# Presentation: 347932

## Preventing Chronic Homelessness Through Effective Transition and Discharge Planning: A Learning Community Workgroup

*Alaska Department of Corrections and Social Security Prerelease Application Process Is Working!*
- Philadelphia 		*September 28, 2006*

## Department of CorrectionsMental Health Services

- Colleen Patrick-Riley, M.S.W., LCSW
- Director Mental Health Release Programs
- Phone: 907-269-7320 / Fax: 907-269-7321
- E-mail: colleen_patrick-riley@correct.state.ak.us

## What Will We Cover?

- Mentally ill in Alaska Corrections
- How our DOC/SSA prerelease agreement started
**Memorandum** between Corrections and SSA
- Must get buy-in from DDS
**T**arget population: limited group
**Building trust**
*Depends on* **credibility and experience working together**
- Mechanics of submitting information
- Results
- Advice – TALK and Partnerships COUNT

## What Happens in the Alaska  Department of Corrections(DOC)?

## Number Incarcerated

- _Year__	__	__# in Custody__	__# Mental Disabilities_
- 1990		2,700
- 1997		4,100			37%   (1,154)
- 2005		5,000   *estimate*	37%+ (1,850)
- 36,370 bookings statewide in FY 2006 (of 22,342 people)
- 32,423 releases statewide in FY 2006 (of 21,511 people)
- 80% of bookings are for misdemeanor crimes
** Typically, the number of offenders on felony probation/parole equals the number in DOC custody*

## Alaskan Inmates with Mental Disabilities 

*Of the 5,000 inmates in DOC on any day:*
- 37% have a mental disability
- 29% have a mental illness
- 12–15% have a severe mental illness
- 75–90% of mentally ill have a co-occurring disorder
*DOC mental health has seen:*
- >13,500 individuals since 1982
- >2,000 unique individuals each year
- Many recycle in our system

- Alaska in 1997:
- 37% of incarcerated inmates have mental disabilities in Alaska (1,154 of the 2,472)
- 29% experienced mental illness
- 12% were seriously mentally ill
- 8% were identified as chronic alcoholics with a history of psychosis
- 0.04% had identified developmental disabilities
- 	Data based on a 1997 1-day study by *Care Systems North* funded by *Alaska Mental Health Trust Authority* (AMHTA)

_**Alaska Inmates Have Mental Disorders**_

## How Did Alaska DOC and Social Security Make an Agreement?

***Community networking pays off!***
- DOC and SSA Directors met at a meeting of the Alaska Interagency Council on Homelessness
**Addressed what was missing in the system**
**Informal talks led a formal agreement **
**MOU 11/04 between Alaska Corrections and SSA with a buy-in from Disability Determination Services Unit**
**DOC, SSA, and DDS met to agree on eligibility criteria, pilot target population, determination process, and documentation needs and to define our prerelease application process**

## Sample Memorandum

## Partnership and CommunicationCollaboration Works

**Three-legged stool – Corrections, SSA, DDS**
**Win/win situation – All three critical partners makes it work**
**Quick clear information and records provided to SSA yields quicker approvals, providing funds for treatment and housing**
**Reduce recidivism, clinical and legal, *****with the right supports***

## Pilot Target Population

_*Individual must have:*_
- Psychotic disorder
- Documented symptoms
- Functional impairment
- Inability to work to support him/herself
- Release to DOC felony mental health release program

_*DOC staff must:*_
- Prescreen
- Present written evidence
- Testify
- Use strict criteria
- Have credibility

## Those who do not meet strict Prerelease Application Criteria can apply for SSA at release

**What Happens to People Who Do Not Meet Prerelease Criteria?**_** **_

## Building Trust

- Corrections commitment to prescreen has been critical for credibility with SSA and DDS

## Can submit ROI, summary letter, and written materials up to 60 days prior to release
All written materials must be submitted prior to interview
Can call to schedule intake interview 2–3 weeks in advance
Can do telephone intake interview up to 30 days in advance of release

*All written materials must be submitted prior to interview*
- Can call to schedule intake interview 2–3 weeks in advance
- Can do telephone intake interview up to 30 days in advance of release

**Mechanics of Applying**_***Timeline***_

## 
It’s a PAIN but worth it in the long run!

Takes 6–8 hours per person for a clinician to review chart, get clarifying information from staff, and write a clinical summary letter for SSA

**It’s a ****PAIN**** but worth it in the long run!**
- Takes 6–8 hours per person for a clinician to review chart, get clarifying information from staff, and write a clinical summary letter for SSA

_**Staff Time Investment**_

## Applications initially done beginning November 2004 with NO new staff members but a commitment to work extra hours to demonstrate value 
Applications were done by myself and our felony mental health release program clinician coordinator 
Subsequently one new reentry clinician hired May 2006 who does apps in addition to other tasks connected to our APIC effort

- Applications were done by myself and our felony mental health release program clinician coordinator
- Subsequently one new reentry clinician hired May 2006 who does apps in addition to other tasks connected to our APIC effort

_**Staff Time Investment**_

## Name, demographics
Criminal history
Convictions, reason for current incarceration and scheduled release date
Past psychiatric history
Psychiatric history in DOC
Diagnoses and specific examples of symptoms that resulted in diagnosis, current treatment, notations on special housing or special handling
Include substance abuse history and whether symptoms persist if sober
Highlight records to review
Must include documents from psychiatrist
Must address functional impairment
State opinion – is person too impaired to work?
Include release plan

- Criminal history
- Convictions, reason for current incarceration and scheduled release date
- Past psychiatric history
- Psychiatric history in DOC
- Diagnoses and specific examples of symptoms that resulted in diagnosis, current treatment, notations on special housing or special handling
- Include substance abuse history and whether symptoms persist if sober
- Highlight records to review
- Must include documents from psychiatrist
- Must address functional impairment
- State opinion – is person too impaired to work?
- Include release plan

_**Written Cover Letter**_*2–5 pages*

## Sample Letter

## Cover Letter with ROI and DOC records
We submit 2–5 years of DOC records if available
Facilitate getting community treatment records with ROI if available
SSA prefers 2+ years of evidence but will accept less if you can build a strong case
SSA wants evidence of qualifying diagnosis and specific symptoms in jail and in community
DDS may require additional forms to be completed such as Psychiatric Report or Functional Assessment
DDS may approve for full disability or give approval with plan to review in 1 year

- We submit 2–5 years of DOC records if available
- Facilitate getting community treatment records with ROI if available
- SSA prefers **2+ years of evidence** but will accept less if you can build a strong case
- SSA wants evidence **of qualifying diagnosis and specific symptoms in jail and in community**
- DDS may require additional forms to be completed such as Psychiatric Report or Functional Assessment
- DDS may approve for full disability or give approval with plan to review in 1 year

_**Records to Be Submitted**_

## Telephone Intake Interview

**Recommend clinician sit in on telephone intake interview between applicant and SSA**
- Individual may not:
- Remember pertinent detailed information
- Have insight
- Be fully able to represent reality of illness and symptoms
- DOC clinician participating in interview can be the one who wrote the letter or one who has worked with individual in a correctional facility

## Previously Approved for SSI or SSDI
If <12 months, no new application is needed
Just go in person to notify SSA of release
Individual needs to show proof of release

If >12 months, NEW application is required for SSI
Recommend submission of summary letter with 2+ years’ records
SSA can supplement by pulling up paper archive records
SSDI clients likely will require only proof of release

	*SSA’s move toward electronic records started in some parts of the country January 2006. SSA is working to make all areas electronic in 2007.

- If <12 months, no new application is needed
- Just go in person to notify SSA of release
- Individual needs to show proof of release
- If >12 months, **NEW** application is required for SSI
- Recommend submission of summary letter with 2+ years’ records
- SSA can supplement by pulling up paper archive records
- SSDI clients likely will require only proof of release
*	***SSA’s move toward electronic records started in some parts of the country January 2006. SSA is working to make all areas electronic in 2007.*

**Prospects for Approval**

## SSI: based on limited income and resources as well as a favorable disability determination
Apply first month, could be approved to start receiving benefits second month (depends on time to complete disability determination and amount of exit $ at release) 
Maximum benefit amount in Alaska is $603
Funds are paid on the first of the month (e.g., May 1 for the month of May)
Payments stop if in jail >30 days

- Apply first month, could be approved to start receiving benefits second month *(depends on time to complete disability determination and amount of exit $ at release)** *
- Maximum benefit amount in Alaska is $603
- Funds are paid on the first of the month (e.g., May 1 for the month of May)
- Payments stop if in jail >30 days

_**SSI/SSDI Must Meet Same Standards for Disability Determination**_

## SSDI: based on disability determination and work history – takes longer to research and calculate
Apply first month, then must have 1 full month out of custody before eligible for benefits
5-month waiting period from date of established disability onset:
If onset is in the past, applicants may receive benefits quickly
If onset is recent, applicants must first serve the waiting period before beginning to receive SSDI benefits
Maximum benefit amount will vary and is based on complicated calculations of % of prior work earning (have client who gets $1,015 per month); if person’s SSDI doesn’t reach $603, then person may get both SSDI and have SSI make up the balance difference
Payments stop only when the person is convicted

- Apply first month, then must have 1 full month out of custody before eligible for benefits
- 5-month waiting period from date of established disability onset:
- If onset is in the past, applicants may receive benefits quickly
- If onset is recent, applicants must first serve the waiting period before beginning to receive SSDI benefits
- Maximum benefit amount will vary and is based on complicated calculations of % of prior work earning (have client who gets $1,015 per month); if person’s SSDI doesn’t reach $603, then person may get both SSDI and have SSI make up the balance difference
- Payments stop only when the person is convicted

_**SSI/SSDI Must Meet Same Standards for Disability Determination**__** **_

## 
Initial Application 
37% approval at first review for general applicants
50% approval at first review for schizophrenics
Often takes 3–8 months for first decision

Appeals	
Approximately 1/3 of applicants submit appeals 
30–60% get approved after review appeal hearing
% varies depending on location in the USA
Can take 18 months–3+ years

_*Initial Application*_
- 37% approval at first review for general applicants
- 50% approval at first review for schizophrenics
- Often takes 3–8 months for first decision
_*Appeals*_
- Approximately 1/3 of applicants submit appeals
- 30–60% get approved after review appeal hearing
- % varies depending on location in the USA
- Can take 18 months–3+ years

***Results: ***National Average

## Alaska Prerelease Results Based on SSA Research March 2006

## Alaska Prerelease Results	

- 100% allowance rate of claims with decisions
- All cases completed within 120 days of filing – one new case still pending
- 76% completed in 60 days or less
*N* = 20 individuals in Prerelease Pilot
- 17 new applications
- 2 prior SSDI approvals suspended while in jail
- 1 prior SSI approval suspended in jail <12 months

## Detailed Prerelease Results	

## Alaska Control Group Results Based on SSA Research March 2006

##  Alaska Control Group Results	

- 54% allowance rate
- 11% completed approval within 60 Days
- 39% completed approval in 90+ days
- 18% claims denied
- 7% never filed an application
*N* = 28 individuals in control group comparison
-  15 applicants had initial claim allowance rate
-   6 claims pending
-   5 initial claim denials
-   2 applicants never filed
- [Additional 48 individuals did not meet study criteria as they were already entitled at time of incarceration]

## Control Group Details	

## 100% Approval Results Continue

- Alaska has continued to make applications
- DOC/SSA consumers and others appreciate the effort and results
- We build on the success of this process to create partnerships in new areas

## Where to from Here?

- Alaska plans to expand the DOC/SSA prerelease application process to include individuals who meet strict diagnostic and functional criteria that:
- Are in custody and end of sentence and will *not* be in a DOC mental health release program at release
- Are out of custody and *are* in DOC felony or misdemeanor release programs but were released too quickly to process

## What Else Next?

- Alaska DOC/SSA and Department of Public Assistance are in process of discussing how we can expand the DOC/SSA Prerelease Application process to include prerelease applications (within 30 days) for:
- Public Assistance
- Medicaid
- * **Bring the right people to the table**** –               persistence and a cooperative attitude count!**

## ADVICE from ALASKA: Communication, Partnership, Collaboration

**Create a three-legged stool : **
**SSA, DOC (or other agency), and DDS **
**We now plan to add DPA to make a four-legged stool**
**Meet to set up initial agreed on procedures and have periodic meetings to review how it’s working**
**Get a buy-in from administration and designated contacts in each agency to make it work well**
**Remember, ****it’s a win-win proposition**** for everyone**
**Helps SSA and DDS to do their work**
**Gets SSA and DDS understandable and complete information quickly**
**Helps DOC and community agencies to assist eligible mentally ill offenders to get benefits and get them more quickly**
**Helps individuals to have a better chance of succeeding in the community**

## ADVICE from ALASKA: Getting Started

- Get to know/meet with your local SSA manager/DDS manager to create your own process (do it by conference call if you can’t meet in person)
- Don’t know who SSA manager is? Call the national 800 # to find out the name of the manager in your local office
- Talk to the SSA manager about starting a Prerelease Program – you know it exists in other parts of the country, tell them what resources you can put toward making it happen
- DOC advocate/clinician has to learn who adjudicators are, what they want, and what to provide
- SSA claim rep and DDS claim review rep have to learn that they can rely on your information

## Aha Experience!

- Alaska SSA Director Paul Brandt and Alaska DOC thought we had created something new in November 2004 when we started this process
- Lo and behold, the same kind of information is in the SOAR manual
- It can be purchased or downloaded from the Internet
- It has information that can be used by providers in the community or by corrections as well
- Alaska offers a sample MOU between Corrections and SSA

## Handouts

*Sample Memorandum of Understanding (MOU)*
*Sample Letters*
*SSA Booklets can be obtained from SSA*
*Release Program Descriptions Available*

## Additional Resource Information

- _Alaska Social Security Administration_
- Paul Brandt, former Alaska State Director now Director of Region 8
- E-mail: _[paul.b.brandt@ssa.gov](mailto:paul.b.brandt@ssa.gov)_
- Kathy Zuleger, Alaska Operations Mgr, _[katherine.zuleger@ssa.gov](mailto:katherine.zuleger@ssa.gov)_
- _National Social Security Administration_
- Toll free # operates M–F, 7 a.m.–7 p.m., 800-772-1213
- Ask for the name of the manager of your local or regional office (OR)
- Identify local contact information by going to _http://www.ssa.gov/reach.htm_ and clicking on Social Security Office Locator to look up information by zip code
- _State of Alaska Disability Determination Services_
- Sandra Kelley,  Alaska State Director, _[sandra.kelley@ssa.gov](mailto:sandra.kelley@ssa.gov)_

## Additional Resource Information

- _SOAR _
- SSI/SSDI: Outreach, Access, and Recovery for People Who Are Homeless _http://pathprogram.samhsa.gov/SOAR_
- Documenting Disability: Simple Strategies for Medical Providers _http://pathprogram.samhsa.gov/SOAR/tools/document_disability.asp_

## Build Your Own Partnership

- Good Luck!