Programmatic accessibility is one of the key elements of the ADA andallows all individuals with visible and invisible disabilities tobenefit from all City services, programs and benefits offered to thepublic. In order for all City programs and services to be “accessibleto and usable by people with disabilities”, as mandated by the ADA,modifications to policies or practices may be necessary.

Consider, for example, a City-funded soup kitchen. The usual ruleis that people must stand in line to be served. Consequently,individuals who find it very difficult to wait in line due to anxietyattacks or a physical condition that makes it hard to stand, may beeffectively excluded from that program. Title II of the ADA, however,mandates that city funded programs or services must modify theirpolicies, practices or procedures to allow people with disabilities tofully participate. Therefore, the soup kitchen staff may give a numberto the person waiting in line and allow her to wait elsewhere or beseated until her turn comes.

• A modification to a policy, practice or procedure (commonlyreferred to as an accommodation) implies that people with disabilitiesare, in fact, encouraged and welcomed to participate in all cityprograms and activities. Some examples of policy modifications mayinclude, but are not limited to, the following:
• A public building with a “no pets” policy allows individuals with service or support animals to enter the premises.
  A person who is unable to fill out complicated forms due to confusion,high levels of anxiety, etc. can ask for assistance in organizing andwriting down information.
• An individual with a psychiatric disability who receives evictionnotice from a publicly funded building because he talks loudly tohimself and disturbs other tenants, may ask for an extension andreconsideration while he gets treatment to help him manage the symptomsof his disability, and while the public housing provider sound-proofshis room.
• A person who, because of significant health problems, cannot leavethe house long enough to apply for benefits could request (and receive)a home visit, or phone services in order to complete the applicationand receive the benefits.

Sometimes the City and County of San Francisco may sponsor programsthat are designed specifically for people with disabilities, but thatdoes not eliminate the obligation to make modifications to all programswhen requested to do so. For example, the department of Parks andRecreation may sponsor an adaptive swim class for people with physicaldisabilities but, the existence of such a class would still not permitthe exclusion of a person with a disability from participating in anyrecreational swimming program available to the general public.