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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?
  • 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…
  • 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 Best 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…

Approval rates on initial application

of 60-95% can be achieved

for people who are homeless

components of successful work
Components of Successful Work
  • 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
  • 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
  • Characteristics:
    • Respect
    • Safe environment
    • Promises kept
    • Listening, clarifying, and believing
    • Addressing of basic needs
    • Assurance of future contact
obstacles to engagement
Obstacles to Engagement
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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)
  • 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
  • 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
  • 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
  • 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

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
  • 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…

CONTACT:

Yvonne M. Perret

Executive Director

Advocacy and Training Center

1116 Bedford St.

Cumberland, MD 21502

Yvonne.perret@gmail.com