The Child Development Nurse Team are practitioners and/or nurses who have extensive training and knowledge in Child Development, usually following many years of working closely with children in a variety of specialist settings and supporting families through challenging life experiences.
The Nurse Team undertake various assessments to assist the information gathering required for children on our referral pathway. This may include ADI – Autism Diagnostic interview (with main parent/carer) or other specialist developmental assessment activities or observations with the child.
They also offer support whilst waiting to be seen and assessed by a Paediatrician, plus guidance and advice following diagnosis, which may include more longer-term ongoing support for complex sleep problems. They also offer specialist advice and guidance working alongside our Specialist Doctors for children with complex needs, for example, Down’s syndrome.
The Children in Care (CIC) nursing team includes doctors who complete an Initial Health Assessment (IHA) – when a child enters care, Specialist and CIC nurses complete the regular Review Health Assessment (RHA) and compile a summary report and health recommendations that is shared with the GP and in part with the child or young person and their carer and social worker.
Secure Childrens Home – a specialist nurse and allocated GP provide admission health assessments and ongoing health provision for children and young people detained at the home.
More information about the Children in Care (CIC) nursing team
Paediatricians’ are specialist children’s doctors who have a particular expertise in the management of children with long term health problems which may have an impact on other areas of their life.
We undertake the assessment and treatment of children with developmental problems such as delayed milestones, learning disabilities, Autism and Cerebral Palsy.
As part of our Child Development Service, we offer a Specialist Sleep service for children with identified additional needs. This follows a pathway that accepts referrals usually from either your Health Visitor or School Health Professional to assess on an individual basis when all usual strategies have been supported to manage and address the difficulty.
Our approach includes further assessment and advice and may well include recommendations for other strategies and approaches or investigations, following completion of our comprehensive questionnaire and sleep diary.
If children meet our referral criteria and are accepted into our service, then we may also consider the use of short term melatonin therapy to assist and support the sleep hygiene approach.
What we do
Our Speech and Language Therapist and Clinical Psychologists contribute to multidisciplinary assessments, carrying out the ADOS-2 assessment, often in conjunction with a paediatrician as part of the autism spectrum disorder (ASD) assessment process.
The ADOS-2 (Autism Diagnostic Observation Schedule 2nd Edition) is a semi-structured, standardised assessment of communication, social interaction, play, and restricted and repetitive behaviours. It presents various activities that elicit behaviours directly related to a diagnosis of ASD. By observing and coding these behaviours, the test user can obtain information that informs diagnosis, treatment planning, and educational placement.
Sometimes we will carry out an ADOS-2 assessment alone with a child; in this instance we will discuss with the paediatrician to help reach a conclusion in the autism assessment process.
Explanation of ADOS-2:
The ADOS-2 includes five modules, each requiring just 40 to 60 minutes to administer. The individual being evaluated is given only one module, selected on the basis of his or her expressive language level and chronological age. Following guidance provided in the manual, the test user chooses the module appropriate for the individual under evaluation.
- Toddler Module – for children between 12 and 30 months of age who do not consistently use phrase speech
- Module 1 – for children 31 months and older who do not consistently use phrase speech
- Module 2 – for children of any age who use phrase speech but are not verbally fluent
- Module 3 – for verbally fluent children and young adolescents
- Module 4 – for verbally fluent older adolescents and adults
Each module engages the individual in a series of activities involving interactive stimulus materials (all included in the ADOS-2 Kit).
Speech and Language Therapists
If further information about a child’s understanding of language is needed as part of the autism assessment process the Speech and Language Therapists can carry out some formal and informal assessments. They might use one or more of the following formal assessments:
- BPVS3 – British Picture Vocabulary Scales 3rd Edition – assesses the understanding of vocabulary in children aged from 3 to 16.
- CELF- Preschool 2 – Clinical evaluation of language fundamentals – preschool measures receptive language through; sentence recall, phonological awareness, following directions
- CELF 4 – Clinical evaluation of language fundamentals, measures; phonological awareness, word associations, language structure, language content and language memory
- TROG-2 – Test for reception of grammar can be used with children from age 4 and it measures the understanding of grammatical contrasts
- TALC – Test of abstract language comprehension assesses the level of abstract language a child understands
Following assessment, the Speech and Language Therapist will give you some feedback and then write a report of their findings and pass this information onto the paediatrician. You will be able to have this report, either when the doctor receives it or, if more appropriate, as part of the doctor’s final report following conclusion of the autism assessment process.
Clinical Psychology Assessments
If there is a question about a child’s level of learning (cognitive ability) and how much this is impacting on a child’s social communication skills then a child may be seen by the Clinical Psychologist in order to support the autism spectrum disorder (ASD) assessment process. This will help to understand further whether a child might have a learning disability, autism or both. The assessment will usually involve:
- WISC-V – Wechsler Intelligence Scale for Children 5th This instrument is considered to be a highly reliable measure for assessing cognitive ability (knowledge, reasoning and mental efficiency) and consists of several subtests measuring five domains of general intellectual functioning: verbal comprehension, visual spatial processing, fluid reasoning, working memory and processing speed. For children aged 6 to 16.
- WPPSI-IV – Wechsler Pre-school and Primary Scales of Intelligence 4th As above but for children aged 2 to 7.
- ABAS or Vineland – Adaptive Behaviour Assessment System or Vineland Adaptive Behaviour Scales. Both these tools gather information about adaptive skills needed to effectively and independently care for oneself, respond to others and meet environmental demands at home, school, work and in the community.
A child may also be seen by the clinical psychologist for an assessment of their learning where it seems it is essential to understand where their cognitive ability is in order to understand them further, where they do not have access to an educational psychologist (e.g. if they are out of school or being home schooled) or for a second opinion.
A learning disability diagnosis can only be made with information from both their cognitive ability and their adaptive skills.
The Clinical Psychologist can also conduct therapeutic work with children with Neurodevelopmental Conditions, such as ASD when there are no other services that are able to offer support. This would be for short term work for specific emotional or behavioural concerns related to their Neurodevelopmental Condition. We would like to expand this service and be able to offer group work in the future for parents and children.
Explanation for parents using Dan Siegel’s hand brain model (and flipping your lid)
Explanation for parents using Dan Siegel’s Window of Tolerance model
Explanation for Kids (6-12 year olds) using Dan Siegel’s hand brain model (and flipping your lid)
Guidelines for requesting the supply of a wheelchair or child buggy
The provision for wheelchairs and child buggys for those with a permanent illness or disability is funded by the local Clinical Commissioning Group (CCG) and provided through Millbrook Healthcare. The Red Cross provide equipment in the case of non-permanent conditions.
Referrals must be completed by GP’s, Health or Social Care professionals only. The referral should be completed by the doctor or health professional requesting the equipment.
It has been agreed that Health Visitors will make the referral if they identify a need for a child on their caseload in consultation with the paediatrician.
Once completed the referral form should be sent/emailed to Millbrook Health Care. Millbrook would aim to contact the family within two weeks of receipt of the referral. Millbrook provide a repair service for the equipment they supply, and this can be at the home if necessary.
Following the initial referral from a professional any replacement equipment can be requested directly from Millbrook by the parent, care or patient.