Haringey Community Paediatrics: Pathway for children referred with developmental delay

Telephone: 020 3224 4655
Email for referrals: whh-tr.compaed-har@nhs.net

Who is this care pathway for?

This care pathway has been written primarily for families and carers of a child who had an emerging or identified physical disability, the most common of which is cerebral palsy.
 
This information is also likely to be of interest and helpful for professionals as well.

Who do we see?

We see children where there is an emerging or identified developmental delay, who have a Haringey GP or attend a school in Haringey.

How to use this tool

When you scroll down you will see the information provided in this care pathway is set out in the following sections:
  • Who we see?
  • Who can refer and how?
  • Care Pathway: gives a flow-diagram type overview of the pathway
  • Detailed actions: sets out in more detail what is involved in the different parts of pathway
  • Associated documents: more for use by professionals
  • Resources: these are links to relevant web sites
  • Quality standards: this is a list of the quality standards that we report on annually on this web site and these are designated by QS where they appear in the text
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Who can refer and how?

We accept referrals from any professional. If you are concerned about your child, please discuss your worries with your GP, health visitor or other professional who is working with you and your child, as they can make a referral.
 
While we do not accept referrals directly from families, the referral must include acknowledgement that you have consented to the referral.
 
A referral form is included in the Associated Documents section of this web page for use by your professional.
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Care Pathway

Detailed Actions to be Completed

Referral Received

When your child is being referred to this service this should be discussed with you so that you are aware of the reasons for the referral and your consent given

Please note:

  • We use an electronic patient record to hold our clinical notes and documents. This in turn is accessible by other professionals who work for Whittington Health and helps greatly with our information sharing
  • At the end of each appointment we will write a report that is sent to you with an agreed plan and copy list of all relevant professionals. We aim to send this out within 2 weeks of the appointment (QS-1)
  • We welcome and actively seek, and act on feedback from all who use our services (QS-2)

 

Referral Triaged

All referrals are triaged by a paediatrician who will:

  • Review the referral of your child and take a decision based on the information provided
  • Request additional information if there are any gaps identified in the information provided
  • Make any additional referrals to therapy services, e.g. physiotherapy, speech and language therapy etc, so that any waiting time for these services can be minimised
  • Take the more complex cases to our multidisciplinary meeting with the Child Development Centre therapists to ensure that we coordinated care between paediatricians and therapists

The national standard is for all children to be seen within 18 weeks of referral – although we aim to see children well before then.

 

Assessment Phase
 

It may take several appointments to complete the holistic paediatric assessment.

Your child will be seen by a paediatrician who will undertake a holistic assessments that  will take in areas of your child's development (including motor, communication, cognitive skills etc), vision, hearing, medical history and psycho-social history.

The appointments offered may be:

  • Uni-disciplinary – the child is seen by a paediatrician, OR
  • Multi-disciplinary – this brings together a paediatrician and therapists at the same appointment

As part of the assessment the paediatrician will agree a plan for the following with you:

  • Any investigations and how the results will be fed back to you
  • Referrals to local services, e.g. therapy services, early intervention programmes, the voluntary sector, child and adolescent mental health services, social care and tertiary centres
  • Prescribing of medications

 At the end of the assessment if a diagnosis can be confirmed this will be discussed in detail with you as will the management plan and follow up.

 
 
Preparation for School

In the lead up to starting school the emphasis shifts to nursery provision and then to preparing for school.

At follow up appointments we would:

  • Answer any questions that you may still have about the diagnosis and outlook for your child
  • Review your child’s developmental progress
  • Review the management of any existing and emerging health problems
  • Consider if there was a need for additional referrals, as set out in the description of the initial assessment
  • Where indicated, notify Education if your child is likely to need significant additional support in school
  • Agree timing of any follow up appointment or discharge if our contribution had come to an end

 

Follow-up in School Years

For most children with developmental delay the focus of their support moves to education when they go to school. With this the terminology also changes and ‘developmental delay’ to ‘learning delay’ or ‘learning disability’. Assuming that the diagnostic assessment phase has been completed and unless there were any identified medical problems, children are usually discharged from the Community Paediatric Service once they are in school.

If there is any follow up planned this will be agreed with you based on the medical need.

If your child has a place in a special school they will be seen in their school, while children attending mainstream school will be followed up in clinics in the Child Development Centre.

 
 
Discharge or Transition to Adult Services
As indicated above, when our work is complete then we will discharge your child from follow up, while at the same time ensuring that colleagues in universal health services were informed of your child’s needs.
Professionals are always able to refer back to us if you or they had any further concerns about your child.
 
If you child is under follow up with the Community Paediatric Service coming into their adult years, typically this will be a young person who is in one of the borough’s special schools, then we will participate in the transition process to adult services and make any relevant referrals to adult medical services and/or the Adult disability service.
 
 
 
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Associated Documents

Resources

Useful links  
 
This is an NHS website that gives information on Caring for a disabled child that can help in making your daily parenting duties, such as feeding, toilet training.
 
Markfield
Markfield is a community centre in Haringey which promotes the dignity, choice, independence and community inclusion of Disabled people and their families.
 
 
 
The London Borough of Haringey Disabled Children's Team (DCT) provides services for children with disabilities and their families.
Their aim is to provide a quality, child-centred service for disabled children and young people (and their families or carers) who live in Haringey.
 
 
This information is for parents/carers of children with special educational needs and/or disabilities. It explains the support offered in Haringey for those children and young people called the ‘local offer’.
  
 
Disability Living Allowance (DLA) for children may help with the extra costs of looking after a child who is under 16 AND has difficulties walking or needs more looking after than a child of the same age who doesn’t have a disability.
 
 
This is the Haringey Council site for adult learning disability services which also includes information on health services.
 
 
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Quality Standards Table

QS-1
We will send out our clinic letters within 2 weeks of the appointment
 
QS-2
We welcome, actively seek and act on feedback from all who use our services
 
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Working on it!