Eligibility Part 3 Substantial Risk as a Special Needs Requirement. Title IV-E Adoption Assistance in Ohio Topic: Eligibility Part 3: Substantial Risk as a Special Needs Requirement.

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Substantial Risk

"Substantial Risk" is a special needs category that is particularly applicable to private agency adoptions.  According to the ODJFS training session with county agencies on the revised rules, an infant or very young child may be considered a special needs child due to "substantial risk" in the child's family background or medical history.  Substantial risk, is defined in OAC 5101:2-49-03(B)(1) as "a strong probability that a certain result may occur or that certain circumstances may exist."

In order to establish "substantial risk" a pediatrician or other qualified medical professional must write: a statement that essentially connects factors in the child's background with the reasonably strong possibility or probability that the child will develop a certain type of developmental, mental health, medical or other problem in the future.  

 The statement should:  

• Explain the how specific factors in the child's background pose a substantial risk for a developmental disability, developmental delay, mental illness, or medical condition "causing distress, pain, dysfunction or social problems."    

• Include an opinion as to the origin of the problem, past history, prognosis, and recommendations related to potential treatment needs.
•  Include an assessment or evaluation conducted within the past 12 months. 

Important Practical Tip: Substantial risk may sounds like a challenging standard to meet, but in reality it should not be too difficult.  Family histories of inherited mental illness or medical conditions, prenatal exposure to drugs or alcohol and a host of other risk factors are not that difficult to identify.

Doctors, psychologists and other health care professionals will probably not be familiar with the adoption assistance program. Private agency representatives and parents should tell the professional what is needed to meet the eligibility requirement for “substantial risk.”   This “prompting” does not question the doctor’s diagnosis, but rather informs them of the kind of issues that need to be addressed and the kind language that needs to be employed to satisfy the state requirement set forth in the rule.  Once the provider understands that the purpose of the “substantial risk” determination is to support the child in the event of future problems, they are usually quite willing to help.  Tell them what must included to meet the eligibility standard.  

Make sure that the provider understands that with respect to adoption assistance, special needs captures a spectrum of conditions that are beyond the ordinary, which will require treatment or therapy.  Moderate developmental delays, mental health problems or medical conditions are regarded as special needs as well as profound disabilities.  So, the child need not be at risk of developing profound disabilities or life threatening conditions.  The relative severity of a child's special needs is not so much an eligibility issue as the basis for negotiating the amount of adoption assistance.  The child does not have to be at risk for life threatening conditions, only those beyond the ordinary that will require particular types of treatment.

If the professional provider is reluctant to predict outcomes for a specific child, you can tell them that:

1. You are asking them to make a specific prediction but to write a statement based on their experience that children with background factors similar to those of your child are at substantial risk for certain kinds of problems.  That is, children with backgrounds similar to those of your child, often develop certain types of problems such as ________, or are likely to develop them. 

2. In the end, "substantial" is not a precise term.  Tell the provider to use the term in their statement because it is the language of the eligibility requirement in the Ohio adoption assistance rule.  Emphasize they are affirming the existence of a substantial link between certain background factors and certain medical, developmental, mental health or other problems.  "A child with X.Y,Z factors in his or her background is at substantial risk for A,B,C problems."  So, there is a substantial relationship between your child's background factors and certain types of problems. 

3. The "substantial risk" category is a safety net.  If "substantial needs" is the only special needs condition, the child will receive no assistance until a medical, developmental or other condition emerges.

Example: The More Specific the Better

A pediatrician or other medical provider might write a statement such as the following:

“Given the child’s (name) family history of ___________________________he/or she is at substantial risk for ______________________ , and ___________. or _____________ as he/she grows older.  (If true) ______________ is an inherited condition.  Children with this background commonly/frequently develop _________________ as they grow older.  If the child develops __________________ he or she will need _____________ (therapy/treatment).  Since problems such as ___________ commonly develop at ages _________________, an agreement for adoption assistance is clearly in this child’s best interest so that support will be available if the need arises”  

The statement should be supported by documentation, conducted within the past 12 months that includes significant risk factors in the child’s background and any signs of emerging problems if there are any.  If no problems are evident, them the documentation should focus on risk factors in the child’s history.  Adopting parents should have access to the child’s family and medical history.