The accommodations talk: Removing the dread and promoting inclusivity Neera R. Jain and Lisa M. Meeks

We recently read the article, Why I dread the accommodations talk by Professor Gail Hornstein published in the Chronicle of Higher Education (3/26/17). In this piece, Dr. Hornstein shares her concerns with current practices at her college oriented towards equity for students with psychological disabilities. As a self-proclaimed ally to disability-rights movements and advocate for openness about mental health needs, Dr. Hornstein suggests that current disability disclosure and accommodation practices are problematic and in need of change. The core of her argument is that these practices discourage interpersonal connections between faculty and students, and fail to support long-term resilience and coping skills. As advocates for access and inclusion of students with disabilities in universities, we found Dr. Hornstien’s article alarming and potentially harmful. Rather than supporting students with psychological disabilities, we are concerned that her efforts instead marginalize these students and promote the ableist notion described by Trickett, Watts, and Berman as “person-fixing rather than context-changing.”

Micro-aggression and disparate treatment

A critical source of our concern lies in Dr. Hornstein’s described meeting with a student to discuss accommodations approved by the school’s disability services office. In this encounter, the student submitted a letter communicating her approved accommodation for extended deadlines, voluntarily disclosed a feature of her disability (panic attacks), and expressed concern about the Professor’s stated policy that disallowed makeup exams. Dr. Hornstein’s response was to state that she hoped the student would not have a panic attack and goes on to emphasize how tightly scheduled her course is, implying that accommodations would not be possible and any misstep could be detrimental to her progress in the program. Dr. Hornstein writes that she told the student “let’s hope [a panic attack] doesn’t happen” and “I know you want to do well.” Rather than communicating support, these statements appear to be micro-aggressive at best, and threatening at worst. In our experience, this type of response from a faculty member tends to shut students down. This narrative communicates a need for students to conform to a standard schedule, designed without flexibility, and suggests that there is no room for accommodation. This approach is in direct opposition to the spirit of the Americans with Disabilities Act (ADA) and related guidance, which calls for removal of barriers (not just physical barriers) to educational environments, with a move towards greater inclusivity.

Dr. Hornstein’s piece seems to reveal disparate treatment for students with and without disabilities when she discusses her stated policy about missing assignments. Despite her assertion that missing one exam would be “detrimental,” Professor Hornstein ends her essay by noting that in certain “serious, unexpected circumstances,” students may submit late assignments with the examples of “coming down with the flu or experiencing the death of a close relative. . . staying up all night with a suicidal friend or having an exam the morning after a distressing break-up.” This suggests students can turn in late assignments for supporting someone experiencing a mental health crisis, however, the student with the crisis (in this case, panic attacks) and a legal right to an accommodation cannot. It belies an approach where certain “normative” experiences of crisis can be understood and honored, while a student’s experience of a mental health crisis, documented through the disability services office is to be questioned. We believe this approach represents unequal treatment—the kind of behavior that lends itself to accusations of discriminatory practices.

Dr. Hornstein celebrates her interaction with the student as successful, however, successful inclusion of students with disabilities cannot be measured by their academic success or whether or not they return to a faculty member to discuss further needs. We suspect, instead, the student perhaps did not feel comfortable discussing her disability-related needs with Dr. Hornstein after their initial interaction. In our experience, working openly with students who experience variable symptoms of their disability to plan for the possibility of a flare is the more successful approach. Instead of expressing certainty that a student will be able to “manage their difficulties” disability service providers work with students to develop a plan B should difficulties emerge. This approach allows students to let go of the dread that develops when school is inflexible, and gives them options to address their mental health needs and complete school work with reasonable adjustments instead of simply “playing through the pain.” This flexibility, critically, often allows students the ability to persist through a semester instead of experiencing a full-blown episode that may prevent them from continuing their education. This approach aligns with the spirit of the ADA, to facilitate participation rather than enforcing traditional practices that work to exclude students who function in diverse ways.

The integrity of the accommodations process

Hornstein’s approach compromised the integrity of the disability services office through questioning the significance of the student’s disability experience and how well it had been assessed. Standard practice in a disability services office is to assess the student’s historical and current experience of disability and accommodations with information from the student and their clinical team. This information is first used to understand whether a student’s condition rises to the level of a disability covered by anti-discrimination law. Where a student is found eligible, their experience of disability is understood in the context of the academic environment to determine what adjustments are needed to ensure the student has access to the educational experience. Faculty should understand that before a student approaches them with an accommodation letter, a significant amount of time and consideration has been taken to understand a student’s experience, and that the recommended accommodations are not simply rote.

The process of accommodation letters described in the piece, while imperfect, is in place on most campuses for particular reasons. The process separates faculty—who largely have no particular knowledge about disability, accommodations, disability-rights law, and who are not privy to student health records—from the determination of who qualifies for accommodations, and what accommodations might be appropriate. Through this process students are able to maintain a level of privacy that allows them to disclose the nature of their disability only if they choose to, not by default. Students, “vetted” by the disability services office, can present a plan to their faculty member to be implemented without the need to share information they fear will result in stigmatization. The process recognizes the distinct power differential between faculty and students by deliberately excluding detailed information about the nature of a student’s disability. Students who are asked to provide more information about their disability often will—not because they want to share, but because they feel pressured by doubting faculty members to justify their need for accommodations. By setting the accommodation letter aside and communicating a need for the student to “straighten up and fly right,” Professor Hornstein implied that accommodations do not apply to her classroom, and that she is better equipped to make judgments about her student's accommodation needs than the disability services office. In the role of a faculty member, however, Dr. Hornstein is an educator, not a clinician. Her role is not to determine whether the student’s disability is sufficient to warrant any consideration of accommodations in her course.

Rather than dismissing disability service office recommendations outright, or questioning the significance of a student’s condition, we suggest that faculty partner with their campus disability services office when they have concerns about recommended accommodations or wish to make their courses more inclusive. In this way, faculty and disability service providers can combine their relative expertise and work towards greater equity for students with disabilities. This partnership can work towards two goals: 1. To ensure that courses are designed with inclusion in mind from the beginning (see, for example, the concepts of Universal Design for Instruction), and 2. To ensure that recommended accommodations are appropriate for the course environment, or identify new and innovative accommodations given the combined understandings. Within a partnership model, rather than dismissing accommodation recommendations outright, faculty can discuss their concerns about accommodations given the structure of the class. Working with disability services and the student, a suitable arrangement can be reached that honors a student’s right to privacy and equity, while upholding the integrity of the educational environment.

Overcoming disability

Perhaps the most troubling aspect to this piece is Professor Hornstein’s orientation towards self-reliance and resilience as solutions for students with psychological disabilities. Many students with disabilities will not be able to "resilience themselves" out of an inaccessible world. Suggesting they can reinforces the idea that people with psychological disabilities can simply make their conditions go away, that the difficulties they face are entirely personal and not at least in part socially constructed. This approach ignores the structural barriers that continue to exclude students who do not function in ways powerful decision-makers deem necessary and normative. Students are often highly resilient but beaten down by inflexible conceptions of what it means to be a student.

The idea that psychological disability can simply be “overcome” through coping strategies and improved resilience is problematic. Many people experience long-term psychological conditions, and live with them, most successfully when their social worlds have flexibility. People with disabilities often spend a great deal of time and effort behind the scenes working to mitigate the impact of their disability and inaccessible environments on their daily living. For things they cannot mitigate alone, they often request accommodations. These accommodations help bridge the gap between inaccessible structural forces, such as an inflexible curriculum, and ensure that no student is barred from that curriculum simply by having a disability. The goal, however, should not be for students to succeed in the face of inaccessible academic environments through force of will, but rather to reform our environments to be more accessible and inclusive. We must reduce the burden of this extensive behind-the-scenes work to meaningfully include students with psychological disabilities in our colleges and universities.

We are also concerned that when Dr. Hornstein says, “students who are deaf, visually impaired, or in a wheelchair have a specific and permanent need for a particular accommodation” while students with psychological disabilities have variable needs with “overly broad and vague criteria” she creates an unnecessary dichotomy between types of disability, all of which are expressly covered by the ADA. Dr. Hornstein’s response to her student perpetuated a stereotyped view of persons with psychological disabilities—that they are simply overreacting to stressors and need to develop better coping skills. She suggests that she knows better than her students what constitutes a crisis that requires accommodation. This approach is paternalistic and presumptive. The past experiences and personal qualities of each person contribute to their understanding of a crisis. A survivor of sexual assault who experiences PTSD may very well find themself in a crisis that Dr. Hornstein deems unworthy of such a label. We need to honor the expertise of students with disabilities by accepting their understanding of a crisis, and accommodating them accordingly, rather than dismissing them.

Finally, Dr. Hornstein suggests that the accommodation letter gave her student “permission to meet with me and to reveal, if she so chose, potentially embarrassing private information that she would not otherwise have told a professor. And it gave me a chance to model an attitude of nonjudgmental assessment of the circumstances, and to encourage self-reliance, coping skills, and confidence in a student’s strengths and talents.” We offer an alternate interpretation. The accommodation letter affords students with disabilities their right to privacy and protection under the law. This includes protection from inquiry into the specifics of their disability. It is not the job of faculty to delve into the background of the student to determine if they are entitled to accommodations. Implementing meaningful partnerships between faculty, disability services, and students with disabilities is needed to create a more collaborative and inclusive educational environment.

Neera R. Jain is a doctoral student at the University of Auckland Faculty of Education and Social Work, and the Policy Advisor to the Coalition for Disability Access in Health Science and Medical Education. 

Lisa M. Meeks is an Assistant Professor of Medicine and Director of the Medical Student Disability Services office at the University of California San Francisco School of Medicine.