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Using Comprehensive Postsecondary Transitional Support Services to Enhance the Health, Independence, and Employment Success of Persons with Severe Physical and/or Psychiatric Disabilities: The University of Illinois Approach

Kimberly D. Collins, Bradley N. Hedrick & Norma J. Stumbo

Division of Disability Resources and Educational Services (DRES)

College of Applied Health Sciences

University of Illinois at Urbana-Champaign

This material was based on work supported by the National Science Foundation (NSF), Grant No. 0533197.

Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of NSF.

Introduction

The Individuals with Disabilities Education Act (IDEA), the Rehabilitation Act and the Americans with Disabilities Act (ADA) have unquestionably served to improve the accessibility of higher education for students with disabilities. However, inadequate postsecondary transitional preparation and discontinuities in the statutory bases of disability accommodation policies and practices of secondary and postsecondary educational institutions continue to impede the enrollment and success of students with severe disabilities in higher education. Concomitantly, ineffectual self-advocacy and disability management skills and the aforementioned discontinuities in accommodation policies and practices exacerbate the likelihood that students with such disabilities who enter college will not graduate.

To address these concerns, the University of Illinois at Urbana-Champaign has provided comprehensive transitional and educational support services for students with disabilities for nearly six decades. The intent of these supports has always been to optimize the postsecondary educational participation, rate of graduation, and employment of persons with severe disabilities. The program, which currently serves approximately 1,000 students annually, provides individualized training to help students improve their ability to independently manage their disability-related needs. This report will: (1) describe the philosophical underpinning organizational structure and history of the Illinois Model from a general perspective, as well as the population specific perspective of students with severe physical disabilities and students with psychiatric disabilities; (2) describe the educational components of the Illinois program and the importance of these educational components in ameliorating the negative impact of severe disabilities upon their pursuit of a college education and access to gainful employment; and (3) describe the graduation and employment outcomes of students who have used these programs and services.

Illinois Model Overview

Philosophy

Today, the "accessibility" of educational services is most often discussed within the context of actions which educational agents/agencies must take to ensure that persons with disabilities are not afforded less of an opportunity to access and/or benefit from their educational resources, programs and services than those afforded to persons without disabilities. From this perspective, the practice of making programs, facilities and services accessible is frequently operationalized as the enactment of compulsory, minimum provisions that must be accorded to persons with disabilities to ensure compliance with national and state nondiscrimination laws. As a result, the process of making resources accessible too often reflects a legalistic overtone and conservative philosophy of "say no when we can, and yes when we have to." Furthermore, this legalistic approach to the facilitation of access is statutorily limited to those programs and services that are otherwise provided to students without disabilities. Thus, many of the unique educational needs of persons with disabilities can and frequently do go unaddressed.

For example, neither the Rehabilitation Act nor the Americans with Disabilities Act require that institutions of higher education accommodate the needs of students that are deemed to be of a "personal" nature, such as personal assistant support services. Fortunately, in many cases, students who need such services have developed effective skills and strategies to manage these needs on their own. However, for many others with the most severe physical disabilities this is not the case. The latter students are all-too-frequently not prepared at the time of high school graduation to effectively recruit, interview, hire and fire, train, schedule, pay, and evaluate individuals to assist them in the performance of such activities of daily living as transferring in and out of bed to a wheelchair, bathing, using the toilet, dressing, and eating, independent of familial assistance. As a result, college-based transitional support services are essential to ensure that these functional requirements continue to be effectively met while the students are away at college. In addition, educational services are needed to aid students in acquiring the knowledge, skills and experiences necessary for them to assume responsibility for the independent management of these needs prior to graduation. Without such support services, many students will simply not take the risk of leaving home to take advantage of their best educational opportunity, while others who do avail themselves of the opportunity to go away to college will fail to graduate due to problems related to their inability to coordinate these necessary services on their own.

Second, both the Rehabilitation Act and the Americans with Disabilities Act call for services to be provided in the most integrated setting possible. Therefore, in terms of housing services, distributing accessible rooms throughout the campus residence halls is generally considered an idyllic enactment of the law. For many if not most students with disabilities, including those with severe disabilities who possess the knowledge, skills, and self-confidence to effectively manage their activity of daily living support service needs, that would certainly be true. However, for institutions to safely, effectively and affordably provide the transitional residential support services noted earlier in order to assist students who are not yet ready to independently manage their personal assistant support service needs, a more centralized approach is operationally essential. The clustering of rooms to accommodate this population subset allows institutions to minimize the cost of securing and maintaining adequate personal assistant support service personnel, and enables them to ensure the availability of back up personal assistant support service personnel. Based on the self-reported experiences of former and current Illinois students with disabilities who resided at Beckwith Hall, the University's transitional residence hall for students who require assistance in the coordination and management of personal assistant support services, the centralized approach is programmatically beneficial as well. Indeed, decades of former Beckwith Hall residents report with great regularity that Beckwith afforded them an unprecedented opportunity to have ready and prolonged access to successful, relevant peers with disabilities from whom they could learn coping strategies and collaboratively engage in disability management problem solving related to common issues and concerns. As a result of mainstreaming and/or inclusion in the K-12 arena, such opportunities have typically been reduced to more ephemeral week long summer camp experiences. Residents also overwhelmingly report that they greatly appreciated the fact that Beckwith afforded them a unique social context in which they were the norm rather than the outlier. Their description of this benefit is not unlike that reported by students of racial/ethnic minorities regarding the benefits of minority cultural centers.

Clearly, institutions can robustly meet the legal standards set forth under the Rehabilitation Act and the ADA without enacting programs to facilitate the needs of students who are ill prepared to coordinate their personal assistant support service personnel. Similarly, although the provision of accessible rooms that are distributed throughout campus residence halls would represent the quintessence of ADA enactment, the absence of accessible room clusters would also fail to result in a housing model that would meet the aforementioned needs of many students with the most severe physical disabilities.

Similarly, persons with psychiatric disabilities need extensive supports to be able to complete their post-secondary education, however, most college mental health services are set up to provide only short-term therapy/interventions. These students need specific interventions that include long-term individual therapy, help with medication, coaching, and accommodations to help them complete their degrees. In addition, many students are admitted to college with undiagnosed cognitive and psychiatric disabilities, and if those remain undiagnosed, the students are frequently lost to postsecondary education through attrition. Providing neuropsychological testing to these students experiencing significant academic difficulties represents another service borne of student need, rather than compliance with the law.

Finally, adapted physical activity and health and wellness programming represent another area of programming for which there is great need, which has received minimal support from the legalistic model of disability support services. Persons with disabilities, according to the Surgeon General, are at elevated risk of a plethora of diseases and problematic health conditions secondary to their disabilities. Given the importance of sports in our society and its visibility and stature within the higher education community, one could easily surmise that adapted sports would be an excellent means by which to address these problems of hypokinetic lifestyles by students with disabilities. In recognizing this need, and the relevance and capacity of sport to serve as a means of improving the health and fitness of students and promoting lifelong physical activity, Illinois has offered recreational and varsity adapted sports programming for students with disabilities for nearly six decades. Longitudinal studies have demonstrated that the most significant predictor of physical activity later in life by Illinois graduates with disabilities was whether or not they participated in DRES's adapted sport programs. Although it is not clear whether egalitarian support of adapted sport and recreational programming is required under Section 504 and the ADA, it is very clear that such programming has great value in addressing the needs of students and improving their quality of life for decades.

The point of the aforementioned examples is to highlight the importance and the benefits of focusing on the disability-related needs of students rather than myopically attending to the fulfillment of the minimum standards of federal and state nondiscrimination laws. The goal of the higher education community must be to identify the barriers to the full participation of students with disabilities in higher education and, subsequently, to take steps to promote their elimination or abatement. This will on occasion require that higher education institutions consider the development of supports that address needs that are unique to the population of students with disabilities. It must not be forgotten that most of the programs and supports that exist were developed on the basis of programmatic assumptions that did not originally take disability into consideration. Therefore, simply endeavoring to avoid discriminatory practices related to such services will too frequently prove to be insufficient to accommodate true access and to make postsecondary education success possible for students with disabilities. This sentiment is reinforced by MacDonald and Stratta (2001) and Sanderson (2001) who noted that higher education institutions needed to go beyond more simple access in supporting the postsecondary matriculation, retention, and graduation of students with disabilities.

The Illinois model of postsecondary educational supports for students with disabilities, which began in 1948, had the unique fortune of having been conceived and implemented prior to the introduction of federal nondiscrimination laws, which while ensuring the provision of a minimum level of opportunity and access, can also serve to artificially limit the vision of what could and should be done. In contrast, the Illinois approach has evolved as a "need-based" model of postsecondary disability support services and, as a result, the "best practice" recommendations offered herein are borne of that philosophy rather than statutory requirements. Therefore, they will both reflect and reinforce an accommodation philosophy of "say yes when we can, and no only when we must."

Organizational Structure

Since its inception, the Division of Disability Resources and Educational Services (DRES) has been located within a college whose focus was on "health." Although this model was initially developed as an outcropping of the medical model of disability, this unique nesting within an academic college serves to reinforce the adoption of a scholarly approach to the provision of educational supports for students with disabilities. As a result, program evaluation is an inextricable component of the programmatic offerings, and decades of student outcome data are available to support the ongoing analysis of the efficacy of ongoing and new services and supports in promoting the unit's mission of ensuring that qualified individuals with disabilities are afforded an equal opportunity to participate in and benefit from the curricular, co-curricular, and vocational opportunities available at the University of Illinois through the collaborative promotion, provision, and/or pursuit of innovative accommodative and educational services and interdisciplinary disability research. Current, efforts by DRES to develop best practices and author administrative tools that support the development of robustly accessible web and electronic media and the three-year project to develop and evaluate a disability metrics model for all community colleges and baccalaureate institutions in Illinois offer exemplars of how this scholarly approach to disability supports is being manifested in the current activities of the unit.

At present, the Division of Disability Resources and Educational Services in the College of Applied Health Sciences annually provides nearly 1,000 students with a comprehensive range of services to enhance optimal access to both the academic and co-curricular programs and resources. Through these comprehensive and interdisciplinary programs and services, DRES's multidisciplinary program model promotes the acquisition of knowledge, aptitude, and skills within a broad range of life areas necessary to maximize the capacity to live independently. In the ensuing sections of this paper, the programmatic components of this approach that exceed the minimal standards will be described in greater detail.

Educational Components

Transitional Supports

Advances in assessment, instructional strategies, and the provision of academic accommodations have made it possible for many more young people with disabilities, including individuals with severe disabilities, to access, participate in, and ultimately benefit from higher education. However, students with disabilities continue to participate in postsecondary education at a significantly lower rate than their peers without disabilities (National Council on Disability, 2003), and this disparity is due to many factors. For example, secondary school students with disabilities continue to be inadequately prepared with regard to the coursework that is required for college entry (National Center for the Study of Postsecondary Educational Supports, 2002). Those who are able to gain entry to college often lack effective self-advocacy skills to move from the entitlement milieu of secondary supports under the IDEA to the "nondiscrimination" context of higher education supports under the Rehabilitation Act and the ADA (Brinckerhoff, 1994; Izzo, Hertzfeld & Aaron, 2001; Stodden, Whelley, Chang, & Harding, 2001). Subsequently, they are frequently ill prepared to inform school officials of their disabilities and/or to communicate their needs for accommodations (Brinckerhoff, 1994; Gordon & Keiser, 1998; Hitchings, et al, 2001; Izzo, Hertzfeld, & Aaron, 2001). In addition, they often lack good study and time management skills, and do not have sufficient knowledge and skills related to the management of their own disability-related needs to be self-determined managers of those needs independent of familial support (Getzel, Stodden, & Briel, 2001). Obviously, each of these deficiencies represents a critical area of knowledge and skill that students with disabilities need in order to gain access to and/or to succeed in postsecondary education. Even many high-achieving students with disabilities are frequently observed to lack these essential skills, and their lack of readiness only serves to exacerbate the anxiety and transitional difficulties experienced by all students.

For example, it is a natural parental inclination to endeavor to "kick all rocks from the paths of their children," and this can frequently be seen in the inadequate preparation of students with severe physical disabilities to self-manage their personal assistant support service needs. Parents and siblings typically provide these services right up to the time of college enrollment, thereby affording the students little or no opportunity to transition to a self-management model that is not dependent upon familial support. Returning for a moment to the "rock kicking" metaphor, it is developmentally necessary for children to learn how to remove or circumvent the rocks in their own paths to the greatest extent possible, and that includes youth with disabilities. Waiting until students arrive for the beginning of class puts students in the precarious position of having to make significant disability management adjustments while concurrently adapting to the greater rigor of the college classroom and the increased independence of the first year of college. The latter scenario puts these students at great risk of being unsuccessful.

The aforementioned example illustrates why transition planning is considered such an important component in the Illinois model, whether it is transition from secondary to postsecondary education or transition from postsecondary to employment. Some practices that have been introduced to facilitate transitional success include credit course enrollment in individualized IT/AT training courses, self advocacy training workshops related to disclosure and accommodation requests, credit courses in kinesiology which introduce students to physical activity options, a wide range of adapted sport and recreational activities, dietary assessment and counseling, and career workshops and counseling.

To facilitate the successful entry of freshmen with disabilities, Illinois recently developed a summer transition program to focus on these issues. The intent of the Illinois Students Taking Effective Preparation (ISTEP) program is to improve student readiness and preparation by providing targeted training prior to the beginning of the academic semester. ISTEP is a transition program open to any student with a disability who has been admitted to Illinois. It is composed of an online educational course and a one-day campus visit during the summer prior to entering college. The students are subsequently invited to participate in seminars and follow-up activities throughout their tenure at Illinois. To promote their enrollment in and completion of the ISTEP curriculum, students are given course credit for their participation in the initial online course and the on-campus portion of the ISTEP curriculum.

Prior to attending the on-campus ISTEP orientation, students visit an online website where they receive educational information and complete exercises on such topics as rights and responsibilities of students with disabilities in higher education in comparison to secondary education, understanding and applying their learning strengths and weaknesses and learning styles, campus support service resources and procedures, self-advocacy, time and stress management, and personal assistant service management when applicable. This minimizes the need for on-site time to be devoted to general information and allows the ISTEP instructors to focus their face-to-face time on practical applications of this knowledge.

During the on-site program, DRES personnel get to know the individual students and their families, work with students individually to ensure that each has a clear understanding of his/her learning strengths and weaknesses, work collaboratively with the students in planning their classroom accommodations, and introduce role-playing sessions in which the students rehearse disclosing their disability to their instructors and requesting their accommodations. They are also afforded the opportunity to rehearse their responses to questions and/or situations that could arise during their instructor meetings to help them become comfortable with their ability to effectively respond to the widest range of instructor scenarios possible.

Students discuss their assistive technology and computer needs relative to their knowledge and skills, so they may ascertain areas in which they could use additional training or assistance and identify strategies for acquiring the training or assistance. The students discuss learning/studying strategies, as well as time management practices and skills relative to the typical college workload, and identify changes that may be required to accommodate their successful adjustment to the rigors of college life. One of the highlights of ISTEP includes a lunch program in which current DRES students participate in a panel discussion and answer questions regarding academic and social aspects of Illinois, including strategies that they have used to effectively manage their disability-related needs. It is informative for the incoming students to interact with current students who have already been through the transition process.

As is the case for many of DRES' pilot programs, seed funding was needed to support the development and pilot testing of ISTEP. Funding for ISTEP was obtained through a three-year grant from the Procter and Gamble Foundation. The three-year timeframe of the grant allowed DRES to collect outcome data to determine the impact of the program and to institutionalize a budget for its ongoing support.

Outcome data have been collected at the end of each year's ISTEP program. As part of the evaluation of ISTEP, pre- and post-test questionnaire data was collected from the participants. They were given a questionnaire that looked at their perceived competence of skills. The results indicated that the students' post-test perceived competency scores were significantly greater than their pre-test scores. This provides evidence that the students who participated in ISTEP perceived themselves to be more competent overall than before they were exposed to the material. DRES is continuing to obtain longitudinal data on GPA, retention, and employment of the students who attend ISTEP to monitor the program's effectiveness in promoting college success.

Career Preparation Supports

Collaborative Career Services Programming. Due to a dearth of work experiences, many students with disabilities do not know what type of career they would like to pursue, have inadequate general work-related knowledge and skills (e.g. timeliness, dressing appropriately for interviews, writing a resume), and do not know how or when to disclose disability information to prospective employers. In response, DRES has worked with the Illinois Career Services Center and the Career Services Network to help educate career advisors on matters related to disability, and to enhance their ability to effectively provide career advising, interest inventories, resume/interview workshops, internship recruitment, and employer recruitment supports to students with disabilities.

Operationally, a staff liaison from DRES is represented on the Career Center Council to ensure that they are aware of the career needs and issues of students with disabilities, and are prepared to address them. The liaison is included on the listserv for Career Center-sponsored events and recruitment opportunities so that the students at DRES can be notified via DRES' website and listserv.

The DRES liaison helps to keep Career Services Center personnel up-to-date with regard to the employment issues and concerns of students with disabilities, and provides in-service training to ensure that their personnel are sensitive to the needs of students with disabilities attempting to access and utilize their services. For example, through this interaction the Career Services Center learned that the considerable distance between DRES and the Career Center was a formidable barrier for many students with disabilities. In response, the Career Center worked with DRES to develop one of eight "career corners" within the physical space of DRES. The DRES career corner is more proximal and, thus, makes career services resources that provide a wealth of information related to internships, recruitment visits, job-seeking skills, and other employment information more accessible to students served by DRES. For example, Career Center personnel schedule weekly two-hour sessions at the DRES Career Corner where they assist individual students with disabilities in developing and refining their resumes. Additionally, the Career Center and DRES co-sponsor events throughout the year in which student panelists speak to Illinois students, faculty, and staff with and without disabilities regarding internships and the disclosure of disability to prospective employers.

DRES also endeavors to support the successful transitioning of students with disabilities to careers by continually communicating information about employment and internship opportunities to students via the DRES listserv, and collaborating with employers who are targeting students with disabilities in their campus recruitment campaigns. At present, DRES works collaboratively with a growing list of public and private employers that includes IBM, NASA, Procter & Gamble, Motorola, Entry Point, and the AAAS Workforce Recruitment Program. These services help to ensure that students with disabilities are optimally targeted for prime internship and employment opportunities. Internships, particularly those that occur away from home, are emphasized because they offer students an invaluable opportunity to test and refine their strategies for living and working more independently.

DRES is also continually seeking ways of improving upon existing relationships with such prospective employers as Procter & Gamble (P&G), the Workforce Recruitment Program, Entry Point, and NASA. With regard to P&G, efforts to increase attendance at recruitment information sessions increased attendance from an average of eight to 33 DRES registered students. Also, new collaborative recruitment programs have been developed with Motorola and SPR, a midwestern information technology service firm. More recently, DRES has targeted students in science, technology, engineering, and mathematics (STEM) fields as co-project investigators on the Midwest Alliance, a project funded by the National Science Foundation, to increase the number of students with disabilities in STEM fields.

Collaborative Study Abroad (SA) Programming. With the increasing globalization of work and, concomitantly, work opportunities, it has become increasingly important that all students, including those with disabilities, have effective access to co-curricular study abroad experiences. As a result, increasing numbers of students with disabilities are seeking study opportunities abroad. In response, the Division has worked with the Illinois Study Abroad Office to address disability-related policy issues and concerns related to study abroad policies, procedures and resources. Illinois has a long history in supporting the participation of students with disabilities in SA. For example, students with physical disabilities participated in what is believed to be the first ever, international study abroad experience with France in 1968, and many Illinois students with disabilities have continued over the years to participate in similar study abroad programs.

Operationally, to facilitate ongoing and effective interaction with SA, one DRES staff member has been designated as the SA liaison. This affords the SA Office and DRES registered students a common DRES contact with whom to discuss disability-related study abroad opportunities and needs. The SA liaison helps students think about issues such as accessibility, accommodations, medical needs, etc. to facilitate the selection of the best possible SA location, and to help ensure that these needs are addressed prior to the trip. The SA liaison also serves as a DRES contact in the event that difficulties arise while they are abroad. DRES also assists the Study Abroad Office in communicating with DRES registered students in a timely manner regarding study abroad events and opportunities via the DRES listserv.

To help students evaluate and select possible study abroad programs, DRES provides a checklist of things that students with disabilities need to consider in selecting a study abroad site. Additionally, the Study Abroad Office has an accessibility audit process that it uses to objectively assess the accessibility of international sites, and the latter data are made available to students for use in evaluating possible study abroad sites. Scholarships are also available through DRES which students with disabilities can apply for to offset a portion of their expenses associated with their participation in a study abroad program.

Information and Assistive Technology Supports

Information Technology (IT) Accessibility Issues

It has rapidly become an indisputable reality that literacy in the use of emergent information technology will be a ubiquitous and inextricably essential knowledge/skill set in all 21st century societal endeavors. Email, web usage, electronic document development and dissemination, chat room interactions, and online processes are omnipresent and continue to grow at an exponential rate. In many respects, this has the potential of being a very beneficial trend for persons with disabilities due to the innate capacity of such technologies to compensate for the functional limitations of a wide range of disabling impairments. Students with limited upper extremity strength, dexterity, and/or coordination can use voice input technologies to effectively perform office tasks that previously relied upon the physical assets that they lacked, and electronic media and speech output technologies afford persons who are blind or who have significant visual language processing deficits to effectively access, synthesize, and utilize information.

Therefore, if institutions of higher education are to help students minimize the intrusive impact of the functional limitations of their respective impairments upon learning, and optimize their access to educational and vocational opportunities upon graduation, it is essential that they afford students with disabilities access to state-of-the-art IT and assistive technologies (AT) that can be used to increase, maintain, or improve their functional capabilities, and offer sufficient ongoing training to maximize their effective use of those technologies.

Programmatically, DRES endeavors to achieve the aforementioned goal by assessing every student's needs and capabilities relative to their computational input, navigation, utilization and output requirements; providing training to enhance their knowledge and skills in the use of essential IT/AT; facilitating the integration of technology in all essential tasks which are limited by disability; and advocating for and supporting the use of accessible design in IT resources by campus information technology providers.

Direct IT/AT Services to Individuals with Disabilities

IT/AT Assessment Services. DRES works with students with disabilities to identify how their functional limitations preclude their access to electronic resources of the campus. Many students are already proficiently using assistive technologies and may require only supplementary training on using the assistive technology or training on the features of software or web resources to enhance their access with the AT. Other students may not be using AT and need to evaluate AT for enhancing their capabilities and independence. DRES personnel work with students and provide training to help students identify and learn how to use AT to maximize their learning potential and independence.

IT/AT Training Services. Information and assistive technology training is provided for a wide range of populations and via a widening array of formats including transitional preparation, individualized IT/AT assessment and tutorial assistance, and through a credit course on the selection and use of individualized assistive technology. Regarding the improvement of transitional preparation in the use of IT/AT, DRES developed summer technology camps in collaboration with the Illinois Division of Rehabilitation Services and the Illinois Bureau of Blind Services to improve the likelihood of students with severe mobility disabilities or blindness to successfully matriculate to college. The overarching goal of these camps is to diminish the risk of students with severe mobility disabilities and/or blindness not matriculating to postsecondary education due to their very limited exposure to essential information and AT by offering them week-long summer residential camps focused on improving their knowledge and use of critical IT/AT. A highly specialized curriculum was created for both camp populations, which incorporated the use of Illinois students and recent alumni with excellent technology skills and expertise to work alongside of and consult with the high school student participants. Illinois senior engineering students were also involved in the design and development of specialized technologies for use in the camp curricula. This residential summer program instructed nearly 60 high school youth with severe disabilities during the course of the three-year pilot, with four students successfully enrolling at the University of Illinois.

Additionally, all incoming students who participate in ISTEP also undergo an IT/AT assessment, and prescriptive and consultative support to optimize their knowledge and skills in the effective utilization of information technology. Students can also enroll in a one hour per week course for academic credit to improve their knowledge, understanding, and skills in the use of IT and AT applicable to their needs and interests.

Promoting Essential Function Use of IT/AT. In endeavoring to maximize utilization of technology to perform essential functions, several practice initiatives warrant special note. First, DRES developed a secure website to provide web-based services to students with disabilities. The secure web service provides online applications for services, online scheduling tool for test accommodations, online electronic text database and portal, and a DRES staff login page where departmental communiqués can be posted for efficient distribution and access.

The online registration form has enhanced the efficiency with which DRES can process applications for service and has eliminated the need for students to physically visit DRES to obtain and/or submit application information. In addition to reinforcing their use of these essential new technologies, the deployment of an online registration process makes this a simpler and less intrusive process for students and thereby serves to lessen the frequency with which students suffer academic harm due to time and distance driven delays in registering for disability support services. Similarly, the online test scheduling tool automates the process whereby students identify the dates and times of course exams for which accommodations will be needed and the process of obtaining faculty approval for test conditions and accommodations. The latter has greatly reduced the need for DRES personnel to be involved in soliciting student exam information and instructor approval, thereby allowing the staff to focus on the management of onsite logistics and proctoring.

Information technology has also been used to significantly improve the timeliness and quality with which students with disabilities are afforded access to course content. For the last nine years, the Division has relied almost exclusively upon technology-based services to accommodate access to print-based educational media by students with vision disabilities and/or severely impaired upper extremity strength, stamina, and/or coordination. This action was taken to minimize reliance upon surrogate aides and readers that limit independence and are unlikely to generalize to the employment setting, while maximizing familiarity and skill in the use of state-of-the-art scanning and multimodal output technologies. The DRES Text Conversion Office scans all print-based curricular media into a computer, converts the scanned content to text, and edits and saves the content as electronic files on an encrypted, secure server supported by DRES. Students can access the files of their curricular content from any network-connected computer via a web interface, using a secure university network login protocol.

In each of the aforementioned situations, the Division has taken steps to reinforce student knowledge and skills in the use of IT and AT to perform routine daily tasks. Interestingly however, reliance upon the use of such accessible, state-of-the-art technologies in the accommodation of students has also served to improve the efficiency with which accommodations can be processed and implemented. For example, the improved efficiency of the online test scheduling system has allowed DRES to expand the duties of the test coordinator to provide hands-on instruction and problem solving consultation for students with verbal learning disabilities in the use of computer reading and voice output systems, which will allow them to compensate for deficiencies in reading speed and/or accuracy. Similarly, DRES's investment in state-of-the-art text conversion equipment and software has nearly eliminated the need for less effective and less efficient volunteer readers, while significantly increasing the unit's ability to meet the needs of an ever increasing number of students needing course materials in accessible, alternative formats. For example, over the past three years the number of pages that required reproduction in one of five accessible formats increased 79% from over 78,000 pages to more than 140,000 pages. However, the time required to produce these pages actually went down slightly from 2,413 hours to 2,391 hours. Thus, by relying on the use of state-of-the-art information technologies to accommodate this need, more students with disabilities were afforded timelier, better formatted, and more accurate renderings of curricular content.

Providing Accessible Computing Environments. The ability to independently access, manage, create, and share information electronically constitutes a set of literacy skills that will be required of all who are to be fully engaged participants in the age of information. Therefore, given the inaccessibility of increasingly ubiquitous computer-based software applications and web-based resources in all areas of endeavor, the promotion of IT accessibility has become a priority initiative for DRES.

In 1996, in recognition of the rapidity with which IT was becoming increasingly interwoven into the academic curricula and campus services, DRES hired an engineer with expertise in augmentative and assistive communication and IT, to coordinate IT services for Illinois students and to promote the pervasive application of universal design throughout Illinois IT systems and resources. As a result, DRES was able to design and implement a multi-tiered, decentralized IT model in which accessible computer workstations are available in Campus Information Technologies and Educational Services (CITES) and Applied Technologies for Learning in the Arts and Sciences (ATLAS) supported instructional computer labs as well as undergraduate and graduate libraries. Compared to many campuses where students must go to a specific laboratory to access AT, this model makes it possible for Illinois students to access AT at the most popular computer labs on campus. In addition, the model includes four strategically placed campus computer laboratories with additional reading systems that include closed-captioned televisions, scanners, optical character recognition software, screen readers, speech output and real-time Braille displays. The intent of this action was again to reinforce the use of IT/AT by students with disabilities whenever and wherever it was needed, and to accommodate the inclusion of students with disabilities in peer study groups and projects within the laboratories of their choice. For more specific information on Illinois computer lab accessibility best practices, please see: .

Improving the Accessibility of IT Resources

Accessibility Training. DRES is endeavoring to enhance website developer knowledge of access needs and solutions by developing training materials, workshops, courses, and tools to help web developers improve the accessibility of campus web resources. REHAB 711 - Designing Universally Accessible Web Resources, is offered online and is designed to teach web content developers about the disability access issues faced by people with disabilities in using the web, and how to use web standards to improve the accessibility of web resources for everyone, including people with disabilities. Library and Information Science 490 - Designing Universally Accessible WWW Resources, is taught on campus as an academic credit course. This course introduces students to the concepts and practices of designing accessible web-based resources. Students do projects during the course to enhance the accessibility of IT. In addition to these formal courses, a number of workshops and online "webinars" have been developed to help people learn about IT accessibility and develop skills in creating accessible administrative and instructional materials.

Web Resources

Web Accessibility Best Practices. More recently, DRES, in cooperation with the College of Applied Health Sciences and the Office of the Chief Information Officer, implemented a centralized IT accessibility program. The CITES/DRES partnership, as it has come to be known, has sought to improve the accessibility of curricular and administrative content and electronic communications by:

To date, the CITES/DRES partnership has developed a web accessibility best practices document to provide a design resource for developers on the markup needed to create web resources on the Illinois campus that would comply with Section 508 and W3C Web Content Accessibility Guidelines 1.0. The document is designed to provide web resource developers with principles and techniques that they can use to integrate accessible graphical styling and automation into their web designs. By incorporating web standards that allow web resources to adapt to the need of people with disabilities, they will also adapt to the capabilities of a wide range of pervasive and desktop web technologies. The best practices techniques also foster forward-looking web design to ensure web resources are not only compatible with current and legacy web browser technology, but that they will also be usable in emerging and future web technologies. The goal of the best practices is to embody not only good accessible web design, but also good web design for everyone, including people with disabilities. In so doing, the accessibility and usability of curricular content will be improved for all students.

Web Resources

Evaluating Functional Web Accessibility. Concurrent with the development of the aforementioned best practices, the CITES/DRES partnership has developed an initial version of the Functional Accessibility Evaluator (FAE). This tool provides a mechanism for efficiently tracking the use of best practices. FAE is a web-based tool that assesses web accessibility from a design and functional standpoint. FAE looks for the use of accessible markup to support navigation, text equivalents, automation, styling, and use of web standards. FAE, which is available at the website below, is a free web service to anyone who would like to use the tool to evaluate the accessibility of web resources. The intent of this initiative is to improve the accessibility of web content by improving the comprehensiveness of the tools used to assess web content accessibility and by making the evaluative output of the process more intuitively understandable and usable to web developers and resource administrators.

Web Resources

Supporting Instructors in Creating Accessible Instructional Materials. Microsoft Office software for Windows is the dominant authoring tool used to create instructional materials, and increasingly these materials are being published to the web for use by students. The built-in Microsoft Office web publishing features have limited support for accessibility and require extensive author knowledge and training to use the limited features to marginally improve the accessibility of web versions. In response to this problem, DRES created the Illinois Accessible Web Publishing Wizard for Microsoft Office to provide a simple way for instructors to create highly accessible web versions of Microsoft Office documents without necessitating that instructors possess content knowledge or expertise regarding either web technologies or web accessibility techniques. Free online "webinar" training is available to help instructors and other users learn how to maximize accessibility of their resources using the wizard.

Web Resources

Collaboration on IT Accessibility. Many of the web resources needed and used by students in higher education include web applications for managing courses and institutional materials (i.e. WebCT, Blackboard, Desire2Learn, Angle, Sakai), web-based email, wikis, and administrative systems for managing registration, financial aid, academic progress toward a degree, and many other types of information. Most of these systems are purchased from third party vendors and, therefore, institutions do not have direct control over the accessibility of these resources. In this situation, third party solutions are needed which prioritize and implement necessary changes, and such solutions require inter-institutional collaborations to leverage their collective capacity to bring about systemic product design changes that promote usability by persons with and without disabilities. Collaborations bring people from several institutions together to identify accessibility problems, solution strategies, and to help foster a culture of accessible design within third party solution developers. DRES is presently involved in a number of these collaborative inter-institutional efforts, and more information regarding these is available at <>.

Specialized Supports for Students With Severe Physical Disabilities

Overview

In 1948, the University of Illinois became the first postsecondary institution in the nation to make its facilities, programs, and services accessible to students who used wheelchairs. Over the ensuing decades, Illinois achieved a number of programmatic firsts related to its services and supports for students with severe physical disabilities, including:

With a history of making the campus accessible to persons who use wheelchairs that spans nearly six decades and the unique services and supports that have been developed, the campus today continues to consistently enroll 60-80 DRES registered students in any given year who use manual or power wheelchairs. This number does not include the inestimable number of students who use wheelchairs and do not register with the Division because the campus is sufficiently accessible to meet their needs without further interdiction or support. Furthermore, although a causal connection with these numerous innovations cannot be inferred, the outcomes of Illinois students with severe physical disabilities have been quite impressive. For example, a recent study of Illinois alumni with spinal cord injuries who graduated between 1978 and 2002, found that 79% of the alumni with paraplegia and 70% of those with tetraplegia were employed at the time of the study, and over 92% had been employed within the past five years (Hedrick, Pape, Heinemann, Ruddel, & Reis, 2006). Similarly, 87% of all Beckwith Hall residents with disabilities from 1981 to 2004 who required personal assistant support services to perform activities of daily living have earned degrees (Gallagher & Hedrick, 2004). Sixty percent of all graduates between 1995 and 2003 who needed personal assistant support services and who resided at Beckwith Hall for one or more semesters obtained employment within a year of graduation, and an additional 30% enrolled in graduate or professional schools upon earning their baccalaureate degrees (Gallagher & Hedrick, 2004). In contrast, according to the National Spinal Cord Injury Network, 32.4% of persons with paraplegia and 24.2% of persons with tetraplegia are employed ten years following the onset of their injury ().

Specialized Transitional Residential Supports

Need

On the basis of data derived from the 1990-91 Survey of Income and Program Participation, Kennedy, LaPlante and Kaye (1997) reported that there were 1,431,000 persons between the ages of 15 and 65 who needed help to perform one or more activities of daily living (ADL), and that such individuals were substantially more likely to be unemployed than their cohorts with less severe or no impairments. According to Kaye (2003), people with disabilities who report being unable to work is nearly ten times as likely as the rest of the population of persons with disabilities to report the need for assistance in the performance of such as bathing, transferring, toileting, dressing, and eating.

Concomitantly, Kennedy, LaPlante, and Kaye estimated that the population of individuals needing assistance in the performance or one or more ADL included 90,000 high school and college-aged individuals with disabilities (15 to 24 years of age). The latter group of young people is at great risk of experiencing significantly lower educational achievement and decades of unemployment as individuals with substantially limiting physical impairments (NOD/Harris, 2004).

For many such students with disabilities who require assistance in the performance of ADL, the challenges associated with the management of their personal assistance needs without familial help and while concurrently endeavoring to pursue a college education are simply too great, and they elect not to attend, or enroll at a school that is near to their home and familial supports. Unfortunately, this severely limits their educational options and reinforces reliance upon family members for activity of daily living supports, which in turn limits their knowledge, skills, and motivation to seek and accept the best employment option without regard to its proximity to home.

Conversely, those students who do matriculate to an institution away from home all too frequently find themselves poorly prepared for the rigors of college life and the freedom of a less structured social context while endeavoring to learn how to independently manage their disability-related needs for the first time on their own. For nearly half of a century Illinois has recognized this need, and sought to provide transitional supports to eliminate or significantly ameliorate these barriers to postsecondary educational opportunity and success.

History

In 1959, disability support services personnel at Illinois sought to create a means by which students with quadriplegia who needed activity of daily living assistance could move away from home, reside in the Champaign-Urbana community, attend the University of Illinois, and become better prepared to manage their disability-related needs and move to the locale of the best available employment opportunity after graduation. As a result of that effort, a unique residential program was created between DRES and the Greenbrier Nursing Home of Champaign (personal communication with Professor Emeritus Timothy J. Nugent, October 27, 2006). The students were able to receive the activity of daily living assistance they required from the Greenbrier staff, and, thus, were able to attend classes. In addition, a host of educational services and supports were provided through DRES that were designed to help students with disabilities acquire the knowledge and skills necessary to manage their own personal assistance (PA) needs and facilitate their movement to less restrictive campus or community housing.

Two years later, in 1961, a private home located on campus about three blocks from DRES was modified and dedicated to serve as a transitional residence for students needing activity of daily living support services. Tanbrier, as the facility came to be known, provided space to accommodate six to eight students with disabilities and a comparable number of live-in personal assistants. Finally, in 1981, Beckwith Hall was opened and a new era in transitional residential support services was born. Since then, Beckwith has served as the primary residence of more than 125 students requiring PA support services.

Beckwith Hall Programs & Services Overview

Background. As noted earlier, Illinois' current transitional residential support services have been housed within Beckwith Hall since 1981. Beckwith Hall is a unique University-owned and operated residence hall that offers transitional postsecondary disability resources, training, and services to support the matriculation, retention, graduation, and employment of students who require assistance in the performance of activities of daily living. The facility, which was in the planning stage three years before the enactment of regulations for the Rehabilitation Act, can accommodate up to 22 students who necessitate such assistance and eight to twelve live-in personal assistants who are also University of Illinois students. A centralized, single facility approach rather than a multi-facility, decentralized strategy was necessary in the late 1970s because the communal showers and bathroom facilities of mainstream residence halls built in the 1950s and 1960s were ill-suited for students necessitating the aid of PAs of either gender. In additional, there were other more basic operational issues that made a centralized approach a necessity.

The foremost operational issue requiring the use of a centralized residence hall was that it would have been very difficult, if not impossible, to sustain sufficient back-up PA personnel to effectively respond every time a scheduled PA failed to show up or to effectively perform the required tasks. Furthermore, even if it could be operationally accomplished, the cost of ensuring 24/7 personal assistant service would have been prohibitively expensive compared to a single site like Beckwith where very few back-up PAs are needed to effectively provide such services for 22 students.

Current Demographics. Historically, the Illinois transitional residential program has predominantly served male students with quadriplegia secondary to a traumatic cervical spine injury. However, over the last decade the demographics of Beckwith residents have shifted significantly. For instance, in the 2006-07 academic year, 44% of Beckwith student residents are women and 56% are men. Of the 18 residents, 17 used power wheelchairs. Seventy-eight percent of the residents have congenital disabilities, such as cerebral palsy or muscular dystrophy, while only 22% have disabilities resulting from traumatic injuries such as spinal cord injury or brain injury. Undergraduates comprise 83% of Beckwith students.

Mission. The mission of Beckwith Hall is to provide housing, PA, and support services to residents with disabilities that facilitate their attainment of their personal and educational goals and help them to optimize their ability to effectively manage their own disability-related needs. The model reflects the independent living philosophy wherein people with disabilities are afforded the right and opportunity to control and direct their own lives and to participate actively in society. To control and direct one's life means making cultural and lifestyle choices among options that minimize reliance on others in decision making and in performance of everyday activities, limited only in the same ways that people without disabilities are limited. It means exercising the greatest possible degree of choice about where you live, with whom you live, how to live, and how to use time. This includes taking risks and having the right to succeed or fail. It also includes taking responsibility for one's own decisions and actions.

The two most important goals of Beckwith Hall are to provide effective PA support services as well as educational programming that serve to improve each student's knowledge and competence in the self-management of his/her disability-related needs, as defined by the student. Although students with disabilities may opt not to participate in the program's individualized disability management training, students who require activity of daily living assistance and who presently lack the knowledge, skills, and/or experience-based confidence to manage those needs independently are the top priority for residency, followed by students without disabilities who assist in the delivery of activity of daily living support services, and all other Illinois students upon request.

Again, in keeping with the tenets of independent living, the Beckwith model is a collaborative, community-based one in which students actively participate in the planning, organization, implementation, and evaluation of Beckwith programming and support services. However, the model also recognizes that early in the student's career, greater responsibility must be borne by the Beckwith staff, due to the students' inexperience in managing their disability and medical needs independent of familial assistance. The goal is to incrementally transfer the responsibility to students over the course of their enrollment. For example, during the new student orientation, Beckwith residents are introduced to McKinley Health Center facilities and personnel as well as to local community clinics and hospitals. They are informed how to schedule appointments and with whom, and are subsequently responsible for scheduling their medical appointments. However, to ensure the health of residents who are transitioning to Illinois, follow-up is performed by a McKinley nurse onsite at Beckwith for chronic or severe conditions that have been diagnosed and are being treated by McKinley health services personnel. This is done to ensure that students do not unintentionally neglect their health and compromise their ability to pursue their academic work because of their inexperience in independently managing such needs. As they gain knowledge and proficiency in the management of their treatment needs, this service is gradually withdrawn.

Beckwith Hall programs and services were created to serve as a bridge for these students. As such, the program endeavors to improve the self-determination of students in a three-phased transitional approach. The first phase of the Beckwith transition program focuses on helping students successfully transition to the daily rigors of life as a University of Illinois student. The second phase focuses on the provision of educational programming to promote the transition of residents to a more self-regulated context, such as other university or private housing, prior to graduation. The focus of the final phase is to help students learn to live as independently, enjoyably, and productively as possible with their disabilities after earning their degrees. Thus, the focus of the third phase is to afford students sufficient opportunities to successfully apply their newly acquired acumen and ability in the management of their personal disability needs to give them the confidence to seek and accept the best available employment opportunity, regardless of its location, assured of the fact that they can manage their own needs.

Orientation services and supports. From its inception, DRES has offered a summer orientation program to help ensure that incoming students with disabilities are sufficiently well prepared in the management of their disability-related needs so they may focus on their academic goals and interests. In the 1940s, medical rehabilitation assumed that persons with severe physical disabilities were incapable of being active and would necessarily be highly dependent. As a result, in the earliest years of the program, the orientation program provided instruction and training to accommodate their independent performance of a wide variety of activities of daily living. Students were taught how to transfer in and out of their beds to and from their wheelchairs, how to dress, bathe, groom themselves, and care for their hygienic needs. Beckwith administrative staff continues to support residents by teaching skills leading to increased independence, as well as identifying necessary assistive technology. Recently, Beckwith-specific ISTEP modules have been developed to transition residents from living at home to living within a congregate living environment. These modules include topics related to PA management, living in a residence hall, wellness, and personal responsibility.

In addition to the orientation and transitional programming provided via the ISTEP summer program, students who required assistance in the performance of ADL and who will be residing at Beckwith Hall are offered a number of other preparatory orientation programs.

Prior to arrival, all applicants are required to visit Beckwith to discuss with the administrative staff their PA support service needs and how they presently manage those needs. For overseas international students, a videotape of the student discussing his or her needs is acceptable. All residents with disabilities requiring PA services must meet with the administrative staff to sign a service contract, identify appropriate activity of daily living goals, and develop a corresponding action plan. The plan and contract are developed and signed by the resident and a member of the administrative staff before formal residence begins.

Subsequently, all new students and live-in PAs are required to move into Beckwith Hall approximately one week before University Housing allows other students to move onto campus. This is done to accommodate their participation in Beckwith's new student orientation program prior to the start of campus orientation programming. The Beckwith orientation program endeavors to ensure that new students are knowledgeable about working with PA staff, become familiar with the campus environment, use campus recreation facilities, buy books, meet the DRES staff, utilize bus service, and settle into the residence hall before returning Beckwith students move in. At the end of the new resident orientation, the returning Beckwith residents serve as mentors for the new students and provide a support for the students and their families as needed. Incoming Beckwith residents are also strongly encouraged to provide McKinley Health Center with medical records and to meet with the medical staff prior to the beginning of the term to ensure continuity of medical service quality and to enhance response timeliness and quality in the event that they experience a health problem.

Personal Assistant Support Services. Up to five hours of in-house, non-academic PAs may be scheduled daily per student. However, residents requiring more than five hours of daily PA services are financially responsible above and beyond the basic PA fee for all additional hours received. Residents requiring assistance with academic activities, such as tutoring, reading, or writing, are also financially responsible for these services. Beckwith Hall staff is not responsible for PA hours that exceed five hours per day or the latter-mentioned academic assistant needs. Students occasionally locate outside agency sponsorship to assist and supplement financial responsibility for services not provided by Beckwith Hall. Students utilizing a ventilator are required to provide their own 24-hour professional nursing care.

Approximately eight to ten PAs live at Beckwith Hall. The PAs work 18 hours per week in exchange for free room and board. If they work more than 18 hours, they are paid an hourly rate. Overall, live-in PA staff stabilizes services and reduces the overall expense of PA service delivery.

Personal assistant services support individuals with disabilities in their daily performance of ADL. According to the U.S. Census Bureau, in 1997 there were 52.6 million people living with a disability, of which 33 million had a severe disability and of which 10.1 million required personal assistance with one or more of their activities of daily living (McNeil, 2001). The amount of PA services required by an individual loosely corresponds to his or her severity of disability and ability to independently perform ADL. The ability to bathe, eat, and dress clearly affect the individual's ability to go to school, work, and participate in community and recreational activities. For those who need help in performing activities of daily living, their self-esteem, livelihood, and quality of life depend on a successful partnership with PAs. Eriksson (2005) noted that students with personal assistants who help manage their environments could be expected to have a greater chance at full participation than those who do not. As such, PA services represent an important component of social inclusion, self-determination, health status, and personal freedom for individuals with severe disabilities (Eriksson, 2005; Hagglund, Clark, Farmer, et al., 2004; Hagglund, Clark, Mokelke et al., 2004).

Several research studies have shown that consumer-directed and managed PA services have significantly better outcomes than similar agency managed services. Some authors suggested that consumer-directed PA services lead to improved empowerment and satisfaction on the part of the individual with the disability (Glendinning, Halliwell, Jacobs, et al., 2000; Hagglund, Clark, Farmer, et al., 2004; Hagglund, Clark, Mokelke et al., 2004). Glendinning et al. (2000) noted specifically that when individuals with disabilities managed their own PAs the instruction was more individualized to meet their specific needs; persons with disabilities felt a greater sense of control and enhanced respect from the PAs, and that choice, control, independence, mental well-being, and emotional well-being were optimized. As for those who served as consumer-directed PAs, the authors also noted that they reported feeling a greater sense of loyalty, affection, and trust than when employed by an agency.

Anderle (1995) noted that for consumer-directed PA services to succeed, individuals with disabilities needed to create thorough and complete job descriptions detailing the tasks required, and develop effective and assertive communication skills. Glendinning et al. (2000) noted that people with disabilities who employ PAs need to be knowledgeable about hiring, training, and managing PAs; they need peer support and opportunities to share ideas and information with other users; they need "employer" skills, such as calculating wages and deductions, providing for professional development; and they require effective conflict resolution skills.

Hagglund, Clark, Farmer, et al. (2004) reported that positive outcomes in these relationships were more likely for those individuals with disabilities who had more education, were more assertive, and more involved in the direction of their PA support service needs. These same authors also noted the critical importance of persons with severe disabilities having adequate financial resources to pay for the PA services needed to ensure that they could participate fully in community and vocational activities. The latter was identified as important because greater community and vocational participation is likely to result in improved health outcomes and lower hospitalization rates.

The Personal Assistant Instruction and Support Program (PAISP) at Beckwith Hall is provided to ensure that students' immediate needs for effective PA support services is met, while working over time to improve self-sufficiency in managing individual PA needs. When students first arrive at the university, they often have minimal background in the management of PAs as paid employees. As a result, in the initial stages of the program, Beckwith personnel assume greater responsibility for recruiting prospective PA staff, performing initial interviews, collecting applications, performing background and reference checks, and performing general instruction. As time progresses, residents with disabilities assume increasing responsibility for these functions.

Figure 1. Beckwith Hall Transition Model.

The Beckwith Hall model is predicated on the practice of gradually transferring responsibility from staff to the students. The model, however, acknowledges that maximal independence for some will be living more independently at Beckwith rather than moving into another university or community residence. The model also hypothesizes that if transitional training in PA management began at home during the last one to two years of high school, the intercept (percentage of responsibility) would be higher and independent living could occur earlier.

The Beckwith Hall process of recruiting PA personnel is a multifaceted one that entails the use of newspaper advertisements, the dissemination of flyers promoting PA job opportunities, presentations to a wide range of student groups and classes, and word of mouth. Subsequently, all applicants are required to participate in an interview with both the Beckwith staff and residents. Reference and criminal background checks are performed on all individuals deemed to be acceptable by both the staff and students. Hepatitis B vaccinations are offered to all PA staff hired by Beckwith.

Within the Beckwith Hall orientation, residents are instructed in Beckwith policies and procedures related to PA recruitment, interviewing, selection, training, scheduling, and evaluation. Additionally, from the beginning residents are required at a minimum to:

All residents and prospective PAs are trained by Beckwith staff and/or other university personnel on the topics of cardio-pulmonary resuscitation (CPR certification is required), skin care, bowel and bladder management, universal precautions against blood-borne pathogens and Hepatitis B vaccination procedures, lifting and body mechanics in performing transfers, general introductions to the symptoms and functional manifestations of any and all medical conditions that may be present in the resident population, rights and responsibilities of persons with disabilities and their PAs within the consumer-directed PA model, Beckwith Hall employment policies and emergency procedures, and specific techniques and/or biomechanics related to the following activities of daily living:

Transitional Disability Management Program (TDMP). The TDMP is a highly individualized educational program designed to improve the disability management knowledge and skills of the residents of Beckwith Hall. Effective disability management results in students achieving their highest level of independence in every aspect of their lives. It involves Beckwith students taking personal responsibility and acquiring the knowledge to find the resources they need to make good life choices.

The TDMP is a comprehensive training program designed to help students:

During each year of their stay at Beckwith, residents are given the opportunity to participate in the TDMP. Students work with the disability specialist, one-on-one, to determine the areas in which they would like to increase their knowledge and skills. The students and disability specialist then collaborate in the creation of customized individual goals and a work plan for their achievement. The goals may relate to their career aspirations, knowledge of disability laws, ability to effectively advocate for themselves, health and wellness, ability to use a new AT or to more effectively perform or manage the performance of certain activities of daily living, or post-graduate objectives. Students meet with the disability specialist at the beginning of each semester to discuss objectives for that semester. Monthly meetings are scheduled to determine progress, and end-of-the-semester evaluations are performed to determine what progress was made.

The TDMP includes specific instructional modules and/or activities related to the following content areas:

Beckwith Hall mentoring program. In 2005, a Beckwith mentoring program was developed in which continuing students were matched with incoming students to assist them with their campus orientation and to serve as a contact as inevitable questions arose. Concurrently, alumni who had resided at Beckwith Hall during some portion of their educational tenure at Illinois are matched by field of study and disability with juniors, seniors, and graduate or professional students within one or two years of graduation to serve as transitional mentors. In the latter roles, the transitional mentors help students begin the process of planning for job interviews, internships, employment, moving to new communities, and securing PA supports in different locales.

Beckwith Hall Organizational Structure and Operational Elements

Staffing. Beckwith Hall employs a full time director, a full time associate director, and a full time disability specialist. The director, with a facilities and program management background, oversees the management of Beckwith Hall. The associate director, with a nursing background, is responsible for the personal assistant training program as well as employee supervision. The disability specialist is responsible for the Transitional Disability Management Program (TDMP) as well as the mentoring program. Beckwith also employs two graduate resident advisors who assist in the planning and execution of residence life activities, provide back-up PA support, and serve as an on-call contact between 5:00 pm and 8:00 am. The program also employs eight to ten live-in PAs who work eighteen hours per week in exchange for room and board. On average, Beckwith residents with disabilities hire and schedule 70-100 hourly student employees and three to ten non-student hourly employees to provide scheduled PA support services.

Beckwith Hall employs a "floating" PA 24 hours per day, seven days per week. The floater screens individuals who are entering and leaving the building throughout the day and is also always on duty to respond to unanticipated urgent needs, such as providing backup for a PA who does not show up on schedule and to aid in the execution of the emergency response plan. The floater also provides PA services when scheduled personnel are unavailable, provides limited ad hoc assistance, and serves as one of three emergency responders in the event of an emergency. Regarding the latter, Beckwith Hall uses a "defend in place" emergency response strategy wherein there are always three staff in the building with responsibility for the execution of the emergency response plan. The team consists of a life safety officer and two emergency responders. The latter plan is different from typical residence hall response plans in that it does not rely on the default practice of comprehensive resident evacuation when a potential emergency is identified. Rather, the Beckwith strategy focuses on threat control and containment and uses selective egress only as warranted. One full-time and one part-time housekeeper and a part-time building service worker are also employed at Beckwith.

Beckwith Hall also has a university-registered student government that includes a president, vice-president, secretary, and treasurer. The Beckwith Student Government as a whole advises the Beckwith staff on any and all matters that impact their residential life, such as PA scheduling, socio-leisure programming, and special events.

Facilities. Beckwith Hall is a two-story building designed specifically for students who require the use of power wheelchairs or carts, and who have very limited upper extremity strength, stamina, range of motion, and/or coordination. The facility is comprised of private sleep-study rooms, a kitchen, and dining hall. A lab is equipped with three computers that access other resources on and off campus. A computer lab on the second floor is equipped with voice recognition software. Each sleep-study room is also Internet ready and cable access is available throughout the building. DRES buses serve Beckwith and provide transportation throughout the campus. In terms of furnishings, all rooms are equipped with a desk, bed, nightstand, dresser, and desk hutch. However, Beckwith residents are allowed to bring their own furniture (e.g. beds, desks) to accommodate their special needs, and personal laundry service is provided in-house to ensure a safe and clean environment for all residents and guests. The exterior doors are secured by an automated locking system that all residents can operate with a personal proximity card reader. In addition, each sleep-study room is equipped with a call system that can be equipped with a wide range of activators to ensure that all residents can use the system to request the assistance of a staff member.

Health status requirement. Beckwith Hall is a residential housing option for students with severe physical disabilities who require assistance with ADL. Such activities might include showering, dressing, feeding, and bowel and bladder assistance. All residents with disabilities requiring a PA must be examined by their personal physician and deemed to be in good health. Students are not allowed to live at Beckwith when their state of health is deemed so poor and/or unstable as to exceed the service capacity of Beckwith Residence Hall staff, and an effective alternative strategy for safely ensuring the students' well-being cannot be identified or enacted. Each student must complete an application for services through DRES which details the medical documentation of his or her disability, general health status (e.g. respiratory, sitting tolerance, skin condition, and medications), bowel and bladder management (e.g. technique and schedule, urinary tract infection history and treatment), and activity of daily living status or level of independence (e.g. ability to transfer, dress, eat, bathe). To further optimize the health and wellness of Beckwith residents, the McKinley Student Health Center employs a part-time physiatrist and a full time registered nurse with a rehabilitation background. Incoming students with disabilities who will be residing at Beckwith are encouraged to make appointments with the McKinley physiatrist and nurse to go over their health and medical histories, to identify any emergent medical concerns and to specify the medications that they are currently taking. In this way, if a health situation were to arise, the staff would be better prepared to respond in a timely and more effective manner.

Food Service and Housekeeping. Beckwith Hall, like any residence hall on campus, provides meals seven days per week during the academic year. Three meals per day during the week and two meals per day on the weekends are included in the residence hall fees. Hourly student and/or non-student employees are hired to serve as meal assistants. The number hired is based on the number of students needing assistance and the amount of the assistance that they require.

Beckwith Hall also operates with increased housekeeping staff compared to typical university housing. Daily housekeeping services include the removal of trash, making the beds, disinfecting the bathroom, and stocking bathroom supplies. Weekly housekeeping services include personalized laundry (including bed linens) and deep cleaning of each room and bathroom. Emergency laundry services are also available to ensure that clothing that has been soiled as a result of bowel or bladder incontinence is promptly cleaned to maintain a clean and healthy residential environment.
Finance. Beckwith is an auxiliary, self-funded program with an annual budget of $400,000 to $500,000. The two primary sources of income are a room and board charge and a PA support service charge. The former includes personnel and operational expenses associated with facility cleaning, security, maintenance and repairs, and food service. The amount charged to residents for room and board is based on a market-based comparison with other private and institutional residence halls for a single room and a 19 meal per week food service package.
The second component of the budget relates to the transitional educational services and supports, including PA services which are covered on a 24/7 basis. Beckwith typically employs 70-100 student hourly employees who serve as personal assistants, night clerks, floaters, (who provide back-up services when PAs are unavailable) and meal assistants. In the 2006-07 academic year, the room and board charge for Beckwith is $12,410 and the PA service fee is $12,630.

Based on the assumption of a census of no less than 18 residents with disabilities and six to eight live-in PAs, this revenue stream is currently sufficient to cover all program expenditures, including annual facility repair costs. Regarding the PA service fee, students can receive up to five hours of PA support services per day. The actual amount of PA support time is based on time/activity assessments that more typically range from one and one-half to three hours per day. Additionally, the residents have access to a floating assistant on a 24/7 basis and meal assistants as required. The PA staff can assist students in setting up their books to study; however, academic aide services (e.g. scribes, tutors, typists) are not included in this cost. Approximately 90% of the residents of Beckwith Hall receive financial support from their respective state departments of vocational rehabilitation services.

Student PAs are typically paid slightly more than minimum wage when hired to ensure that Beckwith is a competitive recruiter. The rate of pay is also tiered to reflect market conditions. For example, PAs are paid a higher hourly rate for early morning, late night, and weekend shifts. To ensure the availability of PAs in the first weeks of the fall term if scheduled staff does not report to work, Beckwith created live-in PA positions for six to eight students who receive gratis room and board at Beckwith for 18 hours of weekly PA services.

Beckwith Hall Outcomes

The outcomes of Beckwith residents have truly been remarkable. In terms of retention and graduation, a total of 151 students have resided at Beckwith Hall since the facility opened in 1981. Of that number, a remarkable 87% (n = 109) have earned Illinois degrees. Success following graduation also has been outstanding. Of the 33 former Beckwith residents with severe physical disabilities who graduated between 1994 and 2003, 21 (64%) obtained professional employment within a year of graduation, and seven (27%) enrolled in graduate or professional school within one year of graduation. Thus, less than 9% (n=3) were unemployed and not enrolled in graduate or professional school within one year of graduation. These data were affirmed by a study performed by the University Office for Planning and Budgeting in 2004, in which over 58% of former Beckwith residents who graduated between 1982 and 2002 and responded to the UI Alumni One Year Out Survey reported that they were employed.

Future Directions

In the 2009-10 Academic Year, Beckwith programs and services will be fully incorporated into a completely rebuilt residential complex bordered by Peabody, Gregory, First, and Fourth Streets. Recently approved by the University of Illinois Board of Trustees, the new residential facility will allow for a number of improvements and new directions. The new facility will be able to accommodate a larger number of students with disabilities, improve recruitment and retention of PAs, increase employment opportunities for students with disabilities within University Housing, include more flexible meal plans, and there will be summer space for year-round housing alternatives (e.g. camps for youths with disabilities).

State-of-the-art "smart home" technologies will be incorporated into the facility to maximize the independence of residents within the facility and to help students become more knowledgeable about the utility of a wide range of emergent technologies in meeting their disability needs.

In addition, the more integrated residential arrangement will better accommodate the development of a living-learning community on disability and the integration of an "independent living/aging in place" research agenda. New features planned for the proposed residence hall include:

Adaptive Transportation Supports

Time and distance constitute formidable barriers to participation by students with severe physical disabilities. Therefore, given the sprawling geography of the Illinois campus, it became quickly obvious that the disability support service model would have to address the barriers of time and distance to make full and active participation by students with severe physical disabilities a reality. As a result, in 1952 the University of Illinois developed the first accessible bus for persons with disabilities. In fact, Illinois developed the prototype for lift-equipped urban buses to accommodate the efficient loading and unloading of passengers who use wheelchairs. The system developed over one-half century ago continues today to offer campus transportation service of unsurpassed quality via a collaborative agreement with the Champaign-Urbana Mass Transit District. The system uses three, forty-foot buses capable of serving 15 students in wheelchairs and 12 semi-ambulatory students, and a mini-bus capable of serving four to six wheelchair riders when their travel needs do not coincide with the fixed route bus schedules. Indeed, although inaccessible transportation is perhaps the most often-cited inhibitor of societal participation by persons with disabilities, the Illinois bus system has proven to be an effective solution to the problems of time and distance for students with mobility disabilities.

Specialized Health and Wellness Programming

Need

The United States spends hundreds of millions of dollars annually in programs to facilitate re-entry of persons with disabilities to the workforce, while only minimally working to encourage their adoption of physically active lifestyles that help to promote health and wellness, and thus, long-term employability Persons with disabilities overwhelmingly are inclined to adopt physically inactive lifestyles (Coyle & Kinney, 1990; Harrison & Kuric, 1987; Price, 1983), which according to The Surgeon General's Report on Physical Activity and Health (1996), are a major contributor to heart disease, adult onset diabetes, and some forms of cancer. Unfortunately, very little research has been performed to identify techniques and strategies for promoting effective participation in physical activities by persons with disabilities.

To counter this public health risk, the World Health Organization has identified the promotion of equity in accessibility and practice of physical activity/sport for persons with disabilities as one of its major recommendations for reducing the prevalence of injury/illness associated with non-communicable diseases in its Physical Activity Fact Sheet (WHO, 2002). Similarly, the U.S. Surgeon General (1996) included the recommendation that communities work to eliminate barriers to physical activity by persons with disabilities, with a special emphasis on increasing physical activity among youth with disabilities, within key action recommendations.

Higher education institutions in Illinois and elsewhere have universally failed to adequately address this deficiency. As a result, the employment longevity of their alumni with disabilities is likely compromised by their lack of programming to increase exercise and physical activity among this population. In contrast, since 1949 Illinois has recognized the importance of making opportunities for co-curricular participation and, in particular, participation in physical activity an integral facet of its programming and services for students with disabilities.

By offering opportunities for students with disabilities to participate in varsity sports, adapted recreational programs, and physical therapy and functional training services, Illinois has actively sought to promote the adoption of physically active lifestyles, thereby improving the health and wellness of its students. Additionally, such programming affords students with disabilities an unparalleled opportunity to acquire the knowledge, experience, and skills necessary to successfully pursue myriad physically active sport and recreation activities for a lifetime.

Program & Services Overview

The overarching philosophy of the program is that students with disabilities should have egalitarian access to co-curricular programming and resources, and affording egalitarian access requires the provision of adaptive and/or alternative programming over and beyond the mere accommodation of access and participation in existing programs and resources when appropriate and feasible. From the legal perspective it has often been espoused that wheelchair sport programming is not legally required since students who use wheelchairs are not denied the opportunity to participate in ambulatory collegiate varsity sports; they are just not "otherwise qualified" to do so. Although DRES has never agreed with the position that it was acceptable or legal to arbitrarily delimit "varsity collegiate sport programming" exclusively to students who are ambulatory, the program has vigorously advocated for such programming on the basis of its physiological, social, and psychological benefits.

DRES' Office of Campus Life assists students with disabilities in accessing such co-curricular programming and opportunities including instructional physical education classes, Division of Campus Recreation sponsored activities and programs, fraternity and sorority programs and activities, registered student organization activities, and social, recreational, cultural, and entertainment events hosted by the Illini Union Board. In addition, Campus Life provides a wide range of adapted programs and activities to ensure intrinsically satisfying and optimally challenging activity programming to maximize the fitness, wellness, and functional independence of Illinois students who cannot access the existing non-adapted sport, recreation, fitness, and wellness programs and activities due to disability-related functional limitations. The following section provides a brief overview of each of the adapted activity components of campus life services.

Adapted Strength and Conditioning. Illinois, like most large universities, has multiple complexes operated by the Division of Campus Recreation which are extraordinarily well equipped and which can easily accommodate the physical activity and exercise needs of the vast majority of students served by DRES. However, in trying to accommodate the needs of the entire student population, these facilities typically do not have sufficient space or expertise to include and/or appropriately supervise all of the specialized equipment required to provide comparable benefit to students with lower extremity disabilities. To fill this void, DRES has a large exercise gym equipped with a wide array of upper body exercise equipment specifically designed for persons with lower extremity disabilities. For example, the gym includes four upper body ergometers configured differently to accommodate different needs, flexible carbon tube exercise stations that are wheelchair accessible, a treadmill with an incorporated lift system designed to accommodate supported walking by persons with impaired gait and/or balance, large raised exercise mats for assisted exercise and stretching, a dumbbell weight area with four specialized lifting tables, a Functional Trainer 360 by Cybex which accommodates nearly any upper or lower extremity exercise imaginable, several highly specialized devices developed to accommodate sport specific plyometric exercise, and a therapy room for individualized services by DRES' physical therapists. All strength and conditioning protocols for participants in the adapted varsity athletic programs are supervised by coaches, and all strength, conditioning, and therapy services are supervised by physical therapists.

Adapted Varsity Sports. Adapted varsity sports programming is offered in men's and women's wheelchair basketball and co-ed track and field. Each year these programs serve approximately 40 students with disabilities. Eligibility in wheelchair basketball and wheelchair track and field is limited to individuals whose disabilities would require a substantial rule change to participate in ambulatory basketball or ambulatory track and field, or that their participation would significantly compromise the safety of such programs. Students with visual impairments are eligible to participate in the adapted varsity track and field program on similar grounds. These delimitations are enacted on the premise that students with other disabilities are only precluded from participating in existing varsity sports programs due to insufficient athletic ability or discrimination. In either case, adaptive programming would not be warranted. For example, student athletes with learning disabilities have ready access to varsity sports when they are highly skilled or a vast array of intramural and free recreation programming when that is not the case. Alternatively, discriminatory practices would be the only reason that a qualified student athlete who is deaf would be denied the opportunity to participate in an existing varsity sports program. In the former situation, adapted programming is unnecessary. In the latter case, adaptive or segregated programming would be unnecessarily undermining the expectation that institutions not discriminate in making their varsity sports offering accessible to otherwise qualified students with disabilities.

Academically, students who participate in the varsity wheelchair basketball program must meet the academic eligibility criteria of the National Wheelchair Basketball Association Intercollegiate Division. Because track and field does not currently have a similar national governing body, DRES' internal practice is to apply the same academic eligibility standards to varsity athletes in track and field that are applied to the basketball participants.

The basketball season begins in October and runs through March. Training typically involves two to three days per week of strength and conditioning, five two-hour basketball workouts weekly and one to two video/classroom sessions. Total weekly training time is limited to the NCAA restriction of no more than twenty hours per week of organized training. During the season both the men's and the women's teams will play 28-32 games, including the postseason. In contrast, the track and field season runs year-round due to the high number of students who participate in road racing events ranging in distance from 5K to marathons in the fall and winter months to shorter 5K, 10K, and track events held throughout the spring and summer months. The training contacts per week are limited to twenty hours, as is the case in basketball.

Specific instructional information related to the Illinois wheelchair basketball program can be obtained through Wheelchair Basketball (Hedrick, Byrnes, & Shaver, 1994) and the Wheelchair Basketball Instructional DVD, produced by DRES' Office of Campus Life and available for purchase at https://www.ottogartenfilms.com/webpages/projects.html. Instructional media related to DRES' wheelchair track and field program is available through the DRES Office of Campus Life.

Intramurals. Over the years, DRES has offered a range of intramural sports based on the level of interest of current students. For example, intramurals have been offered in wheelchair football, wheelchair broomball, wheelchair rugby, bocce ball, sled hockey, wheelchair softball, wheelchair hockey, and goal ball.

Kinesiology 111. As previously noted, students with severe physical disabilities are rarely socialized to pursue physically active lifestyles. Kinesiology 111 is an introductory physical activity course that is offered for credit to students with physical disabilities to afford them an opportunity to explore different sport and recreational interests, while facilitating their adoption of daily routines that include vigorous physical activity and exercise. It is not unusual for 80% of students with severe physical disabilities to enroll in Kinesiology 111 for one or more semesters during their tenure at Illinois.

Adapted Aquatics. Illinois annually enrolls a substantial number of students with severe physical disabilities for whom much, if not all, of the physical activity offerings of campus recreation are simply not viable. Therefore, in an effort to address the needs of students with severe disabilities for optimal physical activity in addition to the passive range of motion exercise program offered in DRES' gym under the supervision of a physical therapist, a therapeutic aquatics program is also offered. This program is scheduled on an individualized basis and is also supervised by a DRES physical therapist. A primary goal of the program is for the therapist to instruct students with disabilities how to train and supervise PAs to facilitate their safe and effective participation in water exercise, with the goal of their being able to continue to participate in water exercise wherever they go following graduation.

Dietary Assessment and Consultation. All freshmen are susceptible to the infamous "freshman 15" which represents the average weight gain in the first year of college. However, this is a more problematic phenomenon for students with severe physical disabilities due to the fact that many of them have substantially diminished muscle mass due to their disabilities and, correspondingly, lower metabolic needs. Such students have a diminished capacity for "burning off" the excess weight once it is added. Thus, students with disabilities may be predisposed to exacerbated weight gain due to their lower metabolic demand and have greater difficulty losing excess weight for the same reason. For example, a person with quadriplegia who has one-third of the muscle mass of a peer without a disability will have a comparably diminished caloric need. Thus, whereas the cohort could perhaps eat 2,500 calories daily without gaining weight, the person with quadriplegia could gain two pounds per week on the same diet if his/her metabolism only required 1,500 calories. This in turn would rapidly begin to compromise the student's ability to perform ADL since the body weight that the student would have to negotiate in transferring and dressing could increase quite substantially over just a matter of weeks. In turn, since 3,500 calories equals a pound of body weight, the person requiring 2,500 calories per day could go on a 1,500 calorie diet and lose one pound every three and one-half days. However, a comparable reduction by the person with a 1,500 calorie metabolism would require almost twice as long to lose one pound of body weight. Therefore, it is even more critical that preemptive interventions be used to prevent excessive weight gain among persons with severe physical disabilities. To address this concern, dieticians are included in the agendas of ISTEP and the student-athlete orientation program. Further, nutritional goals are included in the individualized TDMP plans of Beckwith residents and in the training goals of DRES student athletes.

Outreach. DRES coordinates 10 to 20 adapted sport exhibitions in local secondary schools throughout Illinois annually and provides wheelchair sport clinics around the state that annually serve over 170 youth with disabilities. In addition, DRES has hosted residential summer wheelchair sport camps for youths with disabilities since 1986. These camps now accommodate over 140 youth with disabilities each summer. The DRES Office of Campus Life is also working collaboratively with the Illinois High School Association in organizing a scholastic regular season and championship events in wheelchair basketball and wheelchair track and field for junior varsity and varsity athletes in Illinois high schools. The program currently has eight teams involved from Illinois.

Program Administration

The aforementioned health, wellness, and physical activity programs are housed within the Office of Campus Life unit. Campus Life maintains affiliations with the appropriate national governing bodies of disability sports, and oversees all adapted varsity and recreational sports programming and strength and conditioning programming for student athletes. The unit also coordinates dietary and nutritional consultation for students with disabilities and provides consultative services and support for the inclusion of students with disabilities in all social, leisure, and cultural campus programming. Campus Life also coordinates a limited driver assessment and training program for students with physical disabilities in conjunction with an outside contractor who is a certified driver education and adaptive driving instructor. The latter program is offered due to the sparse availability of such services in central Illinois, and is provided on a fee for service basis.

Staffing. Campus Life has a full time coordinator, head coach of wheelchair basketball, and head coach of track and field and road racing. The unit also has one full-time licensed physical therapist, a part-time licensed physical therapist, and approximately four part-time graduate student employees.

Finance. The programs and services of the Office of Campus Life are underwritten via a wide range of sources. First, all staff positions are underwritten with the use of state/university funds and all non-personnel program expenses are underwritten with auxiliary and/or private or endowment funds. Approximately $200,000 is awarded annually in scholarships to student athletes. The program has a personnel budget of $260,000 and a non-personnel budget of $130,000, not including auxiliary enterprises such as summer camps.

Achievements

Illinois has been a leader in national and international adapted sports since 1949 when students and staff of DRES led the formation of the National Wheelchair Basketball Association and hosted the first National Wheelchair Basketball Tournament. This Illinois program was recognized by the 92nd Illinois General Assembly which passed a resolution commending the Illinois' leadership for its pioneering vision in adapted sports, health and wellness programming for persons with disabilities, and it has been highlighted in numerous media, including Sports Illustrated (Hoffer, 1995) and ESPN's Break Away. Since the program's inception, Illinois student athletes have been mainstays on all international USA Paralympic teams, and more recently, on the Paralympic teams of other nations, including Australia, Canada, Sweden, and Belgium. The legacy of athletic excellence for which the program has long been known continued in the 2004 Athens Paralympics in which 13 Illinois students competed for three nations. In fact, the Illinois athletes were so successful that had they been considered a country in the medal count, they would have ranked 24th among the participating nations. On the Olympic front, Illinois athletes have won two gold, three silver, and two bronze medals in the men's 1,500 meter and women's 800 meter events held in every Olympics since 1984 in Los Angeles.

Outcomes

Although outcome research in this domain remains very limited, researchers have found the impact of these extraordinary services to be significantly related to participation in physical activity later in life. For example, researchers have found the strongest predictor of the current level of health and wellness promoting physical activity among nearly five decades of Illinois alumni with physical disabilities to be their level of participation in adapted sports and recreation during their collegiate years (Hedrick, Lee, & Zhu, 2003; Washburn & Hedrick, 1997).

Specialized Supports for Students With Cognitive and Psychiatric Disabilities

Background

The incidence of psychiatric disabilities in college students is estimated to range from six to more than 20% of the total student population (Offer & Spiro, 1987; Rodolfa, 1987). Evidence suggests that students with psychiatric disabilities begin college, but are frequently unable to complete their educational goals and, subsequently, account for 4.7% of college dropouts (Kessler, Foster, Saunders, & Stang, 1995). Limitations in functioning, secondary to psychological symptoms, contribute greatly to these students' lack of academic success (Wiener & Wiener, 1996). Despite these statistics, students with psychiatric disabilities can successfully obtain postsecondary degrees. Many, however, may need comprehensive support services to attain their educational goals. An increased effort must be made at the postsecondary level to provide support for these students because although symptoms of psychological disorders present a barrier to higher education, many of these symptoms can be overcome with medication, psychotherapy, or a combination of treatments. Support services may include academic accommodations, consultation with professors, psychological support services, medical support with psychotropic medications, and additional supports. DRES fulfills the important role of integrating services necessary to provide support to students with psychiatric disabilities at the postsecondary level.

In 1979, DRES had only one registered student with a learning disability who was receiving accommodative academic modifications and adjustments, and/or auxiliary aids and services. Over the ensuing 27 years, however, that number has grown to more than 176 students who have a learning disability as their primary diagnosis. The number of students with attention deficit-hyperactivity disorder (ADHD), acquired brain injury, and psychiatric disabilities requesting disability support services has also grown significantly during the previous decades. As a result of these changes in the disability demography of Illinois students, 72% of the 947 students registered with DRES and receiving disability support services have documented cognitive and/or psychiatric disabilities. In addition, 30% of the registered population experiences a secondary disability, which includes a cognitive or psychological disability and 6% experience a tertiary disability in these areas. Obviously, this trend is being fueled by the diagnostic mandate of the Individuals with Disabilities Education Act that requires secondary education institutions to identify and appropriately serve students with disabilities, including students with cognitive and psychological disabilities. However, this trend is also impacted by the propensity of the University of Illinois to attract high functioning students with undiagnosed cognitive and/or psychological disabilities.

At DRES, the services for cognitive and psychiatric disabilities are coordinated within one office as these disabilities have a large incidence of co-morbidity (e.g. ADHD and learning disability, and/or learning disability and depression). While the students are assigned a case manager based on their primary disability, they are able to utilize all services of the office. For example, a student may have a learning disability as the primary disability and ADHD as a co-morbid diagnosis. The case manager is the learning disabilities specialist, however, the student may also participate in coaching, or a student may have ADHD and depression and his or her case manager is the clinical psychologist and s/he utilizes coaching and individual therapy. However, the student's ADHD significantly impacts his/her reading abilities so the student may also utilize the learning disabilities specialist for reading strategies.

The Importance of Comprehensive Supports

Success in a postsecondary institution depends on the type and extent of support a student receives (Malakpa, 1997; Spillane, 1992; West et al., 1993). Given the extensive barriers faced by students with psychiatric disabilities, comprehensive disability support services are important in helping students achieve academic success. The disability support office is most effective when it provides accommodations on an individualized basis to students who meet the eligibility requirements. Students with hidden disabilities have unique needs that can be met with comprehensive support services. At Illinois, there are a wide variety of services available to students with cognitive and psychiatric disabilities. To have a comprehensive support program, additional services should include consultation to faculty and staff, self-advocacy training, organizational skills/social skills training seminars, neuropsychological testing, and one-on-one coaching. Psychological support services should include individual and group therapy, crisis management, and consultation. For more intensive therapy needs, students can be referred to other campus programs or professionals in the community. Academic consultation, screening, and referral are offered to all university students who experience difficulty with their academic coursework and suspect a cognitive or psychiatric disability. To accommodate the needs of the rapidly growing subpopulation of students with cognitive and psychological disabilities, Illinois has established a cognitive and psychological disability support team comprised of a clinical psychologist/certified rehabilitation counselor and a learning disability specialist. San Miguel, Forness and Kavale (1996) reviewed the literature regarding social skills deficits in children and adolescents with learning disabilities and suggest that these deficits may be due to psychiatric co-morbidity, which is largely overlooked. They strongly recommend the need for collaboration between learning disability (LD) specialists and psychologists/psychiatrists. The psychologist allows DRES to better coordinate services between other mental health agencies on and off campus, to better identify and serve students with co-morbid conditions, and to better coordinate academic accommodations for students with psychiatric disabilities. In addition to coordinating the academic accommodations for students with LDs, the LD specialist provides individualized training to help students better understand their disabilities and learn compensatory strategies to more effectively manage the functional impact of their LD. An additional advantage of having a licensed clinical psychologist on staff is that it allows the use of graduate assistants, practicum students, pre-doctoral interns, and post-doctoral interns to perform some of the functions such as testing, coaching, and individual therapy, with the psychologist providing supervision.

Academic Accommodations

Students with cognitive and psychiatric disabilities who choose to take advantage of disability support services should meet with their support services provider on a regular, semester-by-semester basis to develop written plans for academic accommodations. Some typical accommodations may include the following: priority registration, reduced course load, extended time on exams, exams proctored in a distraction-reduced environment, and notetaking support. Student with cognitive disabilities may utilize AT when taking certain types of exams, such as using a computer with a spell check program for essay exams or having multiple-choice exam questions on a tape recorder. Some specific accommodations for students with psychological disabilities include not being penalized for missing class or assignments due to an exacerbation of the disability-related condition and working with them on substitutions and extensions, as many psychological conditions do not remain stable throughout the semester. Academic accommodations should be on an individual basis and take into account the functional limitations imposed by the disability, the requirements of the academic program, and the adjustments needed to compensate for these limitations. In addition, programs that teach study skills, test-taking strategies, and management of test-taking anxiety are needed due to the fact that these secondary symptoms may also interfere with academic performance. Continued advocacy and education helps to reduce stigma and has improved student/faculty interactions, provides support to the student, and creates a safe place for students to problem-solve and make decisions.

Academic Coaching

All students struggle to organize themselves and work independently, which are skills required at the college level. However, for some students with disabilities, their disability actually impacts these abilities. They may routinely forget to write down assignments, complete assignments, hand in assignments on time, use their time wisely, break down long assignments, or develop structure. These students are very bright and have the cognitive abilities to succeed at the college level, however, poor organization and time management skills attributable to their disabilities seriously compromise their academic performance. Many students with ADHD, acquired brain injuries, and various psychiatric disabilities (Mowbray & Megivern, 1999) have difficulty in these areas of executive functioning and require continual and repetitive academic monitoring. Olney and Kim (2001) interviewed university students with a variety of disabilities that affect cognitive functioning about their strategies for managing college life. Students talked about both the technical aspects of getting their work done and the personal aspects of managing their identity. Commonly mentioned difficulties were short-term memory, organization, managing stimulation, focus and concentration, mood fluctuations, and getting adequate support. Students discussed a number of strategies they have developed to handle these difficulties, including doing work they enjoy, unplugging the phone while studying, using medication, patterning the way they study, using "white noise" to muffle distractions, and avoiding situations with too many competing stimuli. The main academic difficulties for students with psychiatric disabilities include problems focusing attention to study, completing assignments within time