Learning Difficulty/Disability in children ≥ 6 years

Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Developmental concerns

  • Non verbal child with acute distress and unable to examine adequately for medical conditions causing pain eg tooth abscess, bone infections or osteopaenic fractures

 

Useful Management Information
  •  Refer to local care pathway
  • All children referred for learning difficulty require visual acuity and audiometry results.
  • Developmental optometry and auditory processing assessments are not supported by evidence
  • Are there significant behavioural or emotional issues suggesting that this referral would be better assessed under a behavioural category?
  • In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
  • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: https://www.communities.qld.gov.au/
Minimum Referral Criteria

Category 1
(appointment within 30 calendar days)

  • Definite history of loss of academic ability with deterioration in cognition suggestive of neurological disease. (IQ measurement is not required in order to accept this referral)
Category 2
(appointment within 90 calendar days)
  • Acute severe functional deterioration in a child diagnosed with a  learning disability
Category 3
(appointment within 365 calendar days)
  • Educational psychology assessment suggests intellectual impairment and the child has never been seen by a paediatrician for assessment.
  • Suspected attention deficit disorder without hyperactivity

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc

Essential referral information

Without this information the referral will be returned

  • General referral information
  • WISC or other equivalent IQ measurement within the previous 3 years or detailed information regarding learning abilities (such as NAPLAN report or reading, spelling, maths age equivalent levels) (provided by the school or another external provider). This is not required if there is a concern about developmental regression.
  • Review by school/private psychologist outlining area of difficulty
  • Nature of parents concerns
  • Are there significant behavioural or emotional issues suggesting that this referral would be better assessed under a behavioural category? It is acknowledged that behavioural difficulties can be secondary to learning problems
  • Report presence or absence of Red flags

Presence or absence of Red flags

  • Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
  • Is the child expected to be in out of home care supervised by the department of child safety for more than 6 months?
Additional Referral Information

Highly desirable information – may change triage category

  • Classroom reports of school performance and engagement with school work.
  • Other assessments of academic ability and achievement
  • Audiometry
  • Medical history
  • Family history, including family members affected with ASD, ADHD, learning difficulty or mental illness.
  • Copies of previous of speech, occupational therapy, physiotherapy or cognitive assessments if available.
  • If the child is in foster care please provide the name and regional office for the child safety officer who is the responsible case manager.
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, department of child safety involvement)
  • School history –exclusions or suspensions.

Desirable information- will assist at consultation

  • Pregnancy and birth history
  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any relevant laboratory results or medical imaging reports
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.

Feedback

To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.