1 Introduction

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1.2 Formation of a Steering Group

In 2001 The Education Service of Highland Council seconded a two-year post in order to establish a service to meet the needs of low incidence disability children, including those with DCD. Simultaneously, Children’s Health Services established a working group to examine the pathways of care for children with DCD. Consultation followed between colleagues in Health, Education, the Voluntary Sector and Social Work Services and an Inter-Agency Steering Group was formed with the following aims and objectives:

1.2.1 Aims

• To develop and implement multi-agency and multi-professional guidelines for children who may have Developmental Co-odination Disorder.
• To facilitate collaborative working between Health, Education, parents, children and other relevant agencies.
• To monitor the implementation of the guidelines.
• To review the guidelines in line with developments in practice and increasing knowledge.

1.2.2 Objectives

• To facilitate early identification of children with Developmental Co-ordination Disorder (DCD).
• To facilitate early diagnosis.
• To provide clear pathways of referral.
• To define clearly the role of the varying professional groups.
• To look closely at the mechanisms for liaison between professionals.
• To raise awareness of DCD amongst professionals, parents and the general public.
• For membership of the Steering Group to consist of individuals who may not be specialists or experts in the field but who have a particular interest and who are prepared to invest time.
• For each member of the Steering Group to have a responsibility for keeping up-to-date in terms of his/her knowledge about DCD and in turn to act as a resource for colleagues.
• To collate information on DCD for use by professionals and parents.
• To define clearly the role of the movement group and establish the difference between school movement programmes and therapy sessions/groups.

1.2.3 Establishing a Baseline

The first task of the members of the group was to survey their colleagues in order to define current practice and identify the basic requirements needed both within these guidelines and also for future development.

Educational Psychology

A survey was carried out over the summer and autumn of 2001 on the current knowledge and practice of Highland Council Psychologists in relation to children whose difficulties can be attributed to a Developmental Co-ordination Disorder. There was a 65% return rate. This survey revealed a wide variety of knowledge, experience and professional involvement with this group of children. There was more agreement, however, in issues relating to identification and diagnosis of the condition, with most Psychologists indicating a view that this area of work was predominantly the responsibility of the Health Services. Some Psychologists did, however, see a more prominent role for the Psychologist in terms of joint assessments. Across the Council area there was a high degree of consistency in the perception of the current route for the diagnosis of Developmental Co-ordination Disorder. This was perceived to be mainly by the Occupational Therapy Department, solely or in consultation with a range of other professionals but also sometimes by the Community Paediatrician, again in conjunction with other professionals. However, there was a wide range of levels of satisfaction with this, from very satisfied to very unsatisfied, and a range of suggestions on how this could be improved. The conclusion of the survey, where Psychologists were asked for further comments or observations reflected the wide range of interests, experience and particular job remits.

Schools

A survey of mainstream schools in Highland Council took place in 2001. Twenty-five primaries and seventeen secondary schools responded. It was taken for granted that pupils in special schools would be receiving specialised PE (Physical Education), Occupational Therapy and Physiotherapy.

Of the schools that responded, twenty primaries and five secondary schools reported that they had some kind of movement programme in place. When asked to give details of criteria for involvement, activities used and staff involved, schools demonstrated a wide variation of the interpretation of ‘movement programme’. Programmes included daily Physiotherapy, horse riding, swimming, ‘Brain Gym’ and the ‘special class’ being taken for PE on its own.

Of the schools that were running ‘movement programmes’ along the lines of those suggested in this report, most were co-ordinated by the Support for Learning Teachers (see paragraph 9.1.5) (often with a PE background) in liaison with the Occupational Therapists or Physiotherapists. Some Physical Education teachers were taking pupils for movement programmes but they were constrained by the limited amount of time they could offer.

Many of the schools that responded said that they were in desperate need of information and training.

Health

Within Health there was also a wide range of interest and experience amongst Speech and Language Therapists, Occupational Therapists, Physiotherapists and Community Paediatricians. There was a clear desire for clarity of referral, assessment and diagnostic criteria. The importance of appropriate referrals to Community Paediatricians and occupational Therapists was stressed. The need for further multi-agency and specialist training was highlighted.

All the following points have been covered in general terms but specific points raised by the Speech and Language Therapists included:

• In some areas there is limited access to Paediatricians and Occupational Therapists.
• A need for the provision of practical tips for children with autistic or semantic pragmatic problems who also have co-ordination difficulties, especially as they are not usually referred to Occupational Therapy.
• A broad circulation of Occupational Therapy guidelines to benefit children who may otherwise not be seen for 2 years.
• That Community Paediatricians ensure that all concerned with a child recognise the implications of the diagnosis for that child’s daily life and education.
• Provision of a Trust-wide protocol for the identification, assessment and diagnosis in order to highlight and correct the inequity of provision of service for children with DCD.

Summary of Requirements

A summary of the basic requirements following these surveys is as follows:

• For parents and all professionals to share a common understanding of the terminology used to describe children with Developmental Co-ordination Disorder.
• To facilitate early identification and diagnosis.
• To provide guidelines for referral including prioritisation of referrals, clear referral pathways and criteria for referral to Occupational Therapy.
• To clarify which professionals have the responsibility for the actual diagnosis of DCD.
• To provide clear pathways of care.
• To ensure that serious medical conditions are recognised as early as possible.
• To improve joint working and liaison between colleagues within Health and between Health and Education.
• To develop a common questionnaire which can be shared by all the professionals involved with a child and so reduce duplication of information gathering.
• To establish links with colleagues providing services for other developmental disorders e.g. Autism and Attention Deficit Disorder.
• To raise awareness and provide training.
• To support teachers and health professionals.

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