• Howard H Goldman, William D Frey, and Jarnee K Riley.
• Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA; email: hh.goldman@verizon.net.
• Annu Rev Clin Psychol. 2018 May 7; 14: 453-469.

AbstractThe Social Security Administration (SSA) oversees two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Adults with mental impairments represent a very large component of the programs. Policy makers and SSA are concerned about the accuracy of disability determination and also about low levels of labor force participation among individuals with disabilities. Adults with mental impairments are challenging to assess for work-related functional limitations. They are also a challenge to return to labor force participation. SSA has sponsored several demonstration research programs focusing on improving the accuracy of disability determination and on interventions in supported employment to return individuals with mental impairments to competitive employment. This article reviews the demonstration research focused on both entry into the disability system (at the "front door") and potential exit from it (through the "back door"). All of the research holds promise to "right-size" the SSA disability program.

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