HHS/ASPE. U. S. Department of Health and Human Services.Background

Findings from a Study of the SSI/SSDI Outreach, Access, and Recovery (SOAR) Initiative:

Appendix C:
Stepping Stones to Recovery
Trainer Module Fidelity Assessment

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Trainer Module Fidelity Assessment Summary
Location: _________ Date: _________ Observer: ____________
Opening: Setting the Stage:
Module Essential Information Rating                     Comments                    
Engage in a positive interactive process with the group    
Discuss the approach of this curriculum and its major components    
Exercises (if applicable)
  • Introductions
  • Expectations
   
Module I: The Disability Programs of the Social Security Administration (SSA):
Identify the two disability programs available through the Social Security Administration    
Describe the similarities and differences between Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI)    
List the benefits available under each program    
List and briefly describe the health insurance programs affiliated with each benefit program    
Exercise (if applicable)
(A) Discussing SSI/SSDI
   
Module II: Engaging the Applicant:
Describe the potential roles a case manager may assume when assisting a person with SSI/SSDI application.    
Describe how every step of the application process is a clinical one that involves engagement and trust    
List and describe at least three strategies for engaging with individuals who are homeless and who have a serious and persistent mental illness, including allowing the person some choice and control over what happens    
Describe the importance of creating a comfortable, safe and respectful environment    
Discuss the interviewing techniques that can assist with gathering information    
Exercises (if applicable)
(B) Being Homeless Visualization
(C) Engaging an Individual
   
Module III: The Application Process: Non-Medical Information:
Describe process by which an application is reviewed for approval    
Explain the importance of addressing non-medical criteria fully and its impact on the application process    
Describe how to start the application process    
Define the term "protective filing date" and explain its importance    
Discuss the advantages and disadvantages of applying in person, on-line, or by phone    
Discuss the advantages of accompanying the person to the interview    
List the critical areas for SSI that affect eligibility and/or amount of benefits including: immigration, living arrangement, income/resources, and involvement with the criminal justice system    
List critical areas for SSDI including earnings history and the date that significant work ended    
Demonstrate familiarity with the SSA-8000 SSI Application form and the SSA-16 SSDI Application form    
Explain the significance of becoming an applicant's representative and the process for doing so (completing the SSA-1696 Appointment of Representative form)    
Exercises (if applicable)
(D) Can You Figure Out SSI Eligibility
(E) Determine Living Arrangements
   
Module IV: The Application Process: Medical Evidence:
Describe the function of the Disability Determination Services (DDS)    
Explain how to locate DDS in one's own State    
Describe how to use the SSA-3368 Disability Report form    
Explain how to find and complete the i3368 on-line    
List the kinds of information that should be included on the SSA-3368 form, that is, the medical evidence required for an effective, efficient disability determination    
Explain the importance of the date of onset for SSDI applications and how a complete medical picture can affect determination of this date    
Describe the SSA-827 Authorization to Disclose Information to the Social Security Administration (SSA) and its use in collecting medical evidence    
Exercises (if applicable)
(F) Determining Eligibility Dates
   
Module V: Eligibility Criteria and the Sequential Evaluation:
List the disability criteria as defined by SSA (with the aid of notes)    
Describe the five steps of sequential evaluation used by SSA and DDS for making a disability determination    
Discuss how disabilities based on mental illness(es) must address how the illness impairs a person's ability to function    
Describe the significance of steps 3 and 5 of the sequential evaluation    
Explain how the Dictionary of Occupational Titles is used in disability determination    
Explain what can lead to a denial of benefits    
Explain how a person can be approved before all five steps of sequential evaluation are completed    
Exercises (if applicable)
(G) Considering Eligibility
   
Module VI: Medical Information on Mental Illness:
List the categories of mental disorders used by DDS    
Describe the purpose of the "Blue Book" or "listing" used by DDS    
Explain how the DDS listings of mental disorders are different from those in diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association    
Discuss the utility of familiarity with medications used to treat mental illness    
Discuss the utility of familiarity with the types of different mental health services    
Describe types of mental health services and general classes of medications    
Module VII: Co-Occurring Disorders: Mental Health and Substance Use Disorders:
Describe the history of substance use classification for disability purposes by the SSA    
Discuss the current SSA policy regarding substance use disorders and the 1996 legal changes governing SSA's consideration of substance use    
Demonstrate an understanding of the concept of "material" in disability determination through an exercise    
Describe the steps to determine whether substance use is material to a person's disability    
Exercises (if applicable)
Three Applicant Vignettes
   
Module VIII: Collecting the Medical Evidence: The Usual Process:
Describe the process of gathering medical evidence that DDS generally follows    
List at least four concerns that arise when serving adults who are homeless and who have a serious and persistent mental illness    
Discuss the benefits and potential drawbacks of consultative examinations, as well as what information can be found in a consultative examination report    
Module IX: The New and Improved Process:
Discuss and compare the usual process of gathering medical evidence that DDS generally follows and an improved strategy based on proactive steps a case manager can take.    
List and discuss several ways a case manager can assist with the medical evidence collection process to ensure the most accurate determination is made    
Describe the implementation of the new DDS electronic process    
Exercises (if applicable)
Collecting Medical Evidence
   
Module X: Interviewing and Assessing:
Describe assessment as an ongoing process of observation and discovery    
Discuss a variety of ways to establish a comfortable environment    
Demonstrate the ability to use language that is respectful, non-threatening and sensitive; and to ask open-ended questions    
Demonstrate the use of open-ended questions that can be used in assessment    
Discuss how to use the provided Applicant Assessment Worksheet    
Exercises (if applicable)
(J) The Importance of Language
(K) Interviewing Demonstration
   
Module XI: Functional Information: The Often-Missing Link:
State the key question of DDS, "Does this illness (impairment) keep the applicant from being able to engage in substantial gainful activity?"    
Define substantial gainful activity    
List the areas of functional information that SSA and DDS review    
Discuss the context of functional information in the disability determination process    
Discuss the problem of missing information from existing records and describe some ways to supplement it    
Demonstrate an ability to ask comprehensive questions to elicit this much needed information    
Demonstrate an ability to use language that is respectful, non-threatening and sensitive and to ask open-ended questions    
Exercises (if applicable)
(L) Functional Assessment Role Play
   
Module XII: Writing Functional Responses:
Describe how observations of functional information translate into descriptions of impairment related to a person's illness    
Discuss the importance of communicating clearly to DDS a person's impairments related to the illness    
Demonstrate how to write descriptions of impairment and functional response descriptions    
Exercises (if applicable)
(M) Writing a Functional Description
   
Module XIII: The Full Picture: The Medical Summary Report:
List the components of a Medical Summary Report    
Discuss how to use existing information in the report    
Discuss the need for a physician's signature, regardless of author    
Describe alternative uses for this report with the applicant's permission    
Exercises (if applicable)
Writing a Medical Summary Report
   
Module XIV: Supplemental Medicaid Programs: QMB, SMLB, and QI-1:
Describe the supplemental programs of Medicaid that assist Medicare beneficiaries    
List the income limits for each category of supplemental Medicaid programs    
Identify the tools to find additional information on supplemental Medicaid programs    
Module XV: SSI and SSDI Work Incentives: A Brief Overview:
Discuss how to allay some of the fears that SSI and SSDI recipients have regarding the return to (or beginning of) paid employment and the information necessary to allay these fears    
Explain the different terms used in the world of work incentives under SSI and SSDI    
Describe the work incentives available under SSI and SSDI    
Discuss what happens to Medicaid and Medicare when individuals are employed    
Exercises (if applicable)
Determining Work Incentives and Income
   
Module XVI: Laying the Foundation for a Community SSI Initiative:
Identify the importance of disability benefits for the individual, the case manager, the agency and the community    
Describe at least three strategies for increasing access to disability benefits    
Discuss the groundwork that must be completed before intensifying efforts to help people who are homeless with SSI and SSDI applications    
Describe the support necessary at all levels within participating agencies to make this effort successful    
List the necessary steps to forming collaborations with SSA and the office of DDS    
Closing: Action and Feedback:
Demonstrate a plan to apply knowledge and skills learned in the program through completion of an action plan    
Express their level of satisfaction with the program through completion of a feedback form    
Exercises (if applicable)
  • Personal Action Plan
  • Post-Test
  • Feedback
   


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