The Substance Abuse and Mental Health Services Administration (SAMHSA) developed the Stepping Stones to Recovery curriculum in an effort to help case managers assist homeless adults with serious mental illnesses and co-occurring disorders with the application process for Social Security disability benefits. These benefits – Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) – are among the first steps toward recovery and stability for many people experiencing homelessness. The curriculum provides an in-depth, step-by-step explanation of the application and disability determination process for case managers who assist persons who are homeless to apply for SSI and/or SSDI.
The individual modules of the curriculum are briefly described below. The curriculum is designed to be accompanied by the Stepping Stones to Recovery reference manual recently published by SAMHSA.
Opening: Sets the stage for the content of the curriculum. It also outlines community collaborations necessary for starting an SSI/SSDI community initiative.
Module I: The Disability Programs of the Social Security Administration (SSA) Gives an overview of the two SSA disability programs discussed in the curriculum. It focuses primarily on the basic differences and similarities between the two programs and introduces some of the terms used by SSA.
Module II: Engaging the Applicant introduces several strategies to engage an applicant as well as a technique of interviewing that creates a comfortable situation for individuals who are revealing the private details of their lives. It also introduces some potential roles that a case manager may play in the SSI/SSDI process.
Module III: The Application Process: Non-Medical Information describes the non-medical application process, including the agencies that assess an application, the forms that are required, and the information that is needed. Special attention is given to critical sections of the SSI application: immigration, living arrangement, and income/resources. It also discusses the pros and cons of different application methods (in-person, by phone, online).
Module IV: The Application Process: Medical Evidence focuses on the medical information that must be gathered and assessed for an SSI or SSDI application (especially for the completion of the SSA–i3368 Internet Disability Report). It stresses the medical evidence and its importance in the determination process in particular.
Module V: Eligibility Criteria and the Sequential Evaluation presents the criteria that the Disability Determination Service (DDS) must consider when determining an applicant’s eligibility. It discusses the process used for the determination called sequential evaluation.
Module VI: Medical Information on Mental Illness provides training participants with a general introduction to the Disability Evaluation Under Social Security (also called the ‘Blue Book’ or the ‘listings’) with which the DDS evaluates impairment resulting from illness. It presents information regarding working with individuals who have specific mental illnesses and determining and documenting the different categories of such illness
Module VII: Co-Occurring Disorders: Mental Illness and Substance Use Disorders discusses the challenges of evaluating and documenting co-occurring mental illness and substance use disorders. It explains the legal changes that govern this evaluation.
Module VIII: Collecting the Medical Evidence: The Usual Process presents the typical medical evidence collection process that occurs. Participants will brainstorm about how they can collect such information more effectively and identify sources of medical evidence in their communities. This module also incorporates a discussion of consultative evaluations
Module IX: The New and Improved Process builds on Module VIII to create a practical guide for collecting and submitting the medical evidence to the DDS in a more efficient, complete, and effective manner.
Module X: Interviewing and Assessing expands the discussion on engaging and interviewing begun in Module II. This module focuses on the ongoing and investigative nature of interviewing and assessment. It describes the interviewing and evaluation needed for case managers to understand fully the histories of people they serve, the issues they face, and the impact of both histories and current situations on people’s day–to–day lives.
Module XI: Functional Information: The Often–Missing Link introduces the four areas of functional information that SSA and the DDS use to review and evaluate an applicant’s eligibility and examines the link that a case manager needs to establish between these functional areas and an applicant’s medical problems.
Module XII: Writing Functional Responses builds upon the knowledge gained from the previous module, focusing on using the functional information an individual provides to write functional responses for each applicable area.
Module XIII: The Full Picture: The Medical Summary Report is the culmination of the information presented in previous modules. Participants learn to take the personal, medical, and functional information about an applicant and create a comprehensive medical summary report for submission to the DDS.
Module XIV: QMB, SMLB, and QI–1: Supplemental Medicaid Programs discusses some of the Medicaid programs that are designed to supplement Medicare beneficiaries, mainly: Qualified Medicare Beneficiaries (QMB), Specified Low-Income Beneficiaries (SLMB), and Qualifying Individuals (QI-1).
Module XV: The Next Step: SSI and SSDI Work Incentives presents an overview of work incentive programs available to recipients of SSI and SSDI so that once individuals are receiving benefits and achieving some stability, a case manager can help guide them through those next steps of employment and more successful community living.