Accommodation Requests Research Articles

Character education for students with disabilities

ABSTRACT Many schools see it as part of their mission to provide character education or moral education to their students. Yet many students with disabilities are excluded from these curricula, programs, and policies or denied some of their benefits. This essay explores some specific moral problems and obstacles that disabled students face when it comes to developing or exercising virtues of justice or fairness, self-respect, and self-development. For example, students with disabilities face moral questions about whether and how to request accommodations for their disability, whether to exercise special privileges that they suspect are not necessary to accommodate their disability on particular occasions, what to do when teachers do not provide them with accommodations they need, and how to respond to bias and discrimination directed at those with disabilities. This essay also uses John Rawls’ theory of moral development to consider some of the ways in which schools are impeding or failing to promote the overall character development of disabled students.

Accommodation decision-making for postsecondary students with ADHD: Implications for neuropsychologists

ABSTRACT Neuropsychologists are often asked to evaluate students for attention-deficit/hyperactivity disorder (ADHD) and to provide documentation to support their requests for academic accommodations in college. Research points to the importance of multi-method, multi-informant data when evaluating ADHD and determining the need for accommodations. However, the Association on Higher Education and Disability (AHEAD) directs disability service providers to give primacy to students’ self-reports and their own impressions of students’ narratives over objective, third-party data when rendering accommodation decisions. The organization asserts that in many cases information from parents, teachers, and psychologists is not needed to confirm the existence of a disability or students’ need for accommodations. In this article, we describe the way disability service providers are directed to evaluate accommodation requests, the limitations of these procedures, and the dangers of well-intentioned, but indiscriminate accommodation-granting. We then provide recommendations for neuropsychologists who conduct ADHD evaluations for college students in light of these professional guidelines.

Standardizing the Accommodations Process for Health Care Workers During COVID-19.

The COVID-19 pandemic has resulted in a significant increase in accommodation requests from employees seeking temporary alterations to or relief from their job demands. To maintain consistency and ensure a standard approach, Johns Hopkins Medicine established a COVID-19 Accommodation Review committee that includes experts from the occupational health, legal, and human resources departments, as well as an Americans with Disabilities Act coordinator. In this article, the authors describe the workflow and various components of their institution's accommodations review process, which has resulted in a more consistent and equitable approach to granting requests.

South African guidelines on the determination of death.

Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. This document compiled by the Critical Care Society of Southern Africa outlines the core standards for determination of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence. The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment (https://criticalcare.org.za/resource/death-determination-checklists/). Key points • Brain death and circulatory death are the accepted terms for defining death in the hospital context. • Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. • The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks' corrected gestation. • Brain-death testing while on extra-corporeal membrane oxygenation is outlined. • Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. • The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.

South African guidelines on the determination of death.

Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. This document compiled by the Critical Care Society of Southern Africa outlines the core standards for determination of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence. The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment (https://criticalcare.org.za/resource/death-determination-checklists/). Brain death and circulatory death are the accepted terms for defining death in the hospital context.Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met.The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks' corrected gestation.Brain-death testing while on extra-corporeal membrane oxygenation is outlined.Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation.The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.

High School Students with Learning Disabilities: Requesting Accommodations in Role‐Play

AbstractSelf‐advocacy is an important skill, especially as students transition from high school to postsecondary settings. In this study, five high‐school students with specific learning disabilities (SLD) were taught to use a self‐advocacy intervention to learn to request academic accommodations. A multiple‐baseline across participants design was used to examine the functional relation between the intervention and students’ performance. Students learned the self‐advocacy intervention, consisting of 17 target behaviors, during after‐school sessions across approximately 6 weeks. Based on the visual analysis and percentage of nonoverlapping data, there was strong evidence of a functional relation between the self‐advocacy intervention and an increase in participants’ performance for requesting academic accommodations during role‐play scenarios. Participants maintained self‐advocacy skills 2 weeks after mastery and generalized accommodation requests with other school‐based personnel. Social validity data indicated that participants valued the intervention. Implications for practitioners are discussed for transition and self‐advocacy skills as well as future research opportunities.

Online Self-Determination Toolkit for Youth With Disabilities: Protocol for a Mixed Methods Evaluation Study.

BackgroundYouth with disabilities encounter many challenges during their transition to adulthood including finding employment. Jobs are often inaccessible, and youth often face a lack of support, discriminatory attitudes, and sometimes low self-confidence. Therefore, it is critical to help youth enhance their self-determination skills to advocate for their needs in the workplace.ObjectiveThe aim of this paper is to describe how an online toolkit aimed to improve self-determination in advocating for needs, including disability disclosure and accommodation requests to employers, was co-created with youth with disabilities.MethodsWe will use a mixed method design in which qualitative data (ie, focus groups and mentored discussion forum) are collected to understand the contextual factors during the intervention that could affect outcomes or explain results through the pre-post questionnaires. Fifty youths with disabilities aged 15 to 24 years will be recruited.ResultsData collection is in progress. Planned analyses include focus groups and pre-post surveys to determine the impact of the intervention on self-determination. A qualitative content analysis of the focus groups and all open-ended survey questions will be conducted to understand the impact of the toolkit.ConclusionsOur online toolkit includes evidence-informed content that was co-created with youth who have a disability. It has potential for educational and vocational programming for youth with disabilities.International Registered Report Identifier (IRRID)PRR1-10.2196/20463

Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools.

Introduction:Leaders in medical education have expressed a commitment to increase medical student diversity, including those with disabilities. Despite this commitment there exists a large gap in the number of medical students self-reporting disability in anonymous demographic surveys and those willing to disclose and request accommodations at a school level. Structural elements for disclosing and requesting disability accommodations have been identified as a main barrier for students with disabilities in medical education, yet school-level practices for student disclosure at US-MD programs have not been studied.Methods:In August 2020, a survey seeking to ascertain institutional disability disclosure structure was sent to student affairs deans at LCME fully accredited medical schools. Survey responses were coded according to their alignment with considerations from the AAMC report on disability and analyzed for any associations with the AAMC Organizational Characteristics Database and class size.Results:Disability disclosure structures were collected for 98 of 141 eligible schools (70% response rate). Structures for disability disclosure varied among the 98 respondent schools. Sixty-four (65%) programs maintained a disability disclosure structure in alignment with AAMC considerations; 34 (35%) did not. No statistically significant relationships were identified between disability disclosure structures and AAMC organizational characteristics or class size.Discussion:Thirty-five percent of LCME fully accredited MD program respondents continue to employ structures of disability disclosure that do not align with the considerations offered in the AAMC report. This structural non-alignment has been identified as a major barrier for medical students to accessing accommodations and may disincentivize disability disclosure. Meeting the stated calls for diversity will require schools to consider structural barriers that marginalize students with disabilities and make appropriate adjustments to their services to improve access.

Disability Without Documentation

Disability exists regardless of whether a doctor has confirmed its existence. Yet in the American workplace, employees are not disabled, or entitled to reasonable accommodations, until a doctor says so. This Article challenges the assumption that requests for reasonable accommodations must be supported by medical proof of disability. It proposes an accommodation process that accepts an individual’s assessment of their disability and defers to their accommodation preferences. A documentation-free model is not alien to employment law. In evaluating religious accommodations, employers, and courts, take a hands-off approach to employees’ representations that their religious beliefs are sincere. Disability deserves the same deference. This Article also contributes a novel analysis of agency guidance, exploring how its support of medical documentation requirements conflicts with legislative intent and the American with Disabilities Act’s rejection of the medical model of disability. Documenting disability has its price. It requires access to affordable healthcare and a relationship with a medical provider willing to confirm disability’s existence. Documentation requirements may delay an urgently-needed accommodation—one that would, for example, permit an employee to work from home. Until documentation requirements are relaxed, if not eliminated, disabled employees may be forced to work in dangerous conditions, or not work at all.

Diversity and Inclusion in the American Legal Profession: Workplace Accommodations for Lawyers with Disabilities and Lawyers Who Identify as LGBTQ.

Purpose: Workplace accommodations, vital for employees with disabilities, promote diversity and inclusion efforts in organizations. This article examines who requests accommodations and who is more likely to have requests granted. We investigate the roles of individual characteristics and their intersection, including disability, sexual orientation, gender, race/ethnicity, and age. Methods: Using data from a national survey of U.S. lawyers, we estimate the odds of requesting accommodations and having the requests approved. We also estimate differences in odds according to individual characteristics, adjusting for control variables. Results: Personal identity factors, such as disability status, gender, and age, predict requests for accommodations. Odds of requesting accommodations were higher for women and people with disabilities as compared to men and those without disabilities, but lower for older individuals. Odds of requesting accommodations were higher for an older population segment—older lesbian, gay, bisexual, and queer (LGBQ) lawyers—than for younger lawyers. Accommodations were granted differentially to individuals with multiple marginalized identities. Counter to predictions, being a person with a disability is negatively associated with having an accommodation granted. Older lawyers generally have higher odds of having accommodations granted, but odds for groups such as women and racial/ethnic minorities decline with age. LGBQ lawyers who are racial minorities have lower odds than White LGBQ lawyers of having their accommodations granted. Longer tenure increases the odds of requesting accommodations. Working for a private organization decreases the odds; working for a large organization generally increases the odds. Conclusions: Those most needing accommodations, such as lawyers with disabilities and women, are more likely to request accommodations. Disabled lawyers, older women lawyers, older racial/ethnic minority lawyers, and LGBQ minority lawyers have relatively low odds of having requests granted. The results highlight the need to consider intersectional identities in the accommodation process.

Verification of Healthcare Personnel Immunity as a Strategy for Measles Preparedness

Background: Immunization resistance is fueling a resurgence of vaccine-preventable diseases in the United States, where several large measles outbreaks and 1,282 measles cases were reported in 2019. Concern about these measles outbreaks prompted a large healthcare organization to develop a preparedness plan to limit healthcare-associated transmission. Verification of employee rubeola immunity and immunization when necessary was prioritized because of transmission risk to nonimmune employees and role of the healthcare personnel in responding to measles cases. Methods: The organization employs ∼31,000 people in diverse settings. A multidisciplinary team was formed by infection prevention, infectious diseases, occupational health, and nursing departments to develop the preparedness plan. Immunity was monitored using a centralized database. Employees without evidence of immunity were asked to provide proof of vaccination, defined by the CDC as 2 appropriately timed doses of rubeola-containing vaccine, or laboratory confirmation of immunity. Employees were given 30 days to provide documentation or to obtain a titer at the organization’s expense. Staff with negative titers were given 2 weeks to coordinate with the occupational heath department for vaccination. Requests for medical or religious accommodations were evaluated by occupational heath staff, the occupational heath medical director, and the human resources department. All employees were included, though patient-interfacing employees in departments considered higher risk were prioritized. These areas were the emergency, dermatology, infectious diseases, labor and delivery, obstetrics, and pediatrics departments. Results: At the onset of the initiative in June 2019, 4,009 employees lacked evidence of immunity. As of November 2019, evidence of immunity had been obtained for 3,709 employees (92.5%): serological evidence of immunity was obtained for 2,856 (71.2%), vaccine was administered to 584 (14.6%), and evidence of previous vaccination was provided by 269 (6.7%). Evidence of immunity has not been documented for 300 (7.5%). The organization administered 3,626 serological tests and provided 997 vaccines, costing ∼$132,000. Disposition by serological testing is summarized in Table 1. Conclusions: A measles preparedness strategy should include proactive assessment of employees’ immune status. It is possible to expediently assess a large number of employees using a multidisciplinary team with access to a centralized database. Consideration may be given to prioritization of high-risk departments and patient-interfacing roles to manage workload.Funding: NoneDisclosures: None

Negotiating Accessibility for Electronic Resources

Accessibility of library electronic resources is a must. Its importance derives from professional ethics of librarianship, rising total costs of acquisition, and mounting legal challenges to colleges and universities that fail to provide resources accessible to users with disabilities. Library staff are responsible for ensuring the accessibility of vendor-licensed eresources. This column reviews the accessibility clauses of nine model license agreements for electronic resources. It describes terms that should go into an optimal accessibility clause and creates a composite model clause. It also provides guidance for library staff seeking to negotiate stronger accessibility language into vendor license agreements. Finally, it addresses the impact of accommodation requests on the total cost of acquiring library eresources, concluding with a call to redouble efforts to advocate for greater accessibility and educate both vendors and library staff about its importance.

Perceptions of Extended Time Accommodations Among Postsecondary Students With Disabilities

ABSTRACT Students with disabilities often take tests using extended time accommodations, which provide students with additional time to complete tests in order to reduce the impact of their disability on their scores. At the postsecondary level, students with disabilities must take the initiative to seek and request accommodations, and their perceptions of them likely influence which, if any, accommodations they use when taking a test. Through semi-structured interviews with postsecondary students with disabilities, the current study identified students’ perceptions about extended time accommodations, including the frequency with which they use their extended time, factors that impact their usage (e.g., test format, disability symptoms), and obstacles they face in obtaining and utilizing their accommodations (e.g., instructor-related concerns, social ramifications). It is hoped that these findings assist disability service providers (DSPs), psychologists, and students with disabilities in making more informed decisions regarding the use and provision of extended time accommodations.

Teaching High School Students With Disabilities to Advocate for Academic Accommodations

One factor that may contribute to the success of students with disabilities in postsecondary educational settings may be their ability to advocate for academic accommodations. By incorporating self-determination practices into the curriculum and transition process during high school, students with disabilities may acquire the self-advocacy skills for postsecondary settings. The purpose of this study was to examine the effects of a modified Self-Advocacy and Conflict Resolution (mSACR) training program on the ability of five high school students with high-incidence disabilities to request academic accommodations in a high school general education course. A multiple-probe-across-participants design was employed to evaluate the effects of the intervention on 14 targeted behaviors. Results indicated a functional relation between the mSACR and the ability of students to request accommodations. Findings from this study are discussed along with limitations, suggestions for future research, and implications for educational practice.

Reader response: Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement.

As an American Academy of Neurology (AAN) Corresponding Fellow, I applaud the AAN position statement1

Editors' note: Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement

On behalf of the Brain Death Working Group, Dr. Russell and colleagues have provided medical professionals and the public with formal guidance as to the definition and determination of brain death. This AAN position statement answers many lingering questions faced by neurologists, intensivists, and critical care providers about when and how to perform an assessment of brain death. Among declarations made in this guideline are that brain death is a clinical diagnosis based on the loss of function of the brain as a whole; that medical providers have no legal obligation to provide organ support to patients with brain death (applies to all US states with the exception of New Jersey); and that providers are permitted to conduct brain death testing—including the apnea test—without consent of the patient's surrogate. In response to this position paper, Dr. Nitin Sethi expresses concern regarding the rights of AAN members to recuse themselves from brain death determination or management. Such a recusal might be perceived by family members or caregivers as medical uncertainty regarding a diagnosis of brain death. However, the AAN position statement is consistent with a long-standing moral imperative that extricates AAN members from having to make a brain death determination—or provide continued care to the deceased—when such management conflicts with their own personal beliefs. In a separate comment, Dr. Calixto Machado highlights the importance of this document in that it provides a standardized definition and management strategy of brain death including the performance of the apnea test, which can be referenced by health care professionals and legal authorities. Finally, Dr. Nathaniel Robbins addresses the inherent limitations of clinical brain death determination, which is wholly reliant on motor output and an intact brain stem. Although absence of brain stem function is prognostically useful in and of itself, Robbins asserts, it should not indicate that all functions of the brain have ceased. Higher cortical functions may be preserved and are clinically untestable. In response, Dr. Russell emphasizes that injury to the “brain as a whole” is what constitutes brain death and understanding the nature of the injury limits the possibility of a false-positive declaration. As we are not required to demonstrate that all myocardial cells have died in the event of cardiac death, we need not prove that all nerve cells have died to make a determination of brain death. On behalf of the Brain Death Working Group, Dr. Russell and colleagues have provided medical professionals and the public with formal guidance as to the definition and determination of brain death. This AAN position statement answers many lingering questions faced by neurologists, intensivists, and critical care providers about when and how to perform an assessment of brain death. Among declarations made in this guideline are that brain death is a clinical diagnosis based on the loss of function of the brain as a whole; that medical providers have no legal obligation to provide organ support to patients with brain death (applies to all US states with the exception of New Jersey); and that providers are permitted to conduct brain death testing—including the apnea test—without consent of the patient's surrogate. In response to this position paper, Dr. Nitin Sethi expresses concern regarding the rights of AAN members to recuse themselves from brain death determination or management. Such a recusal might be perceived by family members or caregivers as medical uncertainty regarding a diagnosis of brain death. However, the AAN position statement is consistent with a long-standing moral imperative that extricates AAN members from having to make a brain death determination—or provide continued care to the deceased—when such management conflicts with their own personal beliefs. In a separate comment, Dr. Calixto Machado highlights the importance of this document in that it provides a standardized definition and management strategy of brain death including the performance of the apnea test, which can be referenced by health care professionals and legal authorities. Finally, Dr. Nathaniel Robbins addresses the inherent limitations of clinical brain death determination, which is wholly reliant on motor output and an intact brain stem. Although absence of brain stem function is prognostically useful in and of itself, Robbins asserts, it should not indicate that all functions of the brain have ceased. Higher cortical functions may be preserved and are clinically untestable. In response, Dr. Russell emphasizes that injury to the “brain as a whole” is what constitutes brain death and understanding the nature of the injury limits the possibility of a false-positive declaration. As we are not required to demonstrate that all myocardial cells have died in the event of cardiac death, we need not prove that all nerve cells have died to make a determination of brain death.

Reader response: Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement.

I applaud the Brain Death Working Group for working toward uniform standards for determination of brain death.1

Author response: Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement.

On behalf of the Brain Death Working Group, I thank Drs. Sethi, Machado, and Robbins for their comments and for their support of the recently published AAN position statement on brain death.1

Reader response: Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement.

I read with interest the AAN position statement on brain death, the determination of brain death, and member guidance for brain death accommodation requests.1

Consider implications of court ruling for food‐allergy accommodations

Food allergies present a host of issues for institutions that offer meal plans. Although the 2012 Lesley University settlement agreement with the Department of Justice and the similar 2019 settlement agreement with Rider University provide a roadmap for resolving most accommodation requests, both leave open the question of when an exemption from a mandatory meal plan rather than an allergen‐free meals accommodation may be necessary.