Children’s Speech and Language Therapy Service

GUIDELINES FOR REFERRAL

AT ANY AGE

·  Child has difficulty with eating or drinking in terms of chewing and swallowing

The warning signs for feeding concerns are:

o  Chest infections

o  Coughing whilst eating or drinking

o  Inability to keep food in the mouth

o  Inability to cope with lumps in food after 1 year of age

o  Loss of fluid from the mouth when drinking

o  Drooling (only in conjunction with at least one of the above)

·  Child is heard to have dysfluent speech (stammering), or if parent reports hearing this

·  Child routinely speaks with a hoarse voice ask GP to refer to ENT before referring to SALT

If the child appears to be unable to hear properly refer to audiology

The SALT department use the Care Aim Model which looks at the impact of the communication difficulty on the child’s life at that time. The impact may change over time.

Supporting evidence must be attached to all referrals

RefRefertv

AGE 2 YEARS

REFERRAL NOT NECESSARY / MONITOR / REFERRAL TO SPEECH AND
LANGUAGE THERAPY MAY BE
APPROPRIATE
·  Speech intelligible to close family
·  Understands words and simple phrases without clues
·  Beginning to use two words together
·  The child is acquiring English as an additional language but their skills in their first language are age appropriate.
·  If the child scores green on a screening tool such as ASQ or WellComm. If scores amber advise family and review. / ·  Concerns with speech but
good pretend play, able to
concentrate for short spells
and responds to instructions
·  Little evidence of pretend play
·  Lack of social interest
·  Does not pay sustained attention to an activity of their own choice / ·  Possibly jargon/babble and few words (less than 10)*
·  Very few or no words
·  Small number of words i.e. 10-50*
·  No apparent understanding of what is said
IF THERE ARE ALSO CONCERNS
WITH OTHER AREAS OF
DEVELOPMENT PLEASE REFER VIA
A FAMILY GP TO A PAEDIATRICIAN
FOR A MULTI-DISCIPLINARY
ASSESSMENT

SPEECH SOUNDS TO EXPECT: p, b, t, d, n, m

Written August 15 Updated 18/9/15 Review date Sept 17

RefRefertv

AGE 2 ½ YEARS

REFERRAL NOT NECESSARY / MONITOR / REFERRAL TO SPEECH AND
LANGUAGE THERAPY MAY BE
APPROPRIATE
·  understands many single words and some simple instructions)
·  Large single word vocabulary (50 plus words and beginning to link words together)
·  Intelligible to close family in a known context
·  If the child scores green on a screening tool such as ASQ or WellComm. If scores amber advise family and review. / ·  20-50 single words and parents report making progress (no concerns re: understanding of language)
·  close family understand their speech but others can’t / ·  Poor understanding of language
·  Few or no words although other skills are good (e.g. play )
·  Unintelligible to parents even in a known context
IF THERE ARE ALSO CONCERNS
WITH OTHER AREAS OF
DEVELOPMENT PLEASE REFER VIA
A FAMILY GP TO A PAEDIATRICIAN
FOR A MULTI- DISCIPLINARY
ASSESSMENT

SPEECH SOUNDS TO EXPECT: p, b, t, d, n, m, ends of words may be omitted

AGE 3 YEARS

REFERRAL NOT NECESSARY / MONITOR / REFERRAL TO SPEECH AND LANGUAGE THERAPY MAY BE APPROPRIATE
·  Uses appropriate sentences of 3 or more words and asks questions; ‘What?’, ‘Where?’ ‘Who?’
·  Welcomes and responds to adult suggestions most of the time. Is eager to give and receive information verbally.
·  Some words can still be hard to understand
·  If the child scores green on a screening tool such as ASQ or WellComm. If scores amber advise family and review. / ·  Only saying 2 words (play/attention/understanding appear good)
·  For attention and listening difficulties the child will require Lola/WellComm Programme before referral will be accepted / ·  Poor understanding of language in relation to the child’s level of development in other areas
·  Only saying single words (or learnt phrases) although other skills are good (e.g. good comprehension/play/ attention)
·  close family, can’t understand what is said most of the time
IF THERE ARE ALSO CONCERNS
WITH OTHER AREAS OF
DEVELOPMENT PLEASE REFER VIA
A FAMILY GP TO A PAEDIATRICIAN
FOR A MULTI-DISCIPLINARY
ASSESSMENT

SPEECH SOUNDS TO EXPECT: p, b, t, d, n, m, h, ng (as in sing), s, z, f

AGE 3 ½ to 4 YEARS

REFERRAL NOT NECESSARY / REFERRAL TO SPEECH AND LANGUAGE THERAPY MAY BE APPROPRIATE
·  Sentences are at least 5-6 words long and used appropriately
·  Can understand questions not related to the here and now e.g. ‘What did you play with today?’
·  Speech is mainly understood by family and unfamiliar people
·  Difficulty with sound blends (e.g. boo for blue, gay for grey, ky for sky)
·  The sounds t and d are used for k and g (e.g. tar for car)
·  The child’s language abilities are in line with their other cognitive/learning abilities and their needs are able to be met through the curriculum
·  The child is acquiring English as an additional language but their skills in their first language are age appropriate
·  If the child scores green on a screening tool such as ASQ or WellComm. If scores amber advise family and review / ·  Cognitive/learning skills are at a significantly higher level than understanding of language
·  One area of language is significantly below other areas.
·  No evidence of 5-6 word sentences (although play and understanding are good).
·  Child may become very frustrated when trying to communicate
·  Can’t be understood by family most of the time.
·  Shows a disordered speech pattern (e.g. omits all initial consonants, vowel abnormalities, over use of one dominant sound)

SPEECH SOUNDS TO EXPECT: Most sounds now heard. May have difficulty with k, g, ch, j, sh, th, r, y

AGE 4 - 5 YEARS

REFERRAL NOT NECESSARY / REFERRAL TO SPEECH AND LANGUAGE THERAPY MAY BE APPROPRIATE
·  Sentences are long and appropriate but some grammatical features are still incorrect (e.g. past tense “comed”, “breaked”)
·  Occasional difficulties saying words with lots of syllables or consonant sounds together, e.g. ‘scribble’, ‘elephant’
·  Lisp (th for s). Difficulty with R
·  The child’s language abilities are in line with their other cognitive/learning abilities and their needs are able to be met through the curriculum
·  The child is acquiring English as an additional language but their skills in their first language are age appropriate
·  If the child scores green on a screening tool such as WellComm. If scores amber implement advice and review / ·  Child’s speech is very difficult to understand.
·  Speech sound difficulties appear to be affecting the child’s self esteem.
·  Learning skills are at a significantly higher level than understanding of language or expressive language
·  One area of language is significantly below other areas.
·  Struggles to recall familiar words, word finding difficulty
·  Unable to retell a short familiar story
·  Child is experiencing frustration when trying to communicate

SPEECH SOUNDS TO EXPECT: Most sounds correct, ongoing difficulties with r, th and 2 consonants together

e.g. ‘sw’, ‘gl’ etc.

AGE 6 – 7 YEARS

REFERRAL NOT NECESSARY / REFERRAL TO SPEECH AND LANGUAGE THERAPY MAY BE APPROPRIATE
·  Evidence of a lisp or individual way of articulating some sounds (e.g. r) but child is not aware/concerned
·  Some grammatical features are still incorrect (e.g. felled, buyed)
·  The child is acquiring English as an additional language but their skills in their first language are age appropriate
·  The child’s language abilities are in line with their other cognitive/learning abilities and their needs are able to be met through the curriculum
·  If scores green on a screening tool such as WellComm. If scores amber implement advice and review / ·  Learning skills are at a significantly higher level than understanding of language or expressive language
·  One area of language is significantly below other areas.
·  Struggles to recall familiar words, word finding difficulty
·  Child’s speech is difficult to understand and is not improving
·  Child expresses concern about how they speak

AGE 8-19 YEARS

REFERRAL NOT NECESSARY / REFERRAL TO SPEECH AND LANGUAGE THERAPY MAY BE APPROPRIATE
·  The child/young person’s language abilities are in line with their other cognitive / learning abilities and their needs are able to be met through the curriculum
·  The child/young person does not wish to work on their communication difficulties at this time
·  The child/young person is acquiring English as an additional language but their skills in their first language are age appropriate / ·  Learning skills are at a significantly higher level than understanding of language or expressive language
·  One area of language is significantly below other areas.
·  Comprehension and /or expressive language difficulties where language ability is significantly below the level of other non-verbal cognitive / learning skills or
·  one area of language ability is significantly below other areas
·  Increasing demands of the curriculum have revealed difficulties with specific areas of language processing such as difficulty understanding concepts, difficulty processing lengthy instructions without visual support, difficulties with word finding etc.
·  Difficulty understanding humour or non-literal language, e.g ‘Wash your hands in the toilet’
·  Child/young person’s speech difficulties are impacting on their self esteem and they are keen to work on their speech

Re referral Criteria

Re-referral must be by the parent and either a:

·  significant change to communication must have occurred, and/or

·  significant change of/to the communication environment must have occurred, and/or

·  change in readiness for therapy (child or family) must have occurred.

(The decision to accept the referral may be based on telephone triage by a senior therapist).

Written August 15 Review date Sept 17