A pre-school child development clinic.

Abstract

This is an outline of a programme to set up, in a children's hospital and university paediatric department, a special facility for the study of children showing one or several types of developmental delay or deviation in the early years of life. The children seen would be those who are showing retardation in gross motor skill, impaired facility in use of the hands, abnormality in speech development or deviations relating to social responsiveness and habit training. Referral would be from the family physician or paediatrician (if in private care) or from appropriate public services such as out-patient departments and child health centres. The aim is to have a close relationship with the family physician, to whom reports would go following the initial examination and when the child is reviewed. Since many of these abnormalities require study by special investigative techniques and by specialists in various fields, the clinic should be part of the paediatric department of the children's hospital. The service aspect (to child, parents and referring physician) would be only a part of the function of the clinic. It would concern itself also with teaching to undergraduate medical students and to medical graduates in specialty training (especially in paediatrics and psychiatry) and facilities would also be available to instruct nurses, social workers, clinical psychologists, geneticists and others who might be in need of such experience in order the better to practise their professions. An active programme of research would be planned from the beginning, each member of the staff would be engaged with this in view and have assurance that time would be available for such study, often in close collaboration with other university departments such as psychology, sociology, and other departments of the medical faculty. The staff would include a medical director, (psychiatrist), an assistant director, (paediatrician), a full-time clinical psychologist with special training in assessment of very young children, a beginning staff of two medical social workers, a nursery school teacher and assistant, a secretarial staff and one or two Fellows (from psychiatry and paediatrics). As necessary, therapists in the speech and hearing department and the physiotherapy department of the hospital, could be consulted. The aim is not only to help with the problem as it presents in the early years, but also to facilitate appropriate placement in kindergarten and grade school, with a view to helping the child make the most of his positive attributes. This continuing interest (in cooperation with the Child Guidance Clinic of Greater Winnipeg) might forestall the disappointments and discouragements so commonly seen now when such children are first identified as “problems” as they enter first grade. It is recognized that a facility such as this cannot support itself on the basis of income received for service, nor on the basis of grants from various foundations or federal sources which are predictable only a year at a time. This being so, the board and medical staff of the hospital have recommended that it be a department of the hospital and its budget be a part of the hospital's budget, accepted by the Hospital Service Plan of the Province. This has not yet been definitely assured but steps are being taken toward it or with a view to obtaining financial assistance from the Psychiatric Division of the Department of Health of the Province. If this clinic can be as effective in the field of preventive psychiatry as we expect it to be, a considerable expenditure of public funds will certainly be justified.