[HumanSer] Work Accommodation Concerns

[43210 at Bellsouth.net]

Hello Sarah,
What a journey you have had.  Excellent that you have weathered this struggle to this point.  Especially as your employer appears to not recognize your strengths and talents.

I orked for a mental health clinic for 20 years as a clinical social worker.  I went through paper charts, to a DOS-based EMR, and to a Windows-based EMR.  The first EMR did not work with JAWS, but a little with Window-Eyes.  The last EMR did work, marginally, with JAWS.  Both EMR programs required substantial JAWS scripting by software engineers all paid for ty my state's Blind Services.  It is their job to provide this service and I am sure that there are providers in your state that Blind Services can engage.  Too often we arrive at a point in our careers that we are employed and feel we no longer qualify for services, this is incorrect.  They are there to help us continue our employment, not to fail and become unemployed again with the emotional load that may follow.

I am pushing 80 now and working as a contractor with a private practice.  Still, EMR problems do arise.  I have recently closed my Blind Services case again after more help to make the EMR JAWS accessible.

I left the community mental health center largely due to the EMR issues and management issues.  I had weathered 4 program managers and even more supervisors during my employment.  One supervisor told me when I asked a question about the EMR, "I don't care how you do it, just do it," and shut her door. 

I have twice employed a disability attorney to assist me.  The first time a letter to management stopped them from sanctioning me for a late time stamp on a visual time clock.  

Hang on there and know that your concerns are not yours alone.

JD Townsend, LCSW
Helping the light dependent to see

-----Original Message-----
From: HumanSer <humanser-bounces at nfbnet.org> On Behalf Of Sarah Meyer via HumanSer
Sent: Sunday, June 1, 2025 11:10 PM
To: humanser at nfbnet.org
Cc: sarah.meyer55 at gmail.com
Subject: [HumanSer] Work Accommodation Concerns

Hello,

I have been employed at a community mental health agency for 2 years now = as a therapist and it has been the most challenging experience of my life = in terms of not having effective reasonable accommodations to do my job. I = will try to keep this as brief as possible because it has become such a = complex situation but apologize in advance for the length. I will share some of = the major issues and my questions below. This is honestly a very vulnerable message for me so I just ask for grace and some gentleness in responses.

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Problems:

*	Despite having discussions prior to my hire and ongoing advocacy
efforts, as well as reassurances from the agency for months that they = were prioritizing accessibility to the EMR because they recognized that our work-arounds would not be sustainable/effective, I have never had access = to use any aspect of our EMR (NextGen) with JAWS or any other screen = reading options. I believe some of the issues are that NextGen is housed on a = Remote Desktop, but most notably that the agency has never used the latest = version of the EMR which NextGen has indicated would be most likely to be compatible/accessible with JAWS because that is where their developers = have invested their efforts to meeting accessibility guidelines/requirements.
*	The agency has indicated JAWS scripting is too expensive. They never
engaged with me or VR when trying to reach out to explore if VR could = help with some of the cost.
*	I had to fight to get them to consider work-arounds for months
because they insisted they were "so close" to providing accessibility = for me to independently access NextGen. Eventually I got them to be willing to = try using Word templates for me to do documentation, which I then sent to my supervisor and other leadership to upload into the database. The = templates have had a lot of accessibility barriers themselves, and it has been challenging, to say the least, to acquire information from client charts = in accessible formats. Additionally, I can't access the calendar, = scheduling features, notifications of client arrivals, communication intra-professionally with members of other teams involved in clients' = care, etc. Other staff indicated repeatedly that they knew our work-arounds = were short-term and not truly sustainable (for me, for them, for quality = client care).
*	I've proposed other options including Aira, Seeing AI on work cell,
installation of my own provided Kurzweil 1000 and Duxbury Braille Translation software onto work laptop to try to make various materials = more accessible, and several other accommodations proposed. I also use a = Focus 40 Braille Display which has had a lot of problems not pairing via = Bluetooth. I have requested permission to transfer documents via SD card between = Focus display and laptop but have never received a solid response though they = have previously been very hesitant to allow use of flash drives or anything = that could potentially cause concerns about privacy, which I understand from their perspective. Wired connection with laptop works better, though = still has issues, and JAWS has had other issues as well.
*	The toll of chronic inaccessibility and having to work so much extra
to compensate for these barriers, which also apply to trainings and = other aspects of the job beyond the EMR accessibility barriers, have = repeatedly exacerbated symptoms of multiple other chronic health disabilities. I eventually had to go on an extended medical leave last year. I = continually have tried advocating and have frequently received no response, = inaccurate follow-up, dismissiveness, and have faced an often hostile and = intimidating work environment when I have tried to speak up and advocate.
*	When I returned from my leave last Fall, I truly hoped there would
be improvements; however, the agency has actually doubled down and = indicated that the supposedly temporary work-arounds, which failed miserably = before, are now the ongoing "accommodation system." They have come up with some = new methods for notifying me of client arrivals, and there has been some improvement in support staff notifying me of scheduled client = appointments and cancellations, but this has been inconsistent. The client = documentation I've requested to prepare for sessions and help with pre-filling my templates has at times been missing crucial information, not provided, = and is filled with accessibility problems in their efforts to convert inaccessible PDFs into Word files. The templates I am using for = completing documentation are still in process of being revised for accessibility = and the burden has been placed on me to provide written narratives of the = issues so they can "fix them". Until recently, leadership would not meet with = me, and this has been inconsistent.
*	I've requested having a visual assistant and have yet to receive a
response.
*	The agency has been through significant transitions with "merging"
under a larger umbrella parent company which has also caused a lot of confusion and worsened miscommunications. I also have had issues with getting clear, accurate, timely, accessible information and = determinations of my leave time accommodation requests to manage my other health = concerns, especially during the transition to new leave management entities. I was allowed to work remotely in the past when seeing clients, and during the training refresher/catching up upon my return to work, but I was = recently informed that I am only allowed to conduct client sessions from the = office and only when team leader coverage, support staff, and crisis staff are = on site. (Never mind that many other staff are working hybrid due to = limited office space, work modified schedules including seeing clients past 5PM, etc.).
*	I have been told I've been provided all the necessary accommodations
to fulfill the essential functions of my job, despite my and my medical providers' statements that this is not accurate. I have received = corrective action notices/statements and discussions which place all the blame/responsibility on me for problems with note timeliness, session = length (running over on time), running late to sessions, etc., without acknowledgement of how the accessibility barriers play a significant = role.
*	I am burned out but I care so much about my clients and believe I
have unique assets and skills to support them and the mission of the = agency, plus I am not fully licensed and need the supervision (I am close to = being able to apply for full LMHC licensure which would open more options).

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Questions:

*	I know several folks here have shared about work-arounds to
compensate for inaccessibility; I am wondering where you draw the line, especially in community mental health where the service delivery and documentation expectations/demands are so high and able-bodied staff = even say they struggle to keep up with all of the expectations? I have never = been able to reach a full case load and service delivery because of the accessibility barriers and how much I've struggled to keep up as a = result.
It's hard to not internalize and beat myself up for not being able to = put in all of the extra time and energy to compensate, especially because of = the toll this has taken on my own physical and mental health.
*	If you have worked in a community mental health or otherwise
fast-paced, high demand setting, and had either very limited or no = access to the EMR, how did you keep up with service delivery and note timeliness standards? How much work-life balance has been realistic? I understand = this can vary for each person. What accommodations have been non-negotiables = for you?

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There's unfortunately more but I have already shared quite a lot here.
Please feel free to ask questions if you need additional clarification. = I readily admit I do have areas I am constantly needing to improve in, especially when it comes to time management and being more concise (I do have ADHD which I am still learning to navigate and again I know there = is overlap with the impact of my other chronic health disabilities; I was = so much better at pushing past my limits in school and college/grad school = but chronic override of self-care is never sustainable).

Thanks in advance for taking the time to read and share any feedback.

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Sincerely,

Sarah

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Sarah K. Meyer, MA, LMHCA (she/her)

(317) 402-6632

 <mailto:Sarah.meyer55 at gmail.com> Sarah.meyer55 at gmail.com

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"Although the world is full of suffering, it is full also of the = overcoming of it. My optimism, then, does not rest on the absence of evil, but on a glad belief in the preponderance of good and a willing effort always to cooperate with the good, that it may prevail." =AF Helen Keller

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