Islington Community Paediatrics: Pathway for children referred with developmental delay

Email for referrals: whh-tr.islchildrensreferrals@nhs.net

Who is this care pathway for?

This care pathway has been written primarily for families and carers of a child who has an emerging or identified concern or delay in their developmental.

This information in this page 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 an Islington GP or attend a school in Islington.

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

Who can refer and how?

We accepted 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.

Care Pathway

Detailed Actions to be Completed

Referral Received	Please note that in our service: 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 to copy it to a list of all relevant professionals. We aim to send this out within 2 weeks of the appointment for the large majority (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 consultant paediatrician - if accepted your child will be seen in a paediatric clinic well within the national requirement of 18 weeks. Depending on the complexity of your child and the information available, additional referrals can be made at this time to therapy services to help reduce your time waiting for services. For complex cases we take these to our multidisciplinary central referrals meeting to ensure that we coordinate care between paediatricians and therapists: Agree joint appointments as indicated Request additional information e.g. discharge summaries and clinic letters from hospitals Allocate a key worker if appropriate Attendance at hospital discharge planning meeting where possible/ appropriate
Assessment Phase	It may take several appointments to complete the diagnostic evaluation and to get all the investigation results back for your child. The appointments offered may be: Uni-disciplinary assessments � assessments undertaken by a paediatrician, or Multi-disciplinary � e.g. our Developmental Assessment Clinic brings together a paediatrician and a clinical psychologist who can undertake a joint assessment of your child's cognitive or problem solving abilities The paediatrician will discuss with you: Any investigations as part of the diagnostic work up and on-going management Tertiary referrals as required Prescribing of medications If a diagnosis can be confirmed this will be discussed in detail with you and we will do our best to answer any questions that you may have.
Follow up in Pre School Years	For most children with developmental delay the focus of their support is within their educational setting. As such and unless there are any identified medical problems, children are usually discharged from the Community Paediatric Service once they are in school. The terminology also changes from �developmental delay� to �learning difficulty� or �learning disability�. If there is any follow up planned this will be agreed with you and will be based on any on-going medical issues your child may have. If there is a need for follow up and if your child attends a special school they will be seen by a paediatrician in their school, while children attending mainstream school will be followed up in clinics at the Northern Health Centre.
Follow up in Schools Years	For most children with developmental delay the focus of their support is within their educational setting. As such and unless there are any identified medical problems, children are usually discharged from the Community Paediatric Service once they are in school. The terminology also changes from �developmental delay� to �learning difficulty� or �learning disability�. If there is any follow up planned this will be agreed with you and will be based on any on-going medical issues your child may have. If there is a need for follow up and if your child attends a special school they will be seen by a paediatrician in their school, while children attending mainstream school will be followed up in clinics at the Northern Health Centre.
Transition to Adult Services	By and large children in this pathway will have been discharged from community paediatric follow up well before their adult years. As such preparation for and transition into adult services usually sits with education and social care. However if your child is under follow up with the Community Paediatric Service 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.

Associated Documents

Additional Needs and Disability Service (Islington) Referral Form

Resources Table

Useful links
NHS Choices - tip for caring for a disabled child	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 and getting them to sleep, easier.
Centre 404	Centre 404 is a voluntary sector organisation that offers a range of high quality services to assist children and adults with a learning disability and their family carers. These include: direct support, information, respite, activities, advocacy, help with personal budgets and form filling, and access to social groups and other local networks.
Islington Disabled Children's Team	The London Borough of Islington 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 Islington.
Islington Local Offer	The summaries the Islington Local Offer of all the help there is in the Islington area for children and young people aged 0-25 with special educational needs and disabilities.
Disability Living Allowance (DLA) for children	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.
Children with complex needs in Education	When a child has exceptional need for education, health and social care support that cannot be met from resources/ assessments/ interventions normally available, they will need an Education, Health and Care Plan.
Support for adults with learning disabilities	The Islington Learning Disabilities Partnership can help you if you: Live in Islington and an adult with global learning disabilities Help someone who has global learning disabilities

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