Article archive / November 1, 2012
Originally published: . Volume 4, No. 3. Source pages: 10.
New Orleans clinical neuropsychologist, Dr. Michael Chafetz, and his scientific findings are continuing to draw interest from around the country. However, some responses in his own backyard have been less enthusiastic.
On October 20, 2012, the Louisiana Psychological Association (LPA) On-Line Academy hosted a presentation by Chafetz for Georgia psychologists. In the webinar, “Clinical and Forensic Aspects of a Social Security Psychological Consultative Examination: An Ethical Approach,” Chafetz outlined his emerging research. Many of the attendees consult regularly regarding disability.
The LPA On-Line Academy also hosted a webinar in the public interest for staff members from Senator Thomas Coburn’s congressional office. Chafetz presented his research about psychometric prediction of malingering in social security disability claimants.
However, this past January the Director of Louisiana Disability Determinations Services (DDS), Ms. Terri Spurgeon, sent a memo to psychologist examiners about the Chafetz presentation, noting that the presentation was not sanctioned by DDS or checked for compliance with Social Security Administration (SSA) policy, rules or regulations. She reminded providers to adhere to instructions from DDS and SSA.
Throughout the year, repeated requests by the Times for clarification from Director Spurgeon were ignored. A formal records request sent in early September and the Times called on October 14, 2012, to ask about the request. A representative in Department of Child and Family Services, Executive Division, said that they were the right group to handle such a request, but she “had not seen it come in.”
On Monday this week, October 29, the Times received an acknowledgment from Attorney Celia Alexander that the Department had received the request, and was contacting SSA for additional information, and that might take some time.
Evolving Forensic Psychology
Over the last decades, psychological science regarding medical-legal evaluations has been evolving. Psychologists’ roles in the legal areas have grown along with their research efforts.
In a 2011 article for Psychological Injury and Law, Chafetz wrote, “The roles of psychologists and neuropsychologists in forensic cases have been growing exponentially since the 1970s …” He explained that forensic psychologists have significantly outpaced the roles of psychiatry in the courts. He wrote that this appears to be due to the scientist– practitioner training, including hypothesis- testing and statistical classification methods, that “place psychologists in the forefront” of a courtroom’s requirement for facts.
Consulting in legal cases has driven psychologists’ research about the accuracy of claims of disability, aspects of malingering or what is known as “faking bad.”
An important topic in medical-legal evaluations, one of Chafetz’ areas of expertise, malingering is shown to fall between 30 percent and 64 percent when compensation is involved. Chafetz and others have determined that malingering rates in social security examinations are likely to be between 42 percent and 45 percent.
In one study, the rates of malingering were found to be highest when claimants were seeking federal benefits, followed by state, and were lowest in private cases. And, researchers have also found that the degree of malingering is “dose dependent,” when the higher the reward the higher the degree of malingering. Chafetz’ numerous research studies, published in peer- reviewed journals like The Clinical Neuropsychologist, Psychological Injury and Law, and Applied Neuro- psychology, describe a set of complex psychometric analyses, some embedded in the psychological testing, to predict malingering. This approach has been used in forensic psychology and research, and has evolved over the last decades.
Motivation and personal goals are central to claimants’ behavior in the exam and accuracy of results. He and colleagues studied three groups of individuals, all with lower IQ scores. One group was striving to regain custody of children, one group hoping for employment, and one group seeking disability benefits. The benefit seeking group had high rates of malingering, while the other groups did not, demonstrating tests of malingering can help psychologists gauge poor effort, even with individuals who have low IQs.
Dr. Chafetz and colleagues are producing scientific innovations that cast doubt on some of the procedures and polices of Social Security Administration (SSA).
If his results are correct, SSA may be giving benefits to a subset of individuals who are not truly disabled, improper payments reaching into the billions of dollars.
However, SSA does not conduct this type of research or fund researchers who do. Chafetz and his collaborators work without compensation.
Nor does SSA provide for tests of malingering or faking. Instead, the SSA uses an approach that involves investigators in “Cooperative Disability Investigation” units, called CDIs, who use private investigation methods to uncover “improper SSA payments.” An approach, that may involve labor intensive efforts on the part of SSA employees.
Ethical Binds: Psychologists in the Middle?
The SSA and their departments of disability determinations (DDS) at the state level contract with psychologists to conduct examinations. Mental disorders make up 33 percent of social security disability and 60 percent of social security disability for the poor (SSI).
Psychologists are the appropriate professionals to make many of these judgments.
Psychologists are ethically responsible for the accuracy of their conclusions, and for choosing the psychometric instruments are required to help them make the judgment, and which scientific findings or research is to bear on their judgment.
Psychologists who adhere to SSA policy may find themselves caught in an ethical bind, if they are asked to ignore scientific findings related to the accuracy of their work.
“Psychologists are obligated to keep up with research and to apply research to their work,” Dr. Tom Hannie told the Times. Hannie has worked in forensic and clinical areas for over four decades.
“If you only administer a test and send it on to your client/employer to interpret, or fail to interpret it according to research as commanded by your employer/client, you are not functioning as a Psychologist, you are working as a Technician and should be replaced by a high school graduate.”
Productivity Issues
Aging of baby boomers and the poor jobs economy appear to be in part responsible for a record number of both claims and benefits being paid out for social security disability. This increased workload, and government hiring freezes have overloaded the already burdened personnel in state agencies.
Delays and backlogs have reached months and even years for SSA. Also, because many claims are rejected, then appealed, the backlog for these appeals, decided on by Administrative Law Judges, is also at a high.
In a September 13, 2012 Associated Press article, journalist Stephen Ohlemacker, reported that congressional investigators found that due to SSA personnel being overwhelmed by disability claims, benefits are being awarded without adequate reviews.
Senator Thomas Coburn from Oklahoma, a Republican on the Senate Permanent Subcommittee on Investigations, is studying the issue, the article noted. A sample of 300 cases were reviewed by the congressional group, and more than 25 percent were found to be insufficient or incomplete in evidence.
Currently about 11 million people receive SSD (approximately $1,000 a month) and 8.2 million receive SSI benefits (about $500 monthly). Mental disorders make up about 33 percent of the SSD and about 60 percent of SSI.
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