Interviewing for the MSR
One of the most important tasks for you to accomplish is to make the link between diagnosis and functional impairment so that DDS can fully understand the applicant’s disability. This article discusses how to ask questions that elicit the information you will use to write your Medical Summary Report (MSR).
Gathering Information for the Medical Summary Report (MSR)
The first step is to gather information about the applicant’s impairments. For applicants with a mental disorder, you will focus on the four areas of mental functioning outlined in the Listings. Keep focused on the question DDS must answer: Can the person work at a substantial gainful level?
Using the guidance in this class, SOAR-trained providers are able to gather a thorough history in a respectful manner, which in turn helps DDS understand the impact and duration of a person’s impairment and the effect of their illness(es) on work ability and functioning.
How questions are asked can be critical to obtaining the appropriate information. It is important to be sensitive to influences that affect a person’s ability and willingness to provide information (cultural factors, past experiences with the mental health system, etc.).
- The interviewing process can also uncover sensitive topics like past and current trauma that need to be approached with care
- When asking about trauma, it is critical that the person does not become overwhelmed
- It is equally important that the person will be safe and secure after leaving the interview
- Gathering such personal information requires sensitivity and skill
Interviewers who feel uncomfortable or ill-equipped to explore certain topics should not do so. Instead, they should seek assistance from someone who is more clinically skilled, more able to assess responses, and more confident in ensuring that the person feels safe from self-harm and/or emotional distress when the interview ends.
How Do I Ask?
Your challenge is to gather the greatest amount of information while remaining respectful and compassionate.
- Remember to talk with the person about their strengths and their struggles
- Keep your questions simple and direct without being judgmental
- Consider using the sample questions throughout the MSR Interview Guide
- Make note of the person’s non-verbal as well as verbal responses
Open-ended questions encourage responses that are descriptive and rich with information.
- Avoid yes/no questions, such as “Can you _____?” Most people answer “yes” because they want to be seen in the best light
- Examples: “Why did you leave the last job you had?” “When you do _____, how do you feel?”
Ability or Access?
It is important to distinguish between ability and access. DDS evaluates the extent to which the applicant’s illness impairs their ability to function, rather than impairments in functioning due to lack of access to facilities.
- This is especially important for people who are experiencing homelessness
- Does someone not cook because they can’t manage cooking or because they don’t have a stove?
- How you ask the question can help clarify this issue
- Examples “What do you like to cook?” “When was the last time you did?” “If you had a kitchen would you cook? Why or why not?”
Support and Lack of Support
Someone may appear to function well but have a robust support system making this possible.
- Ask questions that help you assess how the person functions without supports
- Describe the supports
- Who assists?
- How do they help?
- What do they help the person do?
- Job coach at work
- Sheltered work environment
- Companion who accompanies the person on outings or provides frequent reminders
- Case manager or other clinical team member who visits or calls daily
Observations versus Self Report
- Applicants often want to present themselves in the best light possible
- Sometimes the applicant's answers and the case manager's observations are different
- In these cases, it is important to document any discrepancies and link them to the impairment
Writing a Functional Description
A functional description illustrates the impact of illness(es) on an individual’s ability to work. A good functional description:
- Provides a clear picture of the person and his or her life, helping the DDS examiner “see” the person
- Is very descriptive and specific
- Clearly describes how medical or psychiatric symptoms are linked to a person’s ability to function
- “Jane cannot cook” simply states her inability
- “Jane forgot that she put rice to boil on the stove and it started a kitchen fire,” describes the inability and how dramatic the consequences can be
Writing Style: It is important to write clearly and simply.
- Avoid using jargon or acronyms – the DDS examiner may or may not have a medical background or know the service system in your community
- If your Uncle John were to read it, would he be able to understand it?
- Focus on a person’s life “struggles” or “challenges” rather than his or her “weaknesses”
- Use quotes from the person; they can illustrate your point very powerfully
- Use detailed descriptions of your interactions with the applicant
- Evoke the senses to better create a picture of the person
- January, 2017
- Medical Summary Report (MSR)