What is it?

The Infant Neurodevelopment Service (INDS) is a service started on the neonatal unit for children born very prematurely or who had a difficult start requiring medical intervention that might affect a child’s development.

An Infant Neurodevelopment Service clinic is held three times a month. Two clinics a month at Homerton Hospital and one clinic a month at Hackney Ark.

What happens at the clinic?

The twice monthly clinic help to monitor the child’s development over the first two years of life, and support families with advice and therapeutic input if needed.

The clinic is jointly run by:

• Doctors from the Neonatal team at the Homerton Hospital
• Community Paediatric team at the Hackney Ark
• Children’s occupational therapists
• Children’s physiotherapists

How are children followed up?

Children are seen at 3 months post term/after birth and then at varying intervals according to child’s history potentially at

• Six months
• Nine months 
• Twelve months and
• Eighteen months

There is a formal developmental check at 2 years post term/after birth at the Hackney ARK.

How are children referred?

When children are discharged from the Neonatal unit children who meet the criteria are referred to the clinic

What is it?

The Baby Clinics are jointly run with local health visitors and a paediatrician (children’s doctor) who is present at the clinics listed below every week.

What happens at the meeting?

If you have any medical questions about your child these are helpful sessions where you can discuss your concerns with professionals.

Common things discussed with parents at Baby Clinics include: reflux, colic, rashes and vaccinations.

Your child may also receive their 6-8 week baby checks at the Baby Clinic

How are children followed up?

This is a drop in service so you do not need to book an appointment medical questions or concerns can be discuss with professionals who will advise who to contact or involve.

How are children referred?

This is a drop in service so you do not need to book an appointment.

What is it?

MARS meetings are how Hackney Ark responds to the National Service Framework ensuring that services for children with complex and multiple health & social care needs are provided in a joined up and co-ordinated fashion. 

What happens?

MARS meetings bring together the team of professionals from Health, Social Care and Education who work directly with children in a particular geographic area to;

• Discuss new referrals to the Hackney Ark in a confidential forum
• Share information about cases already known to someone in the team

How are children followed up?

The aim of the meeting is to;

• Determine and arrange initial assessment and support for children and families referred, including the possible allocation of a Key worker to help provide ongoing co-ordination of support to a family.

• Provide a forum for reviewing and co-ordinating support that is being offered to children and families already.
• Provide a safe environment for staff to express any concerns that they may have in relation to a case with which they are involved and feel that input from the multi-agency team is required to either move things forward for the child and family or to support them as the worker in what they are attempting or planning to do with the family.
• Provide a safe environment for the sharing of potential Child Protection concerns. 

Find out more: Multi-Agency Referrals (MARs) meetings

What is it?

The Patch Neuro developmental clinic is a local area based community paediatric developmental assessment clinic. It is staffed by community paediatricians and sees children under 5 years of age who have developmental problems, such as delayed walking and talking.

What happens at the assessment?

The appointment takes place at Hackney Ark and lasts for an hour.

Children are assessed through observation and a developmental history to date will be taken from the parent/carer.

Recommendations about further support will be discussed at the appointment with the clinician and a plan will be drawn up.

How are children followed up?

Further reviews may take place at PATCH clinic to see how the child has developed over time.

These may be as often as every 6 months but are based on the individual needs of the child.  

How are children referred?

Referrals come through the MARS process. 

Find out more: Multi-Agency Referrals (MARs) meetings

What is it?

The Complex Communication Clinic is a specialist multi-disciplinary clinic for children where there are particular concerns about their development of communication, social interaction, play and some aspects of behaviour for children under 5 years presenting with possible autism and perhaps in need of a diagnosis.

Who is in the Complex Communication Clinic team?

The team includes: 

• Consultant Paediatrician and Paediatric Registrar,
• Speech and Language Therapists
• Clinical Psychologists
• Occupational Therapist
• Early Years Practitioners
• Play Specialist and
• Keyworker Co-ordinator

What happens at the assessment?

At your first appointment you will be seen by a paediatrician/children’s doctor and either a speech and language therapist or a clinical psychologist.

The paediatrician will ask you specific questions about your child’s early development and also about how your child is now.

He/she will ask you about your child’s communication, social skills, play and behaviour.

The speech and language therapist or clinical psychologist will assess your child by playing with him/her to look at his/her social communication skills, play and behaviour.

After the assessment they will discuss with you what they think may be causing the difficulties and make a plan with you about what will happen next.

It might mean a fuller assessment of your child in different settings over time to understand what is causing any difficulties with communication.

How are children followed up?

This may be part of a process where a child is seen at different clinics with different functions.

It is often difficult to come to a firm conclusion about a child without seeing them over a period of time and in different settings. 

Information from other professionals e.g. education, paediatrician or speech and language therapist helps gives a fuller picture and understanding a child’s strengths and difficulties. It can be helpful to see a child’s development across time to see if your child’s skills changed or developed since the last professional saw him/her.

How are children referred?

Children are referred through the MARS referral process to PATCH and then seen at the Complex Communications Clinic

Find out more: Multi-Agency Referrals (MARs) meetings

What is it?

The Special Advisory Clinic (SAC) is a paediatric assessment appointment delivered by a community paediatrician.

The clinic sees children who are 5 years and under and who may have developmental concerns.

Where do the clinics take place?

SAC developmental assessments usually last around 30 minutes and can take place locally to where families live e.g. in a Children’s or Community Centre.

These clinics run from 3 locations in Hackney and you will be given your appointed at the clinic nearest to where you live.

They locations are:

• Tyssen Children’s Centre
• St Leonard’s Hospital
• Anne Taylor Children’s Centre

What happens at the assessment?

The SAC aims to get more information about a child’s difficulties to see if further assessment is required in other more specialist clinics.

It is sometimes used as a screening assessment if a referral has been made but there is not enough information with the referral to decide what next steps would be helpful.

How are children followed up?

Children maybe be seen once or twice in clinic to pull together all the information required.

If follow-up is required they are usually referred on to other more specialist clinics or services to get further clarity of the difficulties they may be experiencing.

How are children referred?

Referrals often come through the MARS process but professionals e.g. health visitors and GPs may also refer directly to the clinic.

Find out more: Multi-Agency Referrals (MARs) meetings

What is it?

The Social Communication Assessment Clinic (SCAC) is for children and young people aged 5-13 year olds without significant learning difficulties so presenting with difficulties associated with e.g. High Functioning Autism

Once an ASD assessment has been discussed with a family, the appropriate pathway for assessment will be agreed.

Social Care CAMHS referrals for ASD also come through this pathway.

There are four pathways for assessment:

• Under 5’s
• Over 5’s with learning disability (LD 5-19)
• 5-13 without primary learning difficulties (higher functioning)
• Over 14s without LD

Where?

All ASD assessments take place at the Hackney Ark for children aged 2-13.

All young people aged 14 years or over suspected of being affected by an Autistic Spectrum Disorder are assessed at Specialist CAMHS, ELFT, due to overlay with mental health needs.

What happens at the assessment?

We contact referee by week 5 of receipt of referral.

Referrals for assessment are completed within 18 weeks where possible (NICE).

Under 5’s: All children aged 2-4 inclusive (with or without a learning disability) are referred to the community paediatricians at the

Hackney Ark through MARs for neurodevelopmental assessment.

Children with suspected ASD are then referred on to the specialist Complex Communication Clinic (CCC).

CCC provides a Multidisciplinary Team (MDT) assessment.

Diagnostic assessment can then be completed following a number of pathway options:

• Complex Communication Needs Assessment Group
• Individualised assessment (including ADOS)
• Complex Communication Clinic plus visit to education setting or home.

 5-19 year olds / school age with primary learning disability

This assessment is taken up by CAMHS Disability Team, which is a specialist tier 3 NHS service for children with disabilities and mental health/emotional problems at Hackney Ark.

The ASD diagnostic service is completed by a:

• clinical psychologist
• consultant psychiatrist and
• speech and language therapist

…alongside consultation to the wider professional system.

 5-13 year olds / school age without primary learning difficulties (higher functioning)

The Social Communication Assessment Clinic (SCAC) is a joint pathway by:

• Hackney Ark clinicians
• Specialist mental health CAMHS (ELFT)
• Social Care CAMHS and
• Hackney learning Trust (HLT)

This is an individualised assessment with an MDT including:

• Paediatrician
• Psychiatrist
• Clinical Psychologist
• Educational Psychologist and
• Speech and Language Therapist

Social Care bring referrals up to age 18.

14 years old and older (higher functioning)

All young people aged 14 years or over suspected of being affected by an Autistic Spectrum Disorder

are assessed at Specialist CAMHS, ELFT, due to overlay with mental health needs.

All referrals for 14 years and older group go to East London Foundation Trust.

What happens at an ASD assessment:

Individualised assessments may comprise ADOS and 3DI-R (standardised assessments undertaken by specially trained clinicians) alongside developmental history and observation in familiar settings.

Group assessments for under 5’s take place at Hackney Ark and are run by a Multi Disciplinary Team who observe children across three mornings in a play setting, including home and school visits.

All assessments comply with NICE guidelines and use DSM-5 to reach a diagnosis.

How are children referred?

Referrals can be made via schools, other professionals.

All new referrals for other age groups for Hackney Ark are to be sent to MARs (Multi-agency referrals).

Find out more:

Link to Esther’s form on SENCo resource page:

Link to Susan’s documents

14 years old and older (higher functioning)

All young people aged 14 years or over suspected of being affected by an Autistic Spectrum Disorder are assessed at Specialist CAMHS, East London Foundation Trust, to also identify if the young people have mental health needs. 

All referrals for 14 years and older group go to East London Foundation Trust.

Find out more: CAMHS Alliance

Find out more: What is Autism?

School Medical Clinic

What is it?

The School medical clinic is a paediatric assessment appointment with a community paediatrician/children’s doctor.

The clinic sees children of school age 5 – 18 years who may have developmental concerns.

What happens at the assessment?

The medical aims to get more information about a child’s difficulties and to see if further assessment is required in other more specialist clinics.

This clinic is sometimes used as a screening assessment if a referral has been made but there is not enough information with the referral to decide what next steps would be helpful.

Find out more: School Medical Service

School Age Clinic

The school age clinic is a community paediatric/children’s doctor developmental assessment clinic for children of school age 5-18 years old.

This clinic sees children who fit into one of the following two main categories:

First category:

Children with known complex medical and developmental/learning problems that affect schooling and are seen for annual review - These include children with Down’s Syndrome and other chromosome abnormalities as well as those with degenerative metabolic/health conditions.

These children are often referred from one of the 6 Patch clinics when they approach  5- 6 years.

Children at special school in Hackney are usually seen for a medical review within their school and do not need to attend this clinic.

Second category:

Children where there are significant concerns about their learning and behaviour in school but where there is not yet any diagnosis - The clinic offers a holistic assessment with a paediatrician and aims to uncover any underlying medical issues such as epilepsy or genetic abnormalities. 

We commonly see children referred by SENCos and GPs.  They refer children to us when parents feel their child is not progressing at school but there is not a clear understanding of why this is.

We also see children who have newly arrived in Hackney from other boroughs in the UK or outside the UK. 

These children can have complex medical problems and we work jointly with social care as well as health and education to identify and understand what the issues are and what action may need to be taken.   

Most of our clinic letters are copied to school SENCos to help share a better understanding at school of children’s difficulties but this is with their parent/ guardian’s permission.

What happens at the assessment?

The appointment takes place at Hackney Ark and lasts for an hour. The doctor will take a history from the child and their family and examine the child.

Recommendations about further support will be discussed at the appointment with the clinician and a plan will be drawn up. Some children are seen jointly with a psychologist.

How are children followed up?

Children with complex needs will have an annual review in clinic.

Where does the clinic take place?

School medical clinic are run from Hackney Ark.

How are children referred?

Children can be referred by SENCos and GPs. 

Referrals come through the MARS process.

Find out more: Multi-Agency Referrals (MARs) meetings

Health assessments for NEW entrant

Homerton Hospitals School Health Service support children from reception through to leaving school, starting with their health assessments at reception and again in year 6

What happens at the assessment?

For children entering reception (the School Health Entry Check) looks at the following measures:

•         Children's Height

•         Children's Weight

•         Children's Hearing

•         Children's Vision

For children in year 6 (the National Child Measurement Programme Service) the service looks at the following measures:

• Children's Height
• Children's Weight 
• Supporting children with disabilities or additional health needs

Homerton Hospitals School Nursing team is a universal service but can provide a range of care for children with disabilities or children with medical conditions regardless of whether they attend a special or mainstream school.

These can range from providing health assessments to helping to develop Individual Health Care Plans.

Find out more: Homerton School Nursing team – Universal Service

What is it?

LEAP – Assessment Clinic offers a multidisciplinary (dietician, psychologist, paediatrician and physiotherapist) assessment, intervention and group work (HENRY) of children and young people who are significantly overweight.

What happens at the assessment?

We will conduct a 30 minutes telephone or face to face assessment when an advocate if needed.

During the assessment, we will discuss referral, history, expectations, and readiness to change and complete a diet/activity/psychology assessment.

If parents are ready to change and want to engage, we will agree an initial goal to work on and book a clinic appointment for the child and parent.

If the parent or child/young person realise they are not ready to make changes, they are encouraged to contact their GP when the time is right.

How are children followed up?

After the assessment children and young people and their families are offered six to eight core sessions with:

• the dietitian
• physiotherapist
• CAMHS therapist

The assessment cover nutrition, physical activity and behaviour change/Cognitive Behavioural Therapy to support a healthy lifestyle.

The combination of these appointments will depend on need. 

Some children will be offered additional one to one psychology support or referred to appropriate services. 

All children will be offered a weight maintenance programme to help families to maintain their lifestyle changes.

Find out more: LEAP - Lifestyle Eat-well Activity Positivity

Find out more: HENRY (Health, Exercise, Nutrition for the Really Young)

What is it?

This clinic provides medical care to children with Neurodisability who have epilepsy.

What happens at the assessment?

The focus of this clinic is to ensure that:

• epilepsy symptoms are under control
• under given medication and
• to adjust dose to the age and weight of the child or young person as they grow

The clinic also monitors for possible side effects of medications and is an opportunity for the child, young person and family to discuss any arising issues related to epilepsy management.

How are children followed up?

Follow up is usually 3-6 monthly and is arranged on the day of clinic.

How are children referred?

Children are usually referred by their community paediatrician, general paediatrician or paediatric neurologist. 

What is it?

Statutory Assessment Clinic is a clinical appointment with a paediatrician/children’s doctor to assess and complete medical advice needed for new assessments for Education, Health and Care Plans (previously known as a statement of special educational need) or where annual reviews require new information.

What happens at the assessment?

The appointment lasts 30 minutes, you are seen by a community paediatrician. The children’s doctor will take a history and make an examination.

They will aim to identify and document any health issues that may impact or affect the child’s learning.

How are children followed up?

There is no follow-up at this clinic.

The purpose of the clinic is to see children to complete their Education Health and Care assessment form.

If problems are identified the child is referred onto other services.

How are children referred?

The referral is made by the Education Health and Care Plan Co-ordinator as part of the Education Health and Care assessment process.

Find out more: Education, Health and Care Planning Team

What is it?

Audio Tier 2 is an initial hearing assessment clinic provides accurate and age appropriate hearing assessment and prompt intervention, regular monitoring of hearing.  

The 2^ND tier family friendly Audiology Service for children with hearing loss Audiology Service aims:

• To detect and manage appropriately, temporary conductive hearing losses which may impair social, emotional, linguistic and educational development.
• To detect and refer, permanent hearing losses in a timely fashion for appropriate management.
• To monitor stable permanent hearing loss in keeping with local protocols
• To provide advice for health professionals, parents and teachers about hearing loss.
• To co-ordinate and provide training and regular updating in paediatric audiology for members of the Primary Care team and other Community staff.
• To allow seamless liaison with professionals in health, education e.g. writing reports to contribute to EHC plans and provide parent advice and information material. and social care and with tertiary centres where needed
• Provision of the School entry hearing screening for all the state schools in the borough
• Contributes to the new-born hearing screening programme and provides  the school entry hearing screening
• The service also contributes multi professional children’s hearing service working group (CHSWG) in the borough which has parent members

The Paediatric Audiology service sees all children for hearing assessment and intervention who are registered with NHS Hackney GPs The service is provided by appointment and short notice appointments are available, as needed.

Referral can be made by

• The neonatal hearing screening programme in City and Hackney for surveillance
• ENT, Paediatrics, Child Development Team and other consultants
• Third tier paediatric audiology
• General practitioners and the primary care team
• Speech and Language therapists
• Education and social services
• Health visitors

What happens at the assessment?

The Safeguarding School Nursing Service is involved in the Initial Safeguarding School Health Assessment.

This includes:

• Vision and hearing tests

• Height and weight measurements

• Advice and referral to specialist services e.g. bed wetting clinic information, guidance and support for you and your child

Initial Safeguarding School Health Assessments take place following referrals from Children Social Care.

Parental consent will be obtained for these and future Health Assessments Reviews.

The service also offers health advice to families when safeguarding concerns are identified after visits to Accident & Emergency.

Information sharing takes place with consent at Multi Agency Professionals (MAP) meetings and during case conferences and core group meetings.

Find out more: Safeguarding School Nursing Service

What is it?

In this clinic children with safeguarding concerns are seen. Such concerns usually arise following a disclosure made by the child or observations made by professionals or others involved such as doctors, teachers or social workers.  

What happens at the assessment?

The focus of the Safeguarding medical assessment is to determine whether there are clinical signs suggestive or indicative of child abuse. The clinic also provides an opportunity for the doctor and family to try to identify and address any unmet health needs of the child.

How are children followed up?

The majority of children are not followed up in this clinic. If follow up is necessary however, it will be arranged in coordination with Hackney Children’s Social Care

How are children referred?

Children are typically referred to this clinic by Hackney Children’s Social Care. 

Find out more: Children's Social Care in Hackney

What is it?

The Looked After Children Clinic- LAC (previously known as the Health in Care Clinic) is a weekly clinic at the Hackney Ark where children and young people in the care of the local authority have an Initial Health Assessment with a Paediatrician within the first month of becoming looked after.

The aim of the assessment is to identify any health needs and to make a plan for those needs to be addressed. 

What happens at the assessment?

The Paediatrician will (as appropriate):

• talk to the child/young person/social worker/foster carer about the child/young person’s physical and emotional health, education and development.
• Examine the child/young person
• Assess the child’s development

How are children followed up?

Children under five years old have Review Health Assessments every six months.

Children and young people aged 5 - 18 are reviewed annually.

Follow-up health assessments might not be at Hackney Ark. The looked-after children nursing team may carry out these assessments:

• in the child’s home
• at the child or young person’s school or college
• in a community clinic

Some younger children and those with more complex needs are still seen by the paediatric team at Hackney Ark.

How are children referred?

Referrals for health assessments are made by the child/young person’s Social Worker to:

LAC Health Team Coordinator

Tel: 0208 356 1730/2012

Mobile: 07989 852 921

e-mail: whh-tr.hc-lachealthteam@nhs.net

Also see: City and Hackney Looked After Children Health Team Service

What is it?

Team Around the Child (known as TAC) meetings are multi-professional meetings with families to jointly plan and coordinate care and support required by families children with complex needs. 

Team Around the Family meetings are the same as TAC meetings but use slightly different terminology and aim to address social issues affecting the family.

What happens at the meeting?

Professionals are invited to a meeting with the family to discuss an agenda prepared and shared in advance by parents.

Questions raised by parents will be answered to the best ability of the professionals attending.

A team of professionals are created around the child and family in response to needs identified by the family.

This team and process aims to:

• Bring together professionals as invited by parents to discuss issues and answer questions that are of importance to family.
• To create a single plan of action that various professionals are aware of with shared goals that have been directed by the family. 
• To avoid duplication and ensure better use of time, in that different professionals won’t be working on the same task. And to also ensure that people are not working at cross purposes
• Ensure family obtain a consistent message from professionals and provide a forum for differences of opinion or approach to be discussed and options weighed up.

How are children followed up?

Future support will be planed and the way the support will be co-ordinated will be discussed.

How are families/children referred?

The meetings are organised by keyworkers who work with the family and are organised at the request of the family.

Find out more: Key Working Team