VIEW District handicap teams in England : 1983 - 8

The need to study a wide range of attributes and functions when assessing a disabled child has long been recognised. The concept of the multidisciplinary investigation of children with behaviour disorders led to the opening of child guidance clinics first in the United States and then in this country in the 1920s. Paediatricians in the 1940s and 1950s were able to pay more attention to the complex chronic disabilities, and special combined clinics were set up. These early ventures led to recommendations about the way such clinics might be run.' So in a higgledy piggledy way services for disabled children were beginning, but they were being planned in isolation, and were initially exclusively for children with specific disorders; the notion of a service for all disabled children was embryonic. The idea of health and education authorities together planning combined facilities for the investigation, treatment, and special education of young, disabled pupils was also new. In the absence of alternative arrangements local education authorities had been opening their own diagnostic and assessment units; these often operated independently of hospital specialist facilities and without appropriate support 2 3 services. Acting on a recommendation in the Sheldon report on child welfare centres that health authorities should be asked to review their arrangements for the assessment of handicapped children,4 the then Ministry of Health issued a memorandum containing the advice of 'a small group of experts' on the setting up of comprehensive assessment centres for children with all types of handicap.5 The ministry set aside special funds to help regional hospital boards finance such centres and by 1973 there were 52 either in existence or being built. The Court report went further.6 Concerned at the constant failure of clinics specialising in single disabilities to offer a wide assessment of development and residual functions of referred children, the report recommended that each health district, with the support of local education and social service authorities, should organise formally a multidisciplinary team for all handicapped children as a central feature of its comprehensive services for handicapped children. It was also convinced that these 'district handicap teams' should have integrated facilities for prevention and treatment as well as for assessment, and that they should have an operational role as well as a clinical function. By an operational role the committee meant that the district handicap team should be concerned with other district staff in epidemiological surveys and in the identification of disabled children, and in monitoring its own effectiveness; it should also act as a district resource centre for handicap in childhood. The committee suggested that the district handicap team should comprise a consultant community paediatrician, a child health visitor for handicapped children, a specialist social worker, a principal psychologist, and a teacher with wide experience of handicapped children of nursery and infant school age. As a secondary (specialist) service the district handicap team would then see the minority of handicapped children who had complex or severe disorders (or both). It would work both within and from a child development centre, which itself would be situated in or near the district's general hospital. It would be in support of similarly integrated primary care services geared to meet the needs of most handicapped children. The government of the day accepted in principle that 'district handicap teams should provide a framework within which all the needs of the relatively few children with severe handicap, both physical (including sensory) and mental can be met. . .' and it invited health authorities to draw up joint proposals with education and social service authorities for their organisation and operation.' As it simultaneously sanctioned the establishment of community teams for mentally handicapped children and adults, however, in practice it clearly had some reservations about relying on district handicap teams to meet all the needs of all severely handicapped children. The recommendation for 'cradle to the grave' community mental handicap teams had been made by the National Development Group (an advisory body set up by the government in 1975 to look at services being offered to mentally handicapped people), which feared that it would be some time before district handicap teams could become operative but community mental handicap teams could be set up at once. As their report was reprinted in November 1983 we assume it still represents official policy, just as presumably DHSS circular HC(78)5 did, in so far as it has not been officially withdrawn.8 What influence this departmental ambivalence may have had on the development of district handicap teams (and community mental handicap teams for that matter) must Community Paediatric Research Unit, Department of Child Health, Westminster Children's Hospital, Vincent Square, London SWIP 2NS MCO Bax Kingsley Whitmore