Health and Psychology

All reports written by a psychologist are NOT psychological evaluations.  The vast majority of evaluations are brief, question specific evaluations that are extremely limited in scope.  Many of these reports state in the opening paragaph that they are not to be misunderstood as a psychological evaluation.  These kinds of reports include things like evaluations for employment or appeals of psychological evluations done for employment, specific test result reports, single issue reports and something referred to as a consultative examination for social security disability.

I spend a couple days a week working for a company doing social security disability evaluations.  I also spend time in my clinical practice doing psychological and forensic evaluations.  My main forensic reports have to do with school and test accommodations for disability (forensic means law) and the reports can eventually go to an administrative law judge.  My psychological evaluation reports generally go to a treating therapist or physician.  Consultative Examinations performed by a psychologist for the Disability Determination Service are very different from other types of evaluation.  They are very brief, and are focused on functional impairment for the purpose of employment.  They are simply one piece of documentation used by a Disability Analyst to make a determination of disability.

My Consultative Examinations involve administering psychological tests provided to me by the Disability Analyst.  I do NOT choose the tests.  so if you ask me why I'm doing a specific test, my answer is "Because it's on the list."  I have limited to no records about a person I'm evaluating for SSD.  

The people I evaluate are not clients or patients.  I refer to them as claimants.  I usually ask a claimant to complete a four page intake form that gives me some basis for attempting to understand test scores on which to base recommendations about functional limitations to work.  I'm also not allowed to get information from other sources, because that information isn't mine to evaluate.  That information is to be sent to the Disability Analyst so they can evaluate it and consider it in their determination.   Unless the Disability Analyst has sent the information to me, I'm not supposed to consider it in my evaluation.

The issue of fraud, faking symptoms, exaggerating symptoms, or just magnifying symptoms is a HUGE issue that makes everyone involved in Social Security Disability very frustrated.  Estimates on the degree of obvious fraud range from 2% to upwards of 50% of disability applicants.  I the 5 clinics I work at currently, the average is 20%.  So about 1 in 5 applicants is reporting symptoms that are so significantly exaggerated that I suggest the Fraud Unit of social security investigate the claim.  A much larger percentage are putting forth a very poor effort.  An unusual problem also exists where people do not believe they are disabled and try to perform better than they should.  This appears to happen for a couple of reasons.  First, they were talked into applying for Social Security Disability and thought they'd automatically be denied and now are going through an evaluation.  Second, they've had SSD as children and are now adults trying to show they don't need to have a payee for benefits.  Third, they are recently diagnosed and are cognitively impaired and didn't really understand there was a problem.  These people can fall apart during testing as they come to realize they can't do some tasks.  What I advise everyone applying for disbility is to simply do their best on the evaluations.  Exaggerating or fabricating symptoms just limits how much self-report information from the claimant can be used or relied on.

My average forensic report for disability accommodations for a school or a test runs 50 pages or so and has a table of contents and an executive summary.  My average SSD Consultative Examination report runs 6 pages.  There's quite a difference.  My intake form for a disability accommodation report is 11-21 pages, not the 4 page form for SSD.   It's a very brief history.  

The questions for Social Security are the following:

• Can this person follow simple instructions?
• Can they follow detailed instructions?
• Can they pay attention and concentrate?
• Can they follow safety rules?
• Can they show up to work and remain at work for a work-day?
• Can they get along with other people?
• Can they manage their benefits?
• Is the person compliant with treatment and/or medication?
• If their symptoms are due to a drug or alcohol problem will they improve if they stop abusing substances?