Identifying TANF Recipients with Disabilities and Cognitive Limitations: Step 2

1
Identifying TANF Recipients with Disabilities and
Cognitive LimitationsStep 2 Looking Deeper
Functional Assessment

• Mary Hanley OTRL
• Ramsey County, Minnesota
• June 11, 2007

2
Introduction

• In the last call we discussed Red Flags that
  might
• indicate more significant problems.
• In this call well 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 dont meet eligibility for
  SSI
• benefits.

3
Further Assessment

• 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.

Donna Pavetti
4
Sharing the Results

• 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.

5
Useful Interventions and Next Steps

• 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

6
Functional Assessments

• Functional assessment measures ones 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.

7
Functional Observation Tool Content Areas

• 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

8
General Guidelines for working with Functional
Deficits

• Deficits are neurocognitive
• Deficits are hidden
• Mislabeled as motivational
• Information processing system is compromised
• Medications dont improve negative symptoms
• No primary rehabilitation
• Be creative

9
Guidelines - continued

• 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
• Dont 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 dont do well with unstructured job
  search.

10
On the Job Strategies

• 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

11
On the Job Strategies

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

12
On the Job Strategies

• 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

13
On the Job Strategies

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

14
On the Job Strategies

• 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

15
On the Job Strategies

• 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

16
Next Call

• In the next call well 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.