Child Development Centre Website
Services in the CDC
Before your child can access the services in the CDC they must first be referred
Children referred to the Centre are first seen by the Paediatrician who will examine the child and, if necessary, initiate medical investigations. In most cases an assessment of the child’s abilities and needs will be required so that a programme of help, individually tailored to the child’s needs, can be provided. The child will be observed at home or in nursery, followed by further observation and more formal testing of abilities in the Centre. Appropriate referrals to the CDC are accepted directly from G.P’s, Consultant Paediatricians, Therapists and Community Doctors. Joint working with other agencies Education Leeds We work closely with the team from Early Years, within Leeds City Council and the Educational Psychologists from Education Leeds. Joint meetings are held every half term to discuss any issues, to aid the smooth transition into an educational setting. Key worker Project Families with children having complex developmental difficulties may find it very useful to access the Keyworker Project. The team help families access services and draw up an integrated needs assessment, if appropriate. We work closely with the team and have meetings on a weekly basis in a multidisciplinary format. Referral Criteria The service is provided for children under 5 years who may have complex developmental disorders including:
A range of different specialised assessments have been developed to meet the needs of individual children and their families. These include specialised assessments for specific aspects of the child’s development e.g.
In addition individual therapists will offer individual therapy as required dependent on the child’s needs. The team liaise and work with other professionals, including: hospital based professionals, community based therapy and medical professionals, Community nursing team geneticists, audiologists, dentists, ophthalmologists, paediatric neurologists, orthotists, orthopaedic surgeons, orthoptists, Portage Service, learning disability teams. At the end of the assessment the Paediatrician sees the parents to discuss the assessment findings and future management of the child. This could involve attendance for regular individual or group therapy at the Centre, home based developmental stimulation (Portage programmes), nursery or school provision. The Centre also liaises with the Education Authority in the cases of children who have special educational needs, i.e. when extra help will be needed in school, in accordance with the 1981 Education Act. A summary of the assessment and recommendations is always sent to the family doctor and child health service, following discussion with the parents/carers. At all times children are monitored closely to check their developmental progress and to review the effectiveness of their therapy. Clinics and Therapies Explained
* Week in the month St. James's is a teaching hospital and Medical students may be present at the clinics. Patients play a very important part in teaching work and we trust you will co-operate in this if we need your help. If you do not wish to participate in teaching in this way, you should advise the Doctor on attendance. Occupational Therapy at the CDC Occupational Therapy looks at the way physical and perceptual problems alter the child’s ability to cope with daily living activities and how their strengths and difficulties affect performance. We work in a variety of settings and can see the child in their home environment, at nursery or school, on the ward at St. James Hospital or at the Child Development Centre. Assessment is carried out by:
If your child has been referred for a team assessment they will automatically see an Occupational Therapist. During the assessment the Occupational Therapist would be observing and assessing the following:
Occupational Therapists have the knowledge and skills to treat the whole child. This requires the active involvement of the child, parent and all carers. All the physiotherapists within the CDC team are chartered and state-registered. They have specialist knowledge and expertise in child development and the acquisition of physical skills. We receive referrals from consultant paediatricians for a range of children from birth to five years of age. Our waiting list is variable, however, you can expect to wait at least eight weeks before receiving an initial appointment. Most physiotherapists at the Child Development Centre work part-time, so it is likely that your child may see different members of the team for treatment sessions or reviews. You will be invited to bring your child to an initial assessment clinic. These are held monthly. The aim of this session is to:
Your child may need to undress. Physiotherapists listen to your concerns about your child and will carry out an assessment of your child’s movement skills. This includes:
Physiotherapists provide information and support to help you understand your child’s abilities and difficulties. The team offer different levels of support according to the findings of the assessment. We see children in a range of settings including the Child Development Centre; nursery or home; and within either group or individual sessions. Our aim is to help you to feel confidant at home in managing your child’s physical difficulties, helping him/her to reach their full potential A clinical child psychologist has a degree in psychology and has undergone further postgraduate training. A clinical psychologist is able to offer help to children, their care-givers and other professionals about:
A clinical psychologist will assess your child’s development and functioning, by observing your child and talking to you. They may see your child at home, at the Child Development Centre and in their pre-school setting. The assessment is based on play activities and discussions with care-givers. Sometimes standard tests and questionnaires are used to look in more detail at your child’s development. The psychologist will discuss the outcome of the assessment to plan the most appropriate next steps with you. These might include:
The psychologist will provide a letter or report outlining the results of their assessment and future action. You will receive a copy of this.
It is important to ensure that your child's hearing is normal. The service avilable at the CDC is a basic screening service tocheck your child's hearing. It may be necessary for your child to be seen in a different setting for more specialised testing.
Joint Paediatric Audiology Clinic
In clinic we usually have an Audiologist present, so parents and other family members can have their hearing checked on the day. We usually go through the birth history and developmental history with families to try and identify any possible factors in the past history, which may be associated with hearing impairment. You child will be examined to look for any signs, which might be associated with conditions where hearing impairment is a part of that condition. We discuss the option of doing some simple tests, such as sending off a specimen of urine, and the option of having blood tests. We can send a sample to the Clinical Genetics Department at St James’s, where Clinical Geneticists have a particular interest in the inheritance of deafness. At the clinic we usually arrange for the children to be referred to the eye specialists (Ophthalmologist) for a formal assessment for two reasons: firstly because children who have hearing problems rely heavily on their vision to help them with learning and lip reading; and secondly because some causes of deafness which are associated with changes at the back of the eye. The conditions we are looking for are very rare, and often no definite cause is found. Most deafness is caused by genetic factors and as yet only a small number of these genes have been identified. The Clinical Genetics Department at St James’s has a screening test for the most common genetic cause of deafness and by sending off blood we can check for this. The appointment usually takes about an hour. The clinic starts at 1.30pm. If you would like us to send you an appointment for this clinic please can you contact Gail Pitman, at St Mary’s Hospital on: 0113 3055214 and she will be pleased to arrange this. Currently there is a wait of a few months for this clinic. If you would like any further clarification regarding the above information, Mrs Pitman will ask one of the Community Paediatricians to contact you and discuss your query. This clinic is now held at the LGI. It is a multidisciplinary clinic to assess the suitability of the use of Botulinum Toxin for children with motor disorders. Your physiotherapist or paediatrician can referral you to this clinic. Children with neurodevelopmental problems that may require additional orthpaediac intervention are seen in this clinic. Your child will be seen jointly by a neurologist, Dr. Clarke and Mr. Scott, orthopaedic surgeon. This clinic is held on a two monthly basis. Your child may need a x-ray on the day. Children (0-16) in whom there are concerns regrding their development can be referred to the clinic by their General Practioner, a paediatrician or therapist. Please let us know if you need an interpreter. This can be arranged with prior notice. We normally send you a questionnaire to complete prior to the appointment. It is ver useful if you could complete this prior to your appointment. Parents very often find it useful to write down a set of questions that you may wish to ask, as at that time you may not remember everything. Children(and their families) are seen by a paediatrician with a special interest in neuro- developmental paediatrics. At the initial visit a detailed medical history is obtained and an examination undertaken. The child may have further blood tests on the same day or arranged for a later date. The entire consultation may take up to 1 hour. The specialist health visitor or play therapist may be present as well, particularly for pre-school children. You are welcome to invite any professional working with your child along to do the consultation. A dedicated clinic children with Down’s Syndrome and their families held within the centre. The child is seen by a doctor, the audiology team and the learning disability nursing team to provide holistic care and surveillance for children with downs syndrome. We also have a number of resource leaflets for children with Down Syndrome. Please do ask and we would be happy to help. Complex Communication Disorders Clinic Children who have complex difficulties with communication are referred for this assessment. The aim of the assessment is to understand the nature of the child’s communication difficulties. Communication difficulties affect many areas of development, which need to be considered during the assessment. Difficulties in other areas of development can also affect communication. To give a fuller picture of your child’s development, he/she will be observed in different situations, for example:
Several days before the assessment session at the CDC, two team members will visit the family at home. Parents/carers can talk to them about their child and the assessment. They will also attempt to engage the child in play and observe how he/she communicates at home. Observation of the child in a pre-school setting is also important, if the child attends one of these. One or two members of the team will, with permission from the parents/carers, arrange to visit and observe how their child relates to other children and how they communicate in the pre-school setting. It also assists the team members if they can discuss the child with relevant staff, as their observations are also very helpful. The assessment session at the CDC itself will last for 2-3 hours. Team members will assess the child through a variety of play activities. Throughout the session, parent/carers will be in the same room as their child. A video link enables other members of the team to observe the assessment. The team prefers, with permission of parents/carers, to video the session so that there is an accurate record of the child’s play and communication. Parents/carers and members of the team can watch the video later. After the play session there is a break of approximately 30 minutes. During this time the team members will discuss the assessment and then give parents/carers an initial action plan for their child. Once the team has made a diagnosis, it will be explained to the parents/carers following the completion of the assessment period. The child psychologist will offer the family an appointment to discuss any concerns they may have about the assessment or the initial plan. A written report will be prepared by the team and will be discussed with the family, at the home visit.With the consent of the family the report will be circulated to professionals involved with the child. Families can share the report with any one they feel appropiate. After the initial assesment in the neuro-developemnt clinic it may be considered appropiate to do a more in depth assessment of your child's needs. This would be discussed with the team at our weekly team referral meetings. The full team assessment is a multi-discplinary assessment involving the entire team. The assessment is done at the centre on Thursday morning. Prior to the assessment a joint visit is arranged in your home with the specialist health visitor/ psychologist or play therapist. The home visit is done to assess the child in a more familiar surrounding and is an opportunity to discuss any concerns prior to the assessment. The assessment session at the CDC itself will last for 2-3 hours. Team members will assess the child through a variety of play activities. Throughout the session, parent/carers will be in the same room as their child. A video link enables other members of the team to observe the assessment. The team prefers, with permission of parents/carers, to video the session so that there is an accurate record of the child’s play and communication. Parents/carers and members of the team can watch the video later. After the assessment session there is a break of approximately 30 minutes. During this time the team members will discuss the assessment and then give parents/carers an initial action plan for their child.We normally ask other professuionals that may be working with your child to along for the feedback. The specialist health visitor will offer the family an appointment to discuss any concerns they may have about the assessment, the written report or the initial plan. The written report will be shown to parents/carers before being circulated to professionals involved with the child. The paediatricians attached to the centre also do clinics at the Special Schools. The special school clinics have a Consultant Paediatrician visit at least every half term. If your child attends a special school you may wish for your child to be seen in that setting. All children with neuro-developmental problems should be assessed for their visual acuity. This is particularly as children are unable to notice or express any problems that may have regarding their vision. An orthoptist is responsible for the initial screen for a child’s vision. The Orthoptist clinic runs on the 1st, 3rd, 4th and 5th Friday afternoon each month. Children are referred to the service by other professionals within the CDC and are often seen as part of a full team assessment. The Orthoptist assess visual acuity and checks for anomalies of binocular vision (e.g. squint) and eye movement disorders. All children with suspected problems are assessed by the Orthoptist initially and then referred to the joint Orthoptic / Optometry clinic at the CDC if necessary. Those children who are not found to have a defect by the Orthoptist are discharged.
An orthoptist is responsible for the initial screen for a child’s vision. The Orthoptist clinic runs on the 1st, 3rd, 4th and 5th Friday afternoon each month. Children are referred to the service by other professionals within the CDC and are often seen as part of a full team assessment. The Orthoptist assess visual acuity and checks for anomalies of binocular vision (e.g. squint) and eye movement disorders. All children with suspected problems are assessed by the Orthoptist initially and then referred to the joint Orthoptic / Optometry clinic at the CDC if necessary. Those children who are not found to have a defect by the Orthoptist are discharged.
Joint Orthoptic / Optometry Clinic This clinic runs on the 2nd Friday of each month. Children are referred to this clinic because an initial assessment by the Orthoptist has detected a reduction in visual acuity or a squint. Children are seen initially by the Orthoptist on this day and are then seen by the Optometrist. The Optometrist tests for refractive error (need for glasses) and also checks the health of the structures of the eye. Children who attend this clinic usually require instillation of eye drops to dilate the pupils and therefore allow the Optometrist to carry out an accurate assessment. Children can be referred from the Eye Clinic at the CDC to the Paediatric Consultant Ophthalmologist at SJUH at the discretion of the Orthoptist or Optometrist. Referrals to the CDC Eye Clinic can be made by writing to: Laura Tuff Speech and Language Therapy at the Child Development Centre (CDC) SLTs are health professionals trained in the assessment, diagnosis and treatment of communication and/or eating, drinking or swallowing difficulties. They may work directly with a child who has difficulties in these areas, or work in indirect ways by offering support and advice to families and others involved with the child, eg teachers They are part of a larger team of approximately 100 SLTs who provide a service across Leeds, working with adults and children with a wide range of communication difficulties and in a variety of settings, such as Community Clinics, Early Years Centres, schools, hospitals and clients’ homes. Children attending at the CDC may have already been seen by a SLT elsewhere, and, after a period of time at the CDC, they are often transferred to another SLT, for example when they start at nursery or school. There is close liaison between SLTs when a child moves to or from the CDC, in order to make these smooth transition times for the child and family. Referral Criteria Language and communication skills
Feeding skills SLTs are also interested in the child’s development of feeding skills. A child may be referred to the SLT if there are difficulties with establishing bottle feeding for a baby
Children can only be referred to the Child Development Centre Speech and Language therapist by a Paediatrician at St James’s Hospital or from their community speech therapists. Assessment The first session will include discussion with the parents/carers, and assessment of the child to gain a picture of the child’s skills and development. For a communication assessment, this will include observation and interaction with the child in play-based activities. Play is a very important part of a child’s development, and provides a good opportunity to observe and assess their overall development as well as their communication skills. For children with eating and drinking difficulties, the SLT will observe the child having a normal feed or meal, and may try different foods or methods of feeding the child to see how the child responds to these. The assessment session may take up to an hour. Follow up Follow up will be arranged with the family which may include:
Joint Neurology Clinic Children with complex neurological disorders are seen in this clinic jointly with a paediatric neurologist. This is held every two months on a Tuesday morning. Dr. Clarke, paediatric neurologist and Dr.Puri conduct the clinic. Children with neuromuscular disorders are seen at the Neuromuscular Clinic at Leeds General Infirmary. A 'first seizure' clinc also is held at at Leeds General Infirmary.
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