9 Current Roles of Professionals

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The roles of professionals described in the following section will be in relation to children with DCD except where otherwise stated when the general role of the professional will be given. The list is presented in alphabetic order as detailed in the previous section.

9.2 Health

9.2.1 The Role of the Clinical Psychologist

In general Clinical Psychologists provide assessment and intervention for children, young people and families where there are issues of behavioural and/or emotional difficulty. The age range of the identified client is 0-16 years, with older children considered if they are still in full-time secondary education. Reasons that children have been referred to this service include behaviour problems, bed wetting and soiling, phobias, low mood, anxiety, poor self-esteem, peer relationship difficulties, family problems, bereavement, eating disorders, psychosomatic illness, self-harm, coping with health problems and school refusal. Clinical Psychologists provide psychometric assessments if it is thought that the child’s cognitive ability is affecting his behaviour, or if there are neurological concerns (e.g. memory loss, post head injury). It should be noted that Clinical Psychologists do not diagnose or advise on medications.

Clinical Psychologists tailor interventions to the specific needs of clients. Assessments and interventions are based on cognitive, behavioural, systemic and solution-focused models of practice in the context of normal child and family development. Interventions might consist of individual work with the child/young person; work with the parents on promoting behavioural change in their child or improving their relationship with their child; and/or family work. Clinical Psychologists also regularly liaise with other agencies involved with the child/young person and are happy to provide consultations to professionals.

9.2.2 The Role of the Community Paediatrician

Any child giving cause for concern, who has not made progress in a movement group or who has lost skills and regressed should be referred to a Community Paediatrician in order to exclude medical reasons for their difficulties. If a child has multiple difficulties referral is also appropriate in order to identify possible co-morbid conditions i.e. a child has problems which are not solely functional or purely learning difficulties.

The Department of Community Child Health operates an open referral system and welcomes pre-referral discussion.

Written referrals are requested either by letter or using the referral forms available in hard copy or disk from the Department.

Parental permission should always be obtained prior to referral.

The Community Paediatrician has a role:

1. To assess the child:
• To identify any medical pathology to explain his/her difficulties, e.g. neuro-degenerative conditions, cerebral palsy, neurofibromatosis.
• To identify co-morbidity such as Attention Deficit Disorder, Autistic Spectrum Disorder.
• To provide an initial diagnosis in respect of ICD10/DSMIV criteria for Developmental Co-ordination Difficulties.
2. In an assessment to be involved in discussion with the parent and where appropriate the child. Also, with their permission, to liaise with colleagues in Health, Education and where appropriate Social Work Services in order to obtain a holistic assessment. Examples of this are determining the child’s cognitive level, ability in PE, capacity for written work and copying from the blackboard, etc.
3. To make appropriate referrals to therapy services and other agencies.
4. To provide general information and advice on DCD to parents and school staff.
5. To monitor the child’s progress and review the child at appropriate intervals, e.g. at P7 to ensure smooth transfer to secondary school where it may be necessary to liaise with secondary school staff, Occupational Therapy and Educational Psychology.
6. To keep the GP fully informed.

9.2.3 The Role of the Health Visitor

In general for children aged between 0 and 5 years:

• Developmental screening of all children at intervals – 6-8 weeks, 6-9 months, 18-24 months, 3+ years, 4+ years.
• Referral of any child failing to reach expected levels to GP and Community Paediatrician (with parental knowledge and consent).
• Refer to other agencies with parental consent.
• Dissemination of information to parents.
• Giving advice on health topics.
• On-going support to families, carers and nursery staff.
• Encouraging appropriate use of services.
• Transfer of information to School Health Service.
• Making entries in the Personal Health Record Book.

9.2.4 The Role of the Occupational Therapist

The Occupational Therapy Service will be provided according to the current Developmental Co-ordination Disorder intervention protocol, and within the level of service available at the current time.

The Occupational Therapy Service is provided within a prioritisation system. Children with Developmental Co-ordination Disorder are appropriate for Occupational Therapy referral. Occupational Therapy referrals are only accepted from a Paediatrician:

• Following a neurological screening to exclude medical pathology e.g. mild cerebral palsy, neuro-degenerative conditions.
• Following assessment to identify any possible co-morbid conditions which may be the primary diagnosis e.g. Attention Deficit Disorder, Social Communication Disorder.
• Where the child has significant functional problems identified.
• When the Paediatrician has given the initial diagnosis of Developmental Co-ordination Disorder. On request and where appropriate the Occupational Therapist can assist in the diagnostic process.
• The Occupational Therapy Service will provide a report in agreement with parents. The report is then circulated to the Paediatrician and other relevant agencies agreed with the parents.
• Following intervention, direct or indirect, the child would be reviewed and if appropriate may be discharged.
• Re-referral is available via a Paediatrician where appropriate.

Occupational Therapy is concerned with enabling the child to participate in daily life. The focus is to improve functional performance in the occupations of childhood, which include play/leisure, self-care and education. The active involvement of the child, family, caregivers and other significant people in the child’s daily life is essential to the process.

The Occupational Therapist’s role is to:

• Provide a comprehensive assessment to establish a baseline of functional skills. The assessment would include both standardised and non-standardised materials, depending on the reason for referral.
• Identify the underlying reasons why the child is having difficulties.
• Establish intervention strategies as appropriate to each individual child.
• Ensure functional problem areas are addressed.
• Provide appropriate information to parents and teachers.
• Facilitate access to other agencies as required e.g. Educational Psychology, Support Groups – HDCD.

9.2.5 The Role of the Physiotherapist

Referrals are accepted from Paediatricians.

Types of problem where referral to a Physiotherapist is appropriate:

• Hypermobile joints.
• Low tone is main/only problem.

Role of the Physiotherapist

• To develop an awareness of DCD to facilitate appropriate referrals.
• To be aware of the referral pathways and process.
• To have a basic knowledge of the assessment procedures for DCD.
• To have awareness of standard definitions – DCD, hypermobile joints, low tone.
• To establish intervention strategies as appropriate to each individual child.
• To provide appropriate information to parents and teachers.

9.2.6 The Role of the School Nurse

The general role described below is currently under review.

9.2.6.a Children aged 5-12 years

• Receive information from Health Visitors about a child’s progress up to the age 5 years.
• Liaise with teachers, Community Paediatricians and other agencies.
• Undertake health reviews and screening.
• Make referrals to GP, Community Paediatrician and other agencies.
• Provide advice and support for parent, teacher or carer.
• Transfer health information to School Nurses at secondary school at age 12 years (ensuring continuity of care).
• Entry in the Personal Health Record Book.

9.2.6.b Children aged 12-until leaving school

• Support, advice on health topics.
• Health assessments and reviews.
• Referral of areas of concern (with parental knowledge and consent).
• Liaison with family, teachers, other agencies.
• Confidentiality.
• Involvement in planning future care.

9.2.7 The Role of the Speech & Language Therapist

The most common neuro-developmental cause for parental concern is speech16 so the Speech and Language Therapist may be one of the first health professionals to assess the child and at that time Developmental Co-ordination Disorder may not be suspected.

The Speech and Language Therapy Service operates an open referral system. In theory, any agency or parent may refer a child to the service but in practice Health Visitors, Ear/Nose/Throat Consultants and Head Teachers are the common referrers. Parental consent must be obtained for the referral. Locally, most children are referred before entering school.

The role of the Speech and Language Therapist (SLT) is to:

• Work as part of a multidisciplinary team to encourage early referral of children having difficulty with communication, speech, language or eating and drinking.
• Assess the child’s communication, speech and language and, where appropriate, eating and drinking.
• Identify ways of helping the child function in everyday life.
• Where indicated and, with parental permission, refer on for further investigations, e.g. Audiology, ENT, Community Paediatrician.
• Monitor the child’s progress and review at appropriate intervals.
• Keep the parents, Health Visitors and GP informed of findings and recommendations.

The parent/legal guardian’s observations and reports help to build a comprehensive picture of the child’s speech and language and guide the therapist in developing appropriate intervention strategies.

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