identifying tanf recipients with disabilities and cognitive limitations: step 2 – looking deeper:...
TRANSCRIPT
Identifying TANF Recipients with Disabilities and Cognitive
Limitations:Step 2 – Looking Deeper: Functional
Assessment
Mary Hanley OTRL
Ramsey County, Minnesota
June 11, 2007
Introduction
In the last call we discussed Red Flags that might indicate more significant problems.
In this call we’ll discuss how to assess functioning inthe areas that Disability Determiners need to decideeligibility 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.
Further Assessment
We started by offering in depth, office based Vocational-Psychological assessment to those with several red flags.
To Enlist Cooperation:
Allay fearsDebunk stereotypes and stigmaJoin with the participantVocational strengths and weaknessesPotential eligibility for other programs and services.
Sharing the Results
Start with asking participant what they think the results areAsk if they have ever been accused of being lazy or unmotivatedTell 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. *
Useful Interventions and Next Steps
In home functional assessments to make the link between diagnosis, symptoms and 4 areas of functional limitation Ongoing Home visitsMental Health and CD Diagnosis and TreatmentCase managementSpecialized on the job strategiesConnecting with Rehabilitation ServicesSupported Employment Options
A. Enclave B. Supported Competitive Employment
Job CoachesSSI application/Advocacy
Functional Assessments
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.
Functional Observation Tool Content Areas
Physical Ability
Communication
Orientation
Personal Hx
Personal Hygiene
Dressing Skills
Laundry and Household Chores
Kitchen Skills
Planning/Decision MakingSocial SkillsTime ManagementPrevocational SkillsSafety/PreventionPace, Persistence, ConcentrationCommunity MobilityMoney Management
General Guidelines for working with Functional Deficits
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
Guidelines - continuedAssessment should start with activity analysis. Break each task down into component parts.Skills training must be highly structuredBe reinforcing - sandwich constructive feedback between validating commentsDon’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.
On the Job Strategies
Concentration and AttentionMore 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
On the Job Strategies
Working MemoryVoice it electronic note pads
Log books
Laptops and PDAs
Planners
Laminated info sheets for job applications
Brain books with detailed instructions
On the Job Strategies
Executive FunctionsEncourage rehearsal of asking for clarification of directions, necessary assistance etc.Job Analysis to assist with problem solvingUse of closed and multiple choice questionsQuestions that generate goals and motivation to accomplish themEvaluate work style needs and learning preferencesExperiential Learning
On the Job Strategies
Executive Functions- continuedJob Coaching
Rehearse interviews, handling criticism, and coworker disagreements
Develop task sequences
Make a task book with each task clearly defined
On the Job StrategiesVisual Spatial
Color Coding, i.e.. keys for a janitorial job with matching colored squares on doorsDiagrams and maps using color codingWearing a bracelet with colored bead in sequence to indicate steps of a taskOverlays on keyboards using shapesGPS systems
On the Job Strategies
Speed/Processing Time
Education of others working with the client to allow processing time to process informationTeach reflective listening skillsOrganization of time to eliminate wasted stepsOrganization of work area
Next CallIn 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.