name of service – hounslow paediatric speech and language ... · paediatric speech and language...

Name of Service – Hounslow Paediatric Speech and Language TherapyWhat our service does Paediatric Speech and Language Therapy (SALT) in Hounslow is a community based service for children and young people, up to the age of 19 years, who experience speech, language and communication difficulties, and dysphagia (difficulty with swallowing). The SALT team ensure children/young people with speech language/communication difficulties and their families/ carers are able to live and develop to their maximum potential. The service provision includes but will not be limited to:

• Assessment, diagnosis, therapeutic intervention and management of SLCN and dysphagia needs in the most appropriate clinical setting, e.g. school, clinic.

• Assessment, diagnosis and therapy intervention with other appropriate professionals in a multi-disciplinary setting

• Assessment, advice and episodes of direct therapy where indicated • Therapy may be delivered on an individual or group basis • Activities, advice and/or programme to support self-management of SLCN or

dysphagia • Advice to patients carers and professionals, (via telephone, face to face, or

reports and programmes) • Training for parents carers, professionals and others as appropriate • Attendance or contribution to case conferences where an open referral is

held, (e.g. TAC meetings, annual reviews). • Supporting access and referral to voluntary organisations (where

appropriate). • Delivering /offering preventative advice to the universal services related to

the pre-school client group (e.g. portage, Children’s Centres, Health Visitors). • Deliver pre-school social communication clinics with community

paediatrician, • To produce reports as requested during the statutory assessment process in

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line with the relevant statutory timescales (for children with an open referral to the Hounslow SALT service).

Where the service is located and the areas it covers The service is provided in a range of settings as based on the clinical need of each child or young person, e.g. community clinics, Special Educational Needs provisions (schools and units), and mainstream school settings. Settings such as schools and nurseries provide access to the education staff involved and they are a highly valuable source of information regarding the child/ young person’s functional communication skills. Community clinics offer accessible facilities for families in their local community and a central base for specialist streams of the service. The setting will be determined through a combination of clinical decision making and patient choice, and a package of care may take place across a number of settings, e.g. clinic, domiciliary and school.

Who our service provides for The service operates an open referral system for children less than 19 years, meeting the criteria registered with a Hounslow General Practitioner (GP) and the following 3 Ealing GP practices (for which a cross commissioning agreement is in place):

• Dr Mangat, The Surgery, 3-5 Cecil Road, Hounslow. TW3 1NU • Dr Htoo, MWH Practice, 1 Vincent Road, Hounslow, TW4 7LH • Dr Sandhu, 48 Berkeley Avenue, Cranford, TW4 6LA

How a child or young person can start using the service See above – once referral is received and accepted at triage a speech and language therapist would see the child within 6 weeks

How decisions are made about eligibility for our service The current referral criteria and entry and exit criteria can be found in Appendix B. The criteria for school aged children with special needs will be developed further during 2016/17 to ensure alignment with the hub and spoke education therapy offer.

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How we communicate with service users and how they are involved in decision making/planning

• Informed about all SALT involvement • Therapists feedback all findings • Reports shared • Joint target setting • Activities modelled • Parent Workshops

How accessible our service is See referral criteria Training our staff have had in supporting children and young people special educational needs and disabilities All Speech and language therapists have a speech and language degree, Continuous CPD within job via supervision, own learning, training courses internal and external, shadowing, accessing more specialist speech and language therapists, attendance at special interest groups, journal club, whole team meetings to share information, CPD days. Who a service user should contact if they want to raise a concern or complain about something

• Any of the below: • Speech and Language Therapist • Team lead • Children’s Therapies Manager • Director • PALS

Who a parent carer/young person can contact for further information All contact goes via admin hub 0208 973 3480 and passed onto the relevant professional

Name of person approving this information Seema Chauhan and Lizzie Potter Job title Interim School-Age and Pre-school SALT team lead’s Email address [email protected]

[email protected]

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mailto:[email protected]

mailto:[email protected]

Appendix A: SALT Service Structure

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SALT Services (0-16)

- all children with Hounslow GP

Pre-School Service Children not in full time educational

setting

Pre-School Community >2 years

Moderate - Severe SLCN SLCN primary presenting

need

Pre-School Special Needs <2 years

SLCN presenting alongside other primary

areas of need

School Age Service Children in full

time educational setting

School- Age Community SLCN primary presenting

need

School-Age Special Needs

SLCN presenting alongside other primary

areas of need

Social Communication difficulties (ASD) Hearing Impairment

Dysfluency Dysphagia Challenging Behaviour

Appendix B

Pre-school Community - Entry Pre-school Special needs - Entry • Hounslow GP • 2;0 years to full time reception • Speech and Language

Communication Needs (SLCN) is the primary presenting need

• Moderate-severe delay/disorder of SLCN - (including speech, dysfluency, language, social com/ASD)

• Language difficulty present in primary language, e.g. not due to English as an additional language (EAL)

• Hounslow GP • Birth - full time reception • SLCN presenting alongside other

primary areas of need • Multiple complex needs, e.g.

syndromes and medical diagnosis. • 3 or more agencies/ professionals/

teams involved • Pre-intentional / non-verbal

communication • Language difficulty present in primary

language

Pre-school Community - Exit (Discharge/ transfer)

Pre-school Special needs – Exit (Discharge/ transfer)

• Within normal limits • Mild difficulties • Did not attend (DNA) and no contact

within 2 weeks • DNA more than one session • Language in line with their age

related norms, general development or learning profile

• Difficulties as a result of EAL • Intervention not indicated at present

(access to re-refer) • Limited progress over two terms with

intervention (direct/indirect) • Full time Reception (transfer to

School Age Service) • GP no longer Hounslow CCG

• Meet criteria for transfer to other stream

• Within normal limits • DNA and no contact within 2 weeks • DNA more than one session • Language in line with their age


• Intervention not indicated at present (access to re-refer)

• Full time Reception (transfer to School Age Service)

• GP no longer Hounslow CCG

School Age Community - Entry School age Special needs - Entry • Hounslow GP • Have entered full time reception • Speech and Language

Communication Needs (SLCN) is the primary presenting need

• Moderate-Severe delay/disorder of SLCN - including speech, dysfluency, language, social com/ASD

• Language difficulty present in primary language

• Clear from referral what specialist SALT input is needed

• Hounslow GP • Have entered full time reception • SLCN presenting alongside other

primary areas of need • Multiple complex needs • 3 or more agencies/ professionals/

teams involved • Language difficulty present in primary

language • Clear from referral what specialist

SALT input is needed

School Age Community – Exit (Discharge/ transfer)

School age Special needs – Exit (Discharge/ transfer)

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• SLCN are within normal limits • Mild difficulties • Did not attend (DNA) and no contact

within 2 weeks • DNA more than one session • Language in line with their age


• Difficulties as a result of English as an additional language


• Limited progress over two terms with intervention (direct/indirect)

• No request for visit by end of Spring term of Reception year


• Meet criteria for other streams of service

• SLCN are within normal limits • DNA and no contact within 2 weeks • DNA more than one session • Language in line with their age



• No request for visit by end of Spring term of Reception year

• If accessing curriculum is primary presenting need (with recommendations only for school) – Advised to contact SEN department


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Appendix B: SALT Referral Criteria <12 Months Checklist - CRITERIA FOR REFERRAL

REFER TO SPEECH AND LANGUAGE THERAPY:

• No babble or sound play (baba;

mama; dada; squeaks or coos) • Baby does not use eye

contact/facial expression/vocal noises to interact with others

• Baby does not stop and look

when hears own name (by 12 months)

• Main carer is not

engaging/interacting with baby

• Main carer is expressing anxiety about baby’s development (combined with other criteria for referral)

FOLLOW UP IN 3 TO 6 MONTHS & ADVISE PARENT OF ACTION BELOW:

• Attention fleeting • Babble or jargon present but no recognisable

words • Communication through gesture rather than

words • Baby responds to some instructions

• Main carer demonstrates appropriate interaction

with baby

QUESTIONS TO PARENT / OBSERVATIONS: Notes / Examples

1. Does your baby turn towards a source of noise e.g. knock at the door?

2. Does your baby look at you when you speak or call their name? 3. Does your baby babble strings of sounds? E.g ‘dadada’ 4. Does your baby ‘take turns’ in conversations by babbling back to an adult? 5. Does your baby smile when people are smiling at them? 6. Does your baby recognise the name of familiar objects e.g. ‘daddy’? 7 | P a g e

REFERRERS OBSERVATIONS:

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18 Months Checklist - CRITERIA FOR REFERRAL


• Little or no pretend play

• No babble or words

• No apparent comprehension or (unable to assess)

• Poor eye contact with carer

• Little or no interest in communicating (not pointing to share joint interest or request)

• Main carer is expressing anxiety

about baby’s development (combined with other criteria for referral)


• Some pretend play, e.g. feeding teddy • Possibly poor attention

• Babble or jargon is present with some single words (may be unclear to others but parents understand)

• Baby uses gesture to communicate with some

words/sounds • Baby responds to simple instructions


1. Does your child have any words? (other than mamma, dada)

2. Does your child point to objects and bring objects to you? 3. Does s/he ‘chatter’ to himself in a tuneful way that sounds like conversation?

4. Does s/he demand something by pointing and saying ‘er er’?

5. Does s/he play in a pretend way e.g. pretend to feed a teddy, pretend to give himself a drink? 6. Does s/he do things you ask? e.g. does he/she follow instructions such as ‘don’t touch’,

‘where’s the ball?’, ‘give it to mummy’, ‘bring me a nappy’ (without associated gesture) 7. Does s/he engage in appropriate eye contact?

8. Can s/he concentrate on a toy for longer than a few seconds?

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2 Years Checklist - CRITERIA FOR REFERRAL


• Few or no words • No apparent comprehension (or unable to

assess this) • Poor eye contact with carer • Little or no interest in communicating (not

pointing to share joint interest or request)

• Little or no pretend play • Main carer is expressing anxiety about

child’s development (combined with other criteria for referral)


• Good pretend play

• Able to concentrate for short periods but easily distracted

• Has started linking two words together – “biscuit gone”, “mummy shoe”

• Responds to simple instructions (but may

need to be shown if more complicated or different to regular routine)


9. How many words do you think your child has? (Reassure the parent that the words do not have to be clearly pronounced to be counted as words)

None

A few

Too many to count

10. Does your child point to objects and bring objects to you?

11. Does your child put two words together to make a simple sentence, such as “daddy gone”?

12. Will s/he point to parts of her/his body?

13. Does s/he respond to questions or instructions, such as: “See if the postman has been” “Where’s your biscuit gone?” “Go and get my bag from the hall”

14. Does the child engage in appropriate eye contact with you/the carer? 15. Does s/he play in a pretend way, such as: Filling a truck with cars/bricks and driving it along?

Pouring a cup of tea and giving it to mother/doll?

16. Can s/he concentrate for a short while on a toy or does s/he flit from one activity to another?

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If the child finds a number of these difficult, please use 18 month questions for additional information


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2½ Years Checklist - CRITERIA FOR REFERRAL


• Poor attention • Poor comprehension (or unable to

assess)

• Few or no words

• Words/speech is unintelligible to mother/close family

• Little or no interest in communicating

(not pointing to share joint interest or request)

• Stammers and parents are anxious

about this • Apparently choosing not to talk

• Main carer is expressing anxiety about



• Good pretend play involving others (e.g. feeding cups of tea)

• Child can follow simple instructions that may

not follow a regular routine • Child mainly talks in short sentences (2+

words) • Child intelligible to close family but not others

• Child stammers but is not aware of this and

family not concerned


17. How many words do you think your child has? (Reassure the parent that the words do not have to be clearly pronounced to be counted as words)

None

A few

Too many to count

18. Does your child put two words together to make a simple sentence, such as “daddy gone”?

19. Will s/he point to parts of her/his body?

20. Does s/he respond to questions or instructions, such as: “See if the postman has been” “Where’s your biscuit gone?” “Go and get my bag from the hall”

21. Does s/he play in a pretend way, such as: Filling a truck with cars/bricks and driving it along?

Pouring a cup of tea and giving it to mother/doll?

22. Can s/he concentrate for a short while on a toy or does s/he flit from one activity to another?

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3 Years Checklist - CRITERIA FOR REFERRAL


• Not following simple adult instructions (without gestures/visual cues)

• Not yet regularly using sentences longer than 2 words

• Using mainly learned phrases/chunks of language

• Is unintelligible most of the time to the family

• Little or no pretend play • Rarely responds to adult suggestions in play • Cannot attend for longer than a few minutes

and/or little interest in sharing talk or play • Habitually hoarse voice (not associated with

colds) • Stammers and parents are anxious about this • Not using ‘long’ (fricative) sounds (f,v,s,sh) • Apparently choosing not to talk

• Main carer is expressing anxiety about



• Child using appropriate sentences of three

or more words

• Child usually responds to adult suggestions in play with appropriate eye contact

• Good pretend play is evident

• Child intelligible to close family but not

others

• Child using ‘long’ (fricative) sounds (f, v, s, sh) but not in the right places in the word

• Child stammers but is not aware of this

and family not concerned


23. Does your child talk in sentences? How many words does s/he put together?

24. Can s/he obey increasingly complicated instructions, e.g. “Find the one that Granny gave you”, or those involving words such as “big”, “under”, “who”?

25. Can s/he give her/his attention to something you want her/him to do for longer than a few

minutes (other than TV)? Does s/he let you play with her/him? 26. Can the family understand most of what s/he says?

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4:0 Years Checklist - CRITERIA FOR REFERRAL


• Not using sentences of 5+ words • Uses utterances which are echoed or repetitive

• Uses unusual word order

• Struggling to include other children and adults in their

play/conversation

• Still finding new routines difficult (distress or challenging behaviours)

• Difficulties and/or frustration finding the right words, e.g. overuses nonspecific words e.g. ‘this’, ‘that’, ‘doing’

• Mainly unintelligible to unfamiliar adults

• Omits the final consonants in words

• Uses the sounds ‘c’/‘k’ and ‘g’ for ‘t’ and ‘d’

• Habitually hoarse voice (not associated with cold)

• Stammers and parents and/or child are anxious

• Apparently choosing not to talk

Parents are anxious about child’s development (combined with other criteria for referral)

FOLLOW UP IN 3 TO 6 MONTHS & ADVISE

PARENT OF ACTION BELOW:ACTION:

• Utterances are appropriate and at least 5-6 words long • Plays appropriately with peers & adults • Sounds ‘t’ & ‘d’ are used for ‘c/k’ & ‘g’

• Not using double consonants (‘clusters’), e.g. tr; fl; sp; sm

• Child mainly intelligible to you

• Sounds such as ‘sh’, ‘ch’, ‘j’, ‘r’, ‘th’ are not accurate


27. How many words can your child put together in a sentence? 28. Does s/he get her words in the right order or is it often muddled? 29. Does s/he follow suggestions you make in play? Does s/he ever give wrong or odd

responses to things you say? 30. Does s/he often struggle to remember words? 31. Does s/he often just echo back what you have said to her/him?

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32. Sounds – use the pictures attached and note down how the words are said 33. OPTIONAL QUESTION – Does the child stumble, repeat words or beginnings of words, or get

stuck on words? How often does this happen?


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name of service – hounslow paediatric speech and language ... · paediatric speech and language...

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