1. The SOAR Medical Summary Report Please stay on the line
The SOAR Medical Summary Report Please stay on the line. The webinar will begin shortly. To download this presentation and other materials, click here: Use your phone to hear audio: Toll Free Number: (855) Access code: Contact if you experience technical difficulties. This webinar is being recorded and will be available for viewing within 1 week of this presentation.

2. The SOAR Medical Summary Report
Presented BY:
SAMHSA SOAR Technical Assistance Center
Policy Research Associates, Inc.
Under Contract TO:
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

3. Welcome! Kristin Lupfer, Project Director
SOAR Technical Assistance Center
Policy Research associates, Inc.
Delmar, New York

4. Webinar Instructions Muting Recording availability
Downloading documents
Evaluation
webinar-employment

5. Learning Objectives
Understand 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 submit
Gain access to worksheets, samples and other tools to help support the writing of a Medical Summary Report

6. Agenda Medical 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, Alabama
Questions & Answers

7. Poll Question #1 Have 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

8. The SOAR Medical Summary Report: A Basic Overview
Jen Elder, Senior Project Associate
Policy Research Associates, Inc.
Delmar, New York

9. 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

10. 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

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

12. Introduction Section Demographics
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!

13. Personal History Childhood and family information Education
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

14. Diagnoses and Treatment
Psychiatric and physical
Chronological treatment history
Specific quotes from the applicant or record that illustrate diagnosis
Observations of behavior
Durational issues
Current mental status exam

15. Link to Functional Impairment
Critical 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 functioning
Concentration, persistence, and pace
Repeated episodes of decompensation
Demonstrate impact of illness(es) on ability to work
Medication – effects and side effects
Support and effect of support, compared with lack of support

16. Limitations in Functioning Why the applicant is unable to work
Make the Link
The 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

17. 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

18. 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

19. Medical Summary Report Template
Use the MSR Template to organize and write the MSR
Agency Letterhead
Headings
Signatures

20. 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

21. Poll Question #2
True 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

22. Interviewing and Writing for the MSR
Amanda Toral, Entitlement Specialist
Eleventh Judicial Criminal Mental Health Project
Miami, FLorida

23. Tips for Interviewing 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
Environment
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
Explaining 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

24. Interview Questions Interview 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
Body 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

25. Interviewing, Continued
Multiple 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
Taking 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
Interviewing 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.

26. Tips for Writing 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
Use quotes
Direct quotes from the client will allow DDS to see from the client’s perspective
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…)

27. Writing, Continued 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…)
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
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

28. MSR Sections to Focus On
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

29. MSR Sections to Focus On
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

30. Co-Signatures 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 team
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

31. Co-Signatures
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
Some ARNPs work under an MD who may be willing to co-sign
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

32. Contact Information
Amanda Toral, M.S.
Entitlement Specialist
Jail Diversion Program - SOAR Team
Phone:

33. Interviewing and Writing for the MSR
Daniel Perry, BEST Team Lead
Central City Concern
Portland, Oregon

34. 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

35. 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

36. 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

37. 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!

38. 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

39. 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

40. Email: Daniel.Perry@ccconcern.org
Contact Information
Daniel Perry
BEST Team Lead
Central City Concern
Phone:

41. Poll Question #3 What 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

42. Disability Determination Services Perspectives
Brad Stanley, Medical Relations Officer
Disability Determination Services
Birmingham, Alabama

43. What are we looking for in the MSR submitted on SOAR claims?
Clear description of treatment in a logical and chronological order
History of hospitalization both in the past and current hospitalization or ER visits
Function, Function, Function

44. Medical Information
The 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.

45. 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.

46. 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

47. 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)

48. Contact Information
Brad Stanley 
Medical Relations Officer
Disability Determination Services
Birmingham, Alabama
Phone: , Ext. 112

49. Questions and Answers Facilitated By:
SAMHSA SOAR Technical Assistance Center
Policy Research Associates, Inc.
Please type your question into the Q&A panel located underneath the participant tab, or
To ask a question by phone, please raise your hand by clicking the hand icon in the participant pod. We will unmute you so you can ask your question.

50. For More Information on SOAR
SAMHSA SOAR TA Center Delaware Avenue Delmar, New York (518) 439 – 7415
@SOARWorks