Children s Division Year Health Review Guideline

Transcription

1 SH CP 90 Children s Division Year Health Review Guideline Incorporating 2 Year Integrated Review Summary: Keywords (minimum of 5): (To assist policy search engine) Target Audience: This guideline is designed to define the Healthy Child Programme Year Health Review, incorporating the Integrated Review. Child Health, Speech, Development, Year Integrated Review, ASQ-3, Early Years, Health Review. This guideline applies to all staff who work within the Public Health 0-19 Children and Family Service within Southern Health NHS Foundation Trust. Next Review Date: January 2019 Approved & Ratified by: Children s Division Quality and Safety Meeting Date of meeting: 21 st Date issued: Author: Sponsor: Health Visiting Policy Group Members Liz Taylor (Associate Director of Nursing and Allied Health Professionals, Children and Family Services) 1

2 Version Control Change Record Date Author Version Page Reason for Change 2/7/12 Liz Taylor 1 In line with DH new service offer 19/11/15 Lizzie Christie (Professional Lead for Health Visiting) 20/1/17 Alison Morton (Head of Nursing) 14/3/2017 Barbara Hollis/ Alison Morton 15/6/18 Lucy Dennis and Jane Levers 2 Policy Review and in line with DH new service offer of integrated 2 year review. Title change 2 Minor revision of guidelines following new service specification 3 11 Minor revisions to Healthy Weight guidance and inclusion of BMI 4 9,12 Addition of Vitamin D guidance statement Reviewers/contributors Name Position Version Reviewed & Date Chris O Dea Locality Clinical Manger V1 September 2012 HV Policy Group V1 September 2012 Liz Taylor Associate Director Nursing (Childrens and AHPs) V2 November 2015 Amanda Whelan Professional and Practice Lead Health Visiting V2 November 2015 Sharon Hargreaves Area manager V2 November 2015 Julie Hooper Area Manager V2 November 2015 Barbara Hollis / Alison Morton Clinical Team Lead / Head of Nursing V2 March 2017 Lucy Dennis and Jane Levers Professional lead Health Visiting and School Nursing V3 2

3 Contents Section Title Page 1. Introduction 4 2. Scope 5 3. Definitions 5 4. Duties and responsibilities 7 5. Main guideline content 7 6. Training requirements Monitoring compliance Guideline review Associated Trust documents Supporting references 12 Appendices Appendix A1 Language Screening Checklist 14 Appendix A2 The Two Year Check: Referral Guidelines from Health Visitors to 18 Hampshire Community Paediatric Clinics. 3

4 Children s Division Year Health Review (Incorporating 2 Year Integrated Review) All staff within Southern Health NHS Foundation Trust (SHFT) are personally responsible for complying with Trust policies, guidelines and professional codes relevant to their qualification and role e.g. Nursing and Midwifery Council: The Code Professional Standards of Practice and Behaviours for Nurses and Midwives (NMC 2015). 1. Introduction This guideline must be read in conjunction with the Children s Community Public Health 0-19 Service Overarching Policy (SH CP 72) These guideline is for the year Health Review incorporating the Integrated 2 Year Review are provided to enable staff within Southern Health Foundation Trust staff; Health Visitors, Community Staff Nurses, Community Nursery Nurses, Children in Care Nurses and Family Nurses to work in partnership with children, parents and carers, Early Years providers, and where necessary specialist services to promote health, wellbeing and school readiness. Health visitors have an important role in leading the delivery of the Healthy Child Programme (HCP), (Department of Health (DH), 2009). The Year Health and Development Review is one of the key reviews within the HCP and enables Health Visiting teams to review a child s progress at this important stage ensuring early intervention is offered as required. It aims to optimise child development and emotional wellbeing, reduce health inequalities, and promote school readiness. This is a universal prevention and early intervention programme offered to all families with a child aged years; this HCP review can also form part of an Integrated Review: Parents / carers are the experts in their child s health and wellbeing and health visitors work in partnership with them to promote child development, assess need, and identify problems or issues at the earliest opportunity. If a child is in early education such as a nursery, pre-school, or with a child minder they will receive an Integrated Review, incorporating findings from the ASQ-3 and ASQ-SE domains with the Early Years Foundation Stage Developmental assessment categories. This encourages a partnership approach between parents/carers, the Health Visiting services and Early Years settings. An integrated review supporting school readiness has been highlighted as a Health Visiting High Impact Area which articulates Health Visiting s contribution to children s public health for Local Authority commissioners. Parents / carers will be able to actively participate in their child s review, through the use of the Ages and Stages Questionnaire (ASQ-3) and Ages and Stages Social and Emotional Questionnaire (ASQ-SE). The ASQ-3/ ASQ-SE are a parent-led assessment of age related development. It helps parents / carers and professionals to work together and review five areas of child development: Communication, gross motor skills, fine motor skills, problem solving, and personal-social development. The ASQ-3 will act as a starting point for discussion on these key areas of development. In the UK neither the ASQ-3 nor ASQ: SE-2 are being used as screening tools and neither are diagnostic tools. The ASQ-3 / ASQ-SE will also generate data for a population measure of child development at age two as part of the Public Health Outcomes Framework (DH, 2013). The HCP Year Review also includes growth monitoring, a review of behaviour and health, health promotion discussions and any parental/carer concerns not already covered. 4

5 The purpose of the review is: To enable an assessment of a child s health and development at age years using an appropriate assessment tool. To identify the child s progress, strengths, and needs at this age in order to promote positive outcomes in health and wellbeing, learning and behaviour, and promote school readiness. To facilitate appropriate intervention and support for children and their families, especially those for whose progress is less than expected. To support timely referral to education groups, or specialist practitioners and services to promote health and wellbeing and support school readiness. To enable appropriate and timely information sharing to safeguard children in accordance with Working Together to Safeguard Children (HM Government, 2015). To ensure clear and consistent evidence-based practice resulting in quality and equity of delivery of the Healthy Child Programme 0-5 Years (DH, 2009-ammended August 2010). To generate information which can be used to plan services and contribute to the reduction of inequalities in children s outcomes. Achieving universal coverage to reach all children aged 2 to 2.5 years within a defined population can be challenging and requires integrated working across Health, Early Years settings, Children s Services, General Practice, and community partners. 2. Scope This guideline is attended for use by all members of the health visiting, Family Nurse Partnership and Children in Care teams within the Children s Division of Southern Health NHS Foundation Trust. It includes all children aged years and their parents / carers living in Hampshire (excluding Portsmouth and Southampton) where care is delivered by Southern Health NHS Foundation Trust staff. 3. Definitions For the full list of definitions please see Children s Community Public Health 0-19 Service Overarching Policy (SH CP 72). For specific definitions pertaining to this guideline please see below: 3.1 Corporate Safeguarding Children Team This team comprises of Specialist Nurses, Professionals and Practitioners working under the guidance of Named Nurses. They provide advice and expertise to those within the Trust who are working with children or adults who have contact with children. They have specific expertise in children s health and development, child maltreatment and local arrangements for safeguarding and promoting the welfare of children. They represent health in the Multiagency Rapid Response Process. 3.2 Personal Child Health Record (PCHR) Individualised record of a child s health from birth, held by parent/carer. 3.3 Electronic Patient Record (EPR) and Family and Child Assessment Form Practitioners are required to keep clear and accurate records as detailed in the NMC Code (2015): Complete all records contemporaneously, at or as soon as possible after an event (ideally within 24 hours) Records should clearly identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need 5

6 Complete all records objectively, accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements Attribute any entries made in the EPR to the named practitioner, complying with the RiO Smartcard user requirements, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation. The Family and Child Assessment Form is contained within the EPR as a record of the assessment of health, wellbeing and wider factors that may impact on outcomes for parent/ unborn child at the Antenatal Contact. It provides a summary of information gathered, risk analysis and plan for future level of care provided within the 4, 5, 6 health visiting model. 3.4 Ages and Stages Questionnaires (ASQ-3) and ASQ: SE-2 British English Versions The ASQ-3 and ASQ: SE-2 are parent-led assessments of child s physical and social emotional development respectively and are the mandated tools within the HCP. The questionnaires are designed for specific ages and it is important that the correct questionnaire is used. The evidence based ASQ-3 covers five domains of child development: communication, gross motor skills, fine motor skills, problem solving and personal-social development. It can help identify need, promoting a discussion between the health professional and the parent/ carer. The ASQ: SE-2 was developed to complement the ASQ-3 by providing information specifically addressing the social and emotional behaviour of children. It covers eight domains of child social emotional development: self-regulation, compliance, communication, adaptive functioning, autonomy, affect, interaction with people and general concerns.it supports the identification of those that may need further evaluation to determine if referral to intervention services is required. In the UK neither the ASQ-3 nor ASQ: SE-2 are being used as screening tools and neither are diagnostic tools. Children with complex health needs and disabilities: The ASQ-3 and ASQ: SE-2 should be offered to all children as part of their one year review and both are helpful tool for identifying children with additional needs. However, where a child already has an identified disability or complex developmental delay, health visiting teams will need to agree with parents/ carers whether they wish to complete the ASQ-3 / ASQ: SE-2 questionnaires as part of their child s one year review. Much rests on health visitors professional judgement and their skill in working sensitively and collaboratively with families to agree the best approach; it may be appropriate to complete all or part of the ASQ-3/ ASQ; SE-2 in these instances. Health visitors should work collaboratively with other professionals in the multi-disciplinary team to ensure a personalised approach to developmental assessment is provided to these children. Where the parent wishes to use the ASQ-3 / ASQ: SE-2 questionnaires, the practitioner should use the appropriate age questionnaires and not an earlier age interval, unless the child was born pre-term. Children with complex health needs and disabilities should be offered all remaining components of the one year health review. Children born pre-term: (this is defined as all children born at less than 37 weeks gestation). The appropriate age-adjusted ASQ-3 / ASQ: SE-2 questionnaire should be used for all children born pre-term, rather than the chronological age. The ASQ-3 app provides a quick means of calculating the correct questionnaire to be used and guidance is contained within the ASQ-3 User Guide located in each team. 3.5 Birth to 3 Network: A Hampshire wide forum hosted by Hampshire County Council delivered in localities, and lead by Early Years advisory teachers. This forum provides a termly opportunity for all Early Years Settings to send practitioners for shared learning and training opportunities. As part of the Integrated 2 Year Review a link health visitor will attend these forums to support delivery 6

7 of evidence based training pertinent to the needs of the local population and to act as a link for Early Years practitioners to discuss health and development for children in their settings. 3.6 Body Mass Index (BMI): Is a person s weight in kilograms divided by the square of height in metres. BMI is age and sex specific and often referred to as BMI-for-age. From the age of 2 years a child s height and weight are measured and BMI calculated. This is expressed as a percentile which can be plotted on a paediatric BMI identification chart. Weight, height, and the proportion of body fat change during growth and development; therefore a child s BMI must be interpreted relative to other children of the same age and sex. 4. Duties and responsibilities In addition to those identified in the Children s Community Public Health 0-19 Service Overarching Policy (SH CP 72) 5. Main guideline content 5.1 All health visitors have a responsibility to ensure that systems are in place for the team to offer and undertake a Year Health Review to all known children within their defined population. This routinely should not be offered before a child s 2 nd birthday (24 months) and not after 30 months of age unless health and wellbeing concerns support clinical decision making to offer an earlier review of health and development. 5.2 Eligible children should be identified using the Information Portal (Data Warehouse). They should be added to the Monthly Team Planner (MTP) on the Electronic Patient Record system for allocation and assessment by a health visitor prior to administrators appointing for the year Health Review. Appointments may be scheduled via an opt-in process or by a designated appointment time. 5.3 The review may be delegated by the health visitor to a community nursery nurse who has undertaken relevant training and demonstrated competency. All children receiving a Universal Plus or Universal Partnership Plus package of care should have their Health Review delivered by a health visitor. 5.4 All practitioners must review Child and Family Records for active care plans and alerts prior to undertaking a year health review. 5.5 Health Review invitations by letter must be generated by RIO editable letter (Please refer to SOP). 5.6 Health Reviews may be booked via telephone if appropriate based on clinicians decision making. 5.7 Local intelligence will inform the process for offering a choice of venues, which may include Children s Centres, GP Surgeries, Early Years settings, or within the home environment. Where possible flexibility of appointment venue, date and time may impact positively on access to the year health review. 5.8 Parents / carers should be asked to complete a copy of the ASQ-3 / ASQ-SE prior to meeting with a member of the Health Visiting team for their Year Health Review. They will need to have the ASQ-3 / ASQ-SE sent to them by post or handed to them together with a letter explaining the review and the questionnaire. Blank ASQ-3/ ASQ-SE questionnaires must not be sent by as this would breach the licensing agreement. 7

8 5.9 Health visitors must ensure administrators within the Health Visiting team are aware of the guidance in relation to the age specific ASQ-3 / ASQ-SE questionnaires and that they are supported to provide the correct questionnaire for specific children identified as due their year health review The questionnaires are designed for specific ages. The appropriate age specific questionnaire will need to be made available for each child prior to their appointment. There is no need to correct for prematurity at the Year Health Review as children will be older than 24 months Due to the sensitivity of the questionnaire in relation to age, postponed appointments may mean that a different questionnaire for a different age range will be required. It is important that any team member rescheduling an appointment provides the correct questionnaires to the parent / carer prior to the appointment where time allows Using the ASQ-3 / ASQ-SE requires some equipment, a basic kit for the 2 Year Review (using the 24, 27 and 30 month questionnaires) might consist of: A book with pictures, ball, clear plastic bottle with lid, raisins, blocks for stacking, large beads / pasta wheels, lace for threading, paper and crayons / pencils, plastic cup with handle, spoon and fork, baby doll. Members of the Health Visiting team undergoing the Year Review are responsible for ensuring they have the correct equipment available when performing the review and that these are cleaned in accordance with Infection prevention and control guidance. SAFETY WARNING: equipment used as part of the ASQ-3 / ASQ-SE are only to be used for the activity being assessed and are not to be treated as toys; children should never be left unsupervised with the equipment Health visitors and CNN should be sensitive towards a parent s interpretation and understanding of the ASQ-3 / ASQ-SE. Literacy or language skills and cultural issues may need to be taken into account and some assistance from a member of the HV team may be required to support some parents / carers in completing the assessment. Interpreters should be used for assessments when parents / carers are unable to complete the British English version due to language difficulties Children with complex health needs and disabilities: The ASQ-3 and ASQ: SE-2 should be offered to all children as part of their two year review and both are helpful tools for identifying children with additional needs. However, where a child already has an identified disability or complex developmental delay, Health Visiting teams will need to agree with parents / carers whether they wish to complete the ASQ-3 / ASQ: SE-2 questionnaires as part of their child s two year review. Much rests on health visitors professional judgement and their skill in working sensitively and collaboratively with families to agree the best approach; it may be appropriate to complete all or part of the ASQ-3 / ASQ: SE-2 in these instances. Health visitors should work collaboratively with other professionals in the multi-disciplinary team to ensure a personalised approach to developmental assessment is provided to these children. Where the parent wishes to use the ASQ-3 / ASQ: SE-2 questionnaires, the practitioner should use the appropriate age questionnaires and not an earlier age interval. Children with complex health needs and disabilities should be offered all remaining components of the two year health review The HCP Year Health Review includes a strengths-based assessment of the following: The child s physical, emotional and social needs in the context of the family, including predictive risk factors using an evidence based tool (ASQ-3/ ASQ-SE). This assessment should include the notification of any changes in family circumstances including: o Who is living in family home /New partner etc. - has there been any changes? o Any changes in physical health parents / carers / their children / wider family. o Any changes in mental health parents / carers / their children / wider family. 8

9 o Any substance misuse parents / carers / their children / wider family. o Any domestic abuse parents / carers / their children / wider family. Changes in circumstances should be recorded by updating the Family and Child Assessment form in the child s EPR and care plans to address any unmet health needs should be developed in partnership with parents/ carers (see 5.16). Parental concerns: Assessment of growth including weight, height and BMI to identify children who are overweight / obese / faltering growth: All practitioners should ensure that they are confident and competent to complete child growth measurements, including accurate plotting and interpretation of child growth (RCPCH, 2015 see Training needs analysis in 0-19 Overarching Policy SH CP 72; SHFT Management of babies at risk of obesity guideline SH CP 160). Results should be recorded in the PCHR and EPR and interpreted using the centile charts within the PCHR. BMI can be calculated on the NHS choices BMI calculator, or manually on a BMI chart. A strengths based, non-judgemental approach should be used to involve parents / carers in the measurement and interpretation of their child s growth, with an explanation of centile charts to enable the appropriate healthy weights conversation to ensue. Children with Down s Syndrome will require specialist growth charts. Children identified as overweight or obese should be offered support and advice as outlined in the healthy weight pathway as appropriate. Advice should be given to the parents about appropriate exercise and activity levels for the 2 year old child as per NICE guidelines. For children who were born pre-term, it is important for practitioners to carefully evaluate and review any developmental concerns reported by parents/carers or other professional whilst completing the 2 year health review contact [NICE 2017]. Community Nursery Nurses any possible concerns with the delegating HV. Where a child is identified as not growing as expected, the health visitor should refer as needed to the General Practitioner / Paediatrician for a medical assessment. To review a child s immunisation status and promote uptake. Making Every Contact Count - promoting the importance of healthy lifestyles and the value of health as a foundation for future wellbeing, for example: Healthy eating including Healthy Start; physical activity; accident prevention; improving parents confidence in managing minor illnesses and reducing unnecessary antibiotic use; sun safety and skin cancer prevention; dental health; promotion of smoke free homes and cars (with signposting to Quit4Life where appropriate); responsive parenting; behaviour management including sleep; promotion of development, play and the home learning environment; and the promotion of free early years childcare offer for eligible families. Information should be offered on Early Years provision by signposting to Hampshire County Council website where parents / carers can get information on the 2 year old offer to see if they qualify and should be encouraged to register their child. Vitamin D supplementation should be recommended and recorded in line with NICE guidance. Staff should refer to NICE Guidance PH56 [Vitamin D; suppplement use in specific population groups] and parents should be signposted to NHS Choices for current recommendations. 9

10 5.16 Plan of care when additional needs are identified The Health Visiting team will: Work in partnership with parents / carers to identify parent s / carer s priorities and reach a shared understanding of risk and resilience factors. Any developmental delay and / or vulnerabilities identified must be discussed with the parents / carers with an agreed plan of support for further assessment and / or early intervention and review. Develop any Universal Plus (UP) / Universal Partnership Plus (UPP) Health Visiting Care Plan in partnership with parents. Care plans will be based on the High Impact Areas or Complex Health Needs Pathways in accordance with the service specification. Parents / carers should be provided with a copy of their care plan. All children referred to other services should be monitored in UP (only returning to Universal when resolution has been achieved). Indicate the level of Healthy Child Programme intervention i.e. Universal, Universal Plus or Universal Partnership Plus in the progress note. Families and children assessed as vulnerable according to SHFT safeguarding policy should be identified on the Electronic Patient Record using the appropriate alert. Document future action plan, including timeframe for future contact, and any agreed appointments in the progress note, PCHR and Family and Child Assessment form. The HV should consider referral to other agencies, including Early Help Hub / Supporting Families as needed. All referrals must be completed with consent from the parent / carer Domestic Violence and Abuse: Health visitors must take a proactive approach in asking parents / carers about their experiences of domestic abuse when safe to do so in accordance with SH CP 78 Domestic Violence and Abuse Policy. The most compelling reason for routine enquiry is that women have reported that they want to be asked (Department of Health 2005). Where it is known that a child is living with domestic violence and abuse, it is important to assess the risk of harm to the mother and her child / children and to consider referral to children services (Domestic Violence and Abuse Policy - SH CP 78) Safeguarding: The health visitor will recognise the risks, signs and symptoms of child abuse / maltreatment and should follow guidance contained within SHFT SH CP 56 Safeguarding Childrens Policy; SH CP 78 Domestic Violence and Abuse Policy; SH CP 88 Protocol for the management of actual or suspected bruising in infants who are not independently mobile Record Keeping: The Health Visiting team will record all contacts in accordance with the Southern Health Record Keeping Policies and Procedures and the SHFT Standard Operating Procedure (SOP). The completed ASQ-3 / ASQ-SE questionnaire will be given to the parent / carer to be stored in the PCHR. The ASQ-3 and ASQ SE summary sheet will be used by the practitioner to inform data entry on the child s EPR- all ASQ-3 / ASQ SE scores should be recorded on the RIO ASQ form. The summary sheet must then be shredded as per current SOP. The HV will complete the PCHR and ensure that the client is aware of and understands what is recorded within professional records as per the Standard Operating Procedure (SOP) If a child is delayed in two or more developmental aspects of the ASQ-3 then the HV should consider contact with the local Community Paediatrician for advice or referral as necessary Interventions at Universal Partnership Plus level may include onward referral for further assessment by specialist service including Speech and Language Therapy, Dietician, 10

11 Portage, and Community Paediatrician as per local pathways. This is not an exhaustive list and local variations will impact on services available to families GPs should be informed of any intervention required following assessment, either by written communication or by face to face discussion by the link HV at face to face monthly meetings A need for referrals to other clinicians identified by a community nursery nurse must be agreed by a health visitor If a child attends an Early Years setting the Year Health Review forms part of an Integrated Review with Early Years Settings. Parents / carers should be advised of the nature of the Integrated Review and encouraged to share findings from the review including the ASQ-3 scores with the setting. Where further intervention is required the member of the HV team should discuss with the parent / carer sharing of information with the Early Year setting to support a plan for specific intervention and a review of outcomes following the intervention If a child does not have a Year Health Review, either due to a cancelled appointment or a did not attend (DNA), the health visitor should reschedule the appointment with the family, ideally this follow up appointment should be made via telephone contact or if this is not possible by letter If a child is not brought for a second planned Year Review appointment the health visitor should follow guidance in Child and Family Was Not Brought and Disengagement Guideline (SH CP 105) and actively engage with partner agencies and key stakeholders including the child s GP to gain information that supports decision making in relation to the most appropriate way of accessing the family. If further appointments are missed; following review of information in the child s electronic patient record and liaison with any other agencies working with the family, the GP should be notified that the child has not received their Year Health Review. If there are safeguarding concerns, seek supervision from the Safeguarding Team and inform Children s Services as appropriate. It is important that the family are made aware that they can continue to contact the Health Visiting team for health advice and support (SH CP 105) To support the Integrated Review with Early Years each Health Visiting team will have a named health visitor link to attend and support the local Birth to 3 Network. 6 Training requirements: See the Training Needs Analysis (TNA) contained within the Children s Community Public Health 0-19 Service Overarching Policy (SH CP 72). 7 Monitoring compliance Element to be monitored Use of ASQ-3/ ASQ-SE Outcome measure of child development at age years Completion of Year HCP Health Review Lead Tool Frequency Reporting arrangements Clinical ASQ-3 Tableau data quality Team (24,27,30 report. Lead months) ASQ-3 (24,27,30 months) Via EPR Open Rio, Monthly Monthly Data to be collected via the Children and Young People s Health Services dataset. Compliance monitored via use of OpenRio and 11

12 recorded on compliance with SOP captured via data warehouse. 8 Guideline review This guideline will be reviewed in three years or earlier if necessary 9 Associated Trust documents SHCP 72 SH CP 56 SH CP 69 SH CP 09 SH CP 54 SH CP 60 SH CP 63 SH CP 72 SH CP 78 SH CP 89 SH CP 105 SH CP 106 SH CP 160 SH CP 202 SH CP 209 Children s Community Public Health 0-19 Service Overarching policy Safeguarding Childrens Policy Transfer of Children In and Out of Health Visiting & School Nursing Teams Guideline Clinic Contacts by Health Visiting Teams Guideline Perinatal Mental Health Guidelines GP Communication Guideline Healthy Start Guideline Children s Community Public Health 0-19 Service Overarching Policy Domestic Violence and Abuse Policy Infant Feeding Policy Child and Family Was Not Brought and Disengagement Guideline Joint Working Protocol: Safeguarding Children and Young People Whose Parents/Carers have problems with Mental Health/Substance Misuse Healthy weight guideline Safeguarding Supervision Policy Children and Young People with Complex Health Needs, Disabilities, and Special Educational Needs Guideline. 10 Supporting references Ages and Stages Questionnaires: A Parent-Completed Monitoring System, Third Edition, (ASQ-3) Squires & Bricker, Paul H Brookes Publishing Co. All rights reserved. ASQ-3 Users Guide (Squires et al, 2009) Integrated review FAQs, Foundation Years Ages and Stages Questionnaires Third Edition (ASQ-3) Ages and Stages Questionnaires Social-Emotional (ASQ:SE) E- Learning for health ASQ training Healthy Child Programme Pregnancy and the first five years of life (DH, amended August 2010) Nice Quality Standard 84 (QS84) Physical activity: encouraging activity in all people in contact with the NHS (July, 2015) NICE NG 72 Developmental follow-up of children and young people who were born preterm NICE PH56 Vitamin D; Supplement use in at risk groups Nursing and Midwifery Council (2015) The Code. NMC 12

13 Public Health Outcomes Framework 2013 to 2016 (DH, 2014) Working Together to Safeguard Children (DE, 2015) RCPCH (2015) Early years - UK-WHO growth charts and resources 13

14 APPENDIX 1 LANGUAGE SCREENING CHECKLIST Name DOB NHS no.. Address Post Code Date... This screening is intended to help you identify children whose skills are delayed, not to show how good their language is the actual levels are amended down to allow for variations in development, particularly for boys. Depending on local service guidelines discuss referral with a Speech & Language Therapist, or suggest family go to a drop in, (if available) if a child: Cannot follow the instruction at the appropriate age Has passed the receptive task but has difficulty using words or speech is delayed/unusual Is stammering and the parents are concerned Has an unusual voice always hoarse or nasal Typically understanding of language develops in advance of speaking so a child will not be able to use words if he/she cannot understand them. Language and learning (non-verbal skills) develop alongside each other so if a child s motor milestones, play and social skills are delayed, then language skills will also be delayed. Often, because speech and language are higher level skills, they may lag even further in a child with global developmental delay, without necessarily meaning the child has a language disorder. The following table gives approximate ages of when to be concerned, how to advise and when to refer. AGE Understanding Use of Language Speech sounds Action 12mths Not responding to name or familiar phrases in set context such No! ; Here you are! and Come to Daddy! (child should show awareness even if not yet mobile) No obvious signs of intention to communicate No babble Monitor at 18mths Advise parents to: Comment on what they are doing using simple words. Use social gesture with words e.g. Bye Bye; Pointing and labelling Play face to face games such as Peek a Boo; Round and round the garden etc. Look at picture books making single word comments. Use symbolic noises 18mths No response to single words : Equipment: ball/cup/ sock/ keys/ball No single words except Mummy Only uses jargon Monitor at 24mths and then if still not responding to single words, refer to Paediatrician/SLT 14

15 24mths Cannot give or point to single toys from choice of five common objects (eye pointing counts) Cannot show body parts on self easy ones such as eyes/nose/mouth/tummy/toes Cannot carry out simple instructions with two key words: Equipment: boy/cat/brush/cloth/cup a) Show me the dog s nose Show me the boy s eyes b) Wash the dog Brush the cat c) Give the cup to Mummy Give the boy to me d) Put the boy on the box Put the car in the cup and Daddy Words heard or reported Only uses a few single words (easily repeated expressions such as Gedown for Get down, Wassat for What s that? do not count as two words. Words heard or reported: Not using the sounds : b m d n Advise parents to: SLT drop in; Children s Centre activities, such as PEEP/ Song & Sign; Mr Tumble from Something Special programme on Cbeebies Use forced alternatives such as Juice or Milk? Create opportunities to talk Comment on chosen play and label/repeat Refer to/discuss with SLT service if not understanding at two word level (expressive delay may be less of a concern) Advise parents to : Join in child s play and comment often on activities, e.g. Josh s running! Good running Katie s washing Play with making sounds with actions e.g. popping bubbles and making a p sound Use and encourage symbolic noises Use stress and intonation patterns in own voice to emphasize key words Repeat and label. Offer: Top tips for Talking 30mths 36mths Cannot carry out any instructions with two information words as above plus: Limited range of two key word instructions and not beginning to follow simple three key word Less than 30 words and not beginning to link words in simple expressions, such as Tom go! No wash! Not beginning to use a wider range of 2 to 3 word Not using: m n p b t d w h Stammering Speech not improving/ Parents do not Refer to SLT Advise parents to see what groups are available at Children s Centres/try to arrange a few sessions at preschool Continue to make a simple commentary on what the child/parent is doing Make a photo book of their child i.e. Josh swimming. Include favourite people/foods/places/activities. Encourage Makaton signing and natural gesture/ Song and Sign sessions/something Special. Offer: Top tips for Talking Refer to SLT Repeat what the child says and add a word. Model words back to the child say the words clearly 15

16 instructions /verbs/negatives: Eqpt: t/dog/bed/box/chair/brush/cloth Negative: Draw two faces one with no eyes and one with no nose. Ask Which one has no eyes? a) Function: Which one do we drink from/eat with/sleep in? b)wash the dog s nose Brush the cat s tummy c) Make the cat sit on the box Make the boy stand on the table d) Make the boy push the table Make the cat jump on the box expressions. Jargon still used. Child not using action words. Child using unusual words but not names of close people/ functional words. understand the child and are concerned. Sounds are missed off the beginnings of words, e.g. ouse for mouse ( but simplifying more complex words is normal e.g. spoon boon, blue boo) Child has one favoured sound. Stammering emphasising the beginning and end sounds. Do not expect the child to imitate but give praise if they do. Resist any attempts to expect the child to correct. Offer explicit praise i.e. Good talking. Interpret behaviours and add language. For example Thomas wants the toilet. Avoid direct questions such as What s this? rather use open ended questions and phrases i.e. I can see a.../ I wonder what this is? Offer: How to help your child speak clearly 42mths No understanding of instructions with three key words as above Not beginning to use a wider range of 3 word expressions. Unable to use language to express needs Unintelligible speech (especially if family can t understand) Not using sounds at the end of words e.g. tap ta Refer to SLT. Advice as above Liaise with early years settings/inco for summer born children. 16

17 48mths Not showing understanding of three key word instructions including: Car/table/chair/large & small spoon b) Position: on/under. Put the car under the table Put the train on the bridge. b) Size: Big and Little animals Find the big spoon Show me the little cat. Not using simple sentences of making self understood using phrases. Not using f or s at the beginning of words. (Still not a worry if s blends reduced poon for spoon) Words are said in an unusual way. Refer to SLT. Liaise with early years settings/inco. Language Refers to the way people understand what is said to them (receptive language) and express their own ideas to others (expressive language). This includes sign language and gesture Speech The way sounds are produced and combined to make words and sentences. Social Communication/Pragmatic language all the non-verbal parts of communication such as eye-contact, understanding inference/metaphor, awareness of mood and emotion in others, awareness of personal space Stammer/Stutter/Dysfluency all ways of describing the hesitations, blocks, repetitions that interrupt the flow of speech and are generally known as stammering Information carrying words/key words The words in a sentence that are essential to understanding roughly one at one year, two at two years and three at three. Delay following the typical pattern of speech and language development but lagging behind peers can be termed disorder in older child Disorder: not following the typical pattern with possibly: uneven profile of language development understanding well ahead of expressive language; understanding lagging behind use of language (Autistic Spectrum Disorder); language well behind other areas of development; unusual speech, including atypical pattern, favoured sound, dyspraxia, inconsistent sound use 17

18 APPENDIX 2 THE TWO YEAR CHECK: REFERRAL GUIDELINES FROM HEALTH VISITORS TO HAMPSHIRE COMMUNITY PAEDIATRIC CLINICS The information given below should be regarded as a guideline only. All children being referred should be seen by a health visitor, who can use their professional judgement as to whether a child should be referred. Referrals that have not been seen and made by a health visitor will not be accepted. At the two year check health visitors may pick up on behavioural or medical problems that don t involve developmental delay. In general, these children are not referred to community paediatric clinics. Local guidelines and pathways should be followed. Developmental delay/regression in one or more areas of development i. Isolated speech and language delay should be referred to Speech and Language Therapy and for hearing test. Referral to community paediatric clinic only if other developmental concerns, e.g. social interaction, global delay, severe delay in understanding of language, specialist education input advised or secured, or concerns from SALT services. ii. Significant gross motor delay, including concerns about tone, asymmetry, regression or stasis (>6 months) of motor skills. Toe walking persisting after two years of age. iii. iv. Significant fine motor delay including concerns about tone, hand preference, asymmetry, regression or stasis (>6 months) of motor skills. A clumsy child should be referred if he or she falls into one of the above categories or if their coordination difficulties are very significant. v. Concerns about hearing refer to paediatric audiology service who can refer on to community paediatric medical service if required (i.e. if there are concerns about developmental problems) vi. Concerns about vision refer to paediatric eye clinic, who can refer on to community paediatric medical service if required (i.e. if there are concerns about developmental problems) These guidelines cannot cover all eventualities completely so if a professional is concerned about a child please discuss them with us. Hampshire Community Paediatricians July