Speech and Language Therapy – Primary School Years Referrals
Who are we?
We are a specialist service that is jointly commissioned by Health and the Local Authority. We provide assessment, direct therapy and advice and recommendations to schools and early years settings for children with speech, language and communication needs, dysfluency (stammering), selective mutism and voice problems.
We see all accepted referrals within 18 weeks and provide follow up within 8 weeks of the initial assessment. The initial assessment usually takes place in clinic because we believe parents need to meet with us in order to understand our role, how we can help their child and what they can do to help their child. If schools have concerns about parental engagement we advise that they evidence this on the referral form. In some cases we are able to see children for initial assessment at school where there is a valid reason. Follow up sessions take place in a variety of settings. We are the service that is commissioned by the Local Authority to provide assessment and therapy recommendations as detailed in part 3 of the Statement or Education Health Care Plan.
We offer a joint training programme with the Communication, Language and Autism Support Service (CLASS). This is a Local Authority traded service. This programme includes training on working with vocabulary, narrative, attention and listening, phonology (speech). We promote other locally available accredited training packages designed for schools such as ELKLAN and ICAN.
Our partners
We work closely with CLASS and where there is a local language outreach service available, i.e. Hailsham, Eastbourne and Peacehaven (outreach and in-reach) we assess referrals via an integrated pathway. This means that a pupil accesses a service from an outreach provider and will not be assessed by ESCITS SLTs unless agreed by the specialist teachers from the outreach team and therapists in their regular partnership meeting. You should always know which provider(s) are involved with a pupil.
Resources
We are able to provide a list of recommended resources. Our language outreach partners also have recommended resource lists. However we expect schools to purchase their own language resources so that they are readily available and teaching staff can become familiar and confident using them.
Making a referral
We expect you to complete all required documentation. Do not leave any sections blank; if you do not have a comment please note ‘not applicable’. We strongly advise that referrals are completed electronically. We will assess referrals based on the following:
Speech, language and communication referrals
· Completion of background information/ consent
· Completion of school information gathering form (appendix 2)
· Completion of a minimum of 12 weeks intervention informed by the Speech Link and Language Link assessments and programmes. This intervention must be summarised with outcomes on appendix 1
· A baseline Speech Link and/or Language Link assessment
· We will evaluate the referral information based on
o The severity of the impairment
o The progress the child has made on the Speech Link/ Language Link programmes
o The impact on curriculum access as evidenced by the child’s curriculum levels
o Whether an EHCP is being considered
Dysfluency (stammering) referrals
· Completion of background information/ consent
· Completion of the information gathering form (appendix 2)
· Completion of the dysfluency questionnaire (appendix 3)
· We accept dysfluency referrals without the school needing to provide evidence of support
Selective mutism/ voice referrals
· Completion of background information/ consent
· Completion of the information gathering form (appendix 2)
· Some outreach services are able to provide initial advice on selective mutism but we will accept selective mutism referrals without the school needing to provide evidence of support
· Where a voice problem is indicated we would usually advise initial referral to ENT services via the GP to ensure there is no underlying pathology. ENT will then refer these children directly to us
This pack includes:
Primary school speech and language therapy referral decision chart…………………….Page 3
Background information/ consent……………………………………………………………………...... Page 4
Support summary document (appendix 1) ……………………………..…………………………….Page 7
School SLT Referral – Information gathering form (appendix 2) ……………………………Page 8
Dysfluency questionnaire (appendix 3)…………………………………………………………………..Page 9
Where to send your school years referral………………………………………………………………Page 10
Background information/ consent
Please complete all areas and discuss and obtain consent from parents/carers before making this referral
Child’s detailsChild’s First Name / Child’s Surname: / Gender:
Male/ Female
Date of Birth: / NHS Number: / Age:
Address:
Postcode:
Contact number(s): / Parents’/Carers’ full names: include address and contact numbers if different to the child
Language(s) spoken by the child:
Language(s) spoken by the family members and at home:
Is an interpreter required Yes/No
Safeguarding
Is the child known to Social Services?
Yes/No
Is the Child a Child in Need Yes/No
Is the Child subject to a Child Protection
Plan? Yes/No
Is the child a Looked After Child? Yes/No
Local Authority with responsibility / Name of Social Worker:
Address for Social Worker:
Contact number for the Social Worker:
Referrers details
Name of Referrer:
Job Title: / Referrer’s Address:
Referrer’s Tel No:
Other professionals’ details
GP:
Address
Tel: / Health Visitor/ School Nurse:
Address:
Tel: / Other professionals or agencies
Involved (please detail who and
What their involvement is):
Have referrals been made to other services? please provide dates
School Details
Name & Address of School: School Year:
Name & Job Title of Contact Person: Tel No:
Does the child have a Statement/ EHCP Yes/ No/ In process of application
Summary of concerns Prompting Referral Please list the main concerns in priority order
Supporting information please include anything that you wish to note in addition to the required referral documentation
Developmental History include information about delayed early milestones
Medical History include any diagnoses that have been made, illnesses, medication, hospital admissions
Hearing Status
Neonatal Hearing screening Status:
Other Referrals to Audiology:
Date/ results:
Any relevant hearing comments re hearing: / Vision/ visual perception
Wears glasses?
Nystagmus?
Other concerns:
Family History & Relevant Social History i.e. other people living in the family home; significant changes or life events; literacy needs of family; medical information where relevant; housing issues; known incidents of domestic violence
Desired Outcome for this Referral what outcomes are the parents/carers/you seeking from this referral?
Signature of Referrer
Signed:______Date: ______
Please print name:
For internal use only:
Discussed at outreach/ ESCITS SLT partnership meeting:
Signed SLT: ______Date:______
Kent Community Health Foundation Trust Consent Form
Child’s Name: / Date of birth: / Age:
The person signing this form needs to have Parental Responsibility* for the young person concerned. Only one signature is required. Please would you sign and return this consent form, confirming you agree to the below:
· A Mother automatically has parental responsibility for her child from birth
· In England and Wales, if the parents of a child are married to each other at the time of the birth, or it they have jointly adopted a child, then they share parental responsibility
· For couples who are not married: From 1 December 2003 a Father shares parental responsibility if he jointly registers the birth of the child with the mother (ie he puts his name on the child’s birth certificate). Before 1 December 2003 a Father must have signed a Parental Responsibility Agreement with the Mother or have obtained a Parental Responsibility Order from the Court in order to share parental responsibility for the child
· Parents do not lose parental responsibility if they divorce. Parental responsibility can be changed by order of the Court
I give permission for: (please complete as appropriate)
My child to be seen by a member of East Sussex Children’s Integrated Therapy Service Yes/No
(including advice for eating and drinking difficulties if required)
Reports to be distributed to:
Other Health Professionals Yes/No
Preschool/school venue Yes/No
Other Agencies involved with my child Yes/No
The exact people reports are to be sent to will be shared with you when your child is seen however, if we have any safeguarding concerns we are required to share information with all agencies regardless of permission given.
A Student Speech & Language Therapist/ Physiotherapist or Occupational Therapist
To be present during my child’s assessment or therapy sessions Yes/No
I am aware that information on my child is held electronically in accordance with the Data Protection Act
Please tick the box ☐
We are required by the Government to monitor that all health services are equally accessible to all groups within the community. Please choose a code from the list below that best described your child’s ethnic origin.
White / A / British / Black or Black
British / M / Caribbean
B / Irish / N / African
C / Any other white background / P / Any other Black background
Mixed / D / White and Black Caribbean / Other Ethnic / R / Chinese
E / White and Black African / S / Any other ethnic category
F / White and Asian / Patient asked / Z / Patient asked but declined
G / Any other mixed background
Asian and
British Asian / H / Indian
J / Pakistani
K / Bangladeshi
L / Any other Asian background
Signature:…………………………………………………………… Printed Name:……………………………………………….
Relationship to Child:……………………………………………… Date:………………………………………………………….
Appendix 1
Support summary document
Name of pupil: Date of birth:
Name of person completing form: Date of completion:
It is recommended that the form is completed electronically to allow you to do this. If this is not possible please provide evidence on the form or on additional pages.
Whole Class Support
Please give summary of resources and strategies used e.g. breaking down instructions, using visuals, or the inclusion development programme
Targets relating to speech language and communication needs that the school have worked on in the past 3-6 months should be entered here (please add further session dates/ targets as appropriate)
Session date / Target / Activity / Session evaluation and next stepPlease describe the level of support you have provided e.g. dates/ frequency
Type of supportExamples:
· 1-1 work
· Small/large group (3/6 children)
· Other services providing support
o SLA time
o Language Outreach
o CLASS
o ESBAS
Dates of input (from & to)
Frequency (daily, weekly etc.)
Appendix 2
School Years SLT referral – information gathering form
Name of pupil: Date of birth:
Name of person completing form: Date of completion:
This form must be completed by the pupil’s class teacher. Where you have indicated concern you must give examples. If you cannot complete electronically please provide evidence on the form or on additional pages.
Area of Language / Characteristics / Yes / No / Comments/ ExamplesFunctional communication / Is the pupil able to make their needs and requests known to staff / ☐ / ☐
Is the pupil able to follow school routines / ☐ / ☐
Is the pupil able to invite and join in play with peers / ☐ / ☐
Is the pupil able to show rejection (say no) in an acceptable way / ☐ / ☐
Is the pupil able to take turns in conversation? / ☐ / ☐
Attention & Listening / Is the pupil able to sit appropriately during whole class teaching? / ☐ / ☐
Is the pupil able to attend for an adequate period of time? / ☐ / ☐
Is the pupil able to respond to whole class instructions? / ☐ / ☐
Is the pupil able to stay on task? / ☐ / ☐
Does the pupil need instructions to be simplified? / ☐ / ☐
Does the pupil rely on peers and copy their actions? / ☐ / ☐
Auditory Working
Memory / Does the pupil regularly forget spoken information e.g. instructions, stories? / ☐ / ☐
Does the pupil have difficulty remembering the steps required to complete a classroom task? / ☐ / ☐
Meaning of Words / Is the pupil able to learn and use new vocabulary? / ☐ / ☐
Is the pupil able to learn and use abstract concepts e.g. first, last, before, after, long/short, same/different? / ☐ / ☐
Does the pupil use generalised vocabulary, e.g. it, this, that, thing, or make mistakes when choosing words? / ☐ / ☐
Does the pupil need extra time to think of the vocabulary that they want to use? / ☐ / ☐
Structure & Rules of
Spoken Language / Are the pupil’s sentences clearly constructed with words generally in the correct order? / ☐ / ☐
Does the pupil use the right word endings, e.g. plural ‘-s’, verb tenses? / ☐ / ☐
Does the pupil use the right grammatical words e.g. pronouns (he/she), auxiliaries (are/ is), prepositions (in/ on/ behind/ in front)? / ☐ / ☐
Social Communication / Please add any comments e.g. volume, topic maintenance
Additional questions
1. Is the pupil making the expected academic progress year on year? YES /NO
2. Do you have concerns about the pupil’s general learning ability? YES /NO
3. Have they had an assessment by an Education Psychologist? YES /NO If yes, you must include the report
Appendix 3
Dysfluency (stammering) questionnaire – you only need to complete this questionnaire if the pupil stammers
Name of pupil: Date of birth:
Name of person completing form: Date of completion:
Please complete this to support new referrals for dysfluency
How would you describe this child’s stammer?
not severe 1….2….3….4….5….6….7….8….9….10 very severe
How easy is it for this child to communicate with adults?
very easy 1….2….3….4….5….6….7….8….9….10 very difficult
How easy is it for this child to communicate with his/her peers?
very easy 1….2….3….4….5….6….7….8….9….10 very difficult
How easy is it for this child to answer the register?
very easy 1….2….3….4….5….6….7….8….9….10 very difficult
How often does this child answer questions in class?
often 1….2….3….4….5….6….7….8….9….10 never
How keen is this child to join in with classroom discussions?
often 1….2….3….4….5….6….7….8….9….10 never
Has there been any teasing or bullying shown towards this child?
none at all 1….2….3….4….5….6….7….8….9….10 frequently
What impact do you feel the child’s stammer has on their ability to access class work/ school life?
no impact 1….2….3….4….5….6….7….8….9….10 severe impact