Pan-Dorset (Bournemouth, Dorset and Poole) Development and Behaviour Referral Pack and Guidance for Professionals

Transcription

1 Pan-Drset (Burnemuth, Drset and Ple) Develpment and Behaviur Referral Pack and Guidance fr Prfessinals 1. Intrductin 1.1. This referral pack has been designed t prvide infrmatin and advice t prfessinals frm health, educatin and scial care, wh have cncerns abut the develpment and behaviur f children and yung peple under their care and are thinking abut a referral t paediatric services. It cntains practical advice and referral frms and shuld be used in cnjunctin with the Develpment and Behaviur Pathway develped lcally by clinicians, prfessinals, parents and carers and the vluntary sectr. There are sme minr differences in hw services are delivered by health trusts acrss Drset, but referral criteria and pathways have been prduced jintly, with stakehlder invlvement frm the utset. There is a strng cmmitment t imprve utcmes fr children, yung peple and families frm all agencies acrss educatin, health and scial care This dcument uses the term develpment and behaviur as shrthand fr a variety f neurdevelpmental cnditins, such as ADHD, autism spectrum disrders, r develpmental crdinatin disrders, r ther brader develpmental difficulties, which may result in a wide range f behaviurs that are cncerning. 2. Current Services 2.1. Currently, Ple Hspital NHS Fundatin Trust prvides acute and cmmunity paediatric services acrss Burnemuth, Ple and east Drset, with a central hub in the Child Develpment Centre at Ple Hspital and clinic bases in varius settings. Drset Cunty Hspital prvides the same services fr nrth and west Drset, again with a central hub in the Children s Centre at the hspital and ther clinics acrss the cunty. There is jint wrking with Drset Healthcare (DHC), which prvides speech and language therapy (SALT), Child and Adlescent Mental Health Services (CAMHS) and learning disability services. Paediatric ccupatinal therapy services are prvided by bth Ple and Drchester Hspitals. The three lcal authrities: Drset, Burnemuth and Ple prvide educatinal psychlgy and learning supprt services t schls. There is a wide range f early years supprt fr pre-schl children, including prtage and additinal input at nursery if apprpriate The new CAMHS referral criteria shuld be cnsulted t, as they may prvide a mre apprpriate service (see Appendix 6) t the child r yung persn and their family. 1

2 3. Backgrund 3.1. In rder fr children t grw and develp t their full ptential, they need t be surrunded by an envirnment (family, hme, nursery, schl) that prvides rich pprtunities fr them t develp, cmmunicate and learn. Mst children will prgress as expected, but sme may find it harder and experience specific difficulties which may need additinal input, smetimes frm universal services and smetimes frm mre specialist services. Children are clearly all individuals and there will be differences between them which may nt be best understd using a diagnstic framewrk. It is imprtant t understand that a child s difficulties require recgnitin and supprt, nt necessarily a specific diagnsis. Supprt may invlve schl, r nursery and child minders, as well as the family in the hme setting. Integrated cmmunity children s services are a vital part f the assessment and interventin prcesses. Gd cmmunicatin between services is essential The majrity f children presenting with behaviural and/r develpmental cncerns at hme and pssibly at nursery r schl can, and shuld, be supprted by universal services, such as health visiting (HV), schl nursing (SN), nurseries and schls. Prfessinals wh knw the child shuld be able t prvide advice, supprt and reassurance (where apprpriate) withut immediate referral t specialist services. Hwever, fr sme children, particularly pre-schl children, initial cncerns may be f significance and referral nwards shuld nt be delayed. It shuld, hwever, be accmpanied by specific advice and an ffer f further supprt whilst the child and family are waiting Lcal services have wrked tgether t design an agreed referral pathway, with referral frms which trigger the cllectin f apprpriate infrmatin, as well as advice n early interventin strategies. The new CAMHS and Speech and Language Therapy Referral Pathways (Appendices 6 and 7) sit alngside the Paediatric Cmmunity/Neurdevelpmental Pathways Schl entry is a natural time f transitin and universal services prvided fr children change at this time. Pre-schlers are predminantly supprted by health visitrs, cmmunity nursery nurses and early year s special educatinal needs and disability c-rdinatrs (SENDCOs). Schl age children are supprted by schl SENDCOs and schl nurses. These prfessinals are well placed t make referrals and c-rdinate all the necessary infrmatin in supprt f this. It is imprtant that schls shuld nt indicate t families that a frmal diagnsis is needed t access educatinal supprt r additinal funding Whilst all children have access t their GP in relatin t health issues, if the primary cncern is abut develpment and behaviur, then a shrt GP cnsultatin slt will nt enable full cnsideratin f all relevant issues. GPs may be asked t prvide additinal infrmatin fr the referral, if required. Referrals received by the paediatric department will be triaged by a cnsultant neurdevelpmental paediatrician Referrals may be accepted frm GPs r ther prfessinals wh knw the child and family in exceptinal circumstances, recgnising that symptms f neurdevelpmental cnditins may 2

3 nt be evident in all settings and sme children may be educated at hme. Hwever, it will still be necessary fr infrmatin t be gathered frm previus r current schls (if available) t supprt the referral. Reprts frm ther prfessinals wh knw the child are likely t be very helpful and shuld accmpany any referral Fr children wh have mved int the area with an already recgnised cnditin, as much infrmatin as pssible shuld be sent n t the cnsultant neurdevelpmental paediatrician, with apprpriate infrmatin sharing t ensure supprt is put in place at schl r nursery as necessary. 4. Wh shuld I refer? 4.1 Children wh present with behaviural and develpmental difficulties, where there is cncern there may be an underlying neurdevelpmental cnditin requiring a diagnstic assessment. Further infrmatin n the cnditins which can be assessed by the neurdevelpmental paediatricians can be fund in Appendix Difficulties shuld be causing an impact n the child s functining and shuld have been present and persistent fr a perid f time in different settings, althugh presentatin may vary. There shuld be nging cncern, even after early interventin/supprt. 4.3 Children and yung peple aged 0 16 years, wh have a Drset GP and live in Burnemuth, Ple r east Drset, shuld be referred t the CDC at Ple Hspital NHS Fundatin Trust. Currently, children aged with a mental health cncern shuld be referred t CAMHS. 4.4 Children and yung peple aged 0 18 years, wh have a Drset GP and wh live in west r nrth Drset, Weymuth r Prtland, shuld be referred t the Paediatric Department, Children s Centre, Drset Cunty Hspital, unless there is a mental health cncern. Of nte, further wrk is being undertaken t align age criteria acrss the cunty. 5. When NOT t use this pathway: 5.1. If any f the fllwing cncerns are als present, then the referrer shuld seek medical attentin sner, usually via the GP, rather than this pathway: Cncerns abut seizures and pssible epilepsy Cncerns abut develpmental regressin, r lss f skills Cncerns abut physical grwth Cncerns abut physical health, including headaches Cncerns abut hearing r visin, and Children with mental health difficulties may meet criteria fr referral t CAMHS (Appendix 6). General health cncerns are nt the remit f this pathway. 3

4 6. Befre Referral The fllwing interventins and actins are expected befre any nward referral. Please cnsider whether referral is apprpriate, using the infrmatin in this pack, and fllw the actins as detailed belw Pre-schl children with cncerns abut develpment and behaviur at hme and/r at nursery The health visitr r nursery nurse wuld be expected t listen t cncerns frm parents r carers and make an assessment f the child s needs, which wuld usually include an bjective assessment with the apprpriate Ages and Stages Questinnaire (ASQ) fr the child s age. The health visitr shuld use prfessinal judgement at this stage t decide whether it is apprpriate t ffer early interventin, supprt with ASQ materials, Children Centre input, Early Help, parenting supprt, and review befre cnsidering referral. Liaisn with the nursery, pre-schl setting r child minders wuld be expected and a reprt requested frm them. This is helpful, even if nursery d nt have cncerns, t build up a picture f the child s strengths and difficulties. Cpies f nursery early years assessments shuld be requested. Referral fr a speech and language therapy assessment may be apprpriate (see Appendix 7), as may a referral fr an audilgical assessment, thugh there is n need fr this t be rutine if the child has passed the Newbrn Hearing Screening Prgramme (NHSP) and there are NO current cncerns abut hearing. The health visitr can refer n t the lcal prtage service; they can ntify the apprpriate educatin authrity (with a Health t Educatin Ntificatin (HEN)/EA2 frm) if it seems likely that the child will need a very high level f additinal supprt at schl If the nursery is cncerned abut a child s develpmental prgress, they shuld fllw the prcesses f the SEND Cde f Practice and, if necessary, seek supprt frm their SENDCO. The health visitr can refer n t the lcal prtage service; they can ntify the apprpriate educatin authrity (with a Health t Educatin Ntificatin (HEN)/EA2 frm) if it seems likely that the child will need a very high level f additinal supprt at schl If cncerns are significant at the first presentatin, r persist after supprt, then the Pre- Schl Behaviur/Develpment Referral Frm (Appendix 1) shuld be cmpleted FULLY and sent t the apprpriate cmmunity paediatrician in the east (Ple Hspital) r t the cmmunity paediatric team at Drset Cunty Hspital. Any referrals nt fully cmpleted may be returned fr further infrmatin. (See Sectin 7) Schl age children where there are cncerns abut learning, behaviur and scial develpment at hme and/r at schl Special Educatinal Needs and Disability (SEND) fall int fur brad categries. Any, r all, can impact n learning, behaviur and scial develpment. The fur areas are:

5 Cmmunicatin and interactin Cgnitin and learning Scial, emtinal and mental health, and Sensry and/r physical needs Schls shuld fllw the SEND Cde f Practice: Schls shuld: Assessment and identificatin f the child s needs Ensure the child has access t quality first teaching, and that a graduated apprach/ respnse is implemented t supprt the child s needs Relevant and purpseful actin and reasnable adjustments shuld be made and, where necessary, drawn tgether in an SEN supprt plan, and Review f the supprt shuld take place regularly. Cnsider whether the child s difficulties may be due t an underlying learning prblem and seek advice frm relevant specialists, fr example, educatinal psychlgist, SENSS, r LSS if there are significant cncerns regarding cgnitive ability, r specific learning difficulties, such as dyslexia Schl shuld ensure parents/carers have been ffered an evidence based parenting/behaviur management curse (e.g. Triple P, Incredible Years/Webster Strattn) Cnsider the whle cntext f the child s daily life and nte the ptential impact f family disruptin, scial deprivatin, parental mental health difficulties and traumatic life events n their presenting behaviur Cnsider whether the child s difficulties may be due t an underlying prblem with cre speech and language skills and, if s, make a referral t the Speech and Language Therapy Service, accrding t their service referral criteria (see Appendix 7) Prvide early supprt/interventin fr identified needs whilst assessment cntinues. Supprt shuld be needs led and des NOT require a specific medical diagnsis t have been made Ask the schl nurse t check hearing and signpst parents/carers fr visin testing at a lcal ptician/ptmetrist where relevant, and Advise parents t take their child t the GP if there are cncerns regarding physical health Supprt fr children with identified difficulties with scial cmmunicatin: Schls shuld implement strategies knwn t be gd practice in supprting scial cmmunicatin and interactin difficulties. These include visual appraches, structured wrk systems and supprt t develp scial and emtinal skills such as Scial Thinking, input frm an emtinal literacy supprt assistant (ELSA) and Scial Use f Language Prgramme etc. 5

6 Such appraches shuld be implemented, mnitred and evaluated in rder t assess the child s respnse t interventins knwn t supprt children with scial cmmunicatin needs, and The Autism Educatin Trust prduces a set f Autism Standards which utline gd practice. Schls shuld aim t be meeting these standards. 7. Making Referrals 7.1. If cncerns regarding the pssibility f an underlying neurdevelpmental cnditin persist, fllwing early supprt and interventin, referral t the cmmunity paediatrician shuld be made n Pre-schl Cmmunity Paediatric Referral Frm (Appendix 1, included in this pack), prviding ALL requested infrmatin. Fr pre-schl children, referrals wuld generally be expected t cme frm health visitrs r cmmunity nursery nurses (under supervisin f named health visitr), but speech and language therapists r early years SENDCOs may wish t refer directly Fr schl age children, referrals shuld be made by the SENDCO. In exceptinal cases, referrals may be accepted frm GPs Fr all children, the referral frm shuld be cmpleted FULLY. Any referrals nt fully cmpleted may be returned fr further infrmatin. It is essential that all available reprts and assessments are included with the frm. Referrals will be reviewed by a cnsultant neurdevelpmental paediatrician Ensure parental cnsent t share infrmatin is agreed and dcumented as part f the referral prcess. Fr lder children and adlescents, it is gd practice t let them knw when a referral is made and the reasns why. 8. Supprt during the time f the Assessment 8.1. Schls will need t ensure they are fllwing a graduated respnse t addressing the child s needs. The identificatin f a child s needs thrugh schl will enable apprpriate educatinal strategies t be implemented. These, alng with recmmendatins frm external assessments, will be incrprated int the child s SEN supprt plan If there are cncerns regarding scial cmmunicatin skills, schls shuld prvide supprt thrugh strategies such as ELSA input, Scial Use f Language Prgramme (SULP), buddy systems, Circle f Friends etc. Schls shuld implement psitive behaviur supprt strategies that are knwn t be helpful in ASD and ther neurdevelpmental cnditins such as ADHD. Whilst assessment cntinues, supprt shuld be needs led and des NOT require a specific medical diagnsis t have been made. 6

7 9. Other cncerns 9.1. Physical skills/c-rdinatin This pathway shuld NOT be fllwed if there are cncerns abut an acute neurlgical abnrmality (lss f mtr skills, changes in persnality r assciated ill-health). Schl r health visitrs shuld advise parents/carers t take their child t the GP. Infrmatin is available n the Ple Hspital NHS Fundatin Trust website (search handuts fr parents ) cvering cmmn c-rdinatin and mtr skill difficulties, which may be helpful t bth parents and prfessinals. C-rdinatin difficulties rarely exist in islatin and can be assciated with cncerns abut behaviur and learning. The advice given in Sectin 6 abve shuld be fllwed. The child must have had the pprtunity t participate in prgrammes that develp their physical skills e.g. Learn t Mve, Mve t Learn, Strycise. If prgress has nt been made fllwing regular input ver tw schl terms, the schl can refer directly t Children s Therapy Services at Ple Hspital r Drset Cunty Hspital fr the child t be seen by either an ccupatinal therapist r physitherapist Sensry issues Sensry issues may exist n their wn, r can be assciated with a variety f neurdevelpmental difficulties. There may be a manifestatin f high anxiety levels ften assciated with autism spectrum disrders but are NOT diagnstic f ASD r nly seen in individuals with an ASD. The ASD Occupatinal Therapy service at Ple Hspital has infrmatin regarding sensry needs n the hspital website (search sensry integratin ) which schls can access. The paediatric therapists cannt see children and yung peple fr sensry assessments unless a frmal ASD diagnsis has been made. The paediatric therapists at Drset Cunty Hspital will see children and yung peple as part f an autism assessment t meet Natinal Institute fr Health and Care Excellence (NICE) guidelines, but nly thse referred directly by the paediatricians in the diagnstic team. They can ffer sensry assessments, pst-diagnsis, fr thse individuals wh d nt have learning needs and whse independence and functin is severely impacted by sensry behaviurs. Schls can implement prgrammes t supprt sensry integratin needs e.g. sensry circuits. Schls can request sensry integratin assessments frm external agencies e.g. SENSS Audilgy Services in the east f the cunty are prvided by DHC frm Shelley Rad, Burnemuth. Referrals fr children in whm there are cncerns abut hearing shuld be addressed t East Drset Audilgy Service, 11 Shelley Rad, Burnemuth BH1 4JQ. In the west, Drset Cunty Hspital prvides audilgy services. Referrals shuld be addressed t Audilgy Department, Drset Cunty Hspital, Williams Avenue, Drchester, Drset DT1 2JY. 7

8 9.4. Mental Health Acrss the cunty there are six cre CAMHS teams and tw Intellectual Disabilities CAMHS teams. These teams ffer specialist assessment and treatments fr children and yung peple with a wide range f mental health difficulties (please refer t Appendix 6 fr further details). CAMHS are able t ffer a specialist service t children aged 0 18 years wh are experiencing mental health difficulties. Parent and wider family supprt is ffered as part f the treatment plan where apprpriate. When reviewing referrals sent t CAMHS, the presenting difficulties will be cnsidered in relatin t the IMPACT, DURATION and CONTEXT. There is an expectatin fr supprt t have been put in place fr the child r yung persn and their family/carer prir t a referral t CAMHS, unless there is significant risk r the symptms are severe. Where the mental health difficulties persist r wrsen, a referral t CAMHS is apprpriate. If the primary cncern relates t a mental health difficulty fr the child r yung persn that is impactful, persistent and/r wrsening despite supprt in place, it wuld be apprpriate t initiate a referral t CAMHS. 10. Data Prtectin The new Data Prtectin Act 2018 came int frce n 25 May In relatin t the pathway, the fllwing prcesses will be in place relating t data, cmmunicatins and accuntability: All referrals t the pathway must have the cnsent f the parent (this is utlined n the referral frm) It must be made explicit t the family that part f the assessment prcess will require sharing f persnal infrmatin acrss health, educatin and scial care settings. Required permissins must be sught and all parties must be made aware. Restricted infrmatin will be clearly identifiable Only infrmatin that is relevant t the assessment prcess will be btained and it will be made clear thrughut the assessment pathway abut hw the infrmatin will be used Depending n the referral rute, the data btained thrughut the assessment prcess will be securely stred n the relevant data systems. Parents/carers will be made aware f where the data is stred. Only clinicians with a specific need t access the infrmatin will have access, and Any breaches t the security f data will be taken seriusly and investigated fully. There is a Data Prtectin Officer (DPO) in place fr each trust (DHUFT, DCH and PGH) t ensure cmpliance with the DPA At the time when persnal data are btained the child and/r parents/carers must be prvided with all f the fllwing infrmatin: The identity and cntact details f the persn cllecting the infrmatin The cntact details f the Data Prtectin Officer in the rganisatin Hw the data will be stred in the rganisatin The purpse fr cllectin f the data and hw it will be used 8

9 The recipient, r categries f recipients, f the data Hw the child and/r parents/carers can request that their infrmatin be remved frm recrds. 11. Further Infrmatin Drset Cunty Cuncil schls can access specialist supprt and advice frm the SENSS team based at Learning & Inclusin Services, Mnktn Park, Winterburne, Drchester, Drset DT2 9PS. Tel: Fr specific advice n behaviur and structuring change, further infrmatin can be fund via Autism Wessex based at Parley Lane, Christchurch, Drset BH23 6BP. Tel: enquiries@autismwessex.rg.uk. Yu d nt need a diagnsis t access this infrmatin. Fr specific ideas abut structuring change, cntact the Autism Educatin Trust based at Natinal Autistic Sciety, 393 City Rad, Lndn EC1V 1NG. Tel: inf@autismeducatintrust.rg.uk. 9

10 Appendix 1 Pre-Schl Cmmunity Paediatric Referral Frm Pre-Schl Cmmunity Paediatric Referral Frm All sectins shuld be cmpleted with as much detail as pssible If yu d nt have the relevant infrmatin, please discuss with the Child s HV r CNN. Please PRINT this frm and send t the apprpriate paediatrician In this versin f the frm, the sectins will expand t accmmdate the text yu enter Full Name and Details: Name: Date f Birth: Click t enter a date. Address: NHS Number (if knwn): Language at Hme: Special requirements: (e.g. interpreter, sensry impairment) Educatin Setting /Pre-Schl/Childminder: Gender: Parent/Carer Name(s): Other Members f the Husehld: Reasn(s) fr referral: (What is yur clinical questin?) Relatinship: Cntact Number: Medical Backgrund: (Pregnancy and birth histry; significant past medical histry. Hearing and visin testing if relevant. Active referrals) Family and scial backgrund: (including emplyment, relevant health issues, scial care, husing etc.) Clinical Query: (What is the clinical questin? What is the backgrund t this? What are yur findings n bservatin/examinatin?) Interventins and Strategies: (what has been dne / ffered / t be dne, t supprt the child/family) Expectatin f utcme: 10

11 Cnsent: Please Nte: Cnsent shuld be frm a parent/carer with parental respnsibility fr the child. Fr this referral: Yes N Fr relevant infrmatin t be shared with the apprpriate prfessinals: Yes N Supprting infrmatin attached: (please include recent ASQs, SLT reprts, nursery assessments. Please request a written reprt frm nursery/pre-schl, particularly if they have raised cncerns) Other agencies/prfessinals invlved (please indicate the key wrker, if exists): Any ther infrmatin r cmments: Referrer Details: Name: Designatin: Address: Cntact Number: Rle with the child and family: Referrer Name and Signature: Date: Click here t enter a date. 11

12 Appendix 2 Schl Age Cmmunity Paediatric Referral Frm Schl Age Cmmunity Paediatric Referral Frm All sectins shuld be cmpleted with as much detail as pssible If yu d nt have the relevant infrmatin, please discuss with the Schl SENDCO and parent(s)/carer(s). This frm will need t be cmpleted and PRINTED and sent t the apprpriate paediatrician. In this versin f the frm, the sectins will expand t accmmdate the text yu enter Full Name and Details: Name: Date f Birth: Click t enter a date. Address: NHS Number (if knwn): Gender: Parent/Carer Name(s): Other Members f the Husehld: Language at Hme: Special requirements: (e.g. interpreter, sensry impairment) Educatin Setting /Schl and Schl Year: Reasn(s) fr referral: (backgrund, strengths/difficulties, impact n child/family/schl, etc.) Relatinship: Cntact Number: Knwn Medical Cnditins/Existing diagnses: (include utcmes/frmulatin f existing assessments if knwn, e.g. cgnitive, mental health, scial care assessments, etc.) Hearing Check: Yes N Date:.. Visin Check: Yes N Date:.. Family and Scial Backgrund: (including emplyment, relevant health issues, scial care, husing etc.) Expectatin f Outcme: 12

13 Cnsent: Please indicate belw that apprpriate cnsent has been btained (including cnsent fr this referral and relevant infrmatin t be shared and a cpy kept within the patient recrd) frm either the Yung Persn aged 13+ r frm the parent/carer with parental respnsibility. In accrdance with the Data Prtectin Act 2018, Yung Peple 13+ have the right t make decisins fr themselves unless it is shwn that they are unable t make them. Cnsent f Yung Persn 13+ Fr this referral: Yes N Fr relevant infrmatin t be shared with the apprpriate prfessinals: Yes N Fr children under the age f 13, cnsent shuld be frm the parent/carer. Please nte: this shuld be a persn wh has parental respnsibility. Cnsent f Parent/Carer with parental respnsibility Fr this referral: Yes N Fr infrmatin t be shared with the apprpriate prfessinals: Yes N Supprting Infrmatin: (please attach all relevant reprts and prvide an interpretatin f these fr the clinician) Learning Level/Academic Prgress: Tick which bxes apply and please give specific infrmatin Individual learning/sen plan: Educatinal Psychlgist: SENISS/SENSS: SALT: Behaviur Supprt Services: CAMHS: Scial Care: Special Schl Outreach: Standardised Spelling Level Standardised Reading Level Standardised Maths Level Yes N Yes N Yes N Yes N Yes N Yes N Yes N Yes N. Other (e.g. EHC plan): 13

14 Interventin/Supprt: Learn t Mve/Mve t Learn Prgramme: Yes N Cmpletin f evidence based behaviur management/parenting prgramme: (please state name f the prgramme) Other: Are there any cncerns regarding the child s emtinal wellbeing due t external life events, family r scial difficulties? Yes N If yes, please prvide as much detail as pssible: Supprting infrmatin attached: (please include reprts frm educatinal and therapy assessments) Any ther infrmatin r cmments: Referrer Details: Name: Designatin: Address: Cntact Number: Click r tap here t enter text. Rle with the child and family: Referrer Name and Signature: Date: Click here t enter a date. 14

15 Appendix 3 - Glssary ADHD ASD r ASC ASQ CAMHS CDC CNN CYP DHC DCH ELSA EP EYFS HEN HV LSS NHSP Ormtr dyspraxia SALT SEAL SENDCO SENISS SN SGS SULP Attentin Deficit Hyperactivity Disrder Autism Spectrum Disrder r Cnditin Ages and Stages Questinnaire Child and Adlescent Mental Health Services Child Develpment Centre Cmmunity Nursery Nurses Children and Yung Peple, r Child and Yung Persn Drset Healthcare Drset Cunty Hspital Emtinal Literacy Supprt Assistant Educatinal Psychlgist Early Years Fundatin Stage Health t Educatin Ntificatin Health Visiting Learning Supprt Services Newbrn Hearing Screening Prgramme Is a frm f dyspraxia. It is als called verbal apraxia r apraxia f speech. It can be difficult t crdinate muscle mvements needed t prnunce wrds. Speech and Language Therapy Scial and Emtinal Aspects f Learning Special Educatinal Needs and Disability C-rdinatr Special Educatinal Needs Inclusin Supprt Service Schl Nursing Schedule f Grwing Skills Scial Use f Language Prgramme 15

16 Appendix 4 Helpful infrmatin t supprt understanding arund neurdevelpmental cnditins A large spectrum f neurdevelpmental cnditins is recgnised in children, ften with significant verlap between individual diagnses. Frequently, children may present with difficulties which DO NOT meet criteria fr a specific diagnsis, but wh wuld benefit frm supprt at hme and/r at schl t help prmte psitive learning and develpment and prevent lng-term sequelae (e.g. lw self-esteem r challenging behaviur). Mst children presenting with cncerns abut learning r behaviur are healthy, but there are sme imprtant medical cnditins which shuld be cnsidered. Therefre, assessment by a paediatrician may be necessary. This paediatrician shuld als be able t make an assessment f many, but nt all, neurdevelpmental cnditins. Examples f cnditins which can and cannt be diagnsed by the Cmmunity/Neurdevelpmental Paediatric teams at Ple and Drset Cunty Hspitals are prvided belw. Further infrmatin is available n the NHS Chices website 1. ADHD: Attentin Deficit Hyperactivity Disrder This is a cnditin characterised by impulsivity, inattentin, distractibility and hyperactivity, which must be present in mre than ne setting and been bvius befre the age f 7 years. Mst paediatricians will nt diagnse ADHD/Hyperactivity in pre-schl children. The first line f interventin is supprt fr parents, with an evidence based parenting prgramme. Parents shuld be referred fr this a diagnsis is nt necessary. Infrmatin frm schl is essential as part f the assessment fr ADHD/Hyperactivity. Cncerns shuld initially be discussed with the teacher and SENDCO. Objective rating scales will be used t prvide mre infrmatin. Medical treatment is an ptin fr sme children. 2. ASD: Autism Spectrum Disrder This is nt as cmmn as the many ther causes f disrdered behaviur in children the spectrum is wide. Difficulties with interactin, cmmunicatin, restricted/repetitive behaviurs and interests are all part f Autism. NICE guidance recmmends that diagnsis is made by a multidisciplinary team, which shuld include: a paediatrician, r psychiatrist and a speech and language therapist. Autism may be recgnised in a very yung child, r may nt becme apparent until after sme time in schl. 3. Attachment Needs and Trauma Children wh have suffered significant trauma, r have had disrupted attachments in their early life, can shw difficulties in adjusting their behaviur in scial situatins. It can affect their learning and prgress in schl, as well as their scial interactin skills and ability t integrate infrmatin thrugh their senses. These children will be best seen in CAMHS, rather than paediatrics. 16

17 4. DCD: Develpmental C-rdinatin Disrder This was ften described with the term dyspraxia, thugh the tw are nt strictly synnymus. It describes children wh have mtr skills at the bttm f the expected range usually belw the 5 th percentile. Children are generally clumsy, with pr mtr skills but n neurlgical abnrmality. Grss r fine mtr skills may be affected, r sme children have an rmtr dyspraxia. Children with Develpmental C-rdinatin Disrder can ften have difficulties acrss areas f functining, including with academic prgress and scial interactin. They usually have nrmal intellectual abilities, but their mtr c-rdinatin difficulties may impact n their academic prgress, scial integratin and emtinal develpment. 5. DLD: Develpmental Language Disrder This cnditin is characterised by mderate t severe language difficulties, in turn having a mderate t severe functinal impact. It des nt respnd well t universal appraches and needs targeted and specialist input. A child with DLD will have nging significant language needs, despite early universal interventin. DLD presents in pre-schl children, but is usually nt diagnsed until a child is in schl. A speech and language therapist wuld make this diagnsis. It can c-exist with ther neurdevelpmental difficulties such as ADHD r Dyslexia. Hwever, if there is a specific diagnsis assciated with a language disrder fr example, an ASD, Dwn Syndrme r a hearing impairment, the child s difficulties wuld be described as a language disrder assciated with X. 6. Dyslexia/Dyscalculia These are specific learning difficulties, affecting literacy and numeracy respectively. They ften verlap with the neurdevelpmental cnditins described here, but they are NOT diagnsed by paediatricians. Cncerns abut these cnditins shuld be discussed with the schl. 7. LD: Learning Disability, can be mild, mderate (MLD) r severe (SLD) In the UK, this term describes an individual with an IQ f less than 70, with sme significant implicatins fr access t services, including CAMHS and adult supprt. The paediatric service is nt cmmissined r prvisined t measure the child s IQ. Yunger children with learning difficulties tend, initially, t be described as having glbal develpmental delay r early develpmental impairment, with LD being used when it is clear there will nt be significant catchup. Psychlgists can make frmal assessments f IQ, but as this scre is nt always the mst useful measure, they tend t prvide different infrmatin. Hwever, it can be essential in deciding whether r nt a child meets diagnstic criteria fr an ASD, r what supprt services they may be eligible fr in child/adulthd. 8. ODD: Oppsitinal Defiant Disrder and Cnduct Disrder These are behaviural cnditins which are defined in the DSM-5 and ICD-10. They ften c-exist with neurdevelpmental cnditins listed here and are als assciated with emtinal distress, but wuld nt be seen as primary paediatric cnditins. Supprt fr parenting and behaviur management wuld be the first line f interventin. 17

18 9. PDA: Pathlgical Demand Avidance 18 This is a cntrversial diagnsis that is neither in the American nr Eurpean classificatin f diagnses. In the UK, it is generally cnsidered t be a manifestatin f Autism rather than a separate diagnsis. Drset des nt have the tls r experience t diagnse r refute this and will nt be in the psitin t be ffering any assessment regarding the questin f PDA. 10. SPD: Sensry Prcessing Disrder Sensry Prcessing Disrder is NOT currently recgnised as a specific diagnstic entity. Many children with an ASD will have sensry prcessing difficulties, but they are nt required fr an ASD diagnsis and can be seen in children withut Autism. The Ple Hspital paediatric and ccupatinal therapy services are nt cmmissined t ffer specific assessment r interventin fr children with sensry prcessing difficulties that are nt part f a diagnsed neurdevelpmental disrder. The Ple Hspital website prvides infrmatin fr families with cncerns abut sensry prcessing difficulties. The paediatric therapists at Drset Cunty Hspital will see children and yung peple as part f an autism assessment t meet NICE guidelines, but nly thse referred directly by the paediatricians in the diagnstic team. They can ffer sensry assessments, pst-diagnsis, fr thse individuals wh d nt have learning needs, where their independence and functin is severely impacted by sensry behaviurs. Drset Cunty Cuncil schls can access specialist supprt and advice frm the SENSS team based at Inclusin Services, Mnktn Park; tel: Fr specific advice n behaviur and structuring change, cntact Autism Wessex; tel: r enquiries@autismwessex.rg.uk. Fr ideas abut structuring change, cntact the Autism Educatin Trust based at Natinal Autistic Sciety, 393 City Rad, Lndn EC1V 1NG. Tel: inf@autismeducatintrust.rg.uk, Auditry Prcessing Disrder This is nt diagnsed by the paediatricians at Ple Hspital, Drset Cunty Hspital r the lcal Audilgy Service. 12. Sleep Disturbance Sleep disturbances are cmmn in children, ften as part f a brader cncern abut behaviur. Services which supprt parents t manage sleep difficulties with a behaviur apprach are available thrugh the health visiting team, r schl nursing service. Services which supprt evidence based practice in the management f children with challenging behaviur (including sleep disturbance) are available thrugh the Actin fr Children (Incredible Years Parenting) and Early Help services within each lcal authrity. The paediatric team at Ple Hspital cannt ffer assessment f children with sleep difficulties that are nt part f a brader neurdevelpmental disrder. Melatnin (and ther medicatins t address sleep difficulties in therwise neurtypical children) is nt advised as first line interventin fr sleep disturbance. The Drset Prescribing Frum des nt supprt prvisin f melatnin prescriptins fr children presenting t the Paediatric Service with a sleep disturbance.

19 13. Turette s Syndrme This is defined as the presence f phnic and mtr tics, fr mre than 12 mnths in adults (smetimes a shrter time in children). The Great Ormnd Street Hspital website has a gd infrmatin sheet n this as des the Turette s Actin website 19

20 Appendix 5 Referral int Pathway Befre Referral 20

21 ... Referral & Supprt Referral Wh shuld I Refer? Children wh present with behaviural and develpmental difficulties where there is cncern there may be an underlying neurdevelpmental cnditin Children and Yung Peple aged 0-16 years wh have a Drset GP and wh live in Burnemuth, Ple and East Drset Refer t the CDC at Ple Hspital NHS Fundatin Trust The difficulties shuld be causing an impact n the child's functining and shuld have been present fr a perid f time Children and Yung Peple aged 0-18 wh have a Drset GP and wh live in West r Nrth Drset Refer t the Children's Centre at Drset Cunty Hspital NHS Fundatin Trust Children and Yung Peple aged 0-18 experiencing mental health difficulties Referral t CAMHS shuld be cnsidered. See Referral Guidance (Appendix 6) Supprt Schls will need t ensure they are fllwing the graduated respnse. Identificatin f a child's needs thrugh schl will enable educatinal strategies t be implemented. Educatinal strategies and external assesments shuld be incrprated int the Child's SEN supprt plan If there are cncerns regarding scial cmmunicatin skills schls shuld prvide supprt via ELSA, SULP etc. Schls shuld implement behaviur management strategies knwn t be helpful fr neurdevelpmental cnditins Whilst assesment takes place supprt shuld be needs led and des nt require a specific medical diagnsis t have been made 21

22 Other Cncerns Physical Skills/C-rdinatin, Sensry Issues & Audilgy 22

23 Appendix 6 CAMHS Referral Criteria and Pathway Cre Child and Adlescent Mental Health Services (C-CAMHS) Referral Supprt and Guidance 23

24 Appendix 7 Paediatric Speech and Language Therapy Service Referral Pathways and Mdels f Care 1. Referral Pathway Fr the assessment f speech, language and scial cmmunicatin characteristics f imprtance t the diagnsis f Autistic Spectrum Disrders. As part f the multi-agency Pan Drset Paediatric Neurdevelpmental and Behaviur Assessment Pathway Acceptance criteria (all referrals) Children and yung peple aged 0 18 years wh are registered with a Drset GP practice. Referrals frm nn-health agencies and rganisatins require signed parental cnsent. 1.2 Additinal access criteria fr this specific referral pathway Fr children and yung peple n the Pan-Drset Paediatric Neurdevelpmental and Behaviur Assessment Pathway requiring multi-agency assessment fr Autism Spectrum Disrders, in accrdance with diagnstic criteria fr Autism (DSM-5). 1.3 Additinal exclusin criteria fr this specific referral pathway Where the service user has been seen fr ASD assessment within the last 12 mnths. 24

25 1.4 Referral rutes and criteria Parent /Carer Direct referrals are nt accepted. If the child is already under the care f the speech and language therapy service, discuss cncerns with the therapist. 0-5 years (pre-schl): discuss cncerns with the health visitr wh will assess needs and liaise with ther early years agencies (i.e. nursery) and cnsider whether t refer fr specialist speech and language assessment in accrdance with the Pan-Drset Paediatric Neurdevelpmental and Behaviur Assessment Pathway. Schl age: discuss cncerns with the schl wh will assess needs and liaise with ther agencies (i.e. educatinal psychlgist) and cnsider whether t refer fr specialist speech and language assessment in accrdance with the Pan-Drset Paediatric Neurdevelpmental and Behaviur Assessment Pathway. Fr children nt in schl, parents t discuss cncerns with the GP. Paediatrician r CAMHS Clinician Referrals will be accepted if additinal speech, language and cmmunicatin infrmatin is required in rder t make a differential diagnsis. Referrals will nt nrmally be accepted if a specialist assessment has already taken place fllwing referral via HV r schl and a reprt with relevant infrmatin has already been prvided. Referrals will nt nrmally be accepted where behaviur is the nly presenting difficulty. Refer t service by electrnic r e-referral r by cmpletin f service specific referral frm. A letter is acceptable if accmpanied by cpies f develpmental histry/backgrund and ther relevant clinical reprts and letters. Send by pst r via secure . Health Visitr / GP Refer t Table 1 'Signs and Symptms in Preschl Children' in this dcument. If criteria is met, refer t service fr specialist assessment by electrnic r e-referral r by cmpletin f service specific referral frm. Schl Refer t Table 2 'Signs and Symptms in Primary Schl Age Children' r Table 3 'Signs and Symptms in Secndary Schl Age Children'. Refer t service fr specialist assessment using specific referral frm. 25

26 2. Recgnitin: ASD signs and symptms in relatin t speech, language and cmmunicatin The signs and symptms in Tables 1 3 are language, scial and cmmunicatin skills and behaviurs, fcusing n features cnsistent with the criteria fr the diagnsis f Autistic Spectrum Disrders (DSM-5). They are nt intended t be used alne, but t help prfessinals wh are cnsidering the pssibility f Autism t recgnise when it is apprpriate t invlve and refer t the speech and language therapy service fr specialist assessment f the child r yung persn s difficulties with speech, language and cmmunicatin. The reprt detailing the utcme f the speech and language assessment (which will include any bserved indicatrs f Autism) is t be included in any nward referral t paediatrics r CAMHS, in accrdance with the Pan Drset Paediatric Neurdevelpmental and Behaviur Assessment Pathway. 2.1 Pre-Schl Age Children Table 1 - Signs and symptms f speech, language and cmmunicatin difficulties which may be pssible indicatrs f Autism in pre-schl children (r equivalent mental age) Spken Language Language delay (in babble r wrds, fr example, less than ten wrds by the age f 2 years). Regressin in r lss f use f speech. Spken language (if present) may include unusual: nn-speech like vcalisatins dd r flat intnatin frequent repetitin f set wrds and phrases ('echlalia'), and reference t self by name r 'yu' r 'she/he' beynd 3 years. Reduced and/r infrequent use f language fr cmmunicatin, fr example, use f single wrds althugh able t speak in sentences. Respnding t Others Absent r delayed respnse t name being called, despite nrmal hearing. Nt fllwing verbal instructins t an age apprpriate level. Other signs and symptms IN ADDITION t the abve Eye cntact, pinting and ther gestures Reduced r absent use f gestures and facial expressins t cmmunicate, althugh may place adult's hand n bjects. Reduced and prly integrated gestures, facial expressins, bdy rientatin, eye cntact (lking at peple's eyes when speaking) and speech used in scial cmmunicatin. Reduced r absent jint attentin shwn by lack f: fllwing a pint (lking where the ther persn pints t may lk at hand). 26

27 2.2 Primary Schl Age Children Table 2 - Signs and symptms f Autism in primary schl children (aged 5 11 years r equivalent mental age) Spken Language Spken language may be unusual in several ways: very limited use mntnus tne repetitive speech, frequent use f steretyped (learnt) phrases, cntent dminated by excessive infrmatin n tpics f wn interest talking 'at' thers rather than sharing a tw-way cnversatin, and respnses t thers can seem rude r inapprpriate. Respnding t Others Reduced r delayed respnse t name being called, despite nrmal hearing. Subtle difficulties in understanding ther's intentins; may take things literally and misunderstand sarcasm r metaphr. Nt fllwing verbal instructins t an age apprpriate level. Other signs and symptms IN ADDITION t the abve Interacting with thers Unable t adapt style f cmmunicatin t scial situatins, fr example may be verly frmal r inapprpriately familiar. Eye cntact, pinting and ther gestures Reduced r absent jint attentin shwn by lack f: gaze switching fllwing a pint (lking where the ther persn pints t may lk at hand) using pinting at r shwing bjects t share interest. 27

28 2.3 Secndary Age Children & Yung Peple Table 3 Signs and symptms f pssible Autism in secndary schl children (lder than 11 years r equivalent mental age). Spken Language Spken language may be unusual in several ways: very limited use mntnus tne repetitive speech, frequent use f steretyped (learnt) phrases, cntent dminated by excessive infrmatin n tpics f wn interest talking 'at' thers rather than sharing a tw-way cnversatin, and respnses t thers can seem rude r inapprpriate. Interacting with thers Unable t adapt style f cmmunicatin t scial situatins, fr example may be verly frmal r inapprpriately familiar. Nt fllwing verbal instructins t age apprpriate level. Subtle difficulties in understanding ther's intentins; may take things literally and misunderstand sarcasm r metaphr. 3. Mdels f care fr the assessment f speech, language and scial cmmunicatin characteristics f imprtance t the diagnsis f Autistic Spectrum Disrders (as part f the Multi-Agency Pan-Drset Neurdevelpmental and Behaviur Assessment Pathway fr Children and Yung Peple) Speech and language therapists are an integral part f the lcal multi-agency diagnstic teams fr Autism Spectrum Disrders. Autism/Autistic Spectrum Disrder (ASD) is a neurdevelpmental cnditin, qualitatively identified by the presence f behaviural impairments: impaired scial interactin, cmmunicatin and scial imaginatin. 28

29 4. Aims and bjectives f the speech and language assessment f scial cmmunicatin characteristics f imprtance t the diagnsis f Autistic Spectrum Disrders The speech and language therapist will aim t assess language, scial and cmmunicatin skills and behaviurs, fcusing n features cnsistent with the criteria fr diagnsis f Autism (DSM-5). This will be achieved thrugh frmal assessment f cre and higher level language skills and interactin with and bservatin f the service user. Cnsideratin will als be given t parent s r carer s cncerns, if apprpriate, the service user s cncerns and the service user s experiences f hme life, educatin and scial care. The assessment will als seek t identify any sensry differences and pssible differential diagnsis/c-existing cnditins. A written reprt f findings will be prvided, including recmmendatins t facilitate the develpment f cmmunicatin. This may als invlve advice arund cnsideratin f the envirnmental needs, need fr rutine and dislike f change, hypersensitivity t nise r textures, dislike f clse prximity t thers, need fr rituals and ther behaviurs that impact n their everyday life. These needs als have implicatins fr learning and learning envirnments. 5. Management f scial cmmunicatin characteristics relating t ASD The management f ASD invlves multi-disciplinary and multi-agency teams. Prvisin f care fr children with ASD is acrss health, scial services, educatin and the vluntary and independent sectrs. There are a variety f different appraches that can imprve language and cmmunicatin skills in individuals with ASD. Cnsideratin needs t be given t wh delivers the interventin, fr example, parents and teachers can usefully bth be invlved. Intrducing interventins as part f a child s daily rutine can als be effective. Fllwing the assessment, the speech and language therapist will prvide a written reprt. This will include: bservatins, results f frmal assessment, backgrund infrmatin and an pinin as t whether the diagnstic criteria fr Autism (DSM-5) has been met in respect f the areas relevant t speech, language and cmmunicatin. Where apprpriate, written advice, strategies and recmmendatins will be prvided t parents and carers. These can be shared with schls and pre-schls. Strategies will: be adjusted t the child r yung persn's develpmental level; aim t increase the parents', carers', teachers' r peers' understanding f, and sensitivity and respnsiveness t, the child r yung persn's patterns f cmmunicatin and interactin; include techniques t expand the child r yung persn's cmmunicatin, interactive play and scial rutines; include age apprpriate play-based strategies t increase jint attentin, engagement and reciprcal cmmunicatin in the child r yung persn. 29

30 The verall utcme f the multi-agency assessment is fed back by the paediatrician r CAMHS clinician t the parents/carers/yung persn and the ther agencies. They will als prvide infrmatin abut Autism and its management and the lcal supprt available. 6. Delivery Mdels fr assessment f speech, language and scial cmmunicatin characteristics f imprtance t the diagnsis f Autistic Spectrum Disrders (as part f the agreed Multi-Agency Pan-Drset Paediatric Neurdevelpmental and Behaviur Assessment Pathway) Prvisin fr this pathway will be at Level 1 (see belw). The assessment appintment fr this pathway will be with a qualified specialist SLT in an apprpriate cmmunity setting. If speech and language difficulties are identified, the service user will be transferred t the apprpriate cmmunity service pathway fr further supprt. Where n further speech and language therapy interventin is indicated, the service user will be discharged t the care f the referrer. 30

31 7. SLT Referral Pathway fr health visitrs and schls SLT Referral Pathway fr Health Visitrs and Schls HV r Schl identify speech and language difficulty in additin t cncerns f pssible ASD and this is evidenced in the referral frm Referral received frm HV (via SystmOne) r Schl (schl must use Paed Service referral frm) Patient registered & added t apprpriate cmmunity clinic caselad & Cluster Lead Triage List Rejected, discharged and returned t referrer Referral Triaged by Cluster Lead Accepted and added t Cluster first assessment WL fr allcatin t a SLT with ASD MAA skills Letter and standard infrmatin Pack 1 sent t parent Case allcated t ASD specialist SLT and an appintment made Appintment letter and standard infrmatin Pack 2 sent t parent Speech and Language Assessment cmpleted including bservatins fr signs and symptms f ASD Features f ASD are als bserved. Discussin with parents and agreement fr further ASD fcussed assessment if needed Treatment fr speech and language difficulties indicated. Patient added t ASD MAA caselad and WL Outcme f assessment reprt sent t parents and referrer Letter cnfirming futher appintment is sent t parent with P2 ASD infrmatin pack Service pathways fr SCLN apply and patient recieves apprpriate interventin and supprt fr speech and language difficulties Paediatrican cnsiders SLT reprt alngside MAA reprts and reaches cnclusin regarding diagnsis. Cmplex cases requiring further MAA discussin will take place n a case by case basis Further Assessment cmpleted & reprt (including DSM V bservatins) sent t parent & referrer with recmmendatin t refer n t Paediatrican via ASD/Neur pathway & include ur reprt. Recmmendatins & advice prvided t parent & schl Treatment fr speech and langugage difficulties cmpleted and/r further assessment fr ASD cmpleted. SLT Care ended and case discharged frm SLT Service Paediatrian advises parents f the 31 utcme. Cpy f utcme reprt sent t Paed SLT