Guide for Assessing Persons with Disabilities - How to determine and implement assessment accommodations - Mental health disabilities

What do you need to know about the disability?

There are many types of mental health disabilities. Our objective here is not to list them but to make you familiar with their possible resulting functional limitations. These limitations can affect cognitive, emotional and social functioning and they may be temporary, recur episodically, or be long-lasting.

Functional limitations associated with mental health disabilities can vary from mild to severe, and may fluctuate in time. In relation to assessment performance, mental health disabilities may interfere with a person's abilities in the following three areas:

1. Mental alertness: Depression, anxiety, and side effects of medication may interfere with a person's attention and slow down speed of information processing and reaction time.
2. Concentration and organization: The presence of others, ambient noise, visual stimuli, intrusive thoughts, low energy levels and/or side effects of medication may all interfere with a person's ability to maintain concentration and organize ideas.
3. Dealing with stress and anxiety: Excessive anxiety, including anxiety about assessment performance, about the interpersonal nature of the evaluation (for example, group assessment), or as a side effect of a medication can affect a person's performance in an assessment.

What information or professional documentation is needed?

Persons with mental health disabilities are the first source of information about their functional limitations and the accommodations that are useful to them. However, due to the variety of ways that mental health disabilities may affect applicants' performance, a report from a qualified professional in the field, accredited by the appropriate regulated professional association, is required to complement the information already provided by the applicant. Because these types of disabilities are not evident and are complex and subject to interpretation, it is of the upmost importance to have as precise a picture as possible as to the effect of the disability on a particular person's mode of functioning.

Professional documentation should reflect the person's current level of functioning. If a long period has elapsed since the documentation was produced, or if there is uncertainty about whether new documentation is needed, the person may be asked to return to a specialist to see if a new assessment should be conducted. The same applies if the documentation suggests that the condition is not stable, or that there are variable medication effects - an update may be required. For a more general discussion on professional documentation requirements and standards, refer to the section on Standards for professional documentation.

Typically, the professional documentation should include:

• a description of the nature and extent of the functional limitations resulting from the disability;
• an interpretative summary of test results if applicable;
• the current effects of any medication being taken, if applicable.
• a description of any accommodations that the person is using, has used or could benefit from; and

Having this information from the professional allows for a description of the person's current strengths and limits with implications for assessment accommodations. Specific accommodations may be suggested in the assessment report. While suggested accommodations may not be directly transferable to the specific assessment situation, depending on the context for which they were intended, they may still provide useful information. When there is a difference between the professional's suggestions and the planned accommodations, it may be necessary to consult with the professional or another external expert familiar with both the applicant and the issues involved. The applicant must agree in writing to this further consultation (see step 3 of the section Determining and implementing assessment accommodations).

What are the key elements to consider?

When determining assessment accommodations for persons with mental health disabilities, the following three elements should be considered:

1. The nature and extent of the person's functional limitations must be clearly understood. The following questions may help to gather useful information:

• Which of the following three abilities are affected by the mental disability: mental alertness, concentration/organization, or dealing with stress and anxiety?
• What is the extent of the functional limitations that are imposed by the mental health disability (mild, moderate, severe), taking into consideration that the disability may be episodic?
• What are the specific effects of the person's medication on mental alertness, energy level, optimum time of day for assessment, etc.?
• What are the accommodations used by the person on the job to accomplish work tasks that are similar to the tasks to be accomplished during the assessment situation?

It is important to reiterate that persons with disabilities are the first source of information on the way their limitations affect them and on how to accommodate their specific needs. Consequently, although for the disability discussed here some documentation will have to be provided by a professional, information on functional limitations will also be gathered through exchanges with the person. To help you to gather these details in a discussion, you may wish to refer to the questionnaire available in appendix 2.

The documentation provided by a professional will ensure a precise understanding of the multifaceted functional limitations associated with the disability. For more information on professional documentation requirements please refer to Standards for professional documentation.

2. A thorough knowledge of the assessment tool to be used is required. Depending on the assessment tool's characteristics, accommodations which are necessary for one tool may be unnecessary for another. Here are some considerations to help you identify the characteristics of your assessment tool.

For an interview:

• Are written documents provided before or during the interview? If so, how much reading is involved?
• Is there time to prepare responses prior to the interview?
• What is the expected length of responses to be given orally?
• Is there a written component? If so, how much writing is involved?
• What is the time allotted?

For a written test:

• Is it an essay-style exam, short answers or a multiple choice test?
• Is it a case study, an in-basket exercise?
• Is it an open book test?
• How many questions are there?
• How much reading and writing are involved?
• What is the time allotted?
• Will the instructions be provided orally or in writing?

For an interactive situation:

• Is it a group setting? If so, how many participants are there?
• Is written documentation provided before or during the situation? If so, how much reading is involved?
• What is the expected length of exercise to happen orally?
• Is there a written component? If so, how much writing is involved?
• What is the time allotted?

3. Knowledge of the qualification being assessed is essential. This information will help you ensure that accommodations do not modify the nature or level of the qualification being assessed. Considerations include:

• What qualification(s) is (are) assessed by the instrument? It is knowledge, abilities/skills, aptitude or personal suitability? How is it defined?
• Is there a speed requirement?
• Does the level of the qualification assessed reflect the job requirement?

Determining appropriate assessment accommodations necessarily requires research and analysis of all three elements above; of the impact they have one another, and the application of the Principles for assessment accommodations. This analysis is the foundation of the rationale for the accommodations. This rational has to explain how the accommodations are enabling the demonstration of the person's qualifications, preventing his or her functional limitations from being a disadvantage. It also has to explain how the person is not being given an advantage compared to others in the appointment process, therefore, that merit is preserved.

Examples of assessment accommodations and considerations

The following are examples and considerations that may be helpful in determining assessment accommodations. It also includes a number of specific examples of assessment accommodations relative to possible functional limitations.

While reviewing these examples, keep in mind that accommodations are determined on a case by case basis and their appropriateness will depend on the nature and extent of the individual's functional limitations, the assessment tool to be used and the qualification to be assessed. Also, accommodations must resemble, if possible, the usual way in which the person would perform the task requested as if he or she was on the job, and must not alter the nature or level of the qualification being assessed. For more details, please refer to Determining and implementing assessment accommodations.

Individual session: Individual assessment sessions are required in cases where test administration differs from standard procedures, to ensure that the specific accommodations requirements of the person can be met without affecting the assessment of the other applicants. For persons with mental health disabilities, individual sessions may be beneficial, even if there are no changes to assessment procedures, as a way to accommodate any functional limitations that are related to mental alertness, concentration and organization problems or difficulties with stress and anxiety.

Additional time: Additional time will frequently be required to compensate for slower information processing, difficulty concentrating, or the effects of anxiety. The amount of extra time provided needs to be determined on a case-by-case basis, as individuals differ widely in the extent of their functional limitations, depending on the nature of their disability.

Breaks: Extra breaks, which are not included in the test administration time, may be useful for persons with mental health disabilities to help relieve anxiety or other symptoms associate with the assessment experience. A stopwatch should be used to keep track of the exact time spent on assessment and the time spent on breaks

Flexible scheduling of assessment sessions: Flexible scheduling of the assessment session can be used to take into account the person's preferred time of day. Due to the episodic nature of some mental health disabilities, flexibility should also be exercised in re-scheduling a session if a person is unable to participate at the scheduled time.

For difficulties in maintaining mental alertness:

• Divide a lengthy examination into two or more parts, with each part administered in a separate session. For example, a morning assessment session could be followed by an afternoon session, or sessions could be scheduled on separate days.
• Additional time will likely be required.

For difficulties in maintaining concentration:

• Present instructions in both oral and written formats.
• Additional time may be required to ensure that instructions are understood.
• Using white noise or environmental sound machine (may be helpful to some persons but may hinder others).

For difficulties in organizing tasks:

• Provide information on test-taking strategies and time management in advance.
• Consider having the administrator provide time check-points as the test session progresses.
• Provide an applicant with a clock, stopwatch, or digital or talking timer to monitor time.

For difficulties handling stress and anxiety

• It is important for the person to be involved in the process of determining the accommodations that will be provided during the assessment, this can help reduce anxiety.
• The person may be permitted to play soothing music using a cassette player and headset.
• For persons who experience a high level of anxiety in interpersonal situations, it is important that the assessor be sensitive to the needs of the person and project a calm presence.
• When the assessment is done individually, the assessor might leave the person alone in the room if she or he prefers to work alone, once proper security arrangements have been made (e.g., taking books and other materials out of the room).
• The person may be invited to use self-talk through written examination tasks, or to walk around during the assessment if this activity helps him or her focus.
• The person may wish to consider obtaining professional help with relaxation techniques or other strategies prior to starting an assessment process.