Poverty and mental disability form a tragic pairing for hundreds of thousands of children in the United States.
The Supplemental Security Income program of the Social Security Administration, meant to support these children and their families, has come under fire for doing too much for too many. A new study, however, suggests it may not be helping as many families as it could.
“This is not gross over-provision of services, if anything it’s gross under-provision,” says Stephen Buka, professor of epidemiology at Brown University. “The reservoir of potentially eligible children who are not receiving benefits is quite substantial.”
In 2013, nearly 1 percent of all US children received support from the Supplemental Security Income (SSI) program because of low household income and mental disabilities, including attention deficit and hyperactivity disorder (ADHD), a mood disorder, an autism spectrum disorder, or other condition.
The program’s size, recent apparent growth, and news reports about instances of fraud prompted criticism that led the Social Security Administration to ask the Institute of Medicine to assess the program.
Researchers conducted a comprehensive analysis of SSI program data from 2004 to 2013. They compared factors such as the prevalence of mental disability in the population eligible for SSI benefits with the prevalence in the general population of children and among those receiving Medicaid. This period included such profound economic shifts as the recession that began in 2008. The committee noted that poverty and disability are often mutually reinforcing risk factors.
“It is the case that ADHD is more common among poor families than middle-class families, but what’s more striking is that if you have ADHD and you are in a poor family, the repercussions and the resulting disability are greater,” Buka says. “Poverty exacerbates the challenges of having a mental disorder.”
The committee concluded that SSI is not overserving the nation’s population of low-income families grappling with childhood mental disability.
“After taking child poverty into account, the increase in the percentage of poor children receiving SSI benefits for mental disorders is consistent with and proportionate to trends in prevalence of mental disorders among children in the general population,” Buka and his colleagues write in the IOM report.
Moreover, the committee’s analysis of state-by-state variations in benefits and the nationally high prevalence of some disorders compared to enrollment in the program led them to estimate that SSI doesn’t reach many children who would be eligible.
The program could benefit from potential reforms, the researchers say. Many children who receive treatment improve markedly. It therefore may be proper to monitor for such progress and to end benefits for children who no longer need them.
“The fact that typically once you are determined to be eligible for benefits you stay on the program until you age out is something we’re critical of,” Buka says. “The program needs to be more vigilant to monitor children’s improvements over time.”
This text is published here under a Creative Commons License.
Author: David Orenstein-Brown University
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