SSA/AUCD: A National Collaboration

1. SSA/AUCD: A National Collaboration

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

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

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

5. Participants • 39 Centers • 30 DDS offices • Central & Regional SSA Offices • Overall Coordination by AUCD

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 functionallimitation(s)

7. Initial Applications Cognitive, psychiatric/emotional impairments • Preschool (ages 3-5) • School-age • Adolescent (ages 14-17)

8. Other Assessments • Low birth weight: by law, continuing disability reviews (CDR) for most at 12 months • Age-18 “redeterminations”

9. Assessment: Protocols • File review • Family history • Developmental pediatric • Psychological • Adaptive functioning • Attention/executive functioning • Academic • Speech & language

10. Assessment: Protocols • Other evaluations, as needed • Older age group components • Psychosocial • Cognitive

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

12. Language • Appear in all age groups • Clarify severity or highlighted school evidence • Reveal undiagnosed disorders • Explain impact of co-morbid disorders

13. Adaptive Functioning • Clarify severity for all age groups • Offer new evidence • Provide standardized instruments & psychosocial interviews • Show importance of clinical social workers

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

15. The Bottom Line • 835 total referrals • 705 assessments • 561 initial • 144 Age-18 redeterminations/CDRs • 239 allow/continue • 16 pending appeal • 130 no-shows

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

17. Adjudicator Materials • Revised parent/caregiver function forms • Updated adjudicators’ test list • Prepared DDS resource guides [selected states]

18. Adjudicator Training Center trainers for IV-T broadcasts • Functional evidence • School records • Communication problems • Integrating evidence • AD/HD • Experts for Q&A broadcasts Interactive CD-ROM

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

20. Collaborations: Result Improve ability to adjudicate complex, technical childhood disability cases for more correct initial & more uniform decisions

21. QUESTIONS?

22. Sequential Evaluation ProcessChildren • Substantial Gainful Activity? • Yes → not disabled No → next step • “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

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

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

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”

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

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

28. Joint Case Reviews • AUCD/DDS/SSA teams • Suggest clarifications for SSA policy/procedures & guidance for disability adjudicators • Expand training & technical assistance

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

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

31. Collaborations: Clinical • Reinforce interdisciplinary nature of childhood disability adjudications • Expand pediatric experts for case reviews, consultations & training • Enhance national adjudicator training & guidance