At Risk Category: Parent is diagnosed with Developmental Disability

Documentation of Need

  1. Written verification of the parent's diagnosis from a physician or licensed clinical counselor such as a clinical psychologist or clinical social worker and
  2. Written report from the multidisciplinary evaluation team of why in their clinical judgment the child is at risk of developing substantial developmental delay due to the parent's diagnosis if EI services are not provided. Report should also meet evaluation/assessment report guidelines.

ICD-9 Code: V-19 Family History of Other Conditions


At Risk Category: Parent is diagnosed with severe mental disorder

as set forth under axis I and axis II of the Diagnostic and Statistical Manual (DSM) IV

Documentation of Need

  1. Written verification of the parent's diagnosis from a physician or licensed clinical counselor such as a clinical psychologist or clinical social worker and
  2. Written report from the multidisciplinary evaluation team of why in their clinical judgment the child is at risk of developing substantial developmental delay due to the parent's diagnosis if EI services are not provided. Report should also meet evaluation/assessment report guidelines.

ICD-9 Code: V-19 Family History of Other Conditions


At Risk Category: Three of these risk factors

  1. Primary caregiver currently abuses alcohol or other substance.
  2. Primary caregiver is currently under 15.
  3. Child is currently homeless.
  4. Chronic illness of primary caregiver.
  5. Mother abused alcohol or other substance during pregnancy.
  6. Primary caregiver has education level less than 10th grade and level in not appropriate to age.
  7. Indicated case of abuse/neglect and child has not been removed from situation.

Documentation of Need

  1. Written report from multidisciplinary evaluation team indicating:
    1. Risk factors present;
    2. How the risk factors were identified; and
    3. Why in their clinical judgment the child is at risk of developing substantial developmental delay due to the identified risk factors if EI services are not provided. Report should also meet evaluation/assessment report guidelines.

ICD-9 Code: V-19 Family History of Other Conditions