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ENews: Volume 14, Issue 2, Second Quarter, 2016

The JAN E-News is a quarterly online newsletter. Its purpose is to keep subscribers informed about low-cost and innovative accommodation approaches; the latest trends in assistive technologies; announcements of upcoming JAN presentations, media events, trainings, and Webcasts; and legislative and policy updates promoting the employment success of people with disabilities.

An e-mail announcement is sent to an opt-in list when a new issue is available. Please use the links at the end of this document to subscribe or unsubscribe.

Index

  1. Dad was Claustrophobic
  2. Thumbs Up to the EEOC’s Proposed Rule Regarding Personal Assistance Services
  3. Sensory Processing Disorder (SPD)
  4. Here’s a Note from my Dentist
  5. Best Practices for Addressing Requests for Adjustable Height Workstations
  6. Sjogren’s Syndrome: Accommodations for the Workplace
  7. JAN Blog Growing
  8. JAN Releases New Resources
  9. E-vents
  10. JAN Exhibit and Training Schedule
  11. Subscribe to JAN Newsletter

1 - Dad was Claustrophobic

My dad was 6’2” and a healthy 200-plus pounds. He could talk to anyone about anything. He worked for the U.S. Department of Agriculture for 43 years. Dad always said that he retired because he forgot his password. He was a veteran of the U.S. Navy, and he served in the Korean War. Dad and Mom were married 62 years before passed away.

Dad was claustrophobic. This is a condition that caused him severe anxiety when he was in closed spaces. He would sweat, have a rapid heartbeat, experience shortness of breath, and become lightheaded. The textbook definition classifies claustrophobia as anxiety, not a separate condition.

Usually claustrophobia affects people when they are in tight spaces. Some may get headaches, dry mouth, hot flashes, chills, or a rash. However, the areas don’t have to be small. They may have a limited escape route, have certain smells or noises, be hot, or be full of people.

Claustrophobia can manifest itself as generalized anxiety like it did with Dad, or with panic attacks and even social phobia. With claustrophobia, accommodation solutions are going to vary by person and job. First and foremost, we want to know what the person thinks would be helpful. For Dad, he avoided elevators, small spaces, and closed doors. He also worked a job where he was outside a good bit.

The condition usually develops because of some traumatic event, but not always. When Dad was in the military, he was assigned to a submarine tender, the USS Bushnell. It was the crew’s responsibility to repair and supply a submarine squadron. There could be no smaller, darker space than a submarine. Something happened during his time in the service, and when was honorably discharged, he would forever take his claustrophobia and the need for accommodations with him.

Accommodations for claustrophobia are case-by-case. You probably work with someone who is claustrophobic, but don’t know it because no accommodations are needed. The job duties and the employee’s limitations are the keys to finding workable solutions. Accommodations could include:

Let’s look at a few situations where an employee with claustrophobia was accommodated on the job.

Aster was a public relations specialist. He would work with the director to secure accounts and develop an outreach plan. Aster had claustrophobia. It was triggered by being in the close proximity of other people. When Aster had to work in a crowded room of clients, his service animal was trained to stand in between him and others. This gave Aster space to avoid feeling like he was pinned in a small area.

Denise worked for a shipping company. As an administrative assistant, she accompanied the vice-president to meetings. She was required to wear a turtleneck as a part of the company’s dress code. Denise decided to start wearing V-necks instead. When pressed on why she was intentionally not following the dress code, Denise disclosed that she had claustrophobia. The company decided it was time to eliminate the requirement of having to wear a blue turtleneck with the company uniform.

Jaylen worked as a radiation therapist in a hospital. His work environment was below ground. The radiation equipment was heavy, and the hospital decided that a renovated basement would be the best fit for the equipment. Jaylen was used to having access to the outside. As an accommodation for his claustrophobia, his employer decided to give him his own workstation with access to an external camera feed that showed him what was happening outside.

These situations show how triggers can vary. For someone who has no experience with claustrophobia, it may be a matter of understanding that symptoms and limitations are very individualized. As with others with claustrophobia, Dad was a hard worker. Sometimes he just needed to do things in another way.

- Beth Loy, Ph.D., Principal Consultant

2 - Thumbs Up to the EEOC’s Proposed Rule Regarding Personal Assistance Services

I’ve worked at JAN for over 24 years and in all that time one of the ongoing barriers to the successful employment of people with disabilities has been the difficulty some people have in getting their personal needs met in the workplace. I’m referring to personal needs that range from help taking off and putting on a coat to help with basic human functions such as eating and toileting – things many people take for granted. Under current law, with limited exception, employers are not required to provide assistance with personal needs, so when people with a disabilities need help meeting personal needs in the workplace, what are they supposed to do? One option is to pay for a full time personal attendant, which for many people can eat up most of their salary. Another option is to try to hire someone just to come in for restroom and lunch time breaks, but it’s very difficult to get someone to do that. What about just asking coworkers to help? There are many issues with this option. For instance, who wants their coworkers helping them in the restroom? What coworker can be available to help whenever needed and how likely is it they will be properly trained to help anyway? And, to top it off, most employers won’t allow coworkers to stop doing work tasks and go help with personal needs.

But all this may be changing in the near future, at least for employees of the federal government.

Background: In February, the Equal Employment Opportunity Commission (EEOC) issued a notice of proposed rulemaking (NPRM) to amend the regulations for Section 501 of the Rehabilitation Act of 1973. The NPRM provides guidance to federal agencies on what they must do to satisfy their obligation to engage in affirmative action in employment for people with disabilities. One very important part of the proposal is to require federal agencies to provide personal assistance services, such as assistance with eating, drinking, using the restroom, and putting on and taking off outerwear, to employees who need them because of a disability, unless doing so would impose undue hardship.

I’m in favor of this proposal for many reasons. One reason is that I think people with disabilities should have the option of working and as I have already stated, in my experience getting personal assistance in the workplace has been one of the major barriers to employment.

Another reason I’m in favor of federal employers providing personal assistance services is that as a taxpayer, I am very happy to see my tax dollars being spent on enabling people to work when they choose instead of paying them disability benefits because they couldn’t get the workplace supports they needed.

And finally, my hope is that if the federal government starts providing personal assistance services, other employers will see the benefit of doing the same and will voluntarily provide personal assistance services to their employees who need them. If so, maybe we’ll finally be able to overcome this longstanding barrier to the employment of people with disabilities.

The EEOC is still working out the details about how the provision of personal assistance services would work and will be reviewing public comments. For more information, see: http://www.eeoc.gov/eeoc/newsroom/release/2-23-16.cfm.

- Linda Carter Batiste, J.D., Principal Consultant

3 - Sensory Processing Disorder (SPD)

Sensory processing refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavior responses.  When someone walks or swims, eats ice cream, or listens to music, completion of the activity requires processing the sensation.  

Sensory Processing Disorder (SPD) is a condition that exists when sensory signals don’t get organized into appropriate responses.  Imagine a neurological traffic jam that prevents certain parts of the brain from receiving the information needed to interpret sensory information accurately.  A person with SPD will find it difficult to process and act upon information received through the senses.  This creates challenges in performing numerous tasks daily.  

Symptoms of SPD, like those of most disorders, occur within a broad range of severity.  While most individuals have occasional difficulties processing sensory information, those with SPD may have chronic difficulties that disrupt everyday life.

Issues with touch, sight, sound, smell, texture, balance and movement, body position, and body awareness can all cause adverse, or uncomfortable responses. Individuals may only be affected by one sense – for example just touch, sight, or movement, or they may be affected by multiple senses.  Individuals may over-respond to sensation and be unable to tolerate clothing, physical contact, light, sound, food, or other sensory input. Yet someone else might under-respond with little to no reaction to stimulation, even to pain or extreme hot and cold.

Individuals with SPD may not be able to acquire socially appropriate responses and tools as easily or effortlessly as those without sensory processing difficulties who begin learning how to integrate sensory information from birth.

Let’s look at this on a practical level and imagine how it might play out in the workplace. Think about your work environment and the things that might be problematic for individuals with sensory issues:

Working in a restaurant or in an adjacent office space might cause a problem because of the pervasive smell of food cooking. Retail areas where merchandise such as bath and body products or tires are sold may be problematic.

Some employers require their employees to wear uniforms, hats, or specific footwear that workers may find difficult or impossible to tolerate.  Working in areas of extreme temperatures may also cause problems.   

Our JAN offices are located on a main artery through town. The portion of the street that runs in front of our building is also a state route.  We hear the continuous roll of trucks, horns blaring, and the sirens of emergency vehicles. A busy call center with the constant ringing of telephones and background chatter may be troublesome as well.

It is easy to see why accommodations in the workplace may be essential for individuals with sensory processing disorders to thrive in their environments. See the common accommodations ideas listed below that might be effective:

Situation: An employee in a large office space was having difficulty with the various smells that assailed her on a daily basis. She disclosed and asked for an accommodation.

Solution:  The employee was accommodated with a modified workplace policy that allowed her to chew gum in order to help ward off the smells she found difficult to tolerate.

Situation: A computer analyst with extreme sensitivity to fluorescent lighting was having great difficulty performing the essential function of his job in an office with overhead fluorescent lighting. The employee asked for an accommodation of telework, explaining how productive he could be when working from home by eliminating all fluorescent lighting. 

Solution: The employer agreed to allow the employee to work from home for a two-month trial period. They agreed to meet at that time to evaluate the situation and determine if a more long-term accommodation of telework would be appropriate. 

Situation: A new employee who was having great difficulty with the level of noise in a busy customer service location asked if she could work from home.

Solution:  The employee’s essential functions consisted of answering phones and assisting customers who came into the busy office. The employer agreed to try accommodations that would limit the employee’s time at the busy customer service counter and allow her to answer phones and do paperwork from a location in the back of the office away from the public and the noise, but denied the request for telework due to the nature of her tasks.

Sensitivity to Touch:

  • Modify a uniform or dress code policy

Situation: A new employee was hired by an established consulting firm that required female employees to wear skirts and stockings when meeting with clients. There was no way this employee could tolerate stockings or pantyhose.

Solution: A JAN consultant recommended the employee talk with her employer about her disability and discuss solutions. A modification in the dress code policy as an accommodation would allow the employee to look every bit as professional while wearing a pant suit when meeting with clients.   

Temperature Sensitivity:

  • Reduce/Increase work-site temperature
  • Use cool vest or other cooling clothing / heated gloves or other heated clothing
  • Use fan/air-conditioner at the workstation / allow workstation heaters
  • Allow flexible scheduling and flexible use of leave time
  • Allow work from home during hot/cold weather

Situation:  An employee who worked in a maintenance garage in a southern state absolutely could not tolerate heat.  Several months out of the year were unbearable and his attendance suffered.

Solution:  The employer installed a swamp cooler that dropped the garage temperature significantly.  The employee was able to tolerate the environment and attendance was no longer an issue.

Do you have difficulties with sensory processing resulting in complications or frustrations on the job?  Consider the information provided above to see if workplace accommodations might be an answer for you in your situation.  Contact JAN for a personal consultation if we can be of assistance. 

Resource:

Sensory Processing Disorder Foundation. (2016). About SPD. Retrieved April 12, 2016 from http://www.spdfoundation.net/about-sensory-processing-disorder/

- Melanie Whetzel, M.A., CBIS, Lead Consultant, Cognitive/Neurological Team

4 - Here’s a Note from my Dentist

One of the more common questions JAN receives is, “Under the ADA, who is qualified to provide medical information when an accommodation is requested?”The ADA does not specifically require that medical information be provided by a licensed medical doctor (MD) to establish the existence of an ADA-qualifying disability and need for accommodation. Employers can expect that the information necessary to determine coverage under the law be provided by an appropriate health care or rehabilitation professional who is familiar with the individual's impairment and functional limitations. Of course, it makes sense that the appropriate professional should have expertise in the disability involved and/or direct knowledge of the individual with the disability. Medical information should come from a credible and reliable source.

In the agency’s guidance on Reasonable Accommodation and Undue Hardship under the ADA, the Equal Employment Opportunity Commission (EEOC) notes that appropriate professionals who can provide medical information can include, but are not limited to, medical doctors, psychiatrists, psychologists, nurses, physical therapists, occupational therapists, speech therapists, vocational rehabilitation specialists, and licensed mental health professionals. Keep in-mind, this is not an exhaustive list of health care professionals. Information can also come from certified physician assistants, nurse practitioners, chiropractors, and other health care providers who are knowledgeable and have expertise in the disability involved. For more information, see the EEOC’s guidance on Reasonable Accommodation and Undue Hardship under the ADA, question 6.

It can be required that medical documentation sufficiently substantiate that the individual has a disability, defines his or her limitations, and makes clear why the reasonable accommodation being requested is needed. Employers who request medical documentation for ADA purposes should not ask for more detailed information than is absolutely necessary to determine eligibility to receive accommodation. EEOC explains that sufficient medical documentation describes the nature, severity, and duration of the impairment, the activity or activities that the impairment limits, the extent to which the impairment limits the employee's ability to perform the activity or activities, and also substantiates why the requested reasonable accommodation is needed. For more information, see EEOC’s guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA, question 10.

When insufficient medical documentation is received in response to an employer's initial request, the employer should notify the individual, preferably in writing, explain why the documentation is insufficient, and allow the individual an opportunity to provide the missing information in a timely manner. The amount of time the individual has to provide sufficient information is up to the employer’s discretion, but anywhere from five to ten business days is common. Medical documentation is insufficient under the ADA if it does not specify the existence of a disability and explain the need for reasonable accommodation. EEOC indicates that medical documentation may also be insufficient if the health care professional does not have the expertise to offer an opinion about the employee's medical condition and limitations; the information does not specify the individual’s functional limitations; or, factors indicate that the information provided is not credible or is fraudulent. For more information, see EEOC’s guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA, question 11.

JAN offers many resources related to medical inquiries and the ADA. For more information about requesting medical information, please contact JAN to speak with a Consultant, or see JAN’s A to Z By Topic: Medical Exams and Inquiries.

- Tracie DeFreitas, M.S., Lead Consultant, ADA Specialist

5 - Best Practices for Addressing Requests for Adjustable Height Workstations

Recently I wrote a JAN Consultants’ Corner about addressing requests for ergonomic chairs. After we started getting questions from employers about how to handle multiple requests for adjustable height workstations, I decided to write an article addressing this issue as well.

Ergonomics in the workplace is not a novel concept. It can be beneficial for all workers to have a workstation that is set up in an ergonomically correct way to prevent common workplace injuries, like carpal tunnel, or to ensure that those with disabilities and medical conditions are able to continue working. Part of an ergonomic workstation set-up can include an adjustable height workstation or sit/stand desk. There are numerous options for those looking to purchase equipment that would allow them to alternate between sitting and standing at their workstation.   

Employers may have a difficult time discerning what is really needed when an employee requests an adjustable height workstation for a back condition, for example. When multiple employees request adjustable height workstations it can be confusing and time consuming for the person in charge of accommodations to process requests in a way that both complies with Title 1 of the ADA and ensures that employees are getting what is really needed. The following questions and answers address best practices when employees request adjustable height workstation in the workplace.

Q1. If an employee asks for an adjustable height workstation, can we ask for medical documentation?

According to the EEOC, when an employee requests an accommodation and the disability and need for accommodation are not obvious, the employer can request a limited amount of medical documentation to substantiate that s/he has an ADA disability and needs the reasonable accommodation requested. If an employee indicates that an adjustable height workstation is needed due to a medical condition, and the disability is not obvious, the employer can ask the employee to provide medical documentation to support the request. An alternative option could be for the employee to complete ADA accommodation documentation that the employer has developed. Employers and employees can find sample medical inquiry forms and accommodation request forms developed by JAN at http://askjan.org/topics/forms.htm

Q2. What if the medical provider indicates that a specific desk is being requested?

An employer ultimately determines what accommodation will be provided and has the ability to choose among reasonable accommodations as long as the chosen accommodation is effective. So, as part of the interactive process, the employer can offer alternative suggestions for types of adjustable height workstations and discuss how the accommodation could be effective. If there are multiple options being considered, the employer may choose the less expensive option, again providing that the desk or workstation purchased is effective. Some vendors offer desktop height adjustable equipment that is placed on existing office furniture while other options include complete desks that raise and lower electronically or manually. The EEOC has said that if more than one accommodation is effective, "the preference of the individual with a disability should be given primary consideration. However, the employer providing the accommodation has the ultimate discretion to choose between effective accommodations.”

Q3. Are there alternatives to providing the adjustable height workstation?

It depends. In some cases an employee may need an ergonomic or adjustable office chair or additional support when sitting, which could be provided by adding a lumbar cushion or seat cushion. An ergonomic assessment could be performed to ensure that the chair being used is placing the employee in an ergonomically correct seating position. Other accommodations for sitting and standing could be explored, depending on the need of the employee. However, for some, having the ability to alternate between sitting and standing with an adjustable height workstation may be the accommodation to focus on. A list of vendors that provide adjustable height workstations for office settings can be found at http://soar.askjan.org/solution/87. A list of vendors that provide adjustable height workstations for industrial settings can be found at http://soar.askjan.org/solution/86.

Q4. What else can we consider to address these types of requests?

While a request for equipment, such as an adjustable height workstation, can be straightforward there may be other factors for an employer to consider if experiencing an increase in accommodation requests. Questions to consider include: Would it be beneficial to have ergonomic assessments completed for all employees on a regular basis as a benefit of employment? Is it time to update office furniture and get rid of desks and chairs that have been used for years? Is it necessary to treat all requests for adjustable height workstations as accommodation requests? Or can we have a policy around requests for adjustable height workstations that offers updated equipment as a benefit of employment?

Some employers find that taking proactive measures can not only help to prevent workplace injuries, but also streamline requests for equipment that might have otherwise gone through the general ADA process. Of course, what works for one employer may not for another. But keeping an open mind about changes that could be made in policies and procedures could be beneficial for both employees and those in charge of handling accommodation requests.

- Elisabeth Simpson, M.S., CRC

6 - Sjogren’s Syndrome: Accommodations for the Workplace

Affecting up to four million Americans, Sjogren’s syndrome is more prevalent, but is less well-known, than similar autoimmune disorders and can go undiagnosed for long periods of time. Sjogren’s shares several characteristics with other autoimmune disorders affecting the joints and may accompany autoimmune disorders including rheumatoid arthritis and lupus. Generalized pain may lead to individuals being limited in motor functioning. Fatigue and weakness are other common symptoms. Additional symptoms such as dry mouth and dry eye tend to be more common in individuals with Sjogren’s compared with other similar autoimmune disorders. Individuals with Sjogren’s may be more likely to develop other medical conditions, including lymphoma and organ dysfunction.

Pain, fatigue, and weakness are common limitations among those with Sjogren’s, so employees may benefit from a modified schedule that could include longer rest breaks, a flexible schedule, and/or use of leave time when needed. Workplace accommodations may include making sure the facility is accessible and moving the employee’s workstation closer to restrooms and needed work-related equipment. In order to reduce or eliminate physical exertion and workplace stress, products may be purchased as an accommodation, such as an ergonomic workstation design and adjustable office chair or a scooter or other mobility aid.

With regard to pain, typical causes include joint swelling, stiffness, and neuropathy. Employees who experience these symptoms may have difficulty both commuting to work and accessing the facilities, so telework or remote work could be considered as an accommodation. Permitting a service animal on the premises or allowing the use of a personal attendant can also aid an employee with mobility, eating, toileting, and grooming needs. Modification to policies may also be considered for those employees who use medications for pain management.

Implementing a variety of products may be considered for fine and gross motor limitations. For office settings, there are many different adjustable workstations available, along with compact material handlers. For those working in the industrial setting, there are alternatives for adjustable workstations and a variety of material handlers, such as drum handlers, ergonomic tools, and compact cranes.

Employees experiencing dry eyes may benefit from accommodations to help manage these symptoms and prevent complications. Typical accommodation approaches include limiting exposure to environmental conditions that exacerbate eye dryness, such as dry and drafty areas, and modifying policies and break schedules to assist employees in managing their symptoms. Employees with dry eye may benefit from periodic breaks away from the workstation to rest eyes or use artificial tears and eye lubricants, limiting exposure to triggers such as fans and vents, providing or allowing the use of a humidifier, modifying lighting to manage photosensitivity, and providing or allowing use of personal protective equipment such as goggles. Telework may be useful if the workplace cannot be suitably modified.

Dry mouth is also a common symptom of Sjogren’s syndrome. In addition to causing discomfort, dry mouth can cause significant dental complications. Employees may benefit from access to beverages and time to brush their teeth after eating. Leave may be needed for dental management.

For more information on accommodating employees with Sjogren’s syndrome, please contact JAN.

Resources:

National Institute of Neurological Disorders and Stroke. (2012). NINDS Sjogren’s Syndrome Information Page. Retrieved April 13, 2016, from http://www.ninds.nih.gov/disorders/sjogrens/sjogrens.htm

Sjogren’s Syndrome Foundation. (2016). About Sjogren’s.  Retrieved April 13, 2016, from http://www.sjogrens.org/home/about-sjogrens

- Teresa Goddard, M.S., Lead Consultant, Sensory Team
- Lisa Mathess, M.A., Senior Consultant, Motor Team

7 - JAN Blog Growing

The Ask JAN Blog provides an opportunity for you to share with others your workplace accommodation solutions. JAN receives over 40,000 contacts per year – conversations with all of you that help us better understand what’s working effectively in your workplaces. We have a great deal to learn from one another. We encourage you to share your experiences and interact with the JAN staff. Your accommodation success stories can benefit many others around the Nation. Enjoy the new postings and additional Spanish selections:

Become a part of the new JAN blogging community!

8 - JAN Releases New Resources

9 - E-vents

10 - JAN Exhibit and Training Schedule

Events of particular interest: Get the most up-to-date and comprehensive training on employing people with disabilities. To view the complete JAN travel schedule go to JAN-on-the-Road.

11 - Subscribe to JAN Newsletter

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This document was developed by the Job Accommodation Network, funded by a cooperative agreement from the U.S. Department of Labor, Office of Disability Employment Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the position or policy of the U.S. Department of Labor. Nor does mention of tradenames, commercial products, or organizations imply endorsement by the U.S. Department of Labor.

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