Five key recommendations:

1. The proposed rule would change the Paragraph B criteria to reflect marked or extreme limitation of a person's function as it relates to their ability to work. SSA proposes the use of standardized testing as one type of evidence to determine work-related function. It is not clear that any such tests exist now, or that testing itself has been proven to be connected to predicting work function.  We recommend that SSA rescind their proposal to use standardized testing to determine satisfaction of Paragraph B criteria or define specific testing that has been rigorously tested and validated in diverse populations, including individuals who are homeless.
2. SSA includes a list of highly structured settings and psychosocial supports to be used as alternative severity criteria. The list presumes that an individual has a regular and stable place to live, is socially connected to family and friends, and is connected to treatment and/or services. Our clients are often socially isolated, disconnected from services, and live on the street or in homeless residential facilities.  The list of highly structured settings and psychosocial supports should be expanded to include examples relevant to people whose impairments have contributed to homelessness and infrequent access to supports.
3. SSA emphasizes the importance of evidence provided by therapists and licensed clinical social workers under a new category called "Evidence from medical sources." SSA will find "evidence from medical sources" to be "especially helpful" but not allowable as a substitute for evidence provided by "acceptable medical sources" such as physicians and psychologists. SSA should expand the list of acceptable medical sources to include licensed nurse practitioners, physicians assistants, and clinical social workers who are trained and qualified to make these types of assessments and may be the only providers available to homeless and severely underserved populations.
4. SSA would expect there to be evidence of serious mental disorder over time, even if the person does not have a relationship with the medical community. SSA should explicitly recognize the unique circumstances of people who are experiencing homelessness, particularly individuals who are chronically homeless, and permit longitudinal evidence from social service workers such as those who work in shelters and other homeless service sites.
5. SSA would replace the listing for substance addiction disorder with an explanation and reference to their policy for determining whether substance use is a contributing factor to the determination of disability. SSA's Drug Addiction or Alcoholism Policy has been inconsistently applied and has been a significant barrier to entitlements for people who have co-occurring physical or mental health and substance use disorders. We continue to recommend that this policy be repealed.

• Email your comments to SSA by November 17 at 5pm EST.
• Go to http://www.regulations.gov, search for docket number SSA-2007-0101 and follow the directions for submitting a comment.
• Include those comments and recommendations you'd like SSA to consider as they change their policy regarding medical criteria to evaluate mental disorders.
• Interested in disability policy issues?  Join the SSI Task Force!  Next teleconference:  Tuesday, January 11, 2011 at 1pm EST.  Contact Sabrina to join the Task Force.