SSA/AUCD: A National Collaboration
description
Transcript of SSA/AUCD: A National Collaboration
April 2005-IOM 1
SSA/AUCD: A National Collaboration
April 2005-IOM 2
AUCD/SSA Project Goals• Do interdisciplinary assessments change
outcomes or improve adjudication for children who would otherwise be denied federal disability benefits?
• Do particular tests or protocols make a difference?
• Provide assistance to families• Enhance adjudicator training
April 2005-IOM 3
Why AUCD?
• Interdisciplinary expertise • Comprehensive developmental view• Family-centered• Connected with community service systems• National network of centers focused on
disability research, training and service
April 2005-IOM 4
AUCD Role: The Centers • Conduct case reviews & clinical assessments• Use common protocols across sites • Recommend/provide additional services for
children & families • Provide training for all disability adjudicators • Help develop/clarify SSA policy & procedures
April 2005-IOM 5
Participants• 39 Centers
• 30 DDS offices
• Central & Regional SSA Offices
• Overall Coordination by AUCD
April 2005-IOM 6
Assessments: Purpose
• Improve documentation: Interdisciplinary & now targeted assessments
• Integrate information to compare child’s functional ability with same-age peers
• Resolve inconsistencies• Explain degree & nature of functional
limitation(s)
April 2005-IOM 7
Initial Applications Cognitive, psychiatric/emotional
impairments • Preschool (ages 3-5) • School-age • Adolescent (ages 14-17)
April 2005-IOM 8
Other Assessments
• Low birth weight: by law, continuing disability reviews (CDR) for most at 12 months
• Age-18 “redeterminations”
April 2005-IOM 9
Assessment: Protocols • File review • Family history• Developmental pediatric • Psychological• Adaptive functioning• Attention/executive functioning• Academic• Speech & language
April 2005-IOM 10
Assessment: Protocols
Other evaluations, as needed Older age group components
Psychosocial Cognitive
April 2005-IOM 11
Major Findings • Importance of language development• Value of adaptive functioning evidence• Benefits of interdisciplinary approach• Inadequacy of some records• Lack of understanding about SSI by
many professionals
April 2005-IOM 12
Language
• Appear in all age groups• Clarify severity or highlighted school
evidence • Reveal undiagnosed disorders• Explain impact of co-morbid disorders
April 2005-IOM 13
Adaptive Functioning• Clarify severity for all age groups • Offer new evidence• Provide standardized instruments &
psychosocial interviews• Show importance of clinical social
workers
April 2005-IOM 14
Interdisciplinary Approach • Develops more complete picture of child • Often increases understanding of
functional limitations• Offers team perspective on child & impact
of disability• Helps resolve inconsistencies &
contradictions in records/assessments
April 2005-IOM 15
The Bottom Line• 835 total referrals• 705 assessments
o 561 initialo 144 Age-18 redeterminations/CDRs
• 239 allow/continue• 16 pending appeal• 130 no-shows
April 2005-IOM 16
AUCD Perspective• Complex cases• Huge challenges: adjudicators w/enormous
case loads & limited pediatric expertise • Evidence most often lacking:
– school records – adaptive functioning measures – language testing – mental health/behavioral problems
April 2005-IOM 17
Adjudicator Materials• Revised parent/caregiver function
forms • Updated adjudicators’ test list • Prepared DDS resource guides
[selected states]
April 2005-IOM 18
Adjudicator TrainingCenter trainers for IV-T broadcasts
Functional evidence School records Communication problems Integrating evidence AD/HD Experts for Q&A broadcasts
Interactive CD-ROM
April 2005-IOM 19
State Collaborations
• Improve quality of referrals & evidence • Improve access to evidence • Tailor assistance for DDS specific needs • Provide specialized pediatric expertise for
lay adjudicators & medical consultants• Expand awareness of SSI requirements
among providers & professionals
April 2005-IOM 20
Collaborations: Result
Improve ability to adjudicate complex, technical childhood disability cases for
more correct initial & more uniform decisions
April 2005-IOM 21
QUESTIONS?
April 2005-IOM 22
Sequential Evaluation ProcessChildren
1. Substantial Gainful Activity?• Yes → not disabled No → next step
2. “Severe”?• No → not disabled Yes → next step
3. a. Meets/medically equals a listing?• Yes → disabled No → last “step”
b. Functionally equals the listings?• Yes → disabled No → not disabled
April 2005-IOM 23
Disability: Children
“Marked and severe functional limitations”
Duration requirement: Has lasted/ expected to last for a continuous period of 12 months or to result in death
April 2005-IOM 24
Listing-Level Severity
Meet or medically equal a listing or “Functionally equal” the listings Part B specifically for <age 18 Same body systems as adults +
growth
April 2005-IOM 25
Functional Equivalence
6 “domains” of functioning Activities/abilities “Marked” limitations in 2 or “extreme”
in 1 Comparison to same-age children w/o
disabilities Other “factors”
April 2005-IOM 26
The Domains Acquiring and using information Attending and completing tasks Interacting and relating with others Moving about and manipulating
objects Caring for yourself Health and physical well-being
April 2005-IOM 27
“Marked” and “Extreme” Interferes seriously (“marked”) or very
seriously (“extreme”) Ability to independently initiate, sustain,
complete domain-related activities (age-appropriate)
Equivalent of functioning expected on standardized testing with scores: At least -2 SD (marked), or At least -3 SD (extreme)
Other descriptors
April 2005-IOM 28
Joint Case Reviews
• AUCD/DDS/SSA teams• Suggest clarifications for SSA
policy/procedures & guidance for disability adjudicators
• Expand training & technical assistance
April 2005-IOM 29
SSA/DDS Perspective• Highlight language & adaptive functioning
issues• Integrate file information & new evidence • Promote interdisciplinary perspective
[“whole child” emphasis of regulations]• Improve access to child-serving agencies• Serve families denied SSI benefits
April 2005-IOM 30
Collaborations: Evidence
• Improve coordination with schools & children’s hospitals
• Train child-serving professionals • Use clinical social workers• Prepare “family friendly” lists to help
identify all existing records & tests
April 2005-IOM 31
Collaborations: Clinical
• Reinforce interdisciplinary nature of childhood disability adjudications
• Expand pediatric experts for case reviews, consultations & training
• Enhance national adjudicator training & guidance