Building Trust—and a Successful Application—in Vermont

I began working as John Doe’s case manager in 2019. He had been recently housed with a permanent supportive housing voucher (which comes with a requirement for case management support) because of a 15-to-20-year history of homelessness. He was now in a single-room occupancy with our local land trust but was considered “chronically homeless” because of the length of his history with homelessness. The rental provided his room, all utilities, and his cleaning supplies. To meet his other needs, he panhandled, got general assistance, and utilized local food shelves. His clothing was often ripped and stained, and he did not have basic supplies like winter boots. In Vermont, lack of winter gear can be fatal. So, my first task was to get him those items.

John had no other income and huge trust issues. He had been through many case managers for several years and expressed that he was certain I would “not stick around.” I am a former LPN and mental health case manager, and it was apparent to me that John had some undiagnosed, but very disabling, mental health issues. Even speaking was strenuous for him. His anxiety level seemed very high whenever we met, and he often enlisted his support animal’s comfort. I frequently recommended he meet with a forensic neuro-psychologist I know, and he asked if I “keep pushing this because you get kickbacks.”

After 2 years of gentle nudging, he began to trust me a bit and finally relented and saw the forensic neuro-psychologist, who is a very likable older gentleman, and John persevered on through months of testing. He applied independently for SSDI/SSI but was struggling to even answer questions on the function report. In the end, he just never turned it in, so of course, he received an initial denial.

At that point I was taking the SOAR Online Course, so everything just kind of worked out in terms of timing. I spoke with my SOAR cohort. Although this was not technically a new applicant, I felt he was very eligible for benefits and would be approved if we could just do a better job presenting his case with an MSR. Though we had already run out of time to appeal the denial, with the guidance of my Cohort, I back-pedaled this case, asked SSA to let us appeal, and they did! We then submitted an MSR, which my Cohort reviewed, and I had it co-signed by the forensic neuro-psychologist.

I do want to say that in doing the MSR for John and others, it became apparent that I needed support. Even though I had done this type of work for 30 years, the MSR goes really deep, and there is some very tough stuff discussed. I definitely had to hear some very difficult things about people’s lives, mostly severe child abuse histories. It was very helpful to do supervision with my boss weekly. I also made sure my clients were able to decompress after our meetings. We broke each MSR interview into at least two or three meetings because of the emotional difficulty.

SSA was very helpful. They said they would really prefer to see more medical evidence, but when I explained the long process to get John Doe this far, they arranged for a medical review with their own psychiatrist.

Through this entire process my client was so nervous and convinced at each turn he had messed up his pending application or someone was out to “get him” and deny his benefits. He also pointed out often that he was not even sure he wanted the benefits. He said he did OK panhandling and getting general assistance. It took some trust on his part, and for me, I walked a fine line of never promising a result but trying to stay positive about my hope for a good outcome.

In the midst of this, I also changed organizations from a homeless healthcare program to the Vermont Center for Independent Living and brought my three SOAR clients with me after signing a hundred releases. I was nervous that would throw a wrench in things, but it did not. I just let SSA know, and they managed to reach me at my new job.

I am so happy to say, John recently received the approval letter we all hope to see, and should be getting his benefits soon.