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The SOAR Medical Summary ReportPRESENTED BY: SAMHSA SOAR TECHNICAL ASSISTANCE CENTERPOLICY RESEARCH ASSOCIATES, INC.

UNDER CONTRACT TO: SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATIONU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Welcome!KRISTIN LUPFER, PROJECT DIRECTOR SOAR TECHNICAL ASSISTANCE CENTER POLICY RESEARCH ASSOCIATES, INC.DELMAR, NEW YORK

Webinar InstructionsMutingRecording availabilityDownloading documentsEvaluationhttp://soarworks.prainc.com/article/soar-webinar-employment

Learning ObjectivesUnderstand the importance of the SOAR Medical Summary Report and what it entails Learn ways that you can use the Medical Summary Report to help support SSI/SSDI applications you submitGain access to worksheets, samples and other tools to help support the writing of a Medical Summary Report

AgendaMedical Summary Report Overview Jen Elder, Senior Project Associate, Policy Research Associates, Inc., Delmar, New York

Interviewing for and Writing the Medical Summary Report Amanda Toral, Entitlement Specialist, Eleventh Judicial Criminal Mental Health

Project, Miami, Florida Daniel Perry, BEST Team Lead, Central City Concern, Portland, Oregon

Disability Determination Services Perspectives Brad Stanley, Medical Relations Officer, Disability Determination Services,

Birmingham, AlabamaQuestions & Answers

Poll Question #1Have you ever written a SOAR Medical Summary Report?

a. Not yet

b. Yes, less than 5

c. Yes, more than 5

d. Making plans to in the future

The SOAR Medical Summary Report: A Basic OverviewJEN ELDER, SENIOR PROJECT ASSOCIATE

POLICY RESEARCH ASSOCIATES, INC.

DELMAR, NEW YORK

The Importance of the Medical Summary Report

(MSR) SOAR Key Component

Applications submitted with a high-quality MSR increases the likelihood of an approval on initial application

Identified by USICH, VA, SSA, and SAMHSA as a Key Strategy for Connecting Individuals Experiencing Homelessness to SSI/SSDI Interagency report released in July 2015 specifically describes

the MSR as a critical component for successful applications

Often takes place of the SSA-3373 Function Report Helps to avoid the limited space and check-boxes of these forms

What is an MSR? A letter which describes the individual and his/her functional limitations and struggles Supports medical records submitted Helps DDS “see” the person you are working with Illustrates the connection between the applicant’s functional

limitations and the impairment Answers the question: “Why is the applicant unable to work?”

Is medical evidence when co-signed by a physician or psychologist

Submitted to SSA/DDS according to your local SOAR Process

Components of the MSR Reference Section Introduction Personal History Diagnostic and Treatment Information Link to Functional Impairment Summary Contact Information

Introduction SectionDemographics

Physical description – hygiene, grooming, dress, make-up, any unique characteristics

Observations about behavior and mannerisms

Include diagnoses and impairment information

Help the DDS examiner “see” the individual as you do!

Personal History Childhood and family information

Brief overview of their background Past trauma that may relate to current diagnoses and

functioning Education

What was the last grade they completed? Did they have any struggles in school?

Employment history Describe their past jobs – include how long they stayed at

each job, the tasks they performed, any struggles they had at work, and why they left

Diagnoses and TreatmentPsychiatric and physical

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 ImpairmentCritical to connect symptoms/effects of illness with marked functional impairments

To the extent possible in all four functional areas:Activities of daily living (ADLs)Social functioningConcentration, persistence, and paceRepeated episodes of decompensation

Demonstrate impact of illness(es) on ability to workMedication – effects and side effectsSupport and effect of support, compared with lack of support

Make the LinkThe MSR is the link that connects the diagnosis to the limitations that the applicant experiences

Being able to document this link is very important in order to demonstrate the applicant’s inability to engage in substantial gainful activity

Diagnosis

Limitations in

Functioning

Why the applicant is unable to work

Summary and Contact Information

Ties all information together for a concise picture of the individual

Contact – names and numbers

Co-signed by case manager, treating physician/psychologist

Medical Summary Report Interview Guide

Tool for gathering information needed to write the MSR

Open-ended questions Tell me about … How often … When was the last time …

Functional questions Context of questions – SGA Distinguish between access

and ability

Medical Summary Report Template

Use the MSR Template to organize and write the MSR

Agency LetterheadHeadingsSignatures

MSR Samples & Support Visit the SOAR website for MSR samples in the SOAR Library!

The SOAR TA Center will review redacted MSR letters and provide feedback upon request

Poll Question #2True or False? The Medical Summary Report is an untested strategy and we are not sure of its importance in supporting applications.

a. True

b. False

Interviewing and Writing for the MSRAMANDA TORAL, ENTITLEMENT SPECIALIST

ELEVENTH JUDICIAL CRIMINAL MENTAL HEALTH PROJECT

MIAMI, FLORIDA

Tips for Interviewingo Face-to-face interviewing

• Meeting in person allows for rapport building and an overall perspective• Over the phone or through someone else may not give the full picture of the individual

oEnvironment• Both client and interviewer should be comfortable• Give options so that client can have a choice in where and when to meet• Don’t assume the client can come to you, arrange what works for both of you

oExplaining the purpose of the interview• An explanation of what type of information you are looking for and what types of

questions you are going to ask, making the client fully aware of the nature of the interview

• Express that the more information you have, the better report you can write. However, let the client know it is ok if they are uncomfortable talking about something specific

Interview QuestionsoInterview Questions

• Use SOAR worksheets (SOAR Tools and Worksheets | SOAR Works!) • Read them ahead of time!• Get comfortable being uncomfortable. Some questions regarding trauma for example, may lead

to responses that you did not expect and may cause the client to react in a way you did not expect

• Let the client talk• Loose conversation may still give you good information for your report and it will build rapport• Some responses may cause client to go off on another topic• Going “out of order” according to the medical summary outline is ok, the worksheets will keep

you on track for what information you need to obtain

oBody language and social cues• Pay attention to the client’s body language – for information for the report, but also to know if the

client is losing interest in the conversation• Be aware of social cues that the client may not be comfortable

Interviewing, ContinuedoMultiple interviews

• Be open to the idea of coming back for another interview• Sitting for hours to get the information may not be conducive to getting the right information• More time may be needed to build rapport for client to be comfortable sharing information

oTaking notes• Ask if it’s ok to write while the client talks, don’t assume the client will be comfortable with it• Take notes on what the client is saying and what you observe • Don’t take everything you see or hear at face value

oInterviewing available support system• If the client has a person in their life that knows them and supports them, ask if they are

comfortable with you talking to that person• Interview family, friends, treatment team, etc. Information from third parties are just as

beneficial as information from the client themselves.

Tips for Writingo Schedule time

• Arrange time to write your report shortly after meeting with the client• Information is fresh in your head and will make the report easier to write• Allows you to write and complete in a timely manner, giving you amble time to request a

doctor signature and have it prepared to send to DDS

o Use quotes• Direct quotes from the client will allow DDS to see from the client’s perspective

o Use medical records• Have medical records on hand when writing the MSR• Use information from the records to comment on past and current diagnoses and

symptoms, to give a full picture of the clients presenting illness and how it has been present over time

• Make sure to report when information is coming from the records (i.e. According to records from Jackson Memorial Hospital…)

Writing, Continuedo Use input from support system and treatment team

• Write about the information provided by others (family, friends, treatment team)• Make sure to comment on where this information is coming from (i.e. According to the

client’s mother…)o Write in a clear and concise manner

• Try not to give too much detail in one category or another so ensure that you are staying on topic

• Medical jargon may be confused and unknown to the person reading it• Given explanations of symptoms instead of just listing them• Explain how the symptoms affect the persons ability to function

o Get a second opinion• Ask a supervisor or co-worker to read over the report for errors• Someone who knows the client may be able to share their perspective • Someone who does not know the client can help to say whether or not they got a good

overall picture of the client

MSR Sections to Focus On

o Psychiatric History• We use bullet points in this section to list all facilities, clinics, programs,

hospitals, and doctors the client has received services from• We provide information from what the client has told us about each, in

addition to referencing information from the medical records we have collected

• We write a couple sentences about each one, references when and for how long they received treatment, what type of treatment, diagnosis and medication information.

• Listed in chronological order, showing just how far back the impairment has been present

MSR Sections to Focus On

o Functional Information• We provide information in each section (ADLs, Social Functioning, Concentration,

Persistence, and Pace, and Episodes of Decompensation) that relates to the Functional Report that is often requested by DDS

• Focus on making the link! symptoms limitations in functioning for that particular area of functioning how this impairs work ability

• Providing this functional information within the MSR, has often eliminated the need for the Function Report

• Make note of this when talking to the DDS adjudicator. Let them know that you have an MSR and explain what information is in it. Some adjudicators we have worked with are unfamiliar with SOAR, have not seen an MSR before and are not aware that the information provided in the MSR is the information they ask for in the Functional Report

Co-Signatureso Getting an MSR co-signed

• Talk to the psychiatrist right after your initial interview with the client• Let them know you will be working on an MSR for the client and would like their assistance, so that they

can expect to hear from you again • Explain the purpose of the MSR, what information it will have and how it will benefit the application• Explain how a doctors signature holds more weight than yours alone, making the MSR medical evidence• Let them know their input is welcomed so they can review and sign the MSR• If you work with this psychiatrist often, build rapport, let them know you will be working together again• If you cannot reach the psychiatrist or feel that they are not receptive, work with the treatment teamo Since you will be communicating with the treatment team for MSR information, discuss the MSR with

them and let them know you may need assistance in presenting it to the doctor and getting it signed

Co-Signatureso If treating physician is someone other than an MD

• Have the ARNP, or whomever is treating the client, sign the MSR; their signature still holds value

• Explain that Social Security only considers medical evidence if signed by psychiatrists or psychologists, and discuss options for getting a co-signature o Some ARNPs work under an MD who may be willing to co-sign

o No MD signature• Submit it anyway! Sometimes it can be difficult to even get the

psychiatrist on the phone. The MSR is still good information, even if only signed by you

Contact Information Amanda Toral, M.S.

Entitlement Specialist Jail Diversion Program - SOAR Team

Phone: 305-548-5346 Email: arubin@jud11.flcourts.org

Interviewing and Writing for the MSRDANIEL PERRY, BEST TEAM LEAD

CENTRAL CITY CONCERN

PORTLAND, OREGON

How BEST Uses MSRs Provide detailed functional information◦Replaces the SSA-3373 Function Report sent to DDS

Supplement medical records:◦Connect functioning to conditions◦Fill in gaps from records◦Clarifies differences between treating sources

Paint a picture of the person and provide observations

Pre-Interview: Everyone is Different

Review available medical records◦Look for missing information◦Determine potential onset date

Become familiar with questions◦Not every question needs to be asked to every client

Interview Tips: Set the Mood

Be intentional about the setting◦It’s often best to meet alone◦Private and comfortable

Be transparent – tell clients why you need the information Do not be judgmental

Interviewing Tips: The Conversation

Treat the interview like a conversation – respond to what is being said◦ Show empathy◦ Reinforce strengths◦ Use basic conversation strategy to build rapport

Tailor the interview style to client Generally avoid yes/no questions Get only the detail that is needed, especially when dealing with sensitive topics

Be Curious!

Post Interview: Further Documentation

Write down detailed observations◦Mental status exams make a great template

Follow up with additional records requests, if needed Reach out to case managers, doctors, family members, etc. for collateral information

Time to Write Start as soon as possible after the interview Incorporate medical records into the functional information Include direct quotes from the client (very useful!) and your detailed observations

Remember, every case is different:◦ Drop sections that do not apply◦ Be intentional about where you include the most detail◦ Fill in gaps from medical records

Contact Information Daniel Perry

BEST Team Lead Central City Concern

Phone: 971-271-6271 Email: Daniel.Perry@ccconcern.org

Poll Question #3What is a good interviewing technique?

a. Pay attention to the applicant’s body language

b. Meet in a private space

c. Show empathy

d. All of the above

Disability Determination Services PerspectivesBRAD STANLEY, MEDICAL RELATIONS OFFICER

DISABILITY DETERMINATION SERVICES

BIRMINGHAM, ALABAMA

What are we looking for in the MSR submitted on SOAR

claims?Clear description of treatment in a logical and chronological orderHistory of hospitalization both in the past and current hospitalization or ER visitsFunction, Function, Function

Medical InformationThe MSR provides a snap shot look at the claimant’s treatment history.Provides medical treatment details, showing the longitudinal effects of the claimant’s illness or impairments.For disability examiners, provides a starting point to discuss the case with the Medical team to see what additional information may be needed in order for a decision to be made.

Function, Function, Function

Why should functional information be included in the MSR?◦ You have a unique opportunity to shed light on how a

individual’s medical condition affects his or her daily activities.◦ Functional information shows how restrictive a impairment is

on someone performing day to day task and even work related task.

◦ Because we routinely do not see the claimant, you can provide insight to the claimants medical impairments but moreover how those impairments affect the claimant everyday.

What kind of functional information are we looking for?

We are looking for (Psychological):◦How well does the claimant follow instructions◦How does the claimant respond to change in their environment

◦Do they get along well with other◦Do they require encouragement to complete task◦Do they take longer to complete task◦Concentration and attention

What kind of functional information are we looking for?

We are looking for (Physical):◦Standing and walking problems◦Fatigue◦Lifting and carrying ◦Problems with bending or stooping ◦Problems using the hands (grasping, decrease strength)

Contact Information Brad Stanley Medical Relations Officer

Disability Determination Services Birmingham, Alabama

Phone: 1-800-292-8106, Ext. 112 Email: Brad.Stanley@ssa.gov

Questions and Answers Facilitated By:

SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc.

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