1. Hidden Disabilities, Disclosure, and Accommodations
Melanie Whetzel, M.A., Lead Consultant
Matthew McCord, M.S., CRC, Consultant

2. Overview
“Hidden Disabilities”
Examples
Accommodation Solutions

3. Hidden disabilities can be any impairment causing limitations:
not obvious to the naked eye;
not easily discerned by others; or
not noticeable in one’s speech, behavior, or mobility.

4. Myths Hidden disabilities are not believable.
Hidden disabilities are downplayed –
not as severe as obvious disabilities like mobility impairments.
Hidden disabilities are hard to accommodate because the need is not obvious.
People with hidden disabilities do not need accommodations.
Accommodations are expensive.

5. HIV/AIDS
Cancer
Diabetes
Heart conditions
Respiratory impairments
Vision loss
Hearing loss
Epilepsy
ADD
Sleep disorders
Migraine headaches
Fibromyalgia
Chronic fatigue syndrome
Mental health conditions
Brain injury
Gastrointestinal disorders
Learning disabilities
Multiple sclerosis

6. Cognitive Impairments Physical Impairments Psychological Impairments
Learning, remembering, concentrating
Physical Impairments
Fatigue, gross or fine motor skills, sleeping
Psychological Impairments
Irritability, social interaction, managing stress
Sensory Impairments
Breathing, seeing, hearing

7. Documenting a Disability
when the disability is NOT obvious
when the need for accommodation is NOT obvious

8. Documenting a Disability
Diagnosed impairment
Major life activity substantially limited by the impairment:
caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.
major bodily functions, including but not limited to, functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.

9. Example:v A longtime IT employee of a university discloses that he has been having severe bouts of depression that have affected his ability to work the night shift. The employee requests that his shift be changed to a day or evening one to help him better regulate his sleep. The manager is totally surprised because there have been no performance problems or issues of any kind with this employee.

10. Solution: The manager asks for medical documentation that will provide information as to why the accommodation is needed. The manager then takes a look at the IT schedules to see what can be done to assist this employee.

11. Disclosure

12. Why Disclose? To ask for job accommodations
To receive benefits or privileges of employment
To explain an unusual circumstance

13. How to Disclose? The individual must let the employer know:
An adjustment or change at work is needed for a reason related to a medical condition
To request accommodation, an individual:
May use “plain English”
Need not mention the ADA
Need not use the phrase “reasonable accommodation”

14. Who to Disclose to? Verbally or in writing, tell the… Employer
Supervisor
HR representative, or
Other appropriate person

15. Job Accommodations

16. Example: An auditor for the state government was unable to walk up stairs due to a heart condition. The scheduled elevator repairs in her building forced her to disclose and ask for an accommodation.

17. Attendance: Allow flexible work environment: Flexible scheduling
Modified break schedule
Leave for counseling
Work from home/Flexi-place

18. Accommodation: She was accommodated with telework for the duration of the repairs.

19. Example: A high school guidance counselor with ADD was having problems with concentration due to the noise outside the office.

20. Concentration: Reduce distractions in the work area:
Provide space enclosures, sound absorption panels, or a private office
Allow for use of white noise or environmental sound machines
Allow the employee to play soothing music using an earbud and computer or music player
Plan for uninterrupted work time
Purchase organizers to reduce clutter

21. Concentration:
Increase natural lighting or provide full-spectrum lighting
Divide large assignments into smaller tasks and goals
Use auditory or written cues as appropriate
Restructure job to include only essential functions
Provide memory aids such as schedulers, organizers, or applications

22. Accommodation:
His school provided him with soundproofing and a floor fan for white noise. 
The accommodation was very successful!

23. Example: A secretary with fibromyalgia and major depression
experienced extreme fatigue
during the afternoon.

24. Fatigue: Allow flexible work environment
Provide a goal-oriented workload
Reduce or eliminate physical
exertion & workplace stress
Implement ergonomic
workstation design

25. Accommodation:
The individual was accommodated with lateral filing cabinets, a wireless headset, forearm supports, and an articulating keyboard tray.

26. Example:
A receptionist in a large office had difficulty remembering faces/names and keeping track of the in/out status of the various case managers on staff due to post-concussive syndrome.

27. Memory: Allow use of job coach / Provide mentor
Provide minutes of meetings and trainings
Use auditory or written cues as appropriate
Allow additional training time
Provide written checklists
Use a color coding scheme to prioritize tasks
Use notebooks, planners, or sticky notes to record information
Provide labels/bulletin board to assist in locating items

28. Accommodation: A Velcro in/out board was provided with the photo and name of each case manager. When entering or leaving the building, the staff members would prompt the receptionist as to their status and he would then move their photo from the “in” to the “out” column, or vice versa, thereby allowing him to keep track of the status of the case managers and better serve clients who were trying to contact them.

29. Example:
A clerk with a learning disability maintained files and had difficulty categorizing and sorting paperwork.

30. Organization: Use daily, weekly, and monthly task lists
Use calendar with automated reminders to highlight meetings and deadlines
Use electronic organizers or mobile devices
Divide large assignments into smaller tasks and goals
Use a color-coding scheme to prioritize tasks

31. Accommodation:
The individual’s workspace was rearranged to eliminate visual distractions. A checklist was developed to help with task sequencing. The employer also provided reading templates and colored marker tabs for filing.

32. Example:
A general construction worker was experiencing frustration with a coworker who was giving him orders / critiquing his abilities as he came in to work and the shifts overlapped.

33. Coworker Interaction:
Encourage the employee to walk away from frustrating situations and confrontations
Provide partitions or closed doors to allow for privacy
Provide disability awareness training to coworkers and supervisors

34. Accommodation:
The employer allowed the employee to walk away from his coworker when this happened, suggesting he take a walk around the building to cool off and report his “absence” to his supervisor.

35. Example:
An employee returning to work after a stroke was dealing with personality changes. The previous supervisory method was no longer effective.

36. Working Effectively: Provide positive praise and reinforcement.
Develop clear expectations of responsibilities and the consequences of not meeting performance standards.
Schedule consistent meetings with employee to set goals and review progress.
Establish written long term and short term goals.
Develop strategies to deal with conflict.
Educate all employees on their right to accommodations.
Do not mandate that employees attend social functions.

37. Accommodation: The supervisor met weekly with the employee to discuss problematic conduct and performance issues. They agreed to put accommodations and strategies into place that would help to improve both performance and conduct.

38. Example: A manufacturing plant requires employees to work an eight-hour shift with just a one-hour break for lunch. An employee with diabetes needs to eat several times a day to keep his blood sugar levels from dropping too low.

39. Hypo/Hyperglycemia:
Allow for storage of medications, such as insulin and/or food
Provide an area to test blood sugar levels
Provide an area to administer medications (insulin)
Provide appropriate containers for needles/syringe disposal
Provide a rest area for reorientation after hypo/hyperglycemic episode
Allow frequent breaks for food as needed
Provide appropriate food for office-sponsored events and reward programs
Consider modifications to policies involving food storage and consumption

40. Accommodation: The employee was allowed to either take two 15-minute breaks each day and make up the time by coming to work 15 minutes earlier and staying 15 minutes later, or take 30 minutes for lunch and then use the other 30 minutes for two 15-minute breaks.

41. Example: An engineer with multiple sclerosis was experiencing heat sensitivity.

42. Heat Sensitivity:
Reduce worksite temperature
Use cool vest or other cooling clothing
Use fan/air conditioner at the workstation
Allow flexible scheduling and flexible use of leave time
Allow work from home during hot weather

43. Accommodation: She was provided a private office where the temperature could be cooler than in the rest of the facility. She was also encouraged to communicate with coworkers by telephone or when possible to reduce the amount of walking she had to do in warmer areas.

44. Example: An office employee with epilepsy began having seizures and was undergoing medical treatment. Her doctor stated she was safe to work if precautions were put into place.

45. Ensuring Safety in the Workplace:
Take some universal precautions to ensure safety in the workplace.
Designate a person to respond to emergencies
Keep aisles clear of clutter
Provide a quick, unobstructed exit
Know when to (or not to) call 9-1-1
Consult employee’s plan of action to determine how to respond/react when employee has a seizure on the job (see "Plan of Action" section for additional information)

46. Accommodation: The employee and her doctor compiled a plan of action so the employer and a few close coworkers would know exactly what to do if she were to have another seizure at work.

47. Example: A real estate appraiser had frequent migraine headaches which caused reduced productivity and frequent absences.

48. Lighting Triggers:
Add fluorescent light filters to existing fluorescent lights to create a more natural lighting
Change lighting completely
Provide an anti-glare filter for computer monitor
Provide a liquid crystal display monitor that has a better refresh rate
Move employee to a private area to allow for personal adjustment to appropriate lighting
Allow the employee to wear sunglasses or anti- glare glasses in the work area
Allow telework

49. Accommodation: The appraiser was given a light dimmer to control her workstation lighting and help her with light sensitivity. She was also provided with leave when she gets migraines.

50. Example: An electric serviceman with progressive hearing loss sometimes worked in a bucket truck and needed to communicate to coworkers. The usual method of communication was via a radio.

51. Use a two-way radio with text messaging capability
Difficulty Communicating in the Field:
Use a high-end professional two-radio system with noise-canceling technology
Use a two-way radio with text messaging capability
Use a cellular phone with text messaging, a two- way mobile device, or a cellular phone that has both text messaging and two-way radio capability
If "in the field" communication takes place within sight, workers may be able to use hand signals and signs to communicate instead of two-way radios
Use a portable TTY and relay service

52. Accommodation: The employer switched to cell phones and the employee was able to use text messaging to communicate. The employer reported the accommodation improved communication and kept a valuable employee

53. Example:
A federal office worker had difficulty working an early schedule, and also experienced fatigue, sleepiness, and the inability to concentrate in the afternoon due to sleep problems associated with PTSD. His attendance was erratic.

54. Sleep Disturbances Allow for a flexible start time
Combine scheduled short breaks into one longer break
Provide a place for the employee to rest during break
Allow the employee to work one consistent schedule
Provide work areas with natural lighting

55. Accommodation:
He was accommodated with a modified schedule and a combined lunch and break time in order to take a rest. He used a folding chaise lounge that just fit into his cubicle and allowed him an hour-long daily nap.

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