Transcript SSI/SSDI Outreach, Access, and Recovery (SOAR Technical

Strengthening Applications:
The Medical Summary Report
Presented by:
National SOAR Technical Assistance Center
Policy Research Associates, Inc.
Under contract to:
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Webinar Instructions
Question instructions
Muting
Recording availability
Agenda
The Importance of the Medical Summary Report
Deborah Dennis, SOAR Technical Assistance Center
Strategies for Writing the Medical Summary Report
Ashley Wright and Corey Gephart, Park Center, Nashville, TN
Collaborating with Physicians for Writing Reports
Larry Klowden, Northwestern Memorial Hospital, Chicago, IL
Supporting SOAR Trainees through Writing Workshops
Jennifer Alfredson and Emily Palmer, Health Care for the Homeless,
Milwaukee, WI
Reviewing Medical Summary Reports for Quality Assurance
Emily Carmody, North Carolina Coalition to End Homelessness, Raleigh, NC
Questions and Answers
Facilitators: National SOAR Technical Assistance Team
The Importance of the
Medical Summary Report
Deborah Dennis
National SOAR Technical Assistance Center
Policy Research Associates, Inc.
SOAR Critical Components
Serving as the appointed representative
Collecting and submitting medical records
Electronically submitting applications and medical
evidence whenever possible
Collaborating with physicians for assessments
and medical information
Collaborating with SSA and DDS
Submitting a Medical Summary Report
The Medical Summary Report
A letter that provides information not found in
most medical records
Provides a vivid picture of the individual for the
DDS examiner who never sees them
Provides a clear link to functional impairment
Often takes the place of the SSA-3373 Function
Report
Helps to avoid the limited space and checkboxes of these forms
The Medical Summary Report
Is medical evidence when co-signed by
physician or psychologist who has seen
individual
Can be sent directly to the DDS disability
examiner or hand delivered to SSA
Receives positive feedback from DDS
examiners across the country
Components of the Medical Summary Report
Reference Section
Introduction
Personal History
Diagnostic and Treatment Information
Link to Functional Impairment
Summary
Contact Information
Introduction Section
Demographics
Physical description – hygiene, grooming,
dress, make-up, any unusual characteristics
Additional information – helps DDS
examiner “see” the individual as case
manager does
Personal History
Developmental
problems
Physical/sexual
abuse
Childhood
Educational
Relationships
Medical problems
Substance use
Current housing
Employment history
Quotes from the individual
are very helpful!
Psychiatric Diagnoses and Treatment
Chronological treatment history
Specific quotes from the applicant or
record that illustrate diagnosis
Observations of behavior
Durational issues
Current mental status exam
Link to Functional Impairment
Critical to connect symptoms/effects of illness with
marked functional impairments
To the extent possible in all four functional areas
Demonstrate impact of illness(es) on ability to work
Medication – effects and side effects
Support and effect of support
Compare with lack of support
Summary and Contact Information
Ties all information together for a concise
picture of the individual
Contact – names and numbers
Co-signed by case manager,
physician/psychologist
Medical Summary Report Worksheet
Serves as a helpful framework for writing
the report
Pulls together information collected using:
Substance Use Worksheet (Module VII)
Applicant Assessment Worksheet (Module X)
Functional Information Worksheet (Module XI)
Breaks into workable sections
Use as a template for your work in the field
Samples and Support
Visit the SOAR website for samples and
abbreviated versions
The SOAR TA Center will review redacted
reports and provide feedback upon request
Worth the Effort
The overall process of applying for
benefits is time-consuming
Putting forth the initial effort for an earlier,
more successful outcome may seem
difficult, but it is worth it for the person
and for the case manager
Strategies for Writing the
Medical Summary Report
Ashley Wright and Corey Gephart
Park Center
Nashville, TN
Steps/Strategies to Writing
• Collect medical records after Releases of
Information are signed.
• Go through medical records and put them in
chronological order.
• Set aside several hours at a time to begin
writing the report with no interruptions.
• Sit down with all information, all Medical
Records, Screening Packet (personal, medical,
employment and substance use history) and
any current Mental Status Exams.
Medical Summary Report
Introduction
Personal History
• Observations
• Diagnosis/symptoms
• How impairments interfere with
ability to work
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Medical Records
Functional Information
•
• Activities of daily living
• Social functioning
• Concentration, persistence
and pace
• Episodes of decompensation
(if applicable)
Summarize all mental health
& medical records
• Include doctors that treated
client, diagnosis & medications
• If inpatient, include admission
& discharge dates
Education
Employment
Relationship
Substance Abuse
Collaborating with Physicians
for Writing Reports
Larry Klowden
Northwestern Memorial Hospital
Chicago, IL
Northwestern Memorial Hospital
• Northwestern Memorial Hospital - Downtown Chicago, IL
• Academic Medical Center
• Northwestern University Medical School
• NU Graduate Psychology Program
• Teaching environment with large residency and
psychology Ph.D. programs
• Stone Institute of Psychiatry
• Comprehensive services – emergency, inpatient,
outpatient, housing
• Multi-disciplinary approach
Stone Institute of Psychiatry
SOAR Implementation
Designed through QI initiative
Key issue - who would prepare Medical
Summary Report?
• Approached head of residency program and
supervisor of psychology students
• They agreed MSR preparation was excellent learning
opportunity
Preparing Medical Summary Reports
Staff assignments for Medical Summary
Report
• If resident is medicating the person, resident
completes MSR
• MSRs for other individuals are prepared by
psychology students under the supervision of
licensed psychologist
• In certain situations, SOAR Coordinator can
complete MSR and outpatient clinic Medical Director
will co-sign
Staff identified to prepare MSR are notified as
early as possible but at least 30 days prior to
required completion date
Multi-Disciplinary Staff
• Staff roles take advantage of multidisciplinary licensed staff
Primary clinician (usually licensed therapist) –
responsible for identifying individuals appropriate
for SOAR application
Case managers and mental health workers -identified as SOAR Coordinators; given overall
responsibility for SOAR application
Resident or psychology student prepares MSR
Benefits and Challenges
Benefits:
MSR is prepared by MD or psychologist
SOAR Coordinator focused and able to handle
more cases
Challenges:
Requires greater coordination – trainees schedule
varied and complicated
Quality control – large number of residents, limited
opportunity for review and trainee turnover
Supporting SOAR Trainees
through Writing Workshops
Jennifer Alfredson and Emily Palmer
Health Care for the Homeless
Milwaukee, WI
Why Did We Do It?
Completed a county-wide survey
Talked about community needs within
our Community Collaborative
Concluded that many people were
trained in SOAR, but not using it due
to fear or worry about writing an MSR
The Idea
To give practical guidance and
information about writing an MSR
To give participants time to practice
writing
To allow participants to complete a full
MSR by the end of the workshop
The Setup: Who To Invite?
Limited the workshop to a small group
of people- only 8
Participants must have already been
through Stepping Stones to Recovery
Participants were to have an actual
client that they were writing an MSR for
The Setup: Workshop Structure
Trainers had regular contact with participants
about 2 months in advance
Reviewed how to set a Protective Filing Date
Reviewed tips for the application
Reviewed collection of information through records
collection and interviews
Spread workshop over 2 weeks
Met 3 hours each week
The Setup: Workshop Structure
Reviewed MSR sections: introduction,
personal history, psychiatric history,
functional information (ADLs; social
functioning; concentration, persistence and
pace)
Gave following sections as homework: work
history, substance abuse history, physical
health history, episodes of decompensation
The Setup: Workshop Structure
Each section was set up and introduced
similarly:
Watch the video with Andrea for that section
Read the example MSR section
Gave tips and advice on writing the section
Allowed time for participants to write the section
Discussed the writing in peer pairs and as a group
What Worked Well?
Discussing the SOAR process over 2
months was helpful to participants to go
through the whole process with guidance
Splitting the training over 2 weeks gave
participants an opportunity to write in
between; giving homework was helpful
Participants said that they felt they could
now “do” the SOAR process on their own
Participants said that they better understood
how to write the MSR
What Would We Change?
 3 hours each week was not enough time; 4 hours
per week would probably work
 Giving homework was helpful and a challenge.
Participants did not write as much on their own as
they did in the group
 Splitting the training up was a great idea, but many
people did not show up the second week
 Participants suggested a formal follow-up after the
MSRs were written to review them as a group
What Would We Change?
 Choosing a client was a challenge for
participants. Some suggestions:
 Increase the time for discussion from 2
months
 Mention the MSR training right after a
Stepping Stones to Recovery training and
begin the process right away
 Have 3 face-to-face meetings: one 2 months
prior to the workshop and then the two
workshops
Reviewing Medical Summary
Reports for Quality Assurance
Emily Carmody
North Carolina Coalition to End Homelessness
Raleigh, NC
SOAR Case Worker Certification
• NC Coalition to End Homelessness (NCCEH)
created process in September 2009
• Slow to start, but beginning to gain momentum
as NC creates more dedicated SOAR case
worker positions in the state
• Currently have 3 case workers certified and 3 in
process
• Starting in 2010- all PATH Benefits Specialist
positions in NC must be certified through
NCCEH
Why Create A Certification Process?
Provides a way to recognize SOAR case
workers who use their SOAR training
Provides an opportunity for state lead to
monitor Medical Summary Reports for
quality assurance
Reinforces SOAR process by using SOAR
checklist for applications and reporting
outcomes
Becoming SOAR Certified in NC
Two Stages of Certification:
STAGE 1 -- Provisional Status
• Attend the two-day SOAR training for caseworkers
• Complete at least one SOAR application using Quality Review Checklist
• Submit copy of Medical Summary Report and Quality Review Checklist to
NCCEH
• Submit SOAR outcomes form to NCCEH
• Complete SOAR Caseworker Certification Exam
STAGE 2 – Fully Certified
• Complete 5 additional applications
• Submit copies of all medical summary reports, quality review checklists and
outcomes to NCCEH for review
• Complete self-assessment and evaluation of SOAR values, skills and
experience
SOAR Case Worker Certification:
Medical Summary Evaluation
Identifying information of applicant (REQUIRED)
Full Name
Date of Birth
Full Social Security Number
Introductory paragraph that provides a clear physical description
(REQUIRED)
Personal History
Childhood description including any abuse history
School history
Work history
Relationship history
Homelessness history
Medical History (REQUIRED if using physical impairment listing)
List of symptoms experienced and described by individual (using SSA
listing for guidance)
Medical Treatment History (citing records obtained by case worker)
SOAR Case Worker Certification:
Medical Summary Evaluation
Mental Health History (REQUIRED if using mental health listing)
List of symptoms experienced and described by individual (using SSA
listing for guidance)
Mental health treatment history (citing records obtained by case worker)
Substance Abuse History (REQUIRED if substance abuse in med. records)
History of use (when started, point of heaviest use, periods of abstinence)
Explanation of how substance use does or does not impact symptoms
including if substances are used to manage current symptoms
Functioning Information (REQUIRED)
Clearly defined paragraphs addressing specific examples of impairment in:
Activities of Daily Living
Social Functioning
Concentration, Persistence, and Pace
Repeated Episodes of Decompensation
Contact Information for SOAR Case Worker and Treating Physician
(REQUIRED)
SOAR Case Worker Certification:
Benefits
• Improves Medical Summary Reports
• Encourages case workers to use SOAR after
training and recognizes their hard work
• Provides state team lead with examples of good
Medical Summary Reports for trainings and oneon-one technical assistance
• Certification requirements for case workers are
easy to include in job expectations for dedicated
SOAR case worker positions
For More Information:
Emily Carmody, LCSW
North Carolina Coalition to End Homelessness
Phone: 919-755-4393
[email protected]
SOAR Case Worker Certification on website:
http://www.ncceh.org/caseworkers/
Questions and Answers
Facilitator: Kristin Lupfer
National SOAR Technical Assistance Center
Policy Research Associates, Inc.
For More Information on SOAR
Visit the SOAR website at www.prainc.com/soar
Or contact:
SOAR TA Center
Policy Research Associates, Inc.
Delmar, NY
518-439-7415
[email protected]