cognitive challenges don’t do well with unstructured job search.

Concentration and Attention
More frequent breaks of shorter duration
Partitions to screen unwanted stimuli
Computer software that allows workers to receive prompts, or screen savers as prompts
Wristwatch with vibrating alarm
Pocket timer with vibrating function
Position away from noise and traffic

Working Memory
Voice it electronic note pads
Log books
Laptops and PDAs
Planners
Laminated info sheets for job applications
Brain books with detailed instructions

Executive Functions
Encourage rehearsal of asking for clarification of directions, necessary assistance etc.
Job Analysis to assist with problem solving
Use of closed and multiple choice questions
Questions that generate goals and motivation to accomplish them
Evaluate work style needs and learning preferences
Experiential Learning

Executive Functions- continued
Job Coaching
Rehearse interviews, handling criticism, and coworker disagreements
Develop task sequences
Make a task book with each task clearly defined

Visual Spatial
Color Coding, i.e.. keys for a janitorial job with matching colored squares on doors
Diagrams and maps using color coding
Wearing a bracelet with colored bead in sequence to indicate steps of a task
Overlays on keyboards using shapes
GPS systems

Speed/Processing Time
Education of others working with the client to allow processing time to process information
Teach reflective listening skills
Organization of time to eliminate wasted steps
Organization of work area

In the next call we’ll discuss why our disabled
TANF participants have been denied Social Security
Benefits in the past and how to assist them in navigating this complex process.
I believe there is key information often missing from applications that if added will result in initial application approvals and shorter waiting periods for those who are eligible.