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