Understanding the Unmet Accommodation Needs of People Working with Mental or Cognitive Conditions: The Importance of Gender, Gendered Work, and Employment Factors

PURPOSE

Workplace support needs for women and men living with mental health conditions are not well understood. This study examined workplace accommodation and support needs among women and men with and without mental health or cognitive conditions and individual and workplace factors associated with having unmet needs.

METHODS

A cross-sectional survey of 3068 Canadian workers collected information on disability, gender, gendered occupations, job conditions, work contexts, and workplace accommodations. Multivariable logistic regression analyses examined gender- and disability-based differences in unmet needs for workplace flexibility, work modifications, and health benefits, and the association of work context (i.e., work schedule, job sector) and job conditions (i.e., precarious work) on the likelihood of unmet accommodation needs. The additive (i.e., super- or sub-additive) and multiplicative effects of disability, gender, and occupational gender distribution on the probability of unmet accommodation needs were also assessed.

RESULTS

The most common unmet workplace accommodation was work modifications reported by 35.9% of respondents with mental/cognitive disability and workplace flexibility reported by 19.6% of individuals without a mental/cognitive disability. Women, employees in female dominant occupations, and participants with mental/cognitive disabilities were more likely to report unmet needs compared with men, employees in non-female dominant occupations, and participants without disabilities but these findings were largely explained by differences in job conditions and work contexts. No interacting effects on the likelihood of reporting unmet needs for workplace accommodations were observed.

CONCLUSIONS

To support employee mental health, attention is needed to address work contexts and job conditions, especially for people working with mental/cognitive disabilities, women, and workers in female-dominated occupations where unmet accommodation needs are greatest.

Long COVID Prevalence, Disability, and Accommodations: Analysis Across Demographic Groups

PURPOSE

This paper examines the prevalence of long COVID across different demographic groups in the US and the extent to which workers with impairments associated with long COVID have engaged in pandemic-related remote work.

METHODS

We use the US Household Pulse Survey to evaluate the proportion of all adults who self-reported to (1) have had long COVID, and (2) have activity limitations due to long COVID. We also use data from the US Current Population Survey to estimate linear probability regressions for the likelihood of pandemic-related remote work among workers with and without disabilities.

RESULTS

Findings indicate that women, Hispanic people, sexual and gender minorities, individuals without 4-year college degrees, and people with preexisting disabilities are more likely to have long COVID and to have activity limitations from long COVID. Remote work is a reasonable arrangement for people with such activity limitations and may be an unintentional accommodation for some people who have undisclosed disabilities. However, this study shows that people with disabilities were less likely than people without disabilities to perform pandemic-related remote work.

CONCLUSION

The data suggest this disparity persists because people with disabilities are clustered in jobs that are not amenable to remote work. Employers need to consider other accommodations, especially shorter workdays and flexible scheduling, to hire and retain employees who are struggling with the impacts of long COVID.

Assessment of university policies for service animals and emotional support animals

OBJECTIVE

Assess administrative responsibilities and experiential effects of emotional support animal (ESA) and service animal (SA) policies on college campuses.

PARTICIPANTS

Students at two four-year universities participated in an emotional support animals and service animals survey. Selected students and professional personnel participated in interviews and focus groups.

METHODS

This mixed-methods study included quantitative survey data from 1,363 students, qualitative individual interviews (3) and a focus group (1) regarding emotional support animal (ESA) and service animal (SA).

RESULTS

Seventy-one students reported having ESAs, 18 had SAs. Barriers for ESAs on campus included no ESAs outside of dorms, while SA-owners reported fewer barriers. University administrators followed federal guidelines for SAs but lacked clear guidelines for ESAs. Qualitative themes included lack of awareness, education, support for SA, and ESA accommodations.

CONCLUSIONS

ESA and SA accommodations continue to rise, on university campuses. Clear guidelines and implementation processes are imperative for future improvements.

Assistive Technology's Potential to Improve Employment of People with Disabilities

PURPOSE

This study investigates how access to assistive technologies affects employment and earnings among people with disabilities.

METHODS

We first document employment and earnings gaps associated with specific impairments and activity limitations using 2017-2021 American Community Survey and 2014 Survey of Income and Program Participation data. We then use accommodations data from the 2012, 2019, and 2021 Current Population Survey (CPS) Disability Supplements to examine employment and earnings growth for people with disabilities related both to any, and to technology-based, accommodations. We also provide short descriptions of three developing assistive technologies that assist people with upper body impairments, visual impairments, and anxiety conditions.

RESULTS

Almost all impairments and activity limitations are linked to lower employment and earnings, with especially low employment among people with mobility impairments and particularly low earnings among those with cognitive impairments. About one-tenth of workers with disabilities received any accommodations, and 3-4% received equipment-based accommodations in the 2012-2021 period; these figures increased slightly over the period. The occupations with the highest disability accommodations rates had greater disability employment growth from 2012 to 2021, but disability pay gaps did not decrease more in these occupations. The three developing assistive technologies we describe illustrate the potential to reduce the estimated employment and earnings deficits.

CONCLUSION

Assistive technology accommodations have potential for improving employment outcomes for people with disabilities.

Neat Gizmo!/That Looks Scary: Employer Reactions to Assistive Technology

PURPOSE

Accommodations are vital for protecting equal access and increasing the employment of people with disabilities. However, the evidence on whether employers are willing or resistant to provide accommodations is mixed. We explore reactions to accommodations specifically associated with Assistive Technologies (AT). While the presence of such a device should reassure hiring managers about the abilities of the candidate to do the job, they also risk raising new questions and uncertainties.

METHODS

Hypothetical job candidates with and without disabilities were presented to participants with hiring experience to examine perceptions of employability, risk, and trust. Several conditions included the candidate describing the use of AT (i.e., an exosuit) and requesting accommodations, with and without extra technical or enthusiastic language to explain the specific device.

RESULTS

Quantitative and qualitative results show that the request for accommodations, in general, is problematic. And while using the exosuit seems to benefit perceptions of trust, it still seems risky and does not categorically improve employability perceptions. Extra language provided by the candidate to explain the device did not improve outcomes but did (in the case of enthusiastic language) make people more open to seeing the positive aspects of the device.

CONCLUSION

While using an AT is a positive advance for a job candidate with a disability, the perceptual risk and the salience of the disability are both increased. Future work is needed to explore the options for better reassuring hiring managers about such devices.

Characterizing Accommodations by Parents of Young Children with Autism: A Mixed Methods Analysis

Symptoms of autism influence families' participation in daily activities, but few studies have broadly explored the types of accommodations caregivers make to their family's routines after their child is diagnosed with autism. The current study used a mixed-methods approach to characterize the rate and types of accommodations made by 171 families and the child and family characteristics that predicted accommodations. Most families (91%) endorsed making accommodations in the past year. Lower income, older child age, marginalized racial/ethnic identity, and higher levels of child problem behavior predicted accommodations in a greater number of domains. Thematic analysis illuminated the types of accommodations caregivers made and their motivation for making these lifestyle adjustments. Findings have important implications for parent-mediated interventions and policy.

Supporting students with blindness and visual impairments in microbiology

The number of students with blindness and visual impairments (BVI) completing an undergraduate degree or majoring in STEM programs is low compared to students without disabilities. Though there are several reasons, numbering among them are instructor inexperience teaching students with BVI and a lack of knowledge regarding accessibility requirements and accommodations that can be provided to support them. This article contains suggestions regarding safety considerations, accessibility, and accommodations useful in supporting students with BVI in microbiology. Most of the information is applicable to other fields and scenarios as well. When students with BVI are provided with the necessary support, they can be as successful in microbiology as their classmates without disabilities. As more students with BVI achieve success, they can serve as role models and contribute to overcoming remaining barriers to success for students with BVI in microbiology and other STEM courses.

Information and communication technology to improve school participation among upper secondary school students with special educational needs

BACKGROUND

Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required.

AIM

To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs.

MATERIALS AND METHODS

Data on 300 students' assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students' ordinal SSI ratings.

RESULTS

In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline.

CONCLUSION

An ICT intervention is promising for improving school participation among upper secondary school students with SEN.

A Sensibility Assessment of the Job Demands and Accommodation Planning Tool (JDAPT): A Tool to Help Workers with an Episodic Disability Plan Workplace Support

Purpose Sensibility refers to a tool's comprehensiveness, understandability, relevance, feasibility, and length. It is used in the early development phase to begin assessing a new tool or intervention. This study examined the sensibility of the job demands and accommodation planning tool (JDAPT). The JDAPT identifies job demands related to physical, cognitive, interpersonal, and working conditions to better target strategies for workplace supports and accommodations aimed at assisting individuals with chronic health conditions. Methods Workers with a chronic health condition and workplace representatives were recruited from health charities, workplaces, and newsletters using convenience sampling. Cognitive interviews assessed the JDAPT's sensibility. A 70% endorsement rate was the minimum level of acceptability for sensibility concepts. A short screening tool also was administered, and answers compared to the complete JDAPT. Results Participants were 46 workers and 23 organizational representatives (n = 69). Endorsements highly exceeded the 70% cut-off for understandability, relevance, and length. Congruence between screening questions and the complete JDAPT suggested both workers and organizational representatives overlooked job demands when completing the screener. Participants provided additional examples and three new items to improve comprehensiveness. The JDAPT was rated highly relevant and useful, although not always easy to complete for someone with an episodic condition. Conclusions This study highlights the need for tools that facilitate accommodations for workers with episodic disabilities and provides early evidence for the sensibility of the JDAPT.

Evaluating an informed consent process designed to improve inclusion of adults with intellectual disability in research

BACKGROUND

Adults with intellectual disability (ID) are both underrepresented in research and enrolled in studies they may not understand. Instead of facilitating research engagement, the informed consent process often fails to elucidate its essential elements.

AIMS

We evaluated whether a novel informed consent process was more effective than current practice at helping adults with ID understand key elements of research.

METHODS AND PROCEDURES

21 adults with ID completed a novel iterative teaching process (ITP) for teaching and assessing informed consent. The ITP was used to compare the baseline (Conventional) approach to an Easy Read and a Conversational approach. Participants were asked a series of questions to assess their attitudes toward, and their comprehension of, the materials.

OUTCOMES AND RESULTS

The pilot found encouraging evidence for the efficacy and feasibility of the ITP. The two novel ITP approaches were both superior to current practice.

CONCLUSIONS AND IMPLICATIONS

This project contributes to a growing literature by introducing a process for teaching and evaluating informed consent. Results indicate that comprehension of informed consent materials can be taught to, and learned by, adults with ID with proper accommodations.

Aging workforce with reduced work capacity: From organizational challenges to successful accommodations sustaining productivity and well-being

Israel is experiencing accelerated workforce aging and increasing retirement age that began in the last two decades. Aging workers suffer from increased illness and impairment rates, challenging employing organizations with reduced work capacity. Occupational health practitioners often assist employers in accommodating these challenges. However, insufficient evidence on prognostic factors, organizational practices, and age management tools hamper successful accommodation. Research on the organizational perceptions of aging workers is also limited. Our study aims to (1) identify the domains in which the aging workforce challenges Israeli organizations according to a multi-level theoretical model we developed, and (2) assess the practices employed by organizations to address the declines in work capacity from employers' and workers' perspectives. Our qualitative study employed semi-structured interviews of 26 employers and workers' representatives from eight Israeli organizations sampled by maximum variation according to organizational characteristics. Thematic framework analysis of organizational perceptions on challenges, facilitators, and practices in use, via aging workers' cases was utilized. We identified organizational challenges on five levels: individual worker, work environment, interpersonal team relationships, organization, and community relationships, stemming from the aging workers' reduced capacity to meet job demands and conditions. Time adjustments, work environment changes, and job task changes were common accommodations practices used by the organizations. Successful accommodations from the employers' perspective preserved workers' and teams' productivity, and from the workers' perspective, those that lowered demand and improved job control without damaging earnings or job status. Taken together, organizations from all economic sectors should prepare for the increasing need to accommodate work conditions for aging workers with limitations to preserve their health and safety. Balancing employers' and workers' perspectives when accommodating workers with reduced work capacity is imperative to promote healthy aging at the workplace. Government intervention is advised to encourage continued job participation to reduce employment termination.

The Religious and Spiritual Needs of Patients in the Hospital Setting Do Not Depend on Patient Level of Religious/Spiritual Observance and Should be Initiated by Healthcare Providers

According to many studies, addressing the religious and spiritual (R/S) needs of patient's increase patient satisfaction. One area of interest is how patient self-perceived level of religiosity and spirituality (R/S) influences hospital needs. In this cross-sectional study, 195 inpatients at a non-faith-based academic hospital in Toledo, OH, USA completed surveys examining self-perceived R/S levels, as well as how those R/S levels impacted preferred services, conversations, and experiences in the hospital. Patients with no religious identity (self-identified as atheist, agnostic, or no religion) were less likely to report discussions about R/S needs than religious respondents (16.7% vs. 47.3%, p = 0.039). Nevertheless, such patients were just as likely to want a R/S conversation started by their healthcare provider (75% vs. 56%, p = 0.241). Those with no R/S identity were more likely to report presumed negative assumptions by hospital staff (25% vs. 0%, p < 0.001). Our data suggests that even for a nonreligious population, it is important to consider R/S needs.

Disability-inclusive employment, cancer survivorship, and the Americans with Disabilities Act

Purpose

This special section of the Journal of Cancer Survivorship examines disability-inclusive employment policy and practice, cancer survivorship, and the Americans with Disabilities Act (“ADA”) of 1990. It considers current issues in research, policy, practice, and law in the United States, including new questions arising in light of COVID-19, such as the nature of disability disclosure, workplace accommodations and remote work, emerging workplace health surveillance technologies, and inclusive employment practices for cancer survivors. It also presents, for comparative purposes, a current analysis of cancer-related disability discrimination in the media in the United States and Israel.

Methods

After the “Introduction,” this special section presents two studies on disclosure of disability in employment: the first addressing disclosure during a job interview of the need for accommodations, and the second addressing disclosure as related to individual and organizational characteristics. The next two articles examine the effects of the COVID-19 pandemic on the work experience: first, for people with disabilities working remotely, with implications for cancer survivors, and second, for cancer survivors and people with disabilities facing potential algorithmic health discrimination due to workplace health surveillance. The final article considers cancer-related stigma and discrimination, as faced in the United States and Israel (using a comparison of mass media).

Results

Disability-inclusive employment laws such as the ADA promote two central requirements: First, social institutions affirmatively remove attitudinal and structural barriers and discrimination confronting people with disabilities as they exercise their rights to participate fully in society. Second, employers, governmental entities, and public accommodations comply with the “accommodation principle,” which requires them to make reasonable adjustments to job tasks, places of work, and public places in society, to enable equal participation by qualified individuals with disabilities. The articles in this special section consider these principles in innovative ways from a disability-inclusive paradigm.

Conclusions

The COVID-19 pandemic has highlighted the need for a robust research literature on disability-inclusive employment policy and practice for people with disabilities and for cancer survivors. This special section offers five articles as a start. The section’s “Introduction” also highlights recent ADA case law and introduces two new national Rehabilitation Research and Training Centers, one on Disability Inclusive Employment Policy (“DIEP RRTC”) and one on Employer Practices Leading to Successful Employment Outcomes Among People with Disabilities (“Employer Practices RRTC”), both designed to help fill this need. The centers are currently examining ways organizations, including those in the gig economy, can facilitate inclusive employment of people with disabilities.

Implications for Cancer Survivors

As highlighted in the Introduction’s discussion of recent ADA cases involving cancer-related employment discrimination, as well as in the special section’s articles, discrimination in employment persists and, indeed, is worsening for cancer survivors and those with disabilities. This discrimination affects people across the demographic spectrum, and it can be especially harmful to people in groups not always acknowledged, such as individuals with multiple, intersectional minority identities associated with race, ethnicity, sexual orientation, and gender identity, as well as people at different stages of the life course. Furthermore, the impact of discrimination in employment is often exacerbated by life experiences such as unemployment and underemployment, financial insecurity, ableism, racism, and sexism.

The disclosure dilemma: requesting accommodations for chronic pain in job interviews

PURPOSE

This study explores the job interview process for those who need disability-related accommodations on the job (in particular an "invisible" disability such as many of the long-term and late effects of cancer and its treatment (e.g., pain, fatigue, cognitive problems)), and explores whether the communication channel or the timing of the disclosure has implications on the perceived employability of applicants, with the aim of helping to close the employment gap for this marginalized population.

METHODS

Using 1917 participants in a partially crossed 2 × 3 × 2 experimental design, we explored disclosing the need for accommodations using each video or audio-only channels, by varying the timing of the disclosure within the interview (early, late, or not at all), and by varying the negotiation strategy used (modest or significant increase over proposed salary). Participants rated the candidate's employability at two different points in time.

RESULTS

Early and late disclosures of the need for accommodations were both associated with poorer ratings of employability. Disclosure via audio was singularly damaging as compared to video disclosure, whether it occurred early or late. Finally, asking for a significant increase in salary resulted in lower ratings of employability, especially if the disclosure of the disability happened late in the process (and proximally to the salary request itself).

CONCLUSIONS

Holding off on the request for accommodations until after the job has been offered may be advisable. Similarly, disability disclosures and requests for accommodation are better received using richer communication channels (video as opposed to audio). Salary requests are also sensitive topics and can be affected by ill-timed disclosures.

IMPLICATIONS FOR CANCER SURVIVORS

If accommodations are needed on the job (based on chronic pain), waiting until later in the process to discuss this topic (using video and not the phone) and ensuring distance in time from making a salary request are apparently the better choices.

College students' disclosure of mental health problems on campus

To explore, in two studies, student experiences with disclosing diagnosed and undiagnosed mental health problems to faculty, staff, and peers. Participants: Participants for both studies were college students at two 4-year public universities. Study 1 was conducted in June 2016 and Study 2 in August 2017. Methods: In Study 1, participants had a formal diagnosis of a mental health condition, were registered for accommodations, and completed semi-structured interviews (n = 6). In Study 2, participants (n = 66) were mostly non-diagnosed and completed an online survey. Results: Study 1 interviews were coded for interactions with faculty (52% positive, 40% negative), staff (100% positive), and peers (31% positive, 54% negative). In Study 2, participants reported better experiences disclosing to peers than faculty. Disclosure experience varied by type of mental health problem. Conclusions: Collaboration across campus and community agencies will better support students with diagnosed and undiagnosed mental health problems.

Experiential education accommodations for students with disabilities in United States pharmacy schools: An exploratory study

INTRODUCTION

We sought to identify challenges and possible outcomes for pharmacy schools providing accommodations on experiential rotations for students with disabilities.

METHODS

A survey was developed and sent to the experiential education departments of pharmacy schools across the nation and anonymous responses were collected. Quantitative survey results were assessed using descriptive statistics, and qualitative results were assessed using thematic analysis.

RESULTS

A total of 43 individuals who self-identified as current members of the experiential education department of their school responded to the survey. Student, preceptor, and institutional challenges and barriers were identified, and various approaches to providing accommodations for students with disabilities during experiential rotations were described.

CONCLUSIONS

Providing accommodations for students on experiential rotations remains a challenge for pharmacy programs. However, guidance for pharmacy schools on proper support of students with disabilities on experiential rotations remains limited.

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

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.

Anxiety, mental illness, learning disabilities, and learning accommodation use: A cross-sectional study

BACKGROUND

Nurse educators require a robust understanding of nursing students' attributes to meet their learning needs and support their success.

PURPOSE

This research seeks to understand the proportion of nursing students with self-reported medically diagnosed anxiety, mental illnesses (MI), learning disabilities (LD), and utilized learning accommodations (LA), and determine how these students compared to a normative sample regarding studying and test-taking anxiety.

METHOD

A secondary analysis of quantitative cross-sectional data that included the Academic Success Inventory for College Students (ASICS) tool. First-year students were surveyed (4-6 weeks after program start, and students in years 1 through 4 were surveyed at the end of both academic terms.

RESULTS

At program start, 21% were diagnosed with anxiety, 16% with MI, 2% with a LD, and 6% accessed LA. By fourth-year these proportions were 23%, 22%, 8% and 13% respectively. Alarming proportions of respondents exhibited anxiety related to test-taking compared to the ASICS normative sample with large effect sizes (Anxiety h = 0.884; MI h = 0.601; LD: h = 2.094; LA h = 0.725).

CONCLUSION

To support students, we highlight a need for early identification and tailored support, enriched faculty knowledge, faculty introspection and willingness to adapt, and time for relational and individual pedagogy.

Development of educational modules for MRTs to better support patients with intellectual and developmental disabilities undergoing imaging procedures: A collaborative patient-oriented initiative

BACKGROUND

Patients with intellectual and developmental disabilities (IDD) experience increased anxiety when undergoing medical imaging procedures for a variety of reasons including sensory overload, comprehension difficulty, and meeting unfamiliar people. There are several strategies that medical radiation technologists (MRTs) can apply to improve the imaging process. The purpose of this project was to work together with patients to develop educational modules and resources for MRTs on how to best support patients with IDD during medical imaging procedures.

DEVELOPMENT PROCESS AND FINDINGS

The project team used a four stage process to (1) determine the educational needs of MRTs around imaging procedures for people with IDD and (2) develop a series of online case-based video modules of challenges and improved practices with accompanying digital resources. First, the project team created and distributed a needs assessment survey to MRTs to identify their educational needs, experience, and interest in learning more about how to best support patients with IDD. The results from this needs assessment underscored that developing skills to better support patients with IDD was an area of interest and need amongst OAMRS members, which led to the formation of a working group whose goal was to identify priority topics and how to best teach these topics. Second, we conducted a focus group with adults with IDD, who had experience with imaging procedures, to ensure the lived experience of people with IDD was a pillar of the modules. Third, we developed a set of video scripts and educational slides, informed by the needs assessment with MRTs and the focus group with adults with IDD. The video scripts focused on four scenarios: (1) Waiting for an imaging procedure, (2) & (3) the imaging process (MRI and PET), and (4) the exit interview. Each of these videos focused on common practice errors made during these scenarios, followed by strategies to address those errors. The educational slides focused on: (1) an introduction to people with IDD (2) Communication and (3) Triggers and Strategies. The fourth and final phase focused on filming the teaching videos with actors with IDD and finalizing the educational slides. Together, the set of educational slides and videos formed the modules for MRTs that will be published online.

LESSONS LEARNED

Undertaking this process to develop educational modules for MRTs on working with people with IDD taught us that people with IDD have lived experiences which should inform the development of educational material; they must be treated as partners during this development process; and a partnered process takes time to carry out.

CONCLUSION

The process that was undertaken allowed the team to develop resources, which can be used by MRTs. Evaluation of the educational modules can inform further refinement and improvement.

Disclosure of a communication disorder during a job interview: A theoretical model

With the passage of the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), the definition of disability was expanded and the terms "speaking, hearing, and communicating" were given status as major life activities. Therefore, any communication disorder which substantially limits these major life activities in the workplace can qualify as a disability under the law. This legal protection means that no employer can ever ask about the presence of a communication disorder, and a job applicant is never required to disclose their communication disorder during the hiring process. However, this right to refrain from disclosure potentially places job applicants in a difficult situation. Applicants can choose to remain silent about their disorder and hopefully avoid hiring discrimination, yet the only way that workplace accommodations can be legally requested is if disclosure of the disability takes place. This disclosure decision-making process is likely complex and dependent upon multiple factors. Aspects such as workplace culture, job duties, severity of symptoms, individual motivations, and characteristics of the communication disorder likely all play a role when weighing the decision to disclose. This article proposes a theoretical model which outlines the factors that might influence the disclosure decision-making process for those with communication disorders before a job interview. Each major component of this decision-making process is highlighted, focusing on which factors might inhibit or foster disclosure within a hiring context. Clinical implications are discussed which can allow speech-language pathologists to assist those who are struggling with this important decision. The article also identifies areas in need of future research.

Exploring the Needs of Cancer Survivors When Returning to or Staying in the Workforce

Purpose Cancer survivors have strong personal desires to resume work to feel productive and meet financial needs. However, they may be faced with physical and psychological challenges. This research addresses the question: "What are the needs of cancer survivors when returning to or staying in the workforce?" by (i) examining cancer survivors' perspectives on supports needed when returning to or staying in the workforce and (ii) exploring personal and employment factors that influence the return to work process. Methods An exploratory qualitative design was used. We conducted focus groups and one-on-one semi-structured interviews with cancer survivors (n = 15). Inductive thematic analysis was used to analyze the data. Results Four key themes were identified as significant aspects of the return-to-work process for cancer survivors: (1) changing perspectives on self and work; (2) managing work and social systems; (3) determining disclosure and accommodation; and (4) the importance of supports for return to work and daily life. Conclusions There is a growing interest in developing targeted interventions to improve work outcomes for cancer survivors. This study informs cancer rehabilitation research by developing an understanding of the supports and strategies that should be implemented to help cancer survivors return to work successfully and improve quality of life.

College Access, Success and Equity for Students on the Autism Spectrum

College may be considered a gateway to success, yet access to college is limited for young adults with autism. Given the research recommendations to elicit student experiences and to communicate among universities to improve college access, success, and equity, the present study examined the questions: What factors are perceived as pathways to success or barriers to success by college students on the autism spectrum? What university provided accommodations and/or support services do they prefer? Participants from four universities completed surveys and semi-structured interviews. Findings from the multi-university study suggest the need to provide transition planning and systematic non-academic social and emotional supports from the start of the college experience as well as specific training for faculty, staff, and peers.

National Prevalence of Disability and Clinical Accommodations in Medical Education

BACKGROUND

This study aimed to evaluate and report the national prevalence of disability across undergraduate medical education (UME) and examine differences in the category of disability, and accommodation practices between allopathic (MD)- and osteopathic (DO)-granting programs.

METHODS

Between May 20 and June 30, 2020, 75% of institutional representatives at eligible DO schools responded to a web-based survey. The survey assessed the aggregate prevalence of disabled DO students, prevalence of DO students by category of disability, and prevalence of accommodations granted. Descriptive statistics were used to summarize results. Using 2019 MD data, comparisons were made between MD and DO programs to calculate overall prevalence and differences in accommodation practices across undergraduate medical education.

RESULTS

DO-granting programs reported a disability prevalence of 4.27% of the total enrollment. Attention-deficit/hyperactivity disorder (ADHD), psychological disabilities, and chronic health disabilities were reported most frequently. DO-granting programs reported higher rates of ADHD than the MD-granting program. The national pooled prevalence of disability across MD- and DO-granting programs was 4.52%. MD-granting programs reported a higher number of students with disabilities and higher rates of psychological disabilities when compared with DO-granting programs. One hundred percent of DO students disclosing disability received some form of accommodation. General clinical accommodations were more frequently provided in MD-granting programs when compared to DO-granting programs.

CONCLUSIONS

This study provides the first comprehensive prevalence of US medical student disability and accommodations. Additionally, these data may serve as a benchmark for DO programs, with implications for curricular development, instructional planning and disability support, and resource allocation in medical education.

Autism and Accommodations in Higher Education: Insights from the Autism Community

This article builds on the growing body of research on higher education for autistic students by soliciting input from autistic adults on their higher education experiences and suggestions on making these experiences more 'autism-friendly'. Sixty-six individuals participated in a national exploratory survey and thirty-one participated in follow-up, online focus groups. The article reviews the accommodations individuals received and the accommodations they would have liked to receive. Concrete strategies are provided for institutes of higher education to address the social and sensory needs of autistic students, areas many participants reported being neglected in their academic experience, such as mentors and a neurodiverse space. These suggestions are intended to complement traditional academic accommodations to improve the outcomes of autistic students.

Accommodations and Adaptations to Overcome Workplace Disability in Inflammatory Bowel Disease Patients: A Systematic Review

Background

Inflammatory bowel diseases (IBD) are chronic, incurable diseases which are often characterized by unpredictable flares and troubling symptoms which can interfere with a patient's ability to work. Accommodations in the workplace can help persons with IBD to cope with their illness and work effectively. We systematically reviewed all studies regarding workplace disability in IBD patients.

Summary

Systematic searches were undertaken on February 5 and March 5, 2018, for the following databases: PubMed, MEDLINE (Ovid), Cochrane Central Register of Controlled Trials, and CINAHL, for studies that addressed workplace needs, accommodations and adaptations using survey tools. Of 430 studies screened, 54 met initial eligibility criteria and then 6 studies were ultimately included, with a total of 7,700 participants. Five studies were quantitative, and 1 study was qualitative. Common themes were the importance of reasonable adjustments and accommodations in the workplace, mixed with the finding that a significant proportion reported that they had some difficulty arranging accommodations. Adaptations most required were access to a toilet or toilet breaks and time to go to medical appointments.

Key Messages

People with IBD often need accommodations, but many do not ask or have difficulty arranging it. Better resources are needed to inform people with IBD about the possibilities for workplace accommodations and practical strategies to request them.

Low verbal assessment with the Bayley-III

Recently, the authors have developed the Bayley-III-NL Low Verbal for developmental assessment of children with language impairment. The Low Verbal version consists of an accommodated cognition scale, and non-accommodated communication and motor scales. The purpose of the study was to evaluate the validity and added value of the Bayley-III-NL Low Verbal for children with a language impairment, in relation to the standard Bayley-III-NL for children without impairment. We administered the Bayley-III Low Verbal to 69 children with language impairment, and the standard Bayley-III-NL to 1132 children without impairments. We used an evaluation form for test administrators and interviews with developmental psychologists to evaluate the suitability of the Low Verbal version for the target group. We analyzed the test results using nonparametric item response theory (IRT) to investigate whether test results can be reasonably compared across the two groups. The results of the IRT analyses support the validity of the Bayley-III-NL Low Verbal: the test items do not suffer from differential item functioning (DIF) across the two groups, and thus measure the ability levels of interest in the same way. The results of the evaluation form and interviews confirm that the Bayley-III-NL Low Verbal has added value for testing children with a language impairment, especially for children up to 36 months old. It is also suitable for children with general developmental delay. We conclude that the Bayley-III-NL Low Verbal can validly assess the cognitive, language, and motor development of young children with a language impairment and is the preferred instrument for this target group.

Validity and suitability of the Bayley-III Low Motor/Vision version: a comparative study among young children with and without motor and/or visual impairments

The aim of the present study was to examine the validity of the Bayley-III Low Motor/Vision version, and its suitability for children with motor and/or visual impairment(s). This version contains accommodated items, that is, adaptations to minimize impairment bias, without altering what the test measures. We hypothesized that the accommodations would not affect the item scores of children without impairment, and that children with impairment(s) would benefit from the accommodations. We tested 41 children without impairment and 63 children with impairment with both the standard Bayley-III and the Low Motor/Vision versions, in randomly counterbalanced order. The test administrators filled in an evaluation form. Results showed that the accommodations did not affect the test scores of children without impairment and did improve the test scores of children with impairment on the Cognition scale, while no improvement was found for the other scales. The test administrators indicated that the vast majority of the children with impairment had been able to show their abilities on the test and that the accommodations were beneficial in 29 out of these 52 cases. For some children, the accommodated instrument appeared to be unsuitable because the impairment was too severe. The conclusion is that the accommodations improve the validity of the Bayley-III when used with children with mild to moderate motor and/or visual impairment, especially with regard to the Cognition scale.