Assessing work disability in the US Social Security Administration (SSA) Disability Programs: Novel methods to assess function
Year: 2016
Type: article
Abstract: Background The SSA administers the two largest disability programs in the U.S.: 1) Disability Insurance (DI), for disabled workers and their families, and 2) Supplemental Security Income (SSI), an income safety net for the aged, blind and individuals with disability. These programs provide benefits to over 18 million individuals at a cost of more than 180 billion dollars/year. Disability examiners are challenged with adjudicating nearly 3 million new applications per year and conducting periodic reviews of existing beneficiaries. Approaches to efficiently, comprehensively and consistently assess function may further inform decisions made by disability examiners. Methods The ICF activity domains served as theoretical framework for instrument development. A scientifically rigorous process was informed by literature, content experts, existing instruments; and, fielding testing instrument questions with more than 5000 claimants and more than 4000 normative sample participants. Exploratory factor analyses were used to empirically identify sub-domains from the hypothesized ICF framework. Confirmatory factor analyses established unidimensionality of the subdomains. Finally, item response theory (IRT) was used to hierarchically arrange items in each subdomain according to difficulty. Computer adaptive testing (CAT) tailors instrument questions to each respondent. Results The instrument covers 8 domains of whole person functioning demonstrating high reliability and minimal ceiling and floor effects. Although there are more than 300 questions, use of CAT administration allows completion of the instrument in 15-20 minutes. Conclusions The dynamic nature of IRT/CAT supports enhancement over time as content changes. The self-report functional assessment instrument provides a comprehensive functional profile to inform work disability decision-making.
Authors: D Brandt, C McDonough, L Chan
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2588649730