PHILADELPHIA -- Two psychologists and a pediatrician testified yesterday that the Social Security disability program for the poor discourages parents from seeking help for their children who receive monthly checks for emotional and behavioral problems.
They told a national commission examining the troubled Supplemental Security Income program (SSI) for children that parents are afraid they will lose monthly checks of up to $458 -- plus a supplement from most states -- if the child overcomes the disability.
"Financially strained families are encouraged to do less and not do more to get help for their children," said Dr. Karen Berberian, director of child psychology at a Philadelphia hospital. "The system discourages families from getting help."
"We are hurting kids," added Dr. Kenneth R. Carroll, a private psychologist in Swarthmore, Pa., who said he spent six years judging children's disability cases, then quit in 1992 because he had "grave ethical and philosophical objections" to new childhood rules.
"You are reinforcing behavior in one sense by giving cash payments as long as the child behaves poorly," added Dr. Mark L. Batshaw, chief physician at a child development and rehabilitation hospital here.
He emphasized, however, that he was criticizing only one aspect of the SSI program.
"In many ways, SSI shows the best of America," Dr. Batshaw said. "It is cost-effective, it is pro-family and it is pro-child" by helping to keep families together and provide help for the children.
Roughly 900,000 children receive $5 billion annually in SSI benefits, about 60 percent for mental disorders, including mental retardation.
The rolls have tripled since 1989 in the wake of three developments: Social Security's rewrite of eligibility standards; the agency's "outreach" efforts to find eligible children; and a 1990 Supreme Court decision, known as Zebley, which required a subjective analysis of many child claimants who don't have an ailment on Social Security's list of qualifying disorders.
The surge in the rolls has sparked complaints from around the country that parents encourage -- some say "coach" -- their children to misbehave and do poorly in school in order to qualify for benefits. In some communities, SSI payments are known as "crazy checks."
Applications have soared steadily, rising from 114,400 in 1989 to 548,000 last year. Approvals peaked at 248,800 in 1992 and dropped to 197,000 last year. The Social Security Administration says only one-third of applicants won benefits at the initial application stage. However, about 65 percent of the cases appealed to a Social Security judge are approved.
Formed by Congress after complaints about the children's program, the commission was appointed two months ago and is racing to produce recommendations in time to influence the welfare legislation passed by the House on Friday and sent to the Senate.
Jim Slattery, a former Democratic congressman from Kansas who heads the commission, emphasized the urgency of the panel's task, saying that the Senate may try to pass its version of the bill by July.
Proposing the most profound changes in national welfare policy since the New Deal, the legislation would make far-reaching changes in the children's program.
It would tighten eligibility standards for children to receive SSI benefits, end cash payments to all but the most severely disabled children, overturn the Zebley decision, and drop from the rolls about 225,000 children who have won benefits through that decision.
Although the children remaining on the rolls would continue to receive cash payments, most new enrollees -- all but the most severely disabled -- would be eligible only for goods and services supplied by the states using federal funds and for Medicaid benefits.
Yesterday's hearing was the second in a series that will take the commission to Baltimore, Kansas City and Los Angeles in the next few months.
The commission heard from mothers of children who receive SSI benefits for serious physical ailments. They pleaded for preservation of the cash benefits, saying that replacing payments with goods and services would rob them of the flexibility they need to care for their children and deprive them of the ability to stay home to care for them.
"I don't think that having vouchers for one particular kind of service or equipment would be nearly as helpful as cash," said Evelyn Sostre. "I know what my daughter needs, and I should be able to choose what is best for her."
Two Philadelphia legal aid lawyers who won the Zebley decision argued that the problems in the program are relatively few, but offered some suggestions to deal with the "perceptions" and "fears" that are being expressed publicly.
As to the assertion that cash benefits are a "disincentive" for parents to seek help for children, Jonathan M. Stein, one of the lawyers, said: "I don't think there's a lot out there that could justify that" conclusion.
Dr. Carroll, the psychologist who once made disability decisions, told the commission that the hearing and others like it would not offer a fair assessment of the program.
"Folks who shouldn't be receiving benefits are not here," he said. "They are not writing letters to their congressmen."
Saying that children are awarded benefits because they fall behind in school, even if the parents fail to make sure they attend classes, he added, "The child, by screwing up, wins a prize."