January 26, 2018

From Kelly Myers, LCSW, PhD Candidate, Graduate Research Assistant, Trauma Informed Oregon

Hiya! I’m Kelly Myers, a PhD student at PSU in Social Work and Social Research and a graduate research assistant at Trauma Informed Oregon for the past two years. Prior to coming back to grad school, I had been working for the past decade as an LCSW in community mental health and residential substance abuse programs. A few years into my career, I got a serious case of the burnouts. It goes by many names—compassion fatigue, vicarious trauma, toxic stress—but what it describes is the emotional and physical exhaustion and trauma that doing human service work often entails. After a mini-break down and a month or two hiding out in the South Pacific diving (no one can talk to you when they have SCUBA equipment in their mouth!), I returned to Social Work with a newfound dedication to self-care, community-care, and what we call Workforce Wellness. My own experience, as well as the experiences of so many of my dedicated and talented colleagues, showed me the importance of having workspaces that promote caring for both the workforce and the clientele. If the workforce is stressed, sick, or otherwise disengaged, then the services and the clients in need suffer, and everyone walks away feeling bad at the end of the day. One of my top interests in the Trauma Informed Care (TIC) movement is its dedication to Workforce Wellness. With that in mind, I recently undertook some research into how employers might, in a trauma informed way, better engage with and meet the needs of ADA accommodation for employees who have a diagnosed trauma experience. This is the beginning of a bigger conversation around accommodation needs and ideas. Please contact us with your thoughts or insights at info@traumainformedoregon.org.

Trauma Informed Approach

Let’s start off that this blog post is NOT legal advice on meeting the legal definition of ADA accommodation standards. This post will discuss a trauma informed approach to meeting the ADA accommodation needs of those with Trauma- and Stressor-Related experiences, which include but are not limited to PTSD, Acute Stress experiences, Other Specified (or Unspecified) Trauma- and Stressor-Related experiences, and Reactive-Attachment challenges. In fact—bonus—the tips and tricks presented here may be applied to ANYONE with an experience of trauma, whether they have been formerly diagnosed or not.

If, after reading this, you need specific information on the legal end of this discussion, check out the Job Accommodation Network—it’s an excellent resource for answering specific questions about ADA accommodation.

So, an employee comes to you saying that they have a trauma-related diagnosis that meets ADA criteria for legally required accommodations in the workplace, what do you do?

Just like meeting the accommodation needs of anyone with a dis/ability, this process starts with a conversation about what the requested needs are. The ADA has lots of physical specifications—the width of doorframes, sink heights, graded ramps, elevators—however when it comes to invisible dis/abilities (mental and behavioral health, autoimmune disorders, other physical illness that do not have outward symptoms) the ADA does not offer specifications about how to accommodate these bodies in work spaces. So, the process begins by ASKING, LISTENING, and DISCUSSING.

As a slight aside, the ADA includes a tricky clause that the person needs to be able to perform the “Essential Functions” listed in their job descriptions as 10% or more of the time, with or without accommodations, or the job may not be a good fit. This wishy-washy clause can activate anxiety and feelings of insecurity for anyone needing accommodations. If your employee is asking for accommodations, trust that this is a vulnerable request to make and it took courage to ask. Begin by assuring them that you will work with them to negotiate their needs.

As a second aside, the comment, “You seem fine” is a violation of ADA privacy and law.  It is not required that you learn the exact nature of the requesting employee’s challenge. A doctor’s note may be required, but full disclosure of the nature, origin, and specifics of the challenge are outside of the needed scope of information. What is needed is knowledge about how the work environment (stressors, structures, etc.) is impacting/exacerbating the symptoms associated with this challenge thereby negatively affecting the employee’s ability to do their job.

What we know about trauma is….

Trauma impacts the regulatory system and the regulation of the senses. Part of the neurobiology of trauma is that it can cause hypersensitivity to sights, smells, sounds, touches, and tastes. This will be different for every person. Awareness of this, can guide your discussion. Another effect of trauma is hypervigilance. This is an acute awareness and attention to situational safety. Safety and control are issues for survivors of trauma (and really, for all people); one important way to address these is through predictability and transparency. Let employees know what is going on, what to expect, anticipated upcoming disruptions, etc. On an individual basis accommodations may mean having a work environment where one can keep their back towards the wall, able to see the door, or it may mean entering/exiting a busy building during less-busy times, going through security with the same officer every day, or having a workspace near a stairwell. Again, this is different for every person. What is activating for one person, may be an accommodation need of another.

People with Trauma- or Stressor-Related experiences, along with those with anxiety challenges or other mental/emotional health concerns (in short, any one of us, on a given day) sometimes have challenges managing the regulatory system of the body. This means that the brain or body becomes activated by something and, instead of re-regulating once the danger has been assessed and safety established, the body remains in a state of dysregulation. Examples of this include elevated pulse, sweating, flushing, obsessive/anxious thoughts, and difficulty focusing. People may need accommodations to allow themselves to re-regulate such as going on a walk, leaving the building, turning the lights out in their office. Remember, every person is different and requires a conversation about their specific needs.

Working with the person to address their specific areas of activation and concern is the best way to map out accommodation needs. Again: ASKING, LISTENING, and DISCUSSING. This is the EXACT same process and conversation that you ought to have with someone with any other kind of dis/ability. If you have multiple employees with physical disabilities, each will have different needs, and these needs may change day to day. This is the same for people with trauma and those with mental or behavioral health concerns. Some days music in the office will be acceptable, some days it will be activating.  Some days a quiet workspace will be productive, while other days headphones must be in place for anything to get accomplished. One person’s soothing headphones are another person’s smothered nightmare. ADA accommodations are unique to each individual person with their life experience and symptoms. So again, the best starting point is a conversation with the requesting individual person about what their accommodation needs are. This should be part of an ongoing conversation, as needs may change over time, or with changes in the environment.

Suggestions

To summarize here are some of the things to consider in meeting the accommodation needs of someone with a history of trauma and/or a Trauma- or Other-Stressor-Related Experiences:

  • Sensory sensitivity
  • Safety concerns
  • Ways to re-regulate (allowing for a variety of ways)

Trauma Informed Care (TIC) provides an excellent framework for considering ways to improve your workplace for everyone—regardless of their specific diagnosis, dis/ability, experiences, or trauma history. By making your workplace trauma informed, you may be able to reduce the amount of accommodation requests/needs by developing an environment that does not re-traumatize those who engage with it.

Here are some suggestions to start this process:

Brainstorm ideas about your work space with your current employees. What are things that bother them? What elements do they like? The suggestions generated can/should be applied to your entire organization and engagement with both established and potential employees and clients.

Consider “universal design” concepts for physical and mental health-related dis/abilities. Where do you interview new potential employees? How is the room set up? How are the lights? Sounds? Smells? Are the chairs accommodating to folks of different body types and mobilities? Do you meet new people on the ground level or are stairs or an elevator required? How is the work space set up? Can folks change the arrangement of their furniture? Are there mobility issues? Safety concerns? Natural light? Areas for privacy? Is there safe, accessible parking?

Neutral walkthroughs of the workplace. Have your staff, a client, a facility worker, a community partner, do a walkthrough. What is their experience of being in your work space? What is noticed? Ask that they give attention to signage, layout, furniture, art, protocols (guests, traffic, bathrooms, expectations). Here is a worksheet to help with this.

The take-home message is that, when approached about ADA accommodations for Trauma- and Stressor-Related experiences, begin by ASKING, LISTENING, and DISCUSSING what the person’s specific needs and accommodations might be. Doing so will make it possible for the employee to be successful. Expanding this idea to make the workplace more trauma informed may benefit everyone! TIC is essential for anyone with a history of trauma and, as we like to say, it’s really quite nice for everyone else, too.