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as information is gathered. Nevertheless, it seems that we are able to trace the
majority of the handicapped under-five population as our figures are not very
different from the national ones.
"AT RISK REGISTER"
Until a few years ago, this Authority had a very large centrally organised
"At Risk Register" of babies who had an "at risk" factor in their history. Our
own survey, carried out in Lambeth in 1969, shows that, contrary to expectations
children on the "At Risk Register" do not yield the expected rate of handicaps
and that information about the vast majority of mentally handicapped children
did not come from the "At Risk Register" but from hospitals, general
practitioners, Child Health Centres and other sources. Our observations were
confirmed by many other workers and subsequently the "At Risk Register"
was discontinued. At present, children whose history or progress warrant additional
observation are noted in the individual child Health Centre and a special effort
is made by Health Visitors and Clinic doctors to follow them closely. If in doubt,
the Clinic doctor or Health Visitor refers the child to Developmental Assessment
Clinics for advice. If a child suspected of a possible handicap is already followed
up in the hospital (e.g. low birth weight babies as at St. Thomas' Hospital) we do
not duplicate the developmental assessment examination but a follow-up is
carried out on the basis of the exchange of information between the hospital and
our own department.
OBSERVATION HANDICAP INDEX
The recommendations for inclusion of a child in the observation handicap
index come from many sources, hospitals, child health centres, birth notification
and discharges from midwifery services, both domiciliary and hospital. However,
no child is entered on the observation handicap index without the appropriate
hospital consultant's confirmation of the diagnosis. The severely mentally
handicapped child is usually identified initially in hospital. If however, the mental
handicap has developed later in the child's life or the child has moved into
the area from somewhere else, or the diagnosis was missed in hospital, the
information on the observation handicap index will come later from other sources.
The under-five population in Lambeth is presented in the Table as follows:-