Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program (2016)

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Appendix E Review of Social Security Administration Case Files To help carry out its task, as set forth by the Social Security Administration (SSA), the National Academies of Sciences, Engineering, and Medicine Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Speech Disorders and Language Disorders requested that the SSA conduct a review of case files to address two primary objectives. Objective 1: Describe the characteristics of the SSI child recipient population that has speech and language delays as the primary impairment code. This objective will help the committee address items 1-5 in the task order as they relate to the SSI childhood disability population. Objective 2: Determine whether professional standards of pediatric and adolescent health care are received by children alleging a speech or a language disor- der who apply for SSI and whose cases are allowed. This objective will help the committee “identify the kinds of care docu- mented or reported to be received by children in the SSI program.” 265 

266 SPEECH AND LANGUAGE DISORDERS IN CHILDREN CASE FILE CHARACTERISTICS The committee requested that the SSA review a random sample of 152 case files from fiscal year (FY) 2014 that meet the following criteria: • Type of claim—Initial Determinations — Eighty percent “functionally equal” the Listings — Twenty percent “meet or medically equal” the Listings • Primary impairment code on Form SSA-831—3153 Speech and Language Delays • Secondary impairment code on Form SSA-831—Any • Regulation basis code—All allowances (meets, medically equals, and functionally equals) CASE FILE EXCLUSION CRITERION The primary impairment code identified by Disability Determination Services (DDS) on Form SSA-831 does not correspond to the child’s pri- mary impairment based on the medical evidence of record. SPECIFIC QUESTIONS AND VARIABLES The committee developed a list of variables and questions derived from SSA Forms 3375-BK, 3376-BK, 3377-BK, 3378-BK, 3379-BK, and 3820- BK (see below). The committee requested that the random sample of 150 case files be reviewed for these variables and to answer these questions (to the extent to which this information is documented). RESULTS The SSA’s Office of Disability Policy used SurveyMonkey® to conduct internal case reviews and exported the results to an Excel file for the com- mittee to analyze. The following results were reported: A. About the Child 1. Date of birth 2. Age at date of filing 3. Age at date of determination 4. Gender 5. Can the child speak and understand English? 6. Age of onset of speech or language impairment? 7. Countable income 

APPENDIX E 267 B. Identification of Speech/Language Disorders 1. Disabling illnesses, injuries, or conditions (from the child’s file) 2.  the child’s illnesses, injuries, or conditions cause pain or Do other symptoms? 3. Does the child have problems seeing? 4. Does the child have problems hearing? 5. Is the child totally unable to talk? 6. Are the child’s physical abilities limited? 7. Does the child display any behavioral problems? B.1 Medical Assessment 1. Has the child been tested for behavioral or learning problems? • If “yes” list the tests administered. 2.  Has the child had, or will he/she have, any medical tests for illnesses, injuries, or conditions? • If “yes” list the tests administered. B.2 Disability Assessment 1. Has the child been tested or examined by Head Start (Title V)? 2.  Has the child been tested or examined by a public or commu- nity health department? 3. Has the child been tested or examined by a child welfare or so- cial service agency or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)? 4. Has the child been tested or examined by an early intervention service? 5.  Has the child been tested or examined by a program for chil- dren with special health care needs? 6.  Has the child been tested or examined by a mental health/ mental retardation center? C. Receipt of Treatment/Evolution of Treatment 1.  Has the child received one or more interventions for speech disorder (as applicable)? 2.  Has the child received one or more interventions for language disorder (as applicable)? 3.  Has the child received one or more interventions for hearing disorder (as applicable)? • If “yes” list the services received. 4. As of the date of filing, does the child take any medications? • If “yes” give name of medicine. • If “yes” give reason for medicine. 5. Does the child have autism? 

268 SPEECH AND LANGUAGE DISORDERS IN CHILDREN D. Disability Evaluation 1. Does the child’s impairment meet a listing? 2. Does the child’s impairment medically equal a listing? 3.  the impairment does not meet or medically equal a listing, If note “marked” or “extreme” for each of the domains of func- tional equivalence: • Acquiring and using information • Attending to and completing tasks • Interacting and relating with others • Moving about and manipulating objects • Caring for yourself • Health and physical well-being E. Types of Evidence in File 1.  What information does this file contain with regard to the child’s speech and language status? 2.  Are there scores or summary information from standardized speech and language measures? 3.  there information from systematic nonstandardized speech Is and language observations (observational rating forms, speech- language samples)? 4.  there information regarding speech and language based on Is informal observation? 5. Was information provided regarding the child’s hearing? 6. Which of the following documentation does the file include • Speech and language records • Occupational therapy records • Physical therapy records • Child health records •  hild Find, Early Intervention (Individual Family Service C Plan or Individualized Education Program) • Psychological consultative exam • Speech and language consultative exam •  orms SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA- F 3379, or 3820-BK