Swindon Neurodevelopmental Pathway Designed Together Links to WSOA

Swindon Neurodevelopmental Pathway Designed Together Links to WSOA Priority 1.1 and Priorities 6.5/6.7 “Climbing a mountain is hard, just like achieving our dreams, but we shouldn’t let things stand in our way and in the end it is worth it” Advice from Falcon Class, Uplands School

Aim of this session To share the work on re-designing the pathway for neurodevelopmental conditions assessment and diagnosis To work together to ensure successful implementation of this pathway

Backgrou nd A review of Children’ s Services in 2016 establish ed: This prompted the redesign of the ASD Pathway for Children and Young People

Formed a multiagency ASD Strategy Group and Project Group Held three workshops during June and July 2018 to obtain the views of stakeholders and parents/carers on their experiences of the current pathway Mapped the existing and new pathways Worked with parents to develop an information leaflet and the new local offer platform My Life What we did

Desire for a single point of contact for triage What we heard Early support whilst waiting for a diagnosis Consistency of approach and experience across the different agencies including schools, health, social care Some of the key themes that came out of those workshops included: Alternative provision/support for those who do not get a diagnosis and to clarify next steps for those that do have a diagnosis Better communication – parents didn’t know they were on a waiting list, how long it was or that their referral had been received Information sharing between providers/agencies – clarity of roles and responsibilities of each contributor to the child Full completion of Early Health Records before referring to a Paediatrician. Parents do not want to be solely responsible for completion of EHRs

A group of conditions with onset in the early developmental period usually manifesting before the child enters school What is a Neurodevelopme ntal Condition? Conditions include: Global developmental delay/LD ASD ADHD Genetic syndromes Motor delays/disabilities Foetal Alcohol Spectrum Disorder (FASD) Tic disorders

ASD is often the default assumption for children with speech and language delay or challenging behaviour The main challeng es Misconception: Children can only get support if they have a diagnosis Children and YP with mental health needs should not be on a community paediatric waitlist unless there is clear evidence of a possible neurodevelopmental disorder in addition challeng es Once ASD is mentioned it can be very difficult to dissuade parents that the child does not have the condition ADHD is 4-5 times more common than ASD and causes secondary social communication difficulties

Quick Quiz Question 1: Of the numbers of under 5’s referred with query ASD, what percentage actually get a diagnosis of ASD? Answer: 50% Question 2: Of the numbers of children and young people over 5 years referred with query ASD, what percentage actually get a diagnosis of ASD? Answer: 30% Fact: Since 1 April 2019, 39% of referrals received have been for ASD Fact: Since 1 April 2019, 27% referrals received are for ADHD A diagnosis of ADHD is 4-5 times more common than a diagnosis of ASD, yet the Community Paediatricians receive more referrals for ASD

The New Pathway Will aim to: Remove assumed diagnosis by the referrer Reduce waiting times for assessment and diagnosis Provide a single point of referral for all Neurodevelopmental Conditions Streamline the assessment process Reduce the number of inappropriate referrals reaching the Community Paediatricians Provide a multi-disciplinary assessment at the earliest point

DRAFT Neurodevelopmental Conditions Pathway for Assessment and Diagnosis ages 0-18 years Early Help Record & Plan (EHRP) (where social need) Core Standards documentation (from Schools) Referral from: Early Year·s Advisor Nursery Health Visitor Social Worker TAMHS Koalas/Special Tots Portage SENCO Ed Psyc Referral from Speech & Language Therapist Referral from Occupational Therapist/ Physiotherapist (detailed report provided) (detailed report provided) Referral from Acute Paediatrician Referral from GP Education, Health & Care Plan (EHCP) More information requested from referrer Educational Psychologist Report ERS referral Referral received by Referral Management Centre (RMC) Triaged by Nurses Criteria based Referral accepted No Explanation of refusal and signpost to local offer Yes MDT triage by: Ed Psyc SLT Specialist Nurse Community Paed Mental Health need identified and not NDC Criteria based Refer to SPA

Refer to SPA (TAMHS/CAMHS) Assessment by Paedatrician Assessment by appropriate clinician eg. SLT, nurse, Ed Psyc Criteria based Complex Case Complex diagnostic questions where having challenges coming to a conclusion and more advice required. Mental Health intervention required Referal to Specialist/Tertiary Centre Parental Consent Required Diagnosis unclear Diagnosis of ASD Diagnosis of ADHD Diagnosis of Chronic neuro disability Face to Face session with parents at Community Paediatrician clinic Link to relevant care pathway for treatment/discharge/ follow up No NDC diagnosis Signpost to local offer and refer back to Lead Professional Signpost to local offer for further information and refer back to Lead Professional

The Referral Process What we need from referrers The new referral form Describe what you see What are the difficulties the parent sees? How is this affecting the child in other environments i.e. school? Supporting documentation Evidence that the above symptoms are significantly impacting school functioning, such that teachers feel that this is holding a child back academically and socially Evidence that the above symptoms are significantly impacting the home environment and any support the parents have accessed to address these behaviour traits. Evidence that previous services have been involved, i.e. Educational Psychologist/Behaviour Support Service, with current behaviour plan and outcomes Copies of relevant reports Early Help Record and Plan Core Standards documentation (schools) School Nurse/Health Visitor report Education Psychologist report Speech and Language Therapy report TAMHS/CAMHS report SEN Plan

For GPs via ERS For all other referrals, including schools, by post to: The Referral Process Referral Management Centre Swindon Clinical Commissioning Group The Pierre Simonet Building Latham Road SWINDON SN25 4DL All referrals will be triaged against a list of criteria within 3 days of receipt If accepted, the referral will then be considered by a Multi-disciplinary Team of Clinicians who will agree the next steps for the child If rejected, you may be asked to provide more documentation to support the referral

Any questions?