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

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.