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Carolina's definitions were developed to encourage entry
for children for whom early intervention services are likely
to have the greatest benefit. The provision of such services
at a very early age will enhance development and may preclude
or diminish the need for services in later years.
In
the first two categories listed above (Developmental Delay
and Atypical Development), the child shows a measurable
delay or exhibits atypical development. However some children
from birth to age three have conditions with a high probability
of resulting in developmental delay or atypical development.
Children with such conditions, as defined in the High
Risk Established and High Risk Potential categories, should
be referred for eligibility determination.
To
qualify for the Infant-Toddler Program in any eligibility
category, the child's multidisciplinary evaluation must
result in a clinical determination that the identified
conditions are associated with developmental concerns,
and that developmental, therapeutic, or educational interventions
would be beneficial. This determination may be based on
clinical judgement, and not necessarily on specific test
scores obtained during the entry multidisciplinary evaluation.
Developmental Delay
Children from birth to age three whose development is
delayed in one or more of the following areas: cognitive
development; physical development, including gross and
fine motor function, vision, and hearing; communication
development; social - emotional development, and adaptive
development. The specific delay must be documented by
scores 1.5 standard deviations below the mean of the composite
score (total test score) on standardized tests or by a
20 percent delay on instruments which determine scores
in months in at least one of the above areas of development.
Atypical Development
Children from birth to age three who demonstrate significantly
atypical behavioral, socio-emotional, motor or sensory
development such as:
1. Diagnosed hyperactivity, attention deficit disorders,
autism spectrum disorders, severe attachment disorders,
other pervasive developmental disorders, or other behavioral
disorders.
2.
Indicators of emotional and behavioral disorders such
as:
a.
delay or abnormality in achieving emotional milestones,
such as attachment, parent-child interaction, pleasurable
interest in adults and peers, ability to communicate emotional
needs, or ability to tolerate frustration;
b.
persistent failure to initiate or respond to most social
interactions;
c.
fearfulness or other distress that does not respond to
comforting by caregivers;
d.
indiscriminate sociability, for example, excessive familiarity
with relative strangers, or
e.
self-injurious or other aggressive behavior.
3.
Substantiated physical abuse, sexual abuse, or other environmental
situations that raise significant concern regarding the
child's emotional well being.
High Risk Established
Children with diagnosed or documented physical or mental
conditions known to result in developmental delay or atypical
development as the child matures. Such conditions are
limited to the following:
Code
Condition
403 Chromosomal Anomaly or Genetic Disorder
404 Metabolic Disorder
405 Infectious Disease
406 Neurologic Disease
407 Congenital Malformation
409 Toxic Exposure
410 Vision Disorder
411 Hearing Disorder
High Risk Potential
Children with documented presence of indicators associated
with patterns of development, which have a high probability
of meeting the criteria for developmental delay or atypical
development as the child matures. Documentation will require
at least three indicators in the 100 through 300 series
of indicators used by the North Carolina Child Service
Coordination Program.
Information about using High Risk Potential as an eligibility
category can be found in the Infant-Toddler Program publication
Consultation Chapter "A" - Serving Children
in the High Risk Potential Category. (For additional information,
see Technical Assistance Bulletin #38 - Technical Assistance
in the Infant-Toddler Program Manual.)
Glossary
of Risk Indicators From the N. C. Child Service Coordination
Program
Parent
or Familial Indicators
100
Maternal Age <15 Years: Mother's age is less than 15
years.
101 Maternal Phenylketonuria (PKU): Mother whose blood
phenylalanine is 10/mg/dl or more, or who has hyperphenylalanemia.
102 Mother HIV Positive: Mother with Human Immunodeficiency
Virus (antibodies to HIV) or Acquired Immune Deficiency
Syndrome (AIDS).
103 Maternal use of Anticonvulsants, Antineoplastic or
Anticoagulant Drugs: This includes such drugs as warfarin
(Coumadin R), and heparin.
104 Parental Blindness: Primary caregiving parent is blind.
105 Parental Substance Abuse : Birth mother during pregnancy
or primary caregiving parent has been a habitual abuser
of alcohol and/or drugs.
106 Parental Mental Retardation: Either parent has been
diagnosed with mental retardation or developmental disability.
107 Parental Mental Illness: Either parent has a diagnosed
illness such as severe depression, bipolar illness, schizophrenia,
or borderline psychotic conditions.
108 Difficulty in Parent-Infant Attachment: Primary caregiving
parent shows substantial lack of attention and interest
in infant, withdrawal from, avoidance of or over stimulation
of the infant or child associated with misreading the
infant's early communications or cues; or parent does
not give clear cues to the child.
109 Difficulty in Providing Basic Parenting: Substantial
evidence that neither one of the child's parents is able
to protect the child from injury and/or abuse, provide
adequate physical care, form an ongoing, stable relationship
with the child, and perceive and respond to the total
child's changing total needs and communications.
110 Lack of Stable Housing: Child's family lives on the
street or in a vehicle, or moves from one dwelling to
another with no permanent shelter, indicating a level
of family disruption which may result in a non-facilitating
environment for the child.
111 Lack of Familial and Social Support: Child and parent(s)
have no family, friends, or other means of social support
to whom they may turn in crises or to meet routine needs,
112 Family History of Childhood Deafness: Parents, grandparents,
siblings, aunts, or uncles have experienced hearing impairment
during their childhood.
113 Maternal Hepatitis B: Mother was positive for Hepatitis
B at the time of delivery.
114 MOW: Infants born to mothers who are seen by a Maternal
Outreach Worker.
115 History of Abuse or Neglect of Parent: Parent reports
a history of having experienced abuse or neglect as a
child.
Neonatal
Conditions
200
Birthweight <1500 grams: Infant's birthweight less
than 1500 grams.
201 Gestation <32 weeks: Infant's gestational age was
less than 32 weeks.
202 Respiratory Distress: Infant experienced respiratory
distress requiring mechanical ventilator for more than
6 hours.
203 Asphyxia: Infant had experienced asphyxia (or Apgar
score less than 3 at 5 minutes).
204 Hypoglycemia: Infant had serum glucose level under
25 mg/dl.
205 Hyperbilirubinemia: Infant has had a bilirubin blood
level of greater than 20 mg/dl.
206 Intracranial Hemorrhage: Infant has had a subdural,
subarachnoid, intraparenchymal or intraventricular hemorrhage
(Grade II-IV).
207 Neonatal Seizures: Infant has had neonatal seizures.
Post-Neonatal
Conditions
300 Suspected Visual Impairment: Infant is not able to
make eye contact or to track visually after the first
few weeks of life.
301 Suspected Hearing Impairment: Parent expresses concerns,
the child fails a hearing screening, or presents with
unresolved chronic otitis media, or presents with physical
abnormality of the ear or oral-facial anomalies.
302 No Well-Child Care By Age 6 Months: No history of
well-child care (including immunizations) reported during
the infant's first 6 months of life.
303 Failure on Standard Developmental or Sensory Screening
Test: Infant has a history of "abnormal" or
repeated "suspect" findings and tests such as
the Denver II Developmental Screening Test or Hearing
Kit Questionnaire.
304 Significant Parental Concerns: Either parent expresses
concern about the child's developmental competence, health
or emotional well-being, (e.g., I'm worried that my child
can't hear me" or "She is very hard to console
and I never can satisfy her"), for which extended
follow-up will be essential to address the presenting
problem.
305 Suspected Abuse or Neglect: A local Department of
Social Services agency has initiated an investigation
on reports that the infant has been physically or sexually
abused, or neglected.
306 Chronic Lung Disease: Persistent oxygen requirements
beyond six months chronological age.
Diagnosed
Conditions
400
Potential High Risk: To use this risk condition for children
from birth to 36 months of age with the expectation that
the child may qualify for the entitlements under the North
Carolina Infant-Toddler Program, there must also be three
risk indicators circled somewhere in the 100, 200 or 300
series. This code can be used alone for any child birth
to 60 months of age when the Child Service Coordinator
has clinical concerns about the child's health, developmental
or social/emotional state in order to qualify the child
for the Child Service Coordination Program. A child with
a diagnosis of failure to thrive should be included in
this risk condition.
401 Developmental Delay: Children from birth to 60 months
of age whose development is delayed in one or more of
the following areas: cognitive development; physical development
including fine and gross motor function, vision, and hearing;
communication development; social-emotional development;
and adaptive development. The specific level of delay
must be: a) for children from birth to 36 months, documented
by a score of one and one-half standard deviations below
the mean of the composite score (total test score) on
standardized tests or by a 20 percent delay on instruments
which determine scores in months in at least one of the
above areas of development. b) for children from 36-60
months of age, documented by test performance two (2)
standard deviations below the mean on standardized tests
in one area of development or by performance that is one
(1) standard deviation below the norm in two areas of
development. Or it may be documented by a 25 percent delay
in two areas on assessment instruments that yield scores
in months.
402 Atypical Development: Children from birth to 60 months
of age who demonstrate significantly atypical behavioral,
socio-emotional, motor or sensory development such as:
(1) Diagnosed hyperactivity, attention deficit disorders,
autism, severe attachment disorders, other pervasive developmental
disorders or other behavioral disorders. (2) Indicators
of emotional and behavioral disorders such as: a) delay
or abnormality in achieving emotional milestones such
as attachment, parent-child interaction, pleasurable interest
in adults and peers; ability to communicate emotional
needs or ability to tolerate frustration; b) persistent
failure to initiate or respond to most social interactions;
c) fearfulness or other distress that does not respond
to comforting by caregiver; d) indiscriminate sociability,
for example, excessive familiarity with relative strangers;
e) self-injurious or aggressive behavior. (3) Substantiated
physical abuse, sexual abuse or other environmental situations
that raise significant concern regarding the child's emotional
well-being.
403 Chromosomal Anomaly/Genetic Disorder: Children from
birth to 60 months of age diagnosed to have one or more
familial disorders with developmental implications such
as tuberous sclerosis, familial retardation syndromes,
Down syndrome, Fragile X, hemoglobinopathies, Fetal Alcohol
Syndrome.
404 Metabolic Disorder: Children from birth to 60 months
of age who have a diagnosis of a metabolic disorder with
developmental implications such as diabetes, cystic fibrosis,
chronic renal failure, short bowel syndrome.
405 Infectious Disease: Children from birth to 60 months
of age who have a diagnosis of an infectious disease that
interferes with daily functioning for greater than three
months a year or is likely to require hospitalization
of more than one month a year such as AIDS, CMV, rubella,
herpes, toxoplasmosis, syphilis.
406 Neurologic Disease: Children from birth to 60 months
of age diagnosed to have any disorder known to affect
the central nervous system, such as cerebral palsy, spina
bifida, microcephaly, macrocephaly, seizures, bacterial
or viral infection of the brain, inability to feed orally
in a full-term infant or sustained in a premature infant,
persistent hypertonia or hypotonia.
407 Congenital Malformation: Children from birth to 60
months of age diagnosed to have any congenital disorder
with developmental implications such as congenital heart
disease, missing or deformed limbs, anatomic malformations
involving the head and neck.
409 Toxic Exposure: Children from birth to 60 months of
age with a confirmed venous blood lead level of 20 ug/dl
or greater. Other toxic exposures may include such toxic
materials as lye, medications, kerosene, alcohol (diagnosed
Fetal Alcohol Effect) or illegal substances confirmed
by a positive drug screen.
410 Vision Disorder: Children from birth to 60 moths of
age diagnosed with a visual impairment that cannot be
corrected with treatment, surgery, glasses, or contact
lenses.
411 Hearing Disorder: Children from birth to 60 months
of age who (1) failed to pass a newborn physiologic hearing
screening (i.e., auditory brainstem response screening
or evoked otoacoustic emissions screening) prior to hospital
discharge and were referred for a hearing rescreen, or
(2) were diagnosed with a hearing impairment that cannot
be corrected with treatment, surgery, or amplification.
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