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Accessing Public Benefits: SSI and SSDI. Yvonne M. Perret, MA, MSW, LCSW-C Advocacy and Training Center National Alliance to End Homelessness Conference July 19, 2006. Mental Illness and Co-Occurring Disorders in Homeless Population.

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Accessing public benefits ssi and ssdi

Accessing Public Benefits: SSI and SSDI

Yvonne M. Perret, MA, MSW, LCSW-C

Advocacy and Training Center

National Alliance to End Homelessness Conference

July 19, 2006


Mental illness and co occurring disorders in homeless population
Mental Illness and Co-Occurring Disorders in Homeless Population

  • In 2000, the Urban Institute estimated that 1% of the population are likely to experience homelessness at least 1/year

  • Estimates of adults with mental illness in the homeless population vary from 25%-60% (National Health Care for the Homeless Council, Community Action Network)

  • Approximately half of those with mental illness also have a substance use disorder

  • Ongoing physical health problems, including infectious diseases, are common and debilitating


What are ssi ssdi
What are SSI/SSDI? Population

  • Supplemental Security Income (SSI): Income benefit, with set Federal Benefit Rate, available to low-income individuals who are blind, or who have a disability or who are 65 or older. Maximum benefit: 2006-$603

  • Social Security Disability Insurance (SSDI): Disability benefit whose amount is based on earnings put into the Social Security System. Has a family benefit as well.


Current reality
Current Reality… Population

  • Only 11% of homeless population currently receiving SSI/SSDI

  • Many more are estimated to be eligible


Getting this benefit is difficult in the best of circumstances
Getting this Benefit is Difficult in the PopulationBest of Circumstances…

  • Nationally, 37% of SSA disability applications are approved upon initial submission

  • This is an aggregate number

  • Not broken down by housing status

  • Increases to 52% after appeals


What we know is possible
What We Know is Possible… Population

Approval rates on initial application

of 60-95% can be achieved

for people who are homeless


Components of successful work
Components of Successful Work Population

  • Focus on recovery

  • Successful engagement and relationship building

  • Attention to all needs of individual

  • Skilled development and understanding of SSI/SSDI applications/medical evidence

  • Addressing co-occurring disorders


Benefits and recovery
Benefits and Recovery Population

  • What does recovery from homelessness involve? A holistic approach to work with homeless individuals and encompasses:

    • Life stability: Housing, treatment and supportive services

    • Employment

    • Ongoing human relationships

    • Successful community living

    • Hope for reaching life goals

  • Without income, recovery is extraordinarily difficult.


Successful engagement
Successful Engagement Population

  • Characteristics:

    • Respect

    • Safe environment

    • Promises kept

    • Listening, clarifying, and believing

    • Addressing of basic needs

    • Assurance of future contact


Obstacles to engagement
Obstacles to Engagement Population

  • Obstacles/problems to address:

    • Trauma of homeless experience

    • Past experience of disrespect

    • History of receiving poor services

    • Symptoms of mental illness

    • Mistrust and disconnection

    • Practical issues (e.g., transportation)


Making characteristics come to life
Making Characteristics Come to Life Population

  • Respect:

    • Ask how individual prefers to be addressed

    • Address basic needs; bring, when possible, food drink, clothing

    • Provide choice and be clear what can do

  • Safe environment:

    • Meet where individual choices; outreach

    • Inquire about comfort; explain purpose

    • Provide personal space


Making characteristics come to life1
Making Characteristics Come to Life Population

  • Promises Kept

    • Rule of practice: Under-promise and over-deliver—offer only what you can provide

    • If you don’t know an answer, say so and offer to find out. Don’t fake it!

  • Listening, Clarifying, and Believing

    • Homeless people often don’t feel heard

    • Clarify any questions using clear language

    • Don’t refute someone’s perception of experience


Making characteristics come to life2
Making Characteristics Come to Life Population

  • Addressing of basic needs

    • Ensure the person is warm/cool enough, can get food, clothing, etc.

    • Ask for housing wishes and work on referrals

  • Assurance of future contact

    • At first meeting, find out how to contact

    • Be clear about next steps and follow them

    • Keep appointments


Ssi ssdi eligibility criteria
SSI/SSDI Eligibility Criteria Population

  • Non-medical: Different for SSI and SSDI

    • More detailed for SSI as is needs-based

    • Cleared by SSA

    • Must be cleared for application to proceed

  • Medical: Exactly the same for both

    • Disability Determination Services (DDS): State agency

    • Makes disability determination for SSA


Medical criteria for eligibility for ssi ssdi
Medical Criteria for Eligibility for SSI/SSDI Population

  • Individual must have medically determinable physical or mental impairment;

  • Impairment must result in death or have lasted or be expected to last 12 months or more

  • Impairment must cause functional limitations that keep the individual from working Substantial Gainful Activity (SGA) (2006: defined as $860/mo. gross earnings)


Functional areas
Functional Areas Population

  • Activities of Daily Living: Washing, dressing, bathing, using transportation, budgeting, housekeeping, using a phone, etc.

  • Social Functioning: Ability to communicate clearly with others; also ability to tolerate being around and interacting with other people on a consistent basis


Functional areas continued
Functional Areas (continued) Population

  • Ability to maintain pace and persistence in the completion of tasks: Cognitive functions such as concentration, memory, following directions, focus, repeated ability to do

  • Periods of decompensation of extended duration: Must have lasted at least 2 weeks or more 3 or more times in the last year


Eligibility for ssi ssdi
Eligibility for SSI/SSDI Population

  • After meeting non-medical criteria, individual must:

    • Meet diagnostic and durational criteria

    • Show “marked” functional impairment in at least two of the four functional areas

    • “Marked” defined as more than “moderate”

  • To determine eligibility, DDS follows a sequential evaluation


Importance of sequential evaluation
Importance of Sequential Evaluation Population

  • Includes 5 steps

  • Eligibility possible at 3rd and 5th steps

  • Need to understand “medical listings”

  • At 4th and 5th step, prior work and residual functional capacity (RFC) considered

  • Person can be denied if can do work that “exists in national or regional economy”


Current consideration of substance use
Current Consideration of Substance Use Population

  • 1996: Legal change; prior to this, if material, ok

  • If substance use deemed “material,” can be denied

  • Determining material:

    • If a person were to be clean and sober, would he or she still be disabled by another illness or impairment?

    • If the answer is yes, the person more likely would be approved

    • If no, the person would be denied.


Deciding material requires comprehensive evaluations
Deciding “Material” Requires Comprehensive Evaluations Population

Evaluations

  • Must be longitudinal

  • Must be comprehensive and address

    all relevant information

  • Should be done with use of open

    ended questions whenever possible

  • Must understand early and ongoing context

    of substance use


Comprehensive evaluations
Comprehensive Evaluations Population

  • Must consider:

    • Trauma history: Discipline, “brain hurt”

    • Educational and other learning difficulties

    • Context of substance use—its purpose for individual

    • Employment: Duration, relationships, tasks, why left


For more information
For more information… Population

CONTACT:

Yvonne M. Perret

Executive Director

Advocacy and Training Center

1116 Bedford St.

Cumberland, MD 21502

[email protected]


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