Plagiocephaly/Torticollis

Essential referral information

Referral will be returned without this. If a mandatory test cannot be obtained, say so in the referral.

- As specified in key criteria, evidence of prenatal alcohol exposure is required (i.e., directly reported, witnessed or documented in formal records), including details regarding frequency, duration and quantity of consumption. Where possible the AUDIT-C should be completed to characterise alcohol exposure during the target pregnancy. - Sufficient screening of symptoms or behaviours of concern. This may include developmental status, mental health status, behaviour and/or social wellbeing - If school-based behaviours are the primary reason for the referral, provide a letter from the school outlining behaviours of concern. - Specify what medical investigations, if any, have been requested or completed (e.g., laboratory tests, medical imaging). Please attach copies of results where available. Please provide a reason when investigations are clinically indicated, but not yet completed. - Medical history including: - Information regarding adverse events during pregnancy or birth - Details regarding relevant medical events - Provide evidence and source of current diagnoses (e.g., Intellectual Disability, Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Anxiety, Post-traumatic Stress Disorder, Reactive Attachment Disorder etc.) - Specify what assessments, if any, have been completed by external service providers (i.e., Allied Health Practitioners, Department of Education). Please provide a summary of findings or attach copies of reports where available. - Sufficient information of screening of developmental concern. Greater detailed information will allow more accurate categorisation - This may be any of the following: - A developmental screening tool - A Community Child Health Nurse or health worker developmental assessment - An allied health assessment - Sufficiently detailed developmental milestone history - A detailed description of the developmental delays and presenting concerns from referrer and parent - See CHQ Red Flag Early intervention Guide and report any developmental red flags child is not meeting - Confirm presence or absence of concerning features: - Is there definite history of developmental regression, and if so what specific loss of skills have been noted? - Is the child expected to be in out of home care supervised by the CSYW for more than 6 months? - Is there a risk of the child’s current placement breaking down? - Is there a risk of parents relinquishing care due to child’s behaviour / developmental concerns? - Is the child unable to attend childcare/school, at risk of expulsion or been repeatedly suspended due to their behaviour or developmental concern? - Is the child engaging in physical aggression or other behaviours that places either themselves or family members (e.g. younger siblings) at risk and /or harming animals or destroying property? - Are there any associated abnormalities on neurological or physical examination