Childhood Disability:
Supplemental Security Income Program
A Guide For School Professionals
This information is written for school professionals
who may teach or provide therapy, counseling and/or other services to
children with disabilities. It outlines the kinds of evidence that the
Social Security Administration (SSA) needs from schools to help determine
disability for a child under the Supplemental Security Income (SSI) program.
The SSI program can provide valuable monthly cash
benefits to children who are disabled under SSA rules and whose families
have little income or resources.
Determining whether a child is disabled under SSI
regulations is a collaborative effort among Federal and State officials.
We rely, to a great extent, upon your professional
expertise and judgment to help us. Your information is not the only information
we consider when we decide if the child qualifies for benefits, but it
is very important to us. We make our decision based on all of the medical,
school and other information that we get.
We appreciate your assistance and support.
Introduction
Under the Supplemental Security Income (SSI) program, Social Security
can provide benefits to children with disabilities. A child who is eligible
for Federal SSI cash benefits is also eligible, depending on the State,
for State supplemental payments, Medicaid, Food Stamps, and other social
services. This financial, medical and rehabilitation services support
may enable a child to achieve a level of functioning that gives him or
her a significant degree of self support. When this support is coupled
with various work incentives provided by the disability program, it can
ultimately lead a child to independence so that he or she can leave the
disability rolls.
To receive SSI payments, a child must meet two
sets of eligibility criteria: financial criteria based on the income and
resources of the child and family; and medical criteria about the child's
impairment or combination of impairments. The local Social Security office
decides if a child's income and resources are within the SSI limits. In
making that decision, the Social Security office must consider the income
and resources of parents who are living in the same household with the
child. The Disability Determination Services (DDS) obtains the necessary
information and makes the medical decision in childhood disability claims.
Income includes earnings, social security checks,
pensions, and non-cash items such as food, clothing or shelter. The SSI
benefit payable each month is affected by other income an individual possesses.
Resources include things like bank accounts, stocks,
bonds, and property. Certain things usually do not count, such as personal
belongings, the family home, and family car.
Social Security reviews every SSI case from time
to time to make sure that people getting benefits are still disabled and
are getting the right amount. Also, SSI beneficiaries (or their payees)
are required to report any changes in their situations, such as changes
in income, resources, household composition, school attendance, marital
status, and improvement in medical condition.
Back to Top
Representative Payees
When a child is eligible, benefits are usually
paid to a responsible individual or organization, known as a representative
payee. Typically, a parent or other relative with whom the child lives
serves as payee. In some cases, though, a friend or family member cannot
serve as payee, and a qualified organization is appointed payee for the
child. No matter who serves as payee, the payments must be spent for the
use and benefit of the child. The payee's first priority is to ensure
that the child's current needs are met.
This includes food, clothing, shelter, medical
care and personal comfort items. Once these needs are met, funds can be
spent on other items, such as life insurance, burial arrangements, needed
renovations to make the child's home safer or more accessible, furnishings
for the child's use, medical equipment, dental care, and school expenses.
Funds not used for the child's current needs must
be saved. Each year, payees are required to account for how benefits are
used.
If you believe a representative payee is misusing
a child's benefits, you should call the local Social Security Office.
Definition of Disability for Children
Under the law, a child is considered disabled if:
-
he or she has a medically determinable
physical or mental impairment (or combination of impairments); and
-
the impairment(s) results in marked and
severe functional limitations; and
-
the impairment(s) has lasted (or is expected
to last) for at least one year or to result in death.
What is a medically determinable physical or mental
impairment?
To meet our definition, a child's impairment must
result from anatomical, physiological, or psychological abnormalities
that are demonstrable by medically acceptable clinical and laboratory
diagnostic techniques. The impairment must be established by medical evidence
consisting of signs, symptoms and laboratory findings, not only by a claimant's
statement of symptoms.
We need evidence from acceptable medical sources
to establish whether a child has a medically determinable impairment.
Acceptable medical sources are:
-
licensed physicians (medical or osteopathic)
-
licensed or certified psychologists (includes
school psychologists, for purposes of establishing mental retardation/learning
disorder/borderline intellectual functioning)
-
licensed optometrists (for the measurement
of visual fields or acuity)
-
licensed podiatrists (for purposes of
establishing impairments of the foot, or foot and ankle, depending on
the State)
-
qualified speech-language pathologists
(for purposes of establishing speech or language impairments )
-
other individuals authorized to send us
copies or summaries of the medical records from a hospital, clinic, or
other health care facility.
Once we have established the existence of an impairment,
we may also use evidence from other sources to show the severity of the
impairment and how it affects the child's functioning. Other sources include
medical sources not listed above, parents, guardians and other care givers,
schools, public and private social welfare agencies, audiologists, etc.
Educators and other school professionals (counselors, nurses, early intervention
team members, etc.) in particular, can provide the specific, reliable
information we need on how the child has functioned in school over the
last 12 months. This information gives us an insight into the child's
day-to-day functioning, which is very important in determining childhood
disability.
Back to Top
Role of the School Professional
School records and appropriate educational personnel are two of the best
sources of evidence about how a school-age child is functioning.
School administrators are asked to ensure that
appropriate points of contact are set up year round. This is vitally important
to ensure timely disability decisions for children throughout the year,
especially during the summer.
In general, we ask schools to provide copies of:
- Academic performance, psychological evaluation,
attendance and behavior;
- Standardized and other specialized testing;
- School-based therapeutic interventions (e.g.,
speech and language therapy) and the use of other special
services, including placement in special education classes or other specially
adapted settings;
- Individual education programs (IEP); and
- Other periodic assessments of the child; e.g.,
comprehensive triennial assessments.
-what the child can and cannot do, or is limited
in doing.
Description of Other Information We Need From
Teachers and
Other Educational Personnel
To decide whether a child qualifies for disability payments, we use information
from both medical and non-medical sources. Medical sources include doctors
and other health care professionals; non-medical sources include teachers
and other people who spend time with the child.
Information from sources
who know the child well is important, because a child's eligibility may
be related to his or her level of functioning at school, at home, or in
the community. The information you provide about a child's day-to-day
functioning in school will help us to determine the effects of his or
her impairment(s) on his or her functioning compared to that of other
children the same age who do not have impairments. We need this information
from you even if the child has been (or was) in your class for only a
short time. Your information is not the only information we will be considering
when we decide if the child qualifies for disability payments, but it
is very important to us.
SSA considers all of the mental and physical limitations
resulting from a child's impairment(s). We address those limitations in
terms of the following broad domains of functioning:
Acquiring and Using Information
We consider how well a child:
Learning and thinking begin at birth. A child learns
as he/she explores the world through sight, sound, taste, touch, and smell.
As a child plays, he/she acquires concepts and learns that people, things,
and activities have names. This lets the child understand symbols, which
prepares him/her to use language for learning. Using the concepts and
symbols acquired through play and learning experiences, a child should
be able to learn to read, write, do arithmetic, and understand and use
new information.
Thinking is the application or use of information
a child has learned. It involves being able to perceive relationships,
reason, and make logical choices. People think in different ways. When
a child thinks in pictures, he/she may solve a problem by watching and
imitating what another person does. When a child thinks in words, he/she
may solve a problem by using language to talk his/her way through it.
A child must also be able to use language to think about the world and
to understand others and express him or herself; e.g., to follow directions,
ask for information, or explain something.
Attending and Completing Tasks
We consider how well a child:
-
is able to focus and maintain attention, and
-
begins, carries through, and finishes activities, including the
pace at which the child performs activities and the ease with which the
child changes them.
Attention involves regulating levels of alertness
and initiating and maintaining concentration. It involves the ability
to filter out distractions and to remain focused on an activity or task
at a consistent level of performance. This means focusing long enough
to initiate and complete an activity or task and changing focus once it
is completed. It also means that if a child loses or changes focus in
the middle of a task, he/she is able to return to it without other people
having to remind him/her frequently to finish it.
Adequate attention is needed to maintain physical
and mental effort and concentration on an activity or task. Adequate attention
permits a child to think and reflect before starting or deciding to stop
an activity. In other words, the child is able to look ahead and predict
the outcome of his/her actions before acting. Focusing attention allows
a child to attempt tasks at an appropriate pace. It also helps determine
the time needed to finish a task within an appropriate timeframe.
Back to Top
Interacting and Relating with Others
We consider how well a child:
-
initiates and sustains emotional connections with others,
-
develops and uses the language of his/her community,
-
cooperates with others,
-
complies with rules
-
responds to criticism, and
-
respects and takes care of the possessions of others.
Interacting means initiating and responding to
exchanges with other people, for practical or social purposes. A child
interacts with others by using facial expressions, gestures, actions,
or words. A child may interact with another person only once, as when
asking a stranger for directions, or many times, as when describing his/her
day at school to parents. A child may interact with people one-at-a-time,
as when listening to another student in the hallway at school, or in groups,
as when playing with others.
Relating to other people means forming intimate
relationships with family members and with friends the same age, and sustaining
them over time. A child may relate to individuals, siblings, parents or
a best friend, or to groups, such as other children in childcare, friends
in school, teammates in sports activities, or people in the neighborhood.
Interacting and relating requires a child to respond
appropriately to a variety of emotional and behavioral cues. A child must
be able to speak intelligibly and fluently so that others can understand;
participate in verbal turntaking and nonverbal exchanges; consider others'
feelings and points of view; follow social rules for interaction and conversation;
and respond to others appropriately and meaningfully.
A child's activities at home or school or in the
community may involve playing, learning, and working cooperatively with
other children, one-at-a-time or in groups; joining voluntarily in activities
with the other children in school or community; and responding to persons
in authority (e.g., parents, teacher, bus driver, coach, employer).
Moving About and Manipulating Objects
We consider how well a child:
These are called gross and fine motor skills.
Moving one's body involves several different kinds
of actions:
Rolling one's body; rising or pulling oneself from a sitting to a standing
position; pushing oneself up; raising one's head, arms, legs, and twisting
one's hands and feet; balancing one's weight on one's legs and feet; shifting
weight while sitting or standing; transferring from one surface to another;
lowering oneself to or toward the floor as when bending, kneeling, stooping,
or crouching; moving oneself forward and backward in space as when crawling,
walking, running, and negotiating different terrain (e.g., curbs, steps,
hills).
Moving and manipulating things involves several
different kinds of actions:
Engaging one's upper and lower body to push, pull, lift, or carry objects
from one place to another; controlling shoulders, arms, and hands to hold
or transfer objects; coordinating eyes and hands to manipulate small objects
or parts of objects.
These actions require varying degrees of strength,
coordination, dexterity, pace, and physical ability to persist at the
task. They also require a sense of where one's body is and how it moves
in space; the integration of sensory input with motor output; and the
capacity to plan, remember, and execute controlled motor movements.
Back to Top
Caring For Yourself
We consider how well a child:
-
maintains a healthy emotional and physical state, including how
well the child gets his/her physical and emotional wants and needs met
in appropriate ways;
-
copes with stress and changes in the environment; and
-
takes care of his/her own health, possessions, and living area.
Caring for and regulating oneself effectively,
with the degree of independence appropriate to a child's age, depends
upon the ability to respond to changes in emotions and daily demands of
the environment. Caring for oneself is characterized by a sense of personal
autonomy, or independence and mastery, or competence. The effort to become
independent and competent should be observable at birth and should continue
throughout childhood. Emotional well-being requires a basic understanding
of the body, including its normal functioning, and physical and emotional
needs.
To meet these needs successfully, a child must
employ effective coping strategies, appropriate to his/her age, to identify
and regulate feelings, thoughts, urges, and intentions. Such strategies
are based on taking responsibility for getting needs met in an appropriate
and satisfactory manner. This includes establishing and maintaining adequate
self-control when regulating responses to changes in moods and environment,
and developing appropriate means to delay gratification.
Caring for and regulating oneself means becoming
increasingly independent in making and following one's own decisions.
This entails relying on one's abilities and skills and displaying consistent
judgment about the consequences of caring for oneself. As a child matures,
using and testing his/her own judgment helps develop confidence in independence
and competence.
Health and Physical Well-being
We consider the cumulative physical effects of:
-
physical or mental impairments, and
-
their associated treatments or therapies on a
child's functioning.
A physical or mental disorder may have physical
effects that vary in kind and intensity, and may make it difficult for
a child to perform activities independently or effectively. A child may
experience problems such as generalized weakness, dizziness, shortness
of breath, reduced stamina, fatigue, psychomotor retardation, allergic
reactions, recurrent infection, poor growth, bladder or bowel incontinence,
or local or generalized pain. A child may have difficulty with senses,
including reduced hearing or visual acuity.
In addition, the medications a child takes (e.g.,
for asthma, depression) or the treatment a child receives (e.g., chemotherapy,
multiple surgeries) may have physical effects that also limit performance
of activities.
A child's illness may be chronic with stable symptoms,
or episodic with periods of worsening and improvement. We will consider
how a child functions during periods of worsening and how often and for
how long these periods occur. A child may be medically fragile and need
intensive medical care to maintain his/her level of health and physical
well-being. In any case, as a result of the illness itself, the medications
or treatment a child receives, or both, he or she may experience physical
effects that interfere with functioning in any or all activities.
All requests for this information will be accompanied
by a release-of-information form signed by a parent or guardian (and/or
by the child, if appropriate).
When you provide information, you should describe
the child's activities, limitations and behaviors as specifically as possible.
For example, "shouts at and shoves other children when teased about
impairment 1-2 times per week" provides clearer and more useful information
than "gets in fights frequently."
How This Information Is Used
We consider all of the relevant information in
the child's case record and will not consider any single piece of evidence
in isolation. The information provided by teachers, counselors, parents,
caregivers, etc., is considered along with the medical evidence to complete
the picture of the child's functioning compared to other children of the
same age who do not have impairments. A complete picture is necessary
in order for the DDS team (which consists of a disability examiner and
a medical or psychological consultant) to make the disability decision.
Need More Information?
Additional information about the Social Security
disability process and the medical criteria that we use to determine disability
in children can be found in our publication, Disability Evaluation Under
Social Security, Publication Number 64-039, commonly referred to as the
"Blue Book." You may obtain a copy of this publication, free-of-charge;
send your request by mail, fax, or phone to:
Office
of Supply and Warehouse Management
239 Supply Building
6301 Security Blvd.
Baltimore, Maryland 21235
Phone: (410) 965-2039
Fax: (410) 965-2037
Email: oplm.oswmrptorders@ssa.gov
Internet: www.socialsecurity.gov (select publications link)
Internal Components:
The Office of Supply & Warehouse Management (OSWM) has introduced
a new ordering warehouse system that has proved to be very reliable and
provides excellent customer service. Your staff and Public Affairs Specialist
(PAS) should request public information materials directly into Supply's
web-based on-line ordering system--the Warehouse Management Control
System
(WMCS).
You may order each publication by using the Inventory Control Number.
You may also go directly to the Medical
Listings ("Blue Book") on-line.
A complete list of available publications
are also on SSA's website.
You may contact the Professional Relations Branch
at the Social Security Administration's Headquarters. The address is:
Social Security Administration
Office of Disability Programs
Professional Relations Branch
4670 Annex Building
6401 Security Boulevard
Baltimore, Maryland 21235
Publication No. 64-049
ICN 436935
December 2001
Back to Top
|
www.socialsecurity.gov
