Every year, millions of workers experience a new work-limiting condition or serious health shock. Some of these workers will experience a permanent or long-term disability that leads them to file for Social Security disability benefits, while others will try to continue working.
For workers who apply for Social Security Disability Insurance and Supplemental Security Income benefits, the Social Security Administration (SSA) faces a tough challenge in accurately determining their eligibility for benefits. And for those who try to continue working, it can be even more challenging to identify the best strategy to help them return to work and stay employed.
A new tool, the Work Disability Functional Assessment Battery (WD-FAB), could help in both cases. The tool aims to provide a more complete picture of a person’s functional abilities. As our new brief explains, the WD-FAB could help inform SSA’s decisions about workers who need disability benefits and could help target interventions to keep people with disabilities employed.
A new tool to help people with disabilities
The WD-FAB uses item response theory (PDF) and computer adaptive testing to quickly interview people and systematically map their self-reported functioning across eight physical and mental health domains, including basic mobility and communication and cognition.
Item response theory orders questions hierarchically. The full WD-FAB instrument contains more than 300 items, or questions, but the computer software selects only the most relevant items based on a user’s prior responses. As a result, people answer an average of 50 questions across a wide range of functional domains in just over 14 minutes.
The instrument was developed by the National Institutes of Health (NIH) and Boston University with funding from the SSA and is ready for testing in the SSA’s programs. The NIH uses a widely accepted concept of disability articulated in the World Health Organization’s International Classification of Functioning, Disability and Health as the conceptual framework for the instrument.
Informing strategies to improve disability determination
When a worker applies to the SSA for disability benefits, assessing and determing eligibility is difficult. The SSA must determine a person’s ability to engage in work, which often requires evaluating more than just the health condition and impairment; the SSA must also make a judgment on how a person’s functional ability interacts with their environment.
During the first two stages of the SSA’s determination process, a disability examiner gathers and evaluates evidence without seeing the applicant. If an applicant’s initial explanation is incomplete, the application could be denied.
The WD-FAB could provide the SSA with a better understanding of someone’s self-reported functional abilities, thereby helping the disability examiner identify gaps where more evidence needs to be developed. Under this approach, the WD-FAB wouldn’t be used to make a decision on a claim, but would rather serve as a tool to assist the examiner in the process of reviewing claims.
Helping people with disabilities stay in the labor force
Most workers who experience a new health condition are able to manage the condition and stay employed in the short term. But within two years, workers with a new health condition are three times more likely to have left the work force. Some workers who experience a new health shock receive services provided by their employers, but many other workers don’t have access to either public or private assistance.
Identifying the appropriate services requires substantial judgment. Workers struggling to manage a musculoskeletal condition may need a different intervention if they also have one or several chronic conditions, such as obesity or depression. The WD-FAB could be tested as a resource to help public and private organizations develop, target, and evaluate their strategies to help workers with new functional limitations stay employed.
Return-to-work-early intervention strategies are aimed at supporting continued employment for workers who develop a new illness or injury or who experience the worsening of a chronic condition that could limit their ability to work. With this new tool, once a worker is identified as high risk, they could be referred to a return-to-work specialist and asked to volunteer to complete the WD-FAB interview. The specialist could then use the WD-FAB functional profiles to inform what intervention strategies could best serve the worker.
Collecting deidentified WD-FAB scores over time would also provide a robust database analysts could use to evaluate and refine interventions, as well as to evaluate the effectiveness of the organizations administering the interventions.
The challenge of understanding and measuring disability has made disability policy controversial and agreement on solutions elusive. The WD-FAB tool leverages advancements in measuring functional ability and offers an opportunity to integrate that information into the Social Security disability determination process. It could also help tailor return-to-work strategies to individual workers’ needs.
These advancements could better inform the decisions of millions of disabled workers and their families and help people stay in the workforce.