1. April 2005-IOM1 SSA/AUCD: A National Collaboration

2. April 2005-IOM2 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. April 2005-IOM3 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. April 2005-IOM4 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. April 2005-IOM5 Participants 39 Centers 30 DDS offices Central & Regional SSA Offices Overall Coordination by AUCD

6. April 2005-IOM6 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)

7. April 2005-IOM7 Initial Applications Cognitive, psychiatric/emotional impairments Preschool (ages 3-5) School-age Adolescent (ages 14-17)

8. April 2005-IOM8 Other Assessments Low birth weight: by law, continuing disability reviews (CDR) for most at 12 months Age-18 “redeterminations”

9. April 2005-IOM9 Assessment: Protocols File review Family history Developmental pediatric Psychological Adaptive functioning Attention/executive functioning Academic Speech & language

10. April 2005-IOM10 Assessment: Protocols  Other evaluations, as needed  Older age group components  Psychosocial  Cognitive

11. April 2005-IOM11 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. April 2005-IOM12 Language Appear in all age groups Clarify severity or highlighted school evidence Reveal undiagnosed disorders Explain impact of co-morbid disorders

13. April 2005-IOM13 Adaptive Functioning Clarify severity for all age groups Offer new evidence Provide standardized instruments & psychosocial interviews Show importance of clinical social workers

14. April 2005-IOM14 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. April 2005-IOM15 The Bottom Line 835 total referrals 705 assessments o 561 initial o 144 Age-18 redeterminations/CDRs 239 allow/continue 16 pending appeal 130 no-shows

16. April 2005-IOM16 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. April 2005-IOM17 Adjudicator Materials Revised parent/caregiver function forms Updated adjudicators’ test list Prepared DDS resource guides [selected states]

18. April 2005-IOM18 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. April 2005-IOM19 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. April 2005-IOM20 Collaborations: Result Improve ability to adjudicate complex, technical childhood disability cases for more correct initial & more uniform decisions

21. April 2005-IOM21 QUESTIONS?

22. April 2005-IOM22 Sequential Evaluation Process  Children 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

23. April 2005-IOM23 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. April 2005-IOM24 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. April 2005-IOM25 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. April 2005-IOM26 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. April 2005-IOM27 “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. April 2005-IOM28 Joint Case Reviews AUCD/DDS/SSA teams Suggest clarifications for SSA policy/procedures & guidance for disability adjudicators Expand training & technical assistance

29. April 2005-IOM29 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. April 2005-IOM30 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. April 2005-IOM31 Collaborations: Clinical Reinforce interdisciplinary nature of childhood disability adjudications Expand pediatric experts for case reviews, consultations & training Enhance national adjudicator training & guidance