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41
Assessment
Special sessions are held for handicapped children in five of the child health clinics. A senior
member of the medical staff with special experience in handicapped children examines each child
referred and decides what further action to take. Such action could be referral to a hospital consultant
or to a speech therapist, formal recommendation for education in a special school or return visits to
the clinic to establish diagnosis. Often, however, where it is thought that observation, stimulation
and training are required, arrangements will be made for the child's admission to one of the special
day nursery units. The service thus provided for children with environmental handicaps has proved
to be of the greatest benefit and some children who were functioning as severely subnormal at
three years of age have, after a time in a special unit, been able to take their place in ordinary school
at the age of five. For the children who are severely subnormal, mongols, microcephalics and the
cerebral palsied, these special clinics also provide an excellent opportunity for assessment of progress
and for parent counselling.
District assessment clinics are held at two of the teaching hospitals in the City. A senior medical
officer from the Council attends and works with the paediatrician. If special placement is recommended
for the child, the senior medical officer arranges this.
Total attendances at the special sessions for handicapped children in the Council's welfare
centres were 160, of whom 37 were new referrals. Unfortunately, figures for the district assessment
clinics are not available since they relate only in part to children from Westminster.
HANDICAPPED CHILDREN
The Handicap Register
Since it has been possible to implement a system of developmental screening tests on all infants,
the "At risk" or "Observation" Register has been discontinued. This allows opportunity for greater
concentration on the handicapped. A single register of all handicapped children is maintained at
City Hall by the senior medical officer for child health and a senior administrative assistant. Children
are placed on the Register at birth if they are notified as having some congenital abnormality. Others
who have had a stormy neonatal existence will be placed on the register as a result of a hospital
discharge report. Most of the children, however, are notified to the Department later in life as a
result of hospital admission, diagnosis by a clinic medical officer or even later notification can come
from a school medical officer. Most of this last category arise when they move into the area as school
children. The purpose of the register is to ensure that handicapped children are followed up at the
appropriate times and that there is co-ordination and implementation of recommended action.
The Handicap Register is used flexibly; many children are on it for a time only. Some conditions,
such as under-stimulation with consequent slow speech development, are rectified by time and
other conditions may be cured by surgery. Thus, to be included in the Handicap Register is by no
means a permanent label, nor does it always indicate that special education will be necessary.
THE DAY CARE OF CHILDREN
As stated earlier, the City Council has a special responsibility for the day care of pre-school
children. A high proportion of working mothers, children being brought up under adverse environmental
conditions, a large immigrant population and a high incidence of mental illness among
parents - all combine to produce an ever-increasing demand for substitute mother care during
the day.
The City Council has eight day nurseries with 450 places. These are open from 8 a.m. to 6 p.m.
Although these hours are long from the point of view of the staff and the children, they do not entirely
meet the needs of mothers who have to work. To an increasing extent, day nursery admission is
recommended in the interests of the child rather than of the parent. Priority is given to children who
are suffering as a result of a deprived home background rather than on purely financial grounds.
Day Nurseries are also being used more and more to avoid the reception of children into care in the
absence of their mothers; many lone fathers are thereby helped to keep their children at home. But
the main contribution of the day nurseries is in the care of "disadvantaged children". Some of them
come from deprived homes where a parent is missing, some from homes where the mother is mentally
ill or mentally subnormal and some from families with multiple problems where the child may be in
danger of neglect or ill treatment. In addition to these social problems, day nursery places are
increasingly being sought for retarded children who need a period of observation and stimulation
in an ordered environment. Twenty-four places in special units are available for these children,
many of whom are not severely handicapped but would benefit from day nursery placement.