SSA-NIH-BU Collaboration to Improve the Disability Determination Process
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Transcript of SSA-NIH-BU Collaboration to Improve the Disability Determination Process
SSA-NIH-BU Collaboration to Improve the Disability Determination Process
Presentation for the SSA Occupational Information Development Advisory Panel: 12/08/10
Beth Rasch, PT, PhD
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Point of clarification
This exploratory work, being conducted by NIH and BU, examines ways in which claimants and their
health care providers can quickly and easily provide information about claimants’ function.
SSA has not yet adopted or endorsed this approach.
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Background
August, 2007 SSA sought help from NIH Identify new diagnostics tests that might expedite
allowances Paradigm: Diagnosis or impairment ≈ disability
SSA / RMD Inter-Agency Agreement NIH signed 3-year agreement with SSA
Initiated on 2/1/08 New 5-year agreement with SSA
Initiated on 2/1/10
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Broad objectives
1) Data analysis 2) Computer Adaptive Tests (CAT)
To improve SSA disability determination process through:
Unprecedented access to SSA data
Focuson
function
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Medical model: disability as a personal trait
Conceptualizing disability: Two opposing perspectives
Social model: disability as a socially created problem
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Prominent models of disability
Nagi model Verbrugge and Jette’s “Disablement Process” IOM model Social model WHO International Classification of Functioning,
Disability, and Health (ICF)
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Health Condition
Activities Participation
Environmental Factors
Personal Factors
Body Functions
Body Structures
ICF: World Health Organization, 2001
Conceptualization
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Contemporary concepts of disability Interactive
Not solely an individual attribute—diagnosis alone cannot predict disability
Multidimensional Complex theoretical models map the interaction of
conceptual elements that constitute the definition of disability
Continuum Not an “all or nothing” concept
Dynamic Disability influenced by the environment Disability can change over time
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Measuring such a concept poses a methodological challenge
To operationalize this concept, individual attributes and environmental features must be measured
Operational definition depends on purpose of data collection process
Measuring disability
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SSA purpose
Identify individuals who are unable to engage in substantial gainful employment due to medically determinable physical or mental impairment/s which can be expected to result in death or which have lasted or are expected to last > 12 monthsSEC. 223. [42 U.S.C. 423](d)(1)
Physical or mental impairment/s must be of such severity that the individual is not only unable to do previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy…SEC. 223. [42 U.S.C. 423](d)(2)(A)
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Framing the problem
There is a gap between contemporary notions of disability and how SSA operationalizes its statutory definition of disability SSA’s operationalization is focused on physical
and mental impairments (medical model) Contemporary disability models depict disability
as the gap between an individual’s functional ability and environmental demands
Diagnosis and impairment may be poor predictors of work disability
Jette & Badley: Conceptual issues in the measurement of work disability. Wunderlich et al, Eds. The
Dynamics of Disability. National Academy Press, Washington, DC, 2002
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Measurement
Health Condition
Participation
Environmental factors
Personal factors
Source: ICF, WHO, 2001
Body structure & function
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SSA’s data gaps
Viewed through the ICF, current SSA assessment processes could improve content coverage of “activity” domains relevant to work. Limited information captured on: Learning and applying knowledge General tasks and demands such as multi-tasking or
organizing time, space and materials for a task Communication Interpersonal interactions and relationships
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Domain selection
Priorities for SSA-IAA Interpersonal interactions and relationships Mobility
Learning and applying knowledge Communication Self care General tasks and demands
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Recommendations:Whole person approach
Capture all conditions during the application process to characterize the sum total of their impact on functioning as it relates to work
Depression
Knee arthriti
s
Heart disease
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FY 2005 initial applications
(2.6 million)
Recommendations:Focus on function
Reconsiderations (0.6 million)
ALJ disposition (0.5 million)
Of appeals, 62% allowed by ALJ
Functional Informatio
n
Assess function: Comprehensively Uniformly Early
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Usefulness for SSA
Dramatically improve breadth, completeness, uniformity, and precision of medical evidence
Collect data when its most useful for decision making
Even small improvements in the process may lead to: less processing time and costs improved accuracy and uniformity of decisions reduced backlogs
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Questions
This exploratory work, being conducted by NIH and BU, examines ways in which claimants and their health care providers can
quickly and easily provide information about claimants’ function.
SSA has not yet adopted or endorsed this approach.