Next Post, Friday, August 22, 2014, "Reasonable Attempt to Place Without Adoption
Assistance as a Special Needs Requirement"
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:
- 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.
- 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.
- 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.
