SSA-NIH-BU Collaboration to Improve the Disability Determination Process

Presentation for the SSA Occupational Information Development Advisory Panel: 12/08/10

Beth Rasch, PT, PhD

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Point of clarification

This exploratory work, being conducted by NIH and BU, examines ways in which claimants and their

health care providers can quickly and easily provide information about claimants’ function.

SSA has not yet adopted or endorsed this approach.

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Background

August, 2007 SSA sought help from NIH Identify new diagnostics tests that might expedite

allowances Paradigm: Diagnosis or impairment ≈ disability

SSA / RMD Inter-Agency Agreement NIH signed 3-year agreement with SSA

Initiated on 2/1/08 New 5-year agreement with SSA

Initiated on 2/1/10

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Broad objectives

1) Data analysis 2) Computer Adaptive Tests (CAT)

To improve SSA disability determination process through:

Unprecedented access to SSA data

Focuson

function

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Medical model: disability as a personal trait

Conceptualizing disability: Two opposing perspectives

Social model: disability as a socially created problem

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Prominent models of disability

Nagi model Verbrugge and Jette’s “Disablement Process” IOM model Social model WHO International Classification of Functioning,

Disability, and Health (ICF)

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Health Condition

Activities Participation

Environmental Factors

Personal Factors

Body Functions

Body Structures

ICF: World Health Organization, 2001

Conceptualization

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Contemporary concepts of disability Interactive

Not solely an individual attribute—diagnosis alone cannot predict disability

Multidimensional Complex theoretical models map the interaction of

conceptual elements that constitute the definition of disability

Continuum Not an “all or nothing” concept

Dynamic Disability influenced by the environment Disability can change over time

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Measuring such a concept poses a methodological challenge

To operationalize this concept, individual attributes and environmental features must be measured

Operational definition depends on purpose of data collection process

Measuring disability

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SSA purpose

Identify individuals who are unable to engage in substantial gainful employment due to medically determinable physical or mental impairment/s which can be expected to result in death or which have lasted or are expected to last > 12 monthsSEC. 223. [42 U.S.C. 423](d)(1)

Physical or mental impairment/s must be of such severity that the individual is not only unable to do previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy…SEC. 223. [42 U.S.C. 423](d)(2)(A)

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Framing the problem There is a gap between contemporary notions of

disability and how SSA operationalizes its statutory definition of disability SSA’s operationalization is focused on physical

and mental impairments (medical model) Contemporary disability models depict disability

as the gap between an individual’s functional ability and environmental demands

Diagnosis and impairment may be poor predictors of work disability

Jette & Badley: Conceptual issues in the measurement of work disability. Wunderlich et al, Eds. TheDynamics of Disability. National Academy Press, Washington, DC, 2002

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Measurement

Health Condition

Participation

Environmental factors

Personal factors

Source: ICF, WHO, 2001

Body structure & function

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SSA’s data gaps

Viewed through the ICF, current SSA assessment processes could improve content coverage of “activity” domains relevant to work. Limited information captured on: Learning and applying knowledge General tasks and demands such as multi-tasking or

organizing time, space and materials for a task Communication Interpersonal interactions and relationships

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Domain selection

Priorities for SSA-IAA Interpersonal interactions and relationships Mobility

Learning and applying knowledge Communication Self care General tasks and demands

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Recommendations:Whole person approach

Capture all conditions during the application process to characterize the sum total of their impact on functioning as it relates to work

Depression

Knee arthriti

s

Heart disease

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FY 2005 initial applications(2.6 million)

Recommendations:Focus on function

Reconsiderations (0.6 million)ALJ

disposition (0.5 million)

Of appeals, 62% allowed by ALJ

Functional Informatio

n

Assess function: Comprehensively Uniformly Early

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Usefulness for SSA

Dramatically improve breadth, completeness, uniformity, and precision of medical evidence

Collect data when its most useful for decision making

Even small improvements in the process may lead to: less processing time and costs improved accuracy and uniformity of decisions reduced backlogs

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Questions

This exploratory work, being conducted by NIH and BU, examines ways in which claimants and their health care providers can

quickly and easily provide information about claimants’ function.

SSA has not yet adopted or endorsed this approach.