238543 SSA-NIH-BU collaboration to improve the disability determination process: A conceptual and operational approach based on contemporary paradigms and novel assessment methods

Tuesday, November 1, 2011: 10:30 AM

Elizabeth K. Rasch, PT, PhD , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
Diane Brandt, PT, MS, PhD , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
Leighton Chan, MD, MPH , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
The Social Security Administration (SSA) is responsible for the nation's largest Federal disability programs. Over time, these programs have experienced a dramatic rise in applications, surpassing 3 million in 2009. Through the years, the SSA sought ways to effectively and efficiently adjudicate its disability claims. These efforts have been hampered by the enormity of the constituent pool and the complexity of translating statutory legislation into an efficient determination process. Thus in 2007, the SSA sought advice from the NIH on new methods that might inform the disability evaluation process. We proposed re-envisioning the disability determination process through the lens of contemporary disability concepts. An inter-agency agreement (IAA) was signed in 2008 to: 1) analyze existing SSA data, and 2) assess the feasibility of developing Computer Adaptive Tests (CAT) to augment SSA's data collection processes. We performed a systematic examination of data content to assess the characteristics of functional information captured during the application and determination processes using the International Classification of Functioning as a conceptual framework, in addition to a thorough literature review. We found a bias in data collection toward diagnosis and impairment, and we identified important gaps in content coverage. We suggested that more comprehensive and rapid assessment of function via CAT, examined in the context of workplace demands, may better predict work capacity. Preliminary work supported feasibility of the CAT approach for the collection of functional information from SSA applicants and providers. Data analysis and CAT development are proceeding concurrently for this multi-year project.

Learning Areas:
Public health or related public policy
Public health or related research

Learning Objectives:
At the conclusion of the session, participants will be able to: 1) describe conceptual gaps associated with the historical underpinnings of the Social Security Administration (SSA) disability evaluation process in the context of current perspectives of disability; 2) recognize the influence of exogenous pressures and the complexities of implementing the nationís largest disability programs; 3) describe the broad objectives of the SSA-NIH-BU collaboration to improve the disability determination process and characteristics of the data; 4) indicate how Computer Adaptive Tests could potentially improve SSAís disability determination processes; 5) indicate the importance and relevance of this work for health policy and more specifically, disability policy.

Keywords: Disability Policy, Assessments

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an author on the content of this abstract because I have a PhD in rehabilitation science with a concentration in epidemiology, my area of research is the health of people with disabilities and related programs and policies, I have published extensively in this area, I am the Chief of the Epidemiology and Biostatistics Section of the Rehabilitation Medicine Department at NIH which studies disability issues, and I am the project lead for the NIH-BU-SSA collaboration described in this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.