[Show abstract][Hide abstract] ABSTRACT: Referrals from preschool medical examinations were followed up for two years to assess attendance rate, waiting time for appointment, appropriateness of the referral, the diagnosis and management of the condition. Altogether 184 children were referrals for ophthalmology, 285 for audiology, and 195 for speech therapy. The median waiting time for an appointment was 46 days in ophthalmology, 175 days in audiology, and 83 days in speech therapy. The poorest attendance rate was identified in speech therapy (75%). Approximately 60% of examined children had a justified referral to ophthalmology and 20% had a clear defect. Over half the children in audiology (55%) had an altered impedance or hearing impairment. Of those with a hearing problem kept under review only half improved spontaneously. In speech therapy 80% of those assessed had a language problem. Many health problems were detected for which parents were unaware or did not use the service. Parental awareness alone will not uncover the sizable level of lingual and sensorial problems in inner city areas. This audit identified specific deficiencies in the provision of services and a number of organisational changes are suggested to improve their effectiveness.
Archives of Disease in Childhood 09/1991; 66(8):921-6. · 3.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The role of child health clinics in an inner London district was examined by a survey of attenders at 52 baby clinic sessions run by the health authority and a review of the uptake of screening. Differences between social groups were examined using A Classification of Residential Neighbourhoods (ACORN) which is based on census data and requires only the full postcode to classify people. Clinic attendance was frequent among all social groups when a child was aged under six months but then declined, mainly reflecting changing needs. About one-half of the attenders saw the clinic doctor, often following referral by the health visitor, with 15% consulting about physical health problems. Differences occurred between ACORN groups in their frequency and reasons for clinic attendance after six months of age and rates of referral following developmental screening. This suggests that ACORN may be of value in monitoring service use and identifying groups with particular needs for services.
[Show abstract][Hide abstract] ABSTRACT: The incidence of sensory or language abnormalities and the factors influencing the clinical medical officers' decisions to refer children who failed developmental tests were studied. There were 1259 children examined and referrals for vision, hearing, and language assessment were made for 39(3.1%), 75(6.0%), and 27(2.1%), respectively. About 80% of these problems, however, were not known to the child health services when the children were 3.5 years old, mainly because children had moved to the district after the age of 3.5, and did not attend the 3.5 year screening clinics. Referrals formed only a small percentage of children who failed a test (11.0% failed vision, 19.5% hearing, and 24.6% language assessments). For vision and hearing the most important reason for the discrepancy was the clinical medical officers' wish to reassess children who failed the test before referring them. For the language test the clinical medical officer's often believed that the screening did not reflect the child's skills, which suggests that language screening as currently used in the district is not effective. Evaluation of the examination has highlighted the need to review the tests being used.
Archives of Disease in Childhood 07/1989; 64(6):829-33. · 3.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Returns of scheduled school entry examinations, from 838 primary school children in West Lambeth Health Authority, were analysed to assess the possible association of a child's home language background, age, sex, behaviour, and examiner with the results of the developmental examination. To allow for variation in social characteristics between participating schools, a ward index of deprivation based on the 1981 census was assigned to all the children in the schools of each ward. Variables representing development were most consistently associated with the child's behaviour during the examination and with the examiner. A child's home language background was associated only with the auditory memory test. The child's ability to concentrate during the test situation was closely related to his performance. With respect to the examiners, it is suggested that community health services need to consider schemes of ongoing in-service training and careful calibration of the tests.
Child Care Health and Development 01/1987; 13(5):329-40. · 1.70 Impact Factor