SOARing Over Lunch - General Questions
Q: Once a caseworker has been trained and doing applications for some time, how many cases should they be able to complete in a year?
We estimate, based on anecdotal reports and outcomes reported in OAT, that SOAR applications take an average of 20-40 hours to complete. This means that a full time, experienced SOAR case manager can usually complete 35-50 quality applications in a year. However, there are many variables that must also be considered. These variables include other activities or tasks the SOAR worker is responsible for in addition to SOAR, any difficulties with collecting medical records, how engaged the applicants are and the amount of support the SOAR worker has from their agency. Talking with your SOAR TA Center Liaison can help you decide how many cases SOAR workers in your agency should be able to complete in any given timeframe.
Q: I am new to SOAR and struggle with many of the acronyms. Can you provide me with a list of the most commonly used acronyms?
Here are some of the most commonly used acronyms. We also recommend that you check out this more complete Glossary.
CE - Consultative Exam
DDS - Disability Determination Services
MSR – Medical Summary Report
SAMHSA – Substance Abuse and Mental Health Services Administration
SGA – Substantial Gainful Activity
SOAR – SSI/SSDI Outreach, Access and Recovery
SSA - Social Security Administration
SSDI - Social Security Disability Insurance
SSI - Supplemental Security Income
VA - Veterans Affairs
Q: I have just passed the SOAR Online Course and live in an area where I am the only SOAR worker. There is no local lead. What are the next steps I should take to develop relationships with the local SSA and DDS offices?
One of the foundations that SOAR is built upon, is collaboration and it is very helpful if SOAR workers have good working relationships with their local SSA and DDS offices. This is important because SSA/DDS can help provide feedback about the quality of the claims being submitted, help with the development of local SOAR processes and help the SOAR worker troubleshoot issues as they arise. You should first contact your Local or State SOAR Lead and/or your SOAR TA Center Liaison.You can also read more about SSA and DDS collaborations in our issue brief, “Collaboration with SSA and DDS: Something for Everyone.”
Q: What do you do when your client cannot be located, halfway through the application process?
Many times applicant’s will be temporarily “missing” during parts of the SSI/SSDI application process. As the applicant’s appointed representative (using the SSA-1696) you are able to represent the applicant and submit most parts of the claim without the applicant being present. However, the applicant will need to be present to sign forms (both paper and electronic) and verify information for SSA should the claim be approved. To help prevent this issue, it is important to gather as much information as you can about a client in the first couple of meetings. It is important to get the names and numbers of friends and family that the applicant has so that if they do become unable to meet, you are still able to gather necessary information. Be sure to notify SSA and DDS if the applicant’s whereabouts are unknown or if their living arrangement changes. If the applicant is approved and then is unable to be located - remember, the medical decision lasts for one year.
Q: What do you do when you engage a client and learn that they are already working with an attorney?
SOAR workers can be a great asset to helping attorneys who are working with our clients. If an attorney is already involved with an appeal, see if you can help by providing additional evidence or documentation. Applicants are able to have more than one representative so you and the applicant have the option to complete a new SSA-1696 for the applicant so that you can be involved with the case. If an applicant wishes to dismiss their attorney they are permitted to do so but the attorney may file a fee petition to SSA and, if benefits are awarded, receive partial payment based on work already completed at the time of withdrawal. Read more about working with attorneys.
Q: What to do when people are not a good fit for SOAR because they are not eligible for SSA benefits but still have needs?
If it is determined that SOAR would not be a good fit for the person being interviewed, there are a number of ways that you can still help the individual. These ways include helping connect the person with housing, employment supports, and mental or physical health services. It is also important never to discourage someone from applying for SSA disability benefits if they so choose. Everyone has a right to apply even if you don’t think they are likely to be found eligible. You can provide helpful information that they can use to apply on their own. Remember - the job of a SOAR worker is not just to help support someone with their application - it is to support them in their recovery.
Q: How do we prove that substance abuse is not material to a person’s disability?
It is important that you document the substance use and provide information that helps DDS make a decision as to whether or not the substance use is material to the applicant’s disability. It is important to be able to illustrate to the DDS examiner that the person would still be disabled even if they were clean and sober. To do this, you should provide details in the Medical Summary Report (MSR) and medical records that illustrate times that the applicant still had symptoms and struggled with their functioning even when they were not using. Common places we are able to access this information is when the applicant was hospitalized, in jail or prison or involved in treatment programs. It is also important to document why the applicant uses - showing that the applicant uses to deal with past trauma or because of their underlying psychiatric issues. It is also helpful to show times when the applicant may have had struggles with being receptive to substance abuse treatment, because of their psychiatric illnesses. Read more about materiality.
Q: Many of the people we are working with have extensive trauma histories. Can you give us some helpful tips about how to document limitations in functioning due to trauma?
You can learn more about SSA’s listing for 12.15 Trauma- and stressor-related disordersin this SOAR Online Course article.There are helpful tips for documentation and a link to a video that we recommend on PTSD. Documenting functional impairment is similar for all conditions, so we recommend reading the SOAR Online Course articles relating to functioning, beginning with Class 5, Article 2.
Q: I am in the leadership of an agency that is having our outreach workers take the SOAR Online Course. As we move forward, what ways can we support the program so that we can get great outcomes for the people we serve?
There are a number of ways you can support the efforts of your agency’s SOAR workers. One, it is important to celebrate success (approvals) and also work to mitigate the negative effects of denials. Instead of fixating on denials, work with that individual and the SOAR TA Center to strengthen the process that you are currently using. Institute a quality review process and consider using the Quality Review Checklist. It is also helpful if the agency leadership is educated about SOAR basics, and participating in SOAR webinars, listening sessions and discussion groups. We also suggest that people who are not going to be doing cases but are going to be supervising people who are completing cases, that they take Class1 in the SOAR Online Course.
Q: How can we, as SOAR workers/programs - support people with their Continuing Disability Reviews (CDRs)?
We encourage you to watch the SOAR webinar, “SOAR Representation with Continuing Disability Reviews (CDRs),” held on November 19, 2014, which provided an in-depth description of CDRs and the SOAR provider's role in assisting with CDRs. We also have a comprehensive article and FAQ section just for CDRs that you can check out.
Q: What are some tips we can use to engage folks who are very leery of working with the service system?
The relationship between the SOAR provider and the applicant, like any relationship, takes time and effort. Many times people we work with may have an extremely hard time trusting others, especially those in the service system. Because of this, it is extra important that we work to engage people at the speed and in the ways that will work for them - as individuals.
It is important to work with individuals taking into account the full context of their lives - their history, needs, strengths, recovery hopes and dreams, culture and spirituality. It is also important not to promise that you will be able to get a person’s claim approved, instead you just let them know you are going to be using the SOAR model to ensure that you are submitting a complete quality application with their help.
Many times it is helpful to include the use of peers in your engagement efforts. People with lived experience lend a great deal of credibility to your efforts if the applicant may have had issues trusting the service system in the past. Read more information about using peers.
Q: What are the first steps to building statewide SOAR infrastructure?
The first step towards growing SOAR in your state is to enlist the help of the SOAR TA Center. The TA Center is fully prepared to provide states with the support necessary to increase the number of SOAR trained case managers completing and submitting quality applications in your state. The support includes on-on-one consultation, help with starting or improving the performance of SOAR State Steering Committees and ways to improve local relationships with SSA and DDS. The first step is to contact your SOAR TA Center liaison.