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The Integration Mandate, confusing combinations & Employment

9/28/2022

Conjecture

The US Supreme Court based its holding in "Olmstead" on the INTEGRATION MANDATE of the Americans with Disabilities Act.
In 1999, the Supreme Court held that "UNNECESSARY INSTITUTIONALIZATION" of people with disabilities violated Title II of the ADA -- specifically the "INTEGRATION MANDATE."

When we're thinking about "INTEGRATION" and Olmstead and especially COGNITIVE DISABILITY ---
- We're thinking about INTEGRATION OF PEOPLE --- and
- INTEGRATION OF KNOWLEDGE across DISCIPLINES and the SOCIETY.

For people with "PHYSICAL DISABILITIES," the INTEGRATION OF KNOWLEDGE has included
- Construction of curb cuts and ramps
- Hearing Devices
- Speech Aid Devices

One of the things that has been so CONFUSING and DIFFICULT for Neuro-Diversity and Psychiatric Disorders ----

People can be "ASYNCHRONOUS" in ways we're not expecting --
They might have INTELLECTUAL, CREATIVE and/or ATHLETIC GIFTS and ---
- Nonetheless, struggle with Executive Functioning issues such as:
  - Working Memory
  - Emotional Regulation
  - Planning
  - Organization
- Nonetheless, struggle with Fatigue.
- Nonetheless, struggle with OVER-EXCITABILITIES

Kaiser Family Foundation (KFF)

Asynchonous/OVER-EXCITABLE people may be/probably using LEGAL and/or ILLEGAL SUBSTANCES to "MANAGE" an unwieldy load.

On the legal side--
- Caffeine
- Sugar
- Alcohol
- Marijuana
- Tobacco/Cigarettes/Vaping
- Prescription Drugs
On the Illegal side ---
- Misuse of Prescription Drugs
- Opioids
- Cocaine
- Methamphetamine
- Etc.

For the Neuro-Diverse Asynchronous Person who is more vulnerable to Psychiatric Disorders ---I would submit the reason they are more vulnerable is because their needs for "HOMEOSTASIS" don't "MATCH" with the MODERN LIFESTYLE.

AND THERE ARE "NO EXCUSES"

"SUPPORTED EMPLOYMENT" is often a component of DOJ (US Department of Justice) Olmstead Settlement Agreements --- it's often a good deal for TAXPAYERS as well in the long run.

That "SUPPORTED EMPLOYMENT" needs to include viable options for the asynchronous person who is often struggling to manage:

BIG STRENGTHS
EXECUTIVE FUNCTIONING CHALLENGES, and
FATIGUE

The way we avoid BURNOUT and BREAK-DOWN is not by doing nothing ----It's by:

Building on Strengths
Compensating for Executive Functioning Issues, and
Individualizing "TIME MANAGEMENT" ---
- especially, for those "SLOW PROCESSORS" who sometimes to often are dealing with a much HEAVIER SENSORY/INFORMATION LOAD.

Individual Olmstead Complaints

9/27/2022

People With Cognitive Disabilities who are Institutionalized or Homeless*

*Also At Risk of Institutionalization

Often when we think of Olmstead we think of the BIG CLASS ACTION.

There have been those.
AND they have not only achieved important gains in those states but they have also set important precedents.

BUT the LARGE OLMSTEAD CLASS ACTION presents numerous challenges ---- LOGISTICALLY and FINANCIALLY.
- That's why we haven't seen more of them.
- Not because the STATES are all in COMPLIANCE.

There are broad REMEDIES in the context of Cognitive Disability.

At Orchid, I'm going to be focusing on initially:

SUPPORTIVE HOUSING, MENTAL HEALTH RESIDENTIAL, FAIR HOUSING ASSISTED LIVING & NURSING HOME PLACEMENTS as desired by the client.
- including Assertive Community Treatment (ACT)

From my perspective, it doesn't have to be ACT but it has to be ADEQUATE and SUFFICIENT.

It is not ultimately my choice --- BUT I'm not going to advise something I don't think is ADEQUATE.
- Having said that, I have been in situations in which the client is the one advising me that they want a Nursing Home placement where I've been pushing SUPPORTIVE HOUSING.
Further, if issues do come up down the road --- we're going to be looking to COLLABORATIVELY (if possible) address those with providers, the State, whoever.
including HOUSING
- EVERYBODY knows HOUSING is a HUGE ISSUE and it's a HUGE ISSUE In COLORADO,

Cook County Sheriff Dart

The STREET is a very dangerous place for someone with a COGNITIVE DISABILITY.

Sheriff Dart in Chicago is famous for saying on 60 Minutes --- now probably 9 years ago ---
- We've got a society that finds it objectionable to warehouse people in a Mental Institute --- but you're fine with a jail --- "YOU'VE GOT TO BE KIDDING ME."
- The same can be said for HOMELESSNESS.

MOTEL VOUCHERS and INTERIM MEASURES

I think it is the STATE'S RESPONSIBILITY to make up the DIFFERENCE to meet the NEED for MOTEL VOUCHERS
- for that segment of the HOMELESS POPULATION that is a PERSON with a DISABILITY and at risk of institutionalization.
  - That is probably a big segment of the chronically homeless population.
NOW, if the STATE can get others --- the FEDS, the MUNICIPALITIES, the COUNTIES, PHILANTHROPIC EFFORTS to fill in the gap ---
- THAT'S GREAT

Voltaire

FURTHER: We are going to be taking a HARM REDUCTION APPROACH.

We don't want the "PERFECT" to be the enemy of the "GOOD" or "MUCH BETTER."

Now the "MUCH BETTER" needs to be determined by the CLIENT --- BUT there are a lot of people (not everybody) who would definitely choose MORE INTEGRATION as opposed to wait another 20 years for PERFECT INTEGRATION.

OLMSTEAD doesn't work well as an EVENT --- it's an ON-GOING PROCESS --- and we do need ON-GOING PLANNING and:

MEASURABLE GOALS
REASONABLE TIME FRAMES, and
FUNDING to SUPPORT an EVOLVING PLAN.

The need for Intensive treatments, Olmstead & MISMATCHED FINANCIAL INCENTIVES

9/23/2022

SEEMINGLY MISMATCHED FINANCIAL INCENTIVES

Some of the "unspoken logic" behind Olmstead and Mental Health Community Services was that:

Intensive Community Services would be so much LESS EXPENSIVE than large MENTAL HEALTH INSTITUTIONS.
The problem was that we severely limited our BED SPACE and didn't adequately INCREASE ACCESS to those INTENSIVE COMMUNITY SERVICES ---
- those INTENSIVE SERVICES may be less expensive than the HOSPITAL, BUT
- those INTENSIVE MENTAL HEALTH SERVICES aren't CHEAP either.

So in Colorado and most States ---

There isn't adequate BED SPACE, AND
There isn't adequate access to INTENSIVE COMMUNITY TREATMENT such as ASSERTIVE COMMUNITY TREATMENT
- MEANING those TREATMENTS/ SERVICES are not AVAILABLE where "REASONABLY MEDICALLY NECESSARY."
- There is generally an ARTIFICIAL LIMIT not based on NEED.

The SERVICE PROVIDERS and INSTITUTIONS who are really taking the FINANCIAL HIT are LAW ENFORCEMENT & JAILS --

Generally, NOT funded by the STATE but by MUNICIPALITIES & COUNTIES.
This has turned into a POLITICAL FIASCO and a NIGHTMARE for People with Serious Cognitive Disabilities and their Families.

Yeah, we're STARTING to address this ---

BUT Mental Health Providers riding-- with COPS is just the TIP OF THE ICEBERG.

SCREENING the PRISON POPULATIONS for:

BRAIN INJURY
Neuro-Developmental Differences/Disorders such as ADHD & Autism
PSYCHIATRIC DISORDERS, and
SUBTANCE ISSUES (that are often CO-MORBID with one or more of the above)

--- could be an important step in not only understanding but acquiring CRITICAL DATA to address a HUMAN RIGHTS TRAGEDY of MODERN TIMES.

Colorado State Government in the past has taken a position that is probably a position that many States take:

"Hey, Olmstead/the ADA don't require that any PARTICULAR or SPECIFIC TREATMENT be AVAILABLE."
With respect to ASSERTIVE COMMUNITY TREATMENT (the GOLD STANDARD in more ways than one for Intensive Community Treatment) ----
- "We provide that as FUNDS and our OUTDATED SYSTEMS allow."

This ATTITUDE is what generally leads to "ASSERTIVE COMMUNITY TREATMENT" being included as a COMPONENT of many if not most US Department of Justice Olmstead Settlement Agreements with States involving people with "MENTAL ILLNESS."

What Olmstead is about is preventing the "UNNECESSARY INSTITUTIONALIZATION" of people with disabilities.When we're talking about people with Neuro-Developmental Differences that can make them more vulnerable to various forms of SENSORY OVERLOAD, STRESS & PSYCHIATRIC DISORDERS that impact a wide and idiosyncratic range of EXECUTIVE FUNCTIONING ----

Rain City
Housing First & Assertive Community Treatment
(Acknowledges what many people probably in Canada & the US already know --- HOUSING ALONE is not always going to be enough)

At 6:27: Canadian Psychiatrist tells it like it is:

Complex Needs
Flawed Systems, and
People who don't get "BETTER"

As the CANADIAN PSYCHIATRIST above so honestly distills:

You don't get people "BETTER" with COMPLEX NEEDS if the "SYSTEM THAT IS SUPPORTING YOU ISN'T VERY GOOD."
The SYSTEM is flawed in BC (British Columbia) probably in most of Canada [in Colorado, and in most of the US].

We're often talking about needing a "SYSTEM" that can address a WIDE RANGE of NEEDS.

I would submit the underlying drivers of those WIDE RANGES OF NEEDS are IDIOSYNCRATIC EXECUTIVE FUNCTIONING CHALLENGES that are impacting every area of life.

AND if we do provide that SUPPORT and really LISTEN to the person's GOALS and DEVELOP & EMPLOY their STRENGTHS---Things start to look a lot "BETTER."

In some ways, this is our RESIDENTIAL SCHOOLS for INDIGENOUS PEOPLE ----

It is not going to be easy to come to terms with what we've done and what we're currently doing.
BUT if we start collecting HONEST DATA and do our best to FUND REASONABLY MEDICALLY NECESSARY Placements, Housing & Intensive Services ---
AND COMPLY WITH CURRENT LAW ---
That would be a BIG STEP IN THE RIGHT DIRECTION.

A Common Issue in the US with regard to INDIGENOUS PEOPLE and PEOPLE with DISABILITIES ---

It's not that the LAWS or TREATIES weren't there --
They were just IGNORED when it was INCONVENIENT.
That is certainly true for Olmstead and it's true in Colorado.

Average or Above Average IQ-----Sensory & Emotional Regulation, Developmental Differences/Disabilities & Olmstead

9/22/2022

Conjecture

High-IQ Patients with Autism or ADHD Face Elevated Risk
https://www.additudemag.com › high-iq-autism-adhd-p...

Apr 6, 2022 — "Individuals with an above-average IQ and high-functioning autism, especially those with co-morbid ADHD, are less likely to be diagnosed and more ..."

If all the justice-involved people had IQs below 70 that on some level would make providing what is needed easier.

The problem is that is not true in the majority of cases.

What is true is that often people of average intelligence to very bright people with Sensory and Emotional Regulation Issues are involved in Criminal Justice.

SUBSTANCE ISSUES are often involved in one way or another in crime -- I would say in an effort to manage SENSORY and EMOTIONAL REGULATION ISSUES.

Further, if most inmates have an IQ above 70 --- they also often don't have a PSYCHOTIC DISORDER --- some do.

So I would say the BULK of people involved in Criminal Justice have

Some type of Neuro-Developmental Difference/Disorder or some BLURRED ASPECTS such as:
- ADHD
- Autism
- Dyslexia
- Giftedness
- OCD
Have IQs above 70
Generally have some type of "Mental Health Issue"
- BUT not necessarily a PSYCHOTIC DISORDER
- ARE probably MORE VULNERABLE to PSYCHOTIC DISORDERS.

When we think about that Olmstead Plan and/or Settlement Agreement and needs for SUPPORTIVE EMPLOYMENT --- this gets complicated quickly.

There must be INDIVIDUAL TAILORING, BUT we also need to have some general principles of NEURO-DIVERSITY so we don't end up with:

BURNOUT
RECIDIVISM, or
A BREAKDOWN

That does involve understanding needs for DIFFERENT WORK SCHEDULES, but also less obvious things as:

Managing TRANSITION TIME
Ensuring you are NOT only compensating for weaknesses, but also BUILDING ON STRENGTHS
- Those STRENGTHS are often HIGHER than we think.
GETTING CREATIVE ABOUT ENTREPRENEURSHIP
- A lot of people in the Criminal Justice System are ENTREPRENEURIAL ---
  - Some of them have gotten CREATIVE -- not necessarily the way the SOCIETY wants.
- We could get INNOVATIVE about providing people BETTER PATHS through more CONSCIOUS DESIGN of ENTREPRENEURSHIP and WORK.
  - BTW: 72% of Entrepreneurs have a Mental Health Diagnosis

I think the Society is concerned about FREE-LOADERS and LAZY PEOPLE.

I really don't think that PERCEPTION should be a problem ---
IF
we're addressing BOTH the UNEXPECTED STRENGTHS & CHALLENGES.

DOJ recognizes that contact with law enforcement is a Consequence of failure to provide adequate services

9/21/2022

Justice Department Finds Maine in Violation of ADA For Over-Institutionalization of Children with Disabilities (June 2022)

See link to DOJ press release above.

DOJ recognizes that one of the consequences of failure to provide adequate services is "contact with law enforcement."

DOJ Findings Letter.

Many Homeless People are Going to Come Under Olmstead --- That's a State Responsibility

9/21/2022

The Olmstead Decision is TARGETED to People with Disabilities who are INSTITUTIONALIZED or AT GREAT RISK of INSTITUTIONALIZATION such as BEING HOMELESS.

There's a lot of COGNITIVE DIFFERENCE/ DISABILITY out there.
It's HOUSING, INTENSIVE SERVICES and SUPPORTED EMPLOYMENT/ ENTREPRENEURSHIP.
There are a lot of reasons why people with COGNITIVE DIFFERENCE/DISABILITY are STRUGGLING in this SOCIETY ---
- and it's not always what people "THINK"
- AND they have Neuro-Developmental Difference such as ADHD, Autism, Dyslexia, etc.
- They are more vulnerable to PSYCHIATRIC DISORDERS and SUBSTANCE ISSUES.
- They are struggling with SENSORY PROCESSING OVERLOAD as well as greater levels of FATIGUE.
- Their SENSORY PROCESSING OVERLOAD and often SLOW PROCESSING -- means they are often treated like IDIOTS but they may be quite SMART even though they don't have the ENERGY to fit into a NEURO-TYPICAL SOCIETY ---
  - without BURNOUT, or
  - BREAKDOWN ost of these people have IQs over 70 --

Importantly, the FATIGUE of NEURO-DEVELOPMENTAL DIFFERENCES/DISORDERS can look DIFFERENT than what we're expecting.Singer/Songwriter Florence Welch of Florence + The Machine has dyslexia and has out a music video entitled "FREE" --- which beautifully captures the seeming contradictions and fatigue of NEURO-DEVELOPMENTAL DIFFERENCE.

Channel 9 News
Aurora Mayor Mike Coffman Warns Douglas County Not to Transport Homeless People to Aurora

Additionally, there are a fair number of homeless people with BRAIN INJURY.

This really is Title II of the Americans with Disabilities ACT and the INTEGRATION MANDATE.

When it comes to HOMELESSNESS -- it's UPPING OUR GAME at DESIGNING "WORK FLOW" for people with NEURO-DEVELOPMENTAL DIFFERENCES/DISABILITIES and BRAIN INJURY -- BOTH more vulnerable to PSYCHIATRIC DISORDERS and SUBSTANCE ISSUES.

THIS is EVERYONE'S RESPONSIBILITY --- and the LEGAL RESPONSIBILITY is on the STATE under OLMSTEAD.

Go With the Flow

The Integration Mandate, confusing combinations & Employment

Individual Olmstead Complaints

The need for Intensive treatments, Olmstead & MISMATCHED FINANCIAL INCENTIVES

Average or Above Average IQ-----Sensory & Emotional Regulation, Developmental Differences/Disabilities & Olmstead

DOJ recognizes that contact with law enforcement is a Consequence of failure to provide adequate services

Many Homeless People are Going to Come Under Olmstead --- That's a State Responsibility

Olmstead Law & Order Thursday

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