1. 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

2. 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

3. 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.

4. Current Reality… Only 11% of homeless population currently receiving SSI/SSDI Many more are estimated to be eligible

5. 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

6. What We Know is Possible… Approval rates on initial application of 60-95% can be achieved for people who are homeless

7. 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

8. 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.

9. Successful Engagement Characteristics: Respect Safe environment Promises kept Listening, clarifying, and believing Addressing of basic needs Assurance of future contact

10. 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)

11. 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

12. 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

13. 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

14. 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

15. Medical Criteria for Eligibility for SSI/SSDI (1) Individual must have medically determinable physical or mental impairment; (2) Impairment must result in death or have lasted or be expected to last 12 months or more (3) Impairment must cause functional limitations that keep the individual from working Substantial Gainful Activity (SGA) (2006: defined as $860/mo. gross earnings)

16. 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

17. 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

18. 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

19. Importance of Sequential Evaluation Includes 5 steps Eligibility possible at 3 rd and 5 th steps Need to understand “medical listings” At 4 th and 5 th step, prior work and residual functional capacity (RFC) considered Person can be denied if can do work that “exists in national or regional economy”

20. 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.

21. 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

22. 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

23. For more information… CONTACT: Yvonne M. Perret Executive Director Advocacy and Training Center 1116 Bedford St. Cumberland, MD 21502 Yvonne.perret@gmail.com