SSA/AUCD: A National Collaboration

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SSA/AUCD A National Collaboration
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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

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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

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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

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Participants

• 39 Centers
• 30 DDS offices
• Central Regional SSA Offices
• Overall Coordination by AUCD

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Assessments Purpose

• Improve documentation Interdisciplinary now
  targeted assessments
• Integrate information to compare childs
  functional ability with same-age peers
• Resolve inconsistencies
• Explain degree nature of functional
  limitation(s)

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Initial Applications

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

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Other Assessments

• Low birth weight by law, continuing disability
  reviews (CDR) for most at 12 months
• Age-18 redeterminations

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Assessment Protocols

• File review
• Family history
• Developmental pediatric
• Psychological
• Adaptive functioning
• Attention/executive functioning
• Academic
• Speech language

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Assessment Protocols

• Other evaluations, as needed
• Older age group components
• Psychosocial
• Cognitive

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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

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Language

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

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Adaptive Functioning

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

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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

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The Bottom Line

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

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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

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Adjudicator Materials

• Revised parent/caregiver function forms
• Updated adjudicators test list
• Prepared DDS resource guides selected states

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Adjudicator Training

• Center trainers for IV-T broadcasts
• Functional evidence
• School records
• Communication problems
• Integrating evidence
• AD/HD
• Experts for QA broadcasts
• Interactive CD-ROM

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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

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Collaborations Result

• Improve ability to adjudicate complex, technical
  childhood disability cases for more correct
  initial more uniform decisions

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• QUESTIONS?

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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

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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

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Listing-Level Severity

• Meet or medically equal a listing or
• Functionally equal the listings
• Part B specifically for ltage 18
• Same body systems as adults growth

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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

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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

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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

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Joint Case Reviews

• AUCD/DDS/SSA teams
• Suggest clarifications for SSA policy/procedures
  guidance for disability adjudicators
• Expand training technical assistance

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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

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Collaborations Evidence

• Improve coordination with schools childrens
  hospitals
• Train child-serving professionals
• Use clinical social workers
• Prepare family friendly lists to help identify
  all existing records tests

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Collaborations Clinical

• Reinforce interdisciplinary nature of childhood
  disability adjudications
• Expand pediatric experts for case reviews,
  consultations training
• Enhance national adjudicator training guidance