Referral Criteria for the Edwin Lobo Community Paediatric Service

Cambridgeshire Community Services NHS Trust
Luton Locality

Referral Criteria for the Edwin Lobo Community Paediatric Service

This pack contains information to help you, identify whether we are the right service to refer a child/ young person to.

Incomplete referrals will not be accepted by the service and will be returned to you.

The Edwin Lobo Community Paediatric Team would like to thankyou in advance for your cooperation

Edwin Lobo Child Development Centre,

Redgrave Gardens,

Marsh Farm,

Luton,

LU3 3QN

Tel:01582 700300

Email address:

Edwin Lobo Child Development Centre Referral Criteria

Inclusion Criteria Exclusion Criteria

WHO DO WE SEE:
Children aged 0-16 years
Who live in Luton and are registered with a Luton GP or live in South Bedfordshire (Dunstable, Houghton Regis and Leighton Buzzard) and registered with a South Bedfordshire GP:
Priory Gardens Health Centre
Chiltern Hills Practice (intra Health)
Caddington Surgery
Eastgate Surgery
Kingsbury Court Surgery
Kirby Road Surgery
West Street Surgery
Toddington Medical Centre
Wheatfield Surgery
Leighton Road Surgery
Salisbury House Surgery
Dr Glaze & Partners
Referrals will be accepted from Health, Education (SENCo’s, Learning support service or Educational Psychology) and Social Care professionals
WHICH CHILDREN/YOUNG PEOPLE:
Child/ young person has one or more of the following problems:

Complex developmental difficulties (affecting more than one area of development).
Neurodisability or medical condition causing developmental disorder or delay e.g. Cerebral palsy.

Children aged over 5 years with suspected Attention Deficit Hyperactivity Disorder (ADHD) for assessment, diagnosis and on-going medication review.
Autistic Spectrum Disorders (ASD), providing a diagnostic service for suspected ASD. Following assessment, we signpost to support services within the community.
Children requiring investigation for possible medical causes of a learning disability where the learning disability has been identified by education services.
Children aged 7 or more experiencing nocturnal enuresis
Encopresis- Children requiring specialist Tier 3 intervention for soiling after being assessed and treated by Primary Care (GP), Community Nurse led Continence Service and Secondary Care (Hospital) with persistent symptoms for more than 6 months.

GP isrecommended to treat constipation and UTI if present prior to referring to Enuresis clinic

Children requiring child protection medical assessment should be requested by the Social Worker (Section 47 medical) using the designated electronic referral form/

/ WE DO NOT ACCEPT REFERRALS FOR:
Children Over 16
(Unless in full time education with Special educational needs/disability)-.

Children and Young people with a primary moderate to severe mental health problem should be referred to Child and Adolescent Mental Health Services (CAMHS).
Children with primary behavioural or emotional problems should first be reviewed by a Health Visitor/School nurse/Family worker or GP and offered strategies / signposting to local servicesincluding parenting support which can be accessed throughan Early Help Assessment. Sources of support can be found on the Local Offer page for the Local Authorities for Luton and Central Bedfordshire (click below).

Luton
Central Bedfordshire

Children with developmental delay in one area such as gross motor skills, speech and language, vision or hearing should be referred directly to the relevant service. eg Physiotherapy ( Luton & Dunstable University Hospital Trust(LDUH/) Occupational Therapy (OT) /Speech & Language Therapy (SALT).

Children are not assessed for specific learning difficulties such as dyslexia (this is managed by education services).
Children diagnosed with ADHD who do not require medication.

School aged children are not assessed to establish a Learning Disability/Cognitive ability (these assessments are undertaken by education services)
We do not offer therapeutic services for children with ASD (this includes on-going emotional and behavioural support which is provided by education and voluntary organisations)
Primary sleep problems not associated with neurodevelopmental disorder
Children under 7 years experiencing wetting or soiling should be referred to the 0-19 Team
Children with Special Needs who are over 4 years and have continence difficulties should be referred toEPUT Continence ServiceTel. 01234 310879
Children with suspected urinary tract infection (UTI) or daytime wetting should be seen in the first instance by their GP and referred to acute paediatrics as appropriate
Children requiring sexual abuse medical assessment under Section 47 Should be referred to The Emerald Centre in Bedford run by Mountain Health 01234 897052
Clumsiness – children over five years should first be referred to EPUT Occupational Therapy Tel. 01582 708141
Growth faltering/ weight loss/ overweight/ obesity – should first be referred to acutepaediatricians for investigation to exclude underlying organic illness.

HOW TO MAKE A REFERRAL TO EDWIN LOBO CHILD DEVELOPMENT CENTRE:

Please complete the Edwin lobo Centre referral formand supply the following supporting information

Referrals will not be accepted unless the following information is provided with the referral form:

Under 5’s- Pre-school Children

An up to date assessment of the child’s developmental needs from the Health Visitor or pre-school/ nursery setting (completed within 8 weeks of the referral) or other professional report relating to current development) ‘Meeting the Needs Of Children, Young People and Their Families In Luton’ – Luton Threshold Framework

Over 5’s- School Age Children

Where concerns are identified by school, or affect school progress, the school SENCO should make a referral. The referral should reflect a graduated response andinclude:

1)An update to date SEND Support Plan or equivalent e.g. Pathway Provision Map, based on the school’s assessment of the child’s development and learning profile ( within the last term)

2)There is an expectation where the child has an educational concern; the school would have had a consultation with School Support Services. For example:

Learning Support
Behaviour Support,
Educational Psychologist or

3)Advice from specialist behaviour provision in their neighbourhood Outcomes and impact from School Support/ outside agency involvement needs to be clearly documented in the referral. The above cycle of Assess, Plan, Do, Review will help Edwin Lobo Community Paediatric Service inform the next phase of the assessment process in line with SEND Code of Practice 2014.

Referrals under category 1 and 2 may be made by the GP or paediatric consultant via a comprehensive referral letter

EDWIN LOBO CENTRE REFERRAL FORM

Please ensure the form is completed in full. The referral will not be accepted and will be returned to you should any sections be incomplete.

Name of child/ young person:……………………………………………DOB: …………………….

Address: ………………………………………………………………………………………………….

……………………………………………………………………………………………………………..

NHS No: ……………………………………………..

Tel. No: ……………………………………………………… Mobile No: ………………………..

Parent/ Carer consents to receiving personal identifiable information by unsecure email YES/ NO

Parent/ Carer email address…………………………………………………………………………..

Name of Parent/ Carer(s)………………………………………………………………………………

Legal parental responsibility: ☐Mother ☐Father ☐Local Authority-(LA)

☐Joint-(Parent & LA) ☐Other

Is the child a “Looked After Child”?YES ☐NO ☐

Does the child have a “Child Protection Plan”?YES ☐NO ☐

Does the child have a “Child In Need Plan”?YES ☐NO ☐

Does the child have a “Team Around The Child” in place?YES ☐NO ☐

Is there any known reason why a home visit should not be undertaken?YES ☐NO ☐

If the answer to the above question is “YES”, give further information:

GP Name: …………………………………………………… Surgery: ………………………….

HV Name: …………………………………………………… Base: ……………………………..

School/Nursery: ……………………………………………Teacher: ………………………….

Ethnic origin:

(Please tick)WhiteBlack or Black BritishOther ethnic group

□White British□Black Caribbean□Chinese

□White Irish□Black African□Any other

□Other□Other

MixedAsian or British Asian

□White/Black Caribbean□Indian

□White/Black African□Pakistani

□White/Asian□Bangladeshi

□Other mixed background□Other

Language(s) spoken at home: ………………………………Interpreter requiredYES / NO

Other professionals involved:

Current Past ReferredContact name & phone

Health visitor/nursery nurse  ………………………………….

Paediatrician  ………………………………….

Physiotherapist  ………………………………….

Speech therapist  ……………………………..

Occupational therapist  ………………………………….

Dietician  .…………………………………

Audiologist  ………………………………….

Orthoptist  ………………………………….

CAMHS  ………………………………….

School nurse  ………………………………….

SENST / EYSS  ………………………………….

Educational psychologist  ………………………………….

Behaviour support service  ………………………………….

Learning support service  ………………………………….

Family worker  ………………………………….

Social worker  ………………………………….

Care co-ordinator  ………………………………….

Other  ………………………………….

Please attach copies of relevant professionals’ reports (with parental consent)

REASONS FOR REFERRAL

Children with complex developmental difficulties (affecting more than one area of development)

Neuro disability or medical condition causing developmental disorder or delay eg. Cerebral palsy

Children aged over 5 years withsuspected Attention Deficit Hyperactivity Disorder (ADHD) for assessment, diagnosis and on-going medication review.

Please complete and contact ELC Admin for Conners Questionnaireson

Tel: 01582 700 300 option 1 or Email:

Autistic Spectrum Disorders (ASD).We provide a diagnostic service for suspected ASD. Following assessment, we signpost to support services within the community.

Assessment for Autism Spectrum Disorder needs to be accompanied by a completed

and

Children requiring investigation for possible medical causes for learningdisability where a learning disability has been identified by education services.

Nocturnal enuresis service for children aged 7 or more

Encopresis- Children requiring specialist Tier 3 intervention for soiling after being assessed and treated by Primary Care (GP), Community Nurse led Continence Service and Secondary Care (Hospital) with persistent symptoms for more than 6 months.

Referrer’s concerns:

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Parental concerns:

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Expected Outcome of Community Paediatric assessment:

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YOUR IMPRESSION OF CURRENT LEVEL OF FUNCTIONING

(Please comment on the following where applicable)

Cognitive/academic attainment: Please state levels compared to national expectations

Reading………………………………………………………………………………………………..

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Writing………………………………………………………………………………………………….

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Listening and speaking………………………………………………………………………………

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Mathematics…………………………………………………………………………………………..

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Other assessments…………………………………………………………………………………..

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Social interaction and communication skills:

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Speech, language and communication skills:

(Response to spoken directions, questions and comments and use of language)

Examples or details of concerns (i.e. level of functioning and/or impact on child)
Attention & Listening
Play and Interaction
Understanding language
Using communication
Speech Sounds
Voice / *Has the child been seen by ENT? Please attach report
Fluency/Stammering
Other (Please State)

Motor skills:

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Fine motor skills

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Self-care/independence skills

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Patterns of behaviour:

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If concerns are regarding behaviour and/or learning, please complete the following:

(The referral may not be accepted if sufficient information is not provided or if primary measures have not been put in place.)

Which interventions or behavioural strategies have already been tried?

At home (include examples of support from health visitor, family worker, EHA, CAMHS, etc):

…………………………………………………………………………………………………………...

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At school or nursery (include support already provided through a SEND support plan and outcomes of that support):

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For children in education their referral must be accompanied by a current SEND support plan or equivalent, showing evidence of the outcomes, of that support.

BACKGROUND HISTORY

Birth and Medical History (including any medication and dose):

……………………………………………………………………………………………………………..

Developmental History (include milestones if known):

……………………………………………………………………………………………………………

Relevant Family and Social History:

………………..…………………………………………………………………………………………

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Any other relevant information:

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Name of referrer: …………………………………Signature: …………………………………

Profession:…………………………………………Contact number:………………………….

Base: …..…………………………………………..Date: ……………………………………….

Date referral discussed with parents/carers: …….…………………….

The Edwin Lobo Centre (Child Development Centre) has my permission to contact all relevant authorities to obtain reports relating to my child for the purpose of their assessment. ☐Yes ☐No

The Edwin Lobo Centre (Child Development Centre) has my consent to communicate with me by my unsecure email address below. ☐Yes ☐No

Signature of parent/carer: ………………………………… Date: ……………………………….

Full Name of parent/carer: …………………………………………………………………………..

Contact Telephone number: …………….…………………………………………………………..

Parent/ Carer email address: ……………………………………………………………………….

Child’s full name: ………………………………………………………..…………………………....

Child’s date of birth: …………………………………………………………………………………..

Name of school/nursery/playgroup: .………………………………………………………………..

School’s telephone number: …………………………………………………………………………

School’s address: ……………………………………………………………………………………..

Once completed, please return this form to the Edwin Lobo Child Development Centre by secure email to:

Checklist to help the referrer ensure all relevant sections of the form have been completed and relevant documents accompany the referral to Edwin LoboCentre Community Paediatric Service

Yes No N/A

All sections of the referral form have been completed?

The reason for the referral meets the services inclusion criteria?

The expected outcome of the referral is clear?

Child aged under 5years- an assessment of the child’s developmental

needshas been completed within 8 weeks of this referral?

Child attends nursery or school- a copy of the SEND Support Plan

has beencompleted within 8 weeks of this referral and is included with

the referral

The parent/ carer has consented to Edwin Lobo Centre contacting

all relevant authorities to obtain reports relating to their child

The parent/ carer’s full contact details are documented?

The parent/ carer agrees Edwin Lobo Centre can contact them via their

un-secure email address?