ROUGH EDITED COPY

SRALAB
PRESENTATION TO MEDICAL STAFF AT THE 
SHIRLEY RYAN ABILITYLAB
AUGUST 5, 2020

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This is being provided in a rough‑draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.
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     >> My name is Dr. Emily ‑‑ I am the chief academic resident physician for this academic year.
And it's my pleasure to introduce today's Grand Round speaker, Louis Orslene, MPIA, MSW serves the Office of Disability Employment Policy U.S. Department of Labor as the lead for the Employer and Workplace Policy Team.
The employer team examines policy issues and barriers facing employers as they seek to recruit, 
Hire, retain and advance individuals with disabilities in the workplace.
The team fulfills its mission by adoption and implementation of disability employment policies and practice that meet the needs of 
Public and private employers and individuals with disabilities.
Prior to joining ODEP, Lou served as a disability policy advisor 
Supporting the Department of Defense Office of Diversity Equity and Inclusion.
He has more than 20 years’ experience implementing and developing public sector initiatives.
And 15 years’ experience providing customized training to private industry, public agencies and non-profit organizations.
Lou served as the co-director as Department of Labor’s Job Accommodation Network.
He has extensive knowledge of workplace accommodations, Title I of the Americans with Disabilities Act and the 
Rehabilitation Act of 1973.
He has degrees in public and international affairs and social work, 
Disability management as well as certificate in managing public and nonprofit organizations.
He holds an undergrad degree in human resource management.
And through collaborations with groups such as the Disability Management Employers Coalition, 
Society of Human Resource Management.
Assistive technology industry association, and the American Association of people with disabilities among others.
Lou is committed to increasing the employ‑ability.
This is deepened through the nexus of employers and individuals with disabilities.
I would like to add that the training center on persons with physical disabilities is pleased to support this Grand Rounds lecture.
The center is funded by the national institute on disability, independent living and rehabilitation research.
The center addresses issues related to chronic unemployment and underemployment of people with physical disabilities 
And includes a robust set of education and dissemination activities.
Including sponsorship of speakers such as Mr. Orslene.
The recording is closed captioned and available soon at WWW.SRAlab.org.
And I will make sure to e‑mail out that link as well.
Thank you all for joining.
>> Good afternoon, everyone.
And thank you for that introduction Emily.
I'm really grateful to the Shirley Ryan AbilityLab and research and training center on rehabilitation outcomes for the opportunity to speak with you today.
Today's topic is enabling work.
Accommodations is an essential element of the return‑to‑work process.
Next slide.
As Emily said I'm Lou Orslene, director of the employment policy team with the Office of Disability Employment Policy 
The office is a nonregulatory agency that partners with employers and all levels of government to promote disability‑
Inclusive policies and practices, next slide.
So today really my goal is to convey three major things: 
And understanding of the business case for supporting individuals with disability returning to work after injury and illness.
To increase your familiarity with the accommodation process.
To ensure successful return‑to‑work.
And then to increase your knowledge of resources of the U.S. Department of Labor, and also State and local resources, 
Such as the Shirley Ryan AbilityLab and the research and training center on rehab outcomes.
Next slide.
So really our society is challenged by all of the millions of American workers leaving the workforce every year 
After experiencing an injury or illness.
Hundreds of thousands of these workers go onto receive State and Federal disability benefits.
And many could remain in their jobs or in the workforce if they received timely, effective support to prevent 
A work disability.
Next slide.
So the follow‑on effects really are ‑‑ they are major losses to the employers.
Employers end up shouldering the direct and indirect costs that come with a loss of a valuable employee.
All levels of government face reductions in tax base, decreased economic activity, and hundreds of thousands 
Of workers go onto receive state and federal disability benefits.
However, many injured and ill workers could remain on the jobs or in the workforce if they received timely effective help.
And the losses to the employees are: That they lose their health oftentimes.
Their family finances, and ultimately their quality of life.
Compared to people without disabilities, individuals who have disabilities are significantly less likely 
To engage in future work.
Those who do work earn less and are much more likely to be poor.
We could go to the next slide.
The National Safety Council reports that the total cost of work injuries in 2018 was $170.8 billion.
This includes wage losses of $52.4 billion and medical expenses of $35 billion and expenses of $57 billion.
Days lost totals to $70 million.
This includes disabling injuries including the day of the injury, follow up and the injured persons return to work.
The next slide, please.
Even beyond really these staggering numbers specific to losses due to work injury.
There's also a very strong business case for retaining workers with disabilities.
And that's been building over the past few decades.
One of the most recent reports is a report that was put out through ACCENTURE in 2018.
Tangible benefits including increases innovation, improved productivity and a better work environment.
Companies known for hiring and retaining injuries with disabilities.
And on average over a four‑year period found these companies had a 28 percent higher revenue.
Double the net income and 30 percent higher economic profit margins than those companies which were not disability inclusive.
Go to the next slide, please.
So early stay‑at‑work and return‑to‑work strategies and programs really succeed in returning injured workers 
To productivity as soon as medically possible.
This is what we should all be working towards in order to prevent needless disability.
These strategies involve early action and coordination between ill and injured workers.
Employers, healthcare workers like yourself, and employment services professionals.
While disability cash and health benefits are essential for protecting workers who have been incapacitated 
With long‑term and permanent disabilities, they should really not be the default path if viable options for return 
Or even partial return to work exists.
By keeping workers engaged in gainful employment, as taxpaying members of the community, 
Fewer individuals will need to apply for disability benefits.
And the workers, their families and their employers will all benefit.
Improving return‑to‑work and stay at work outcomes is a win‑win policy for all stakeholders.
The next slide, please.
>> So according to the American College of Occupational and Environmental Medicine in writing preventing needless work disability 
By helping people stay employed, there was a great quote in there that really captured it.
And the fundamental reason for most medically‑related lost workdays and lost jobs is not medical necessity.
But the nonmedical decision making involved, and the poor functioning of a little‑known but fundamental practice.
The stay‑at‑work and return‑to‑work process.
That's what I'm going to focus on and talk about today really.
Is about this nonmedical decision‑making that really bridges your role and your contributions to the SAW and RTW process.
With those that are working with the person to return to work.
If we can go to the next slide.
And what I'm really speaking of the non‑medical decision making we're really talking about the non‑‑ 
I'm sorry I think I'm one slide ahead.
Apologies for that.
If you could go one more slide? There we are.
There we are.
Sorry, I'll be a little more focused and try to keep us on task.
So when I speak of the nonmedical decision‑making, we're really speaking of the nonclinical role of the medical professionals.
Paramount to this is the medical professionals positively framing the stay‑at‑work and return‑to‑work program from the very beginning.
A disability medical impairment or chronic health condition doesn't necessarily diminish the individual's knowledge, skills and abilities.
The impact of being out of work long‑term includes two to three times risk of poor health with increased High blood pressure, 
Heart, disease, cancer, and a two to three health risk of mental health such as depression.
And also a 20 percent increase in death risk.
Just because a person has a disabling condition and limitation does not mean that they need 
To become disabled in the sense of leaving the workforce.
What we would ask you to do, really, is to support the individuals focus on what activities they can do.
And the goals they want to achieve during recovery.
Help along recovery can really help people understand how they can become more employ able in the future.
We always suggest they use this time productively.
This entire process of stay‑at‑work and return‑to‑work is really what I call disrupting disability.
We really need to help an individual with a disability or a chronic health condition or impairment 
And their family to disrupt disability.
As I said, just because they have this medical condition really doesn't diminish the person's past experiences 
Their knowledge, and their skills.
If we could go to the next slide, please.
Really the medical role or the medical professional is really a vital part of the SAW and Return‑to‑work team.
While differing by composition, the typical team is a return to work coordinator 
A worker's compensation staff, the individual's supervisor and an accommodation subject matter expert.
The clinical role of a medical professional on the team is really the provision of medical opinion 
In support of early SAW and return‑to‑work interventions.
What the team really needs to know in moving forward in this process is the nature, degree, 
And the prognosis of the disabling the potentially disabling condition.
I'll just also note that oftentimes medical professionals are asked to fill out return‑to‑work functional assessment forms 
Physical capacity assessment forms, mental health functional assessment 
And fitness for duty return‑to‑work releases.
And all these forms enable the stay‑at‑work and return‑to‑work process to proceed.
But we know that medical professionals are very busy and, you know, the challenge really is getting 
These forms completed and understanding really, the nature, degree, prognosis.
So that everyone can begin thinking about the implications for the person, for their job position 
And for also for future reassignment for other positions if that becomes an option.
So if we could go to the next slide, please.
There are three major point in this process where you as a medical professional may be pulled in.
Your opinion first may be requested to initiate the transition duty process.
One in which one or more temporary accommodations or adjustments are provided so an employee 
Can perform job duties while recovery from a medical condition.
This really enables the person to return to employment as soon as they're medically stable.
And perform the tasks they have been performing in the past safely.
So during this process the essential functions of the job of an injured or ill individual may be eliminated.
That's all part of this transitional duty process.
The result is the individual returns to their job without restrictions or accommodations.
And really that's the ideal or the optimal outcome of the transitional duty.
You may also be brought in later in the transitional duty process when it's determined an individual 
Has reached maximum recovery.
And now it's discovered that the individual has a permanent medical condition.
At this point, the ADA may require the Americans with Disabilities Act.
And then support is really needed in determining what accommodations will enable the individual to perform 
The essential functions of the position.
So this is the business of returning the individual back to his former position, but in this circumstance 
It's with an accommodation.
And then finally, there's another point of engagement where your services may be requested.
And that is we may be asking you to provide information in order to determine what accommodations 
Would enable the individual to perform the essential functions of a new position that they're qualified for.
So under the ADA, what we attempt to do first is to accommodate the person in the current position.
And offering them an accommodation to meet the essential functions of their position.
If they're not able to do that, then sort of the last‑ditch effort to keep that person employed with this employer is called reassignment.
What we're looking at there we look again at the qualifications of the individual.
We want to compare those to the essential functions of jobs that may be open currently with the employer.
And then we do a job match.
And again, that's when you may be needed, because it's a new position, new essential functions.
And once again we may be asking you for your opinion, and perhaps your ideas about what accommodations might work.
Ideally, the medical professional, yourself, listens carefully, treats, certifies appropriately.
And communicates with the workplace and the supports in order to provide a successful return‑to‑work outcome.
Next slide, please.
So if an individual is not able to return to work without limitations, then the workplace accommodations 
Or adjustments as we sometimes call them, are really a key part of the solution.
So again, according to the American College of Occupational and Environmental medicine, 
They say a permanent or long‑term alteration of workplace capacity occurs.
ADA or reasonable accommodation process may be triggered.
It operates in parallel with stay at work and return to work process.
If the ADA applies it will heavily influence what occurs during SAW and return‑to‑work.
Sometimes there's confusion caused, because once some companies have in their policy that as soon as the person 
Is injured that immediately that triggers the ADA process.
So there may be a parallel process.
So in the previous slide when I talk about the three points of engagement, the transition to return‑to‑work 
Accommodations to a former position and accommodations to reassignment, it may not be as neat as that.
That we progress from one stage to another.
There may be some overlap between.
So in some of the information you're providing, maybe shared multiple times on multiple forms.
Which we know is cumbersome and sometimes challenging for you.
Let's go to the next slide, please.
So let's talk really what I'm talking about in terms of accommodation.
Or in some contexts they call it an adjustment.
So really this is any modification or adjustment to the job or the work environment that enables 
A qualified person with a disability to apply for or perform a job.
Earlier when I talked about disrupting the disabling of an employee, 
Accommodations really serve that purpose.
So again, our focus needs to be on what the person can do as opposed to what they can't.
And a disability, medical impairment, a chronic health condition doesn't necessarily diminish the individual's knowledge 
Skills, and abilities as I've said previously.
So let's talk a little bit about the accommodation process.
So what really is that process? 
It's simply a problem‑solving process used in this case by a stay‑at‑work and return‑to‑work professionals 
To keep the individual engaged in the workplace.
The process is as follows: 
You simply analyze the particular job involved.
That usually involves having a job description, and reviewing the essential functions of that position.
Consulting with an individual to assert the precise and job‑related limitations and how they can be addressed.
And again, this is where your ‑‑ where information from a medical professional comes in.
Oftentimes that person takes a form, which I'll show you in a couple of minutes, to the physician, to the medical professional.
And asks you to fill out what you believe the job‑related limitations are.
Then oftentimes what we'll do is we'll work in consultation with the person, and perhaps the job accommodation network.
Which I will talk about later.
And we identify the potential accommodations and really begin to assess their effectiveness.
And accommodations, again, may be come into play in looking ‑‑ if a person can do their current job.
If they need to do a job with accommodations, or if they really need to be reassigned to another position.
Next, what we'll do is we'll select and implement the most appropriate accommodation for the person as well as for the employer.
If we could go to the next slide, please.
So really, the medical professional's role in the accommodation includes determining limitations.
Or how the disability affect the individual's capacity to learn or to perform the job's essential functions effectively.
And just to let you know, I mean essential functions are employer‑determined.
And these are duties that are regarded as crucial to the job that someone has, or that someone desires to have.
So you're also very helpful in really determining accommodations or adjustments that a person may need to perform these essential functions.
So it's helpful in your learned experience for us to know what has or hasn't worked ‑‑ both in your experience as a medical professional 
And then perhaps with you engaging with the individual for you to mutually understand what limitations are most prominent 
And what accommodations may have worked for that person.
Perhaps that person shares more information with you than a return‑to‑work professional or with their employer.
So really we need everybody's help in understanding where the employee has been, what perhaps accommodations have worked 
For them in the past and what in relation to their limitations might work in the future.
If we could go to the next slide, please.
One more slide.
All right.
So what we would also ask you to do is to provide resources to the patient on stay‑at‑work and return‑to‑work.
There is really a robust foundation for stay‑at‑work and return‑to‑work in the country.
It's just a matter of those ‑‑ that individual tapping into, and the employer tapping into the resources.
We have first the job accommodation network.
That is a free resource.
I will talk about a little bit later.
Locally, you have the Shirley Ryan AbilityLab with vocational rehab services, 
Assistive technology services, and then also the Illinois Department of Rehab Services.
All of these are part of that safety net or that net of services for when someone is injured and attempting to return to work.
If we could go to the next slide, please.
So what I just wanted to put up on the screen for you is to see what form, which is typically provided to you.
And what we need completed in order to move forward in this stay‑at‑work return‑to‑work process.
As I said, unfortunately, there are a number of forms specific to specific processes.
But this is the one that usually typically starts the accommodation process.
And this form really helps employers make decisions as to whether or not the person is covered by the ADA.
And what accommodations may work for the limitations specified.
And just to let you know that as a medical professional, I know that medical professionals are often somewhat timid and shy 
Really to say that a person is covered by the ADA or not.
I know that many employers ask you to make that decision.
But I'm here to tell you that that really isn't your decision.
That's the employer's decision.
So it's not your responsibility, and you are not liable for that decision.
But you can in your best medical opinion provide information that the employer needs.
Again, totally the employer's responsibility in making these types of determinations.
And I know that the form is rather small on the screen.
But for instance, it asks you if the limitations involve any major life activities.
And there are just various boxes that you can tick off in determining whether they do affect any major bodily functions.
And then also just there are a number of questions about the limitations that the person has.
And again any accommodations you might be aware of in your experience that you've heard either from other patients 
That you've had, other professionals that you've worked with, or even if the individual raised perhaps accommodations 
Which may have worked in the past for them or may not have worked in the past.
We also ask you for that information.
If we could go to the next slide, please.
So what I wanted to do now is just to really familiarize ‑‑ if you're not really have had experience with accommodations before 
And you're kind of familiar with a category of accommodations or the types of accommodations.
I just wanted to go through a few categories of them.
One of them is what we call the HR accommodations.
And these are flexible work arrangements.
They could be part‑time schedules.
They could be policies or benefit changes that would enable the person to return to work.
Or leave.
And what many of us are doing these days, of course, in these COVID times is really telework.
And one of the things that I'll caution you particularly with HR accommodations is that supervisors 
Often prefer leave, because it is the easiest type of accommodation provided.
However, it's not usually the best by the employer or by the individual with the disability.
So really I caution that while leave may again be the simplest option, it's often the most counterproductive.
For the individual it may result in comorbidities while off of work.
Or for the employer is may mean paying both the employee and perhaps a temporary replacement.
Offering reasonable and medically suitable work is always preferable to leave.
And that's what the research says and certainly what us who have been working in the field say as well.
So be cautious that if someone ‑‑ if an employer consistently comes, or even the individual is coming to you and saying, 
Well, no, I just want to take a leave.
Just maybe prod a little bit further.
Don't just sign off on that quickly.
Prod a little further and let's see why they prefer leave.
Perhaps it is really the option that's needed at the moment.
But I can just tell you that it's one that is chosen way too often.
And again, really counterproductive.
So next ‑‑ the next slide, please.
Okay.
So the workplace adjustments and equipment.
So these are really environmental adjustments.
And they could be accessible parking lots, accessible restrooms.
Perhaps you have someone that has multiple sclerosis.
More apt to falling and you want to keep them at work or perhaps they're returning to work after a surgery.
Then perhaps they need to be closer to a restroom.
This might be in the same circumstance with somebody with diabetes.
It maybe also the case that we want to offer ergonomic products such as a sit‑stand desk or stool.
While mental health impairments these days seem to be one of the most prevalent health condition and disability 
That we deal with, back impairments, motor impairments are still often occurring in the workplace.
And we find more and more people asking for these desks and stools.
Or perhaps automatic door openers for people who do have medical impairments.
Who have been ‑‑ who are wheelchair users, who are paraplegic or quadriplegic.
Or really just with somebody with cerebral palsy, an automatic door opener can be very, very helpful 
In returning them to work.
The next slide, please.
And the category of communication accessibility accommodations, there are all sorts of different accommodations.
Such as closed captioning, large font, braille format, digital formats, HTML postcards, providing written instructions.
Video phones, CART, amplified headsets, interpreters.
So this is rather a full array of those communication accessibility accommodations that one might need if, for instance, 
I'm blind and at work, or I lose my hearing at work.
Or I'm in an accident and lose my sight or hearing.
Can we go to the next slide, please?.
So there's all sorts of assistive technologies out there these days.
The technology is very sophisticated.
And at this point, many of the technologies such as screen magnification or screen‑reading software.
Operable within operating systems on computers.
Many bugs have been worked out over the past decade, and are very effective in bringing someone 
Who is losing their sight or someone who has lost their sight to enable them to do their job.
If it is one of those white collar jobs that's information sharing, and they're using computer systems.
And there are iPads with apps.
There's various apps which enable ‑‑ which have accessibility features which really enable people 
To work their jobs if it is, again, a computer‑based job.
There's alternate keyboards for someone for instance who has cumulative trauma disorder.
Alternate mice, same condition.
Text highlighting software for someone who perhaps has a cognitive impairment from a stroke.
Who has been in a car accident.
As well as voice input software.
For instance, again, someone who has injured their arms or their hands, and they're no longer able to input 
As they have in the past, there's now voice input software.
And again, over the last 20 years, this technology has really become increasingly effective.
And very quickly for the person to train.
So they're able just to speak into their computers and it's able to capture it.
As a medical professional, I'm sure you're very adept at these kinds of technologies.
If we could go to the next slide, please.
So there's also electronic information accessibility.
And this is more of sort of text or alternatives or captions for non‑text media.
So if I am someone who is blind, I am in a training such as this.
And I need this information to perform the essential functions of my job.
Then we in the field and we have been training others to ensure that if there are graphics on these slides 
That we want to make sure that there's alternate text behind that.
There are alt tags, as one calls them often.
And what this is a description of a chart, of a graph, of a graphic.
So that the person who is blind can understand and has the same understanding that someone who is nondisabled 
Of the information that we're trying to convey.
There's also techniques that one can use to traverse the page from the keyboard.
So there are keyboard shortcut that is somebody who is disabled can use.
That enables them to function and move as quickly as us who are nondisabled in that way 
Through documents and forms and such.
And also there's technology that can give users control over which features to load and to change.
And this is particularly pertinent to website accessibility.
So again, with us functioning, with many tools that are web‑based these days, it can give someone who is blind 
The ability to go directly to the pertinent information that's important to their job, and can avoid their screen 
Reader going and reading all of the various captions that are really containing not information that are pertinent or relevant to their jobs.
And these tools, again, have become very effective over the years.
And there's also design page text with sufficient contrast.
Contrast being another issue that many people with various disabilities deal with.
And there are tools these days built into Microsoft Windows, built into Apple products that one can set 
As a person with a disability.
And then from now on, any information received through that software program or that hardware is set to what I need 
To see or hear, and it enables me, again, to do the essential functions of the job.
If we could go to the next slide, please.
So often we hear myths, and we hear questions about accommodations.
And there are a lot of misconceptions out there.
There are a lot of misconceptions that accommodations really cost too much.
And are cost prohibitive, and I'm not really even going to recommend them.
And as employers I'm not going to embrace them.
And then also there's a lot of myths out there in terms of effectiveness.
So the job accommodation network, a free consulting service of the Department of Labor, 
Annually goes back to all of their employer customers, and they really ask them what was the cost of accommodation.
And this report is put out annually in September for October's National Disability Employment Awareness Month.
And what the last research reveals is that most ‑‑ 58 percent of accommodations cost nothing to make whatsoever.
So when we're really talking about those accommodations that cost nothing, 
We're really talking about those HR accommodations.
So we're talking about giving a more flexible schedule.
We're talking about enabling a person to use leave as needed to return to work over those next couple of months during rehabilitation.
And if those that do occur ‑‑ of those accommodations that do occur, the typical cost is only $500.
If we could go to the next slide.
Now in terms of the impact of accommodations, the survey results consistently have shown benefits 
Employers receive for making workplace accommodations far outweigh the associated costs.
So 85 percent of employers who participated in the JAN survey have really ‑‑ 
Survey is called JAN for accommodation information.
And they've really ‑‑ 74 percent of those employers reported that accommodations are either very effective 
Or extremely effective.
And employers reporting providing accommodations that resulted in such benefits in retaining.
And I'm sorry.
I'm messing up a little here.
Employers reported in this survey indirect benefits and direct benefits whenever they are surveyed.
And some of the benefits really are retaining valuable employees.
Improving productivity and morale.
Reducing workplace accommodations and training costs.
And improving company overall diversity.
So if we could go to the next slide, please.
Next slide? And the next slide.
So on the screen, we see a graphic of the Job Accommodation Network's website.
The job Accommodation Network, which I referred to a couple of times already, really is more often known as JAN.
That's how you'll hear of it.
And employers’ rehabilitation counselor, individuals with disabilities, all of them go for technical assistance to JAN.
It's a free resource as I stated before.
And JAN's consultants, they are professional consultants, all masters and Ph.D. level consultants.
And provide one on‑one counselling within specific industries.
There's also a self‑service portal to search JAN's vast resources to accommodation solutions.
So the graphic here is the front page of the JAN website.
In the top header, one can see that there's an A‑Z.
But going into that A‑Z, one can search accommodation options by ‑‑ and let's go to the next slide, please.
So when you hit the A‑Z of Disabilities and Accommodations.
Then you're taken to a page and you can search by disability, limitation, work‑related function, topic, or accommodation.
And what you basically receive is, for instance, in the graphic on the screen, we can see in the bottom right‑hand corner 
Of that graphic - Addison's Disease.
If you pop open Addison's Disease, it will very specifically talk about the limitations that one has with that disease.
And then very specifically provide accommodations in various industries to those limitations.
If we can go to the next slide, please.
I also wanted to make everyone aware that we are in the process of a number of demonstration projects 
Regarding stay‑at‑work and return‑to‑work.
And we're really looking for state models of how best to create a ‑‑ some systemic change 
Within the state, with all the parties involved.
And to look at developing these models and then of course replicating them throughout the country.
Now the pandemic, of course, has waylaid much of the work of the projects.
Particularly since these projects really involve some very large medical institutions throughout the country.
So really stay tuned for the results of these projects.
But again, the intent is to bring together all of the parties within the stakeholder group in stay‑at‑work and return‑to‑work.
And look at some pretty major systemic change to more effectively ensure that people are returned to work.
Or enabled to stay at work, so that we disrupt that disability process.
So that people while they may remain with an impairment, they may in the future have some sort of chronic health condition 
Related to their illness or injury.
But that doesn't mean that they become totally disabled and that they're not able to work any longer.
So that's the kind of exploration that we're going to do with these eight demonstration projects throughout the country.
So we're hoping once we are out of the pandemic phase that we're able to move forward aggressively to work through these 
Demonstration projects, and then have results in the next year or two.
So with that, I wanted to open it up to some questions.
And hopefully I'll be able to answer those questions.
If not, then I'm certainly willing to go back with my colleagues and conduct some research and provide any questions that you might have.
So with that, if we want to open it up? 
>> Hey guys, this is Emily again.
So for questions, if you would like to unmute yourself and then ask your question and then make sure to mute yourself again afterwards.
That works, if you'd like to type your question into the chat, I'm happy to read it.
Whichever you prefer, thank you.
>> You know, I'm open also if people to not have questions.
If you just wanted to talk about your experience and what have been some of the barriers that you've experienced 
Or perhaps some of the successes that you've had, I think that certainly informs the Department of Labor's work 
Again, if you want to talk about either dysfunction that you've experienced in this process, or talk about some successes.
Or even talking about the burdens.
As I say, what seems to be our challenge is that so many medical professionals really have little to no familiarity.
It's not part of your training or your curriculum as a physician or as a medical professional.
That creates some issues of course.
But then we chronically hear of the burden of the paperwork as well.
Something we're all burdened by.
But it seems to be in particularly ‑‑ a particular difficult to getting the various forms that are needed for this 
Stay‑at‑work and return‑to‑work process completed.
And again, employer makes all of the decisions in terms of the ADA and how they want to move forward.
But again, with employers, they too really are not oftentimes very informed about the accommodation process.
And they are heavily relying on medical professionals to really make these really important decisions.
>> I have a question actually.
Are you able to hear me? 
>> Yes, I can hear you.
It's a bit low, but I can hear you.
So I'll watch the transcription as well.
>> Okay.
One of the groups of people who we know traditionally has had great difficulty returning to work, 
Has been people who have aphasia.
And after a stroke or after a traumatic brain injury.
And so aphasia are people who have communication problems.
And, you know, it's very, very difficult for them to return to work.
They are also often excluded from research studies that look at return‑to‑work.
And I'm just wondering if there's any chance that in any of the demonstration projects 
People with aphasia might be included.
Obviously they need special strategies in order to be included in studies and demonstration projects.
But I just wanted to bring that up, because notoriously, we know from the fact that very few people with aphasia are able to return to work.
So I just want to bring that up as, you know, consideration of that impairment moving forward.
>> Thank you, I appreciate that.
I really do.
And I'll take that back to the RETAIN team and talk to them about it.
I also want to point out that that I am very sure that JAN has a publication on aphasia.
That perhaps would benefit some of your patients.
So you may want to get online.
And again, you can either use the search function or you can go into the A‑Z of disabilities.
And look there for the publication.
But I'm pretty sure that I've seen that before on their site.
But I will take back to the RETAIN group.
There is opportunity, particularly with what's going on.
And we're modifying work plans and we're modifying our strategy and models.
So I will definitely bring that up to the team.
>> Great, thank you.
>> Sure.
Another group of people, of course, that we really struggle with are people with mental health conditions as well.
And so we're spending a lot of energy, time, and resources on looking at models for returning people back after an episode 
Or after some issues that they might have.
You know, certainly understanding the cyclical nature of mental health conditions.
And also the stresses for these folks too during the pandemic.
And keeping at work perhaps when they're isolated at home.
And not getting the feedback they need in their positions, because they're teleworking and such.
So we're definitely looking into that as well.
>> Are there any other comments or questions? 
Okay, thank you all.
>> All right, thanks for the opportunity.
And sorry for the slide glitches at certain points.
So sorry for that.
A pleasure and thank you very much again for this opportunity.
>> Thank you Lou.  
>> Thanks, Lou.
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This is being provided in a rough‑draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.
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