Salford’s Neurodevelopmental Assessment Pathway

Please carefully consider why you feel a request for a neurodevelopmental assessment is required. You should be able to clearly explain your reasons for the request, what support a child has accessed, give specific examples of difficulties you have observed and what you will continue to do to support the child or young person whilst is the assessment process is taking place.

The Neurodevelopmental Assessment Pathway aims to assess the needs of children and young people showing persistent and complex presentations due to a potential underlying neurodevelopmental need. These difficulties should be seen across all environments indicating a pervasive nature to any areas of need. A diagnosis is not required to access support and any requests for a neurodevelopmental assessment should be about the parent/carer requesting this rather than a professional feeling this is a requirement.

Professional views

Please carefully consider why you feel a request for a neurodevelopmental assessment is required. You should be able to clearly explain your reasons for the request, what support a child has accessed and what you will continue to do to support the child or young person whilst a child or young person is waiting for an assessment or undergoing the assessment process.

The Neurodevelopmental Assessment Pathway aims to assess the needs of children and young people showing persistent and complex presentations due to a potential underlying neurodevelopmental need. These difficulties should be seen across all environments indicating a pervasive nature to any areas of need.

Parent/carer priorities

Parents, carers and professionals may see different strengths and needs in different environments. Understanding the holistic picture of a child/young person both at home and in setting is important in considering whether a neurodevelopmental assessment is required. Discussions between parents/carers and professionals are key in considering the reasons for the request being made as well as what support may already be in place and what else may need to happen.

Consideration of the support that has been put in place

Referring to a specialist assessment pathway should not be the first step in supporting a child/young person. An initial period of observations, information gathering and support should be put in place in line with a graduated response. Consideration should be given to a child or young person's needs both at home and in their setting.

Support in Salford is available and accessed through the Graduated Approach. This may include a child being involved in a targeted group in their setting or a request for help from a specialist service. The ‘How to get help’ pages give you information on workshops available, trusted websites as well as how to access a specific service.

Support should be accessed and implemented in line with a child/young person's specific area of need. For example, concentration skills, language and communication skills, mental health or learning skills.

Following initial support, consideration should be given to how the child or young person is responding to this support. Following a review of the child or young persons need where pervasive, persistent and complex needs are observed consideration should be given to whether there is a need for a neurodevelopmental assessment.

Where an initial early support step has not been put in place, the request to the Neurodevelopmental Assessment Pathway will be returned to the referrer. Recommendations will be given on accessing and implementing support as a first step where appropriate.

Professional requests:

So that a clear understanding of the child or young person’s strengths and needs are gathered, a professional who knows the child and family well is best placed to complete the request for an assessment. This is most often a key professional from a child/young persons’ setting.

• Where a request is from a school setting the request should be made by the SENCo. The child should have an Individual Education Plan in place as well as be on the school's SEND register. This is to ensure requests are made in line with the SEND Graduated Response.
• Where a request is made by an Early Years setting the request must be made by the SENCo. The child should also be accessing Play Plans and have the Area SENCo involved. This is to ensure requests are made in line with the SEND Graduated Response.
• A Health Professional who has worked with the child and family extensively, for example a Speech and Language Therapist, a Mental Health Practitioner, a member of the 0-19 Team
• A Local Authority professional who has worked with the family and child extensively, for example an Early Help Practitioner or an Educational Psychologist

All requests will need the referrer to have gathered the holistic picture of the child or young person as set out in the online referral form. Please see the example forms on this page for information that will need to be included.

Parent/carer requests

The best requests come from professionals and parent / carers completing the form together. This is so a holistic picture of the child or young person is obtained.

For parents or carers with a concern we would advise the following:

• In the first instance to raise their concerns with their child’s setting. This builds the holistic picture of the child, identifies the support needed and ensures there is clear communication and a consistent approach to support the child or young person.
• Request advice and support from our Universal services. This can include the Early Help Team via an Early Help Assessment or the 0-19 Team by contacting your local 0-19 Team for advice and guidance. Following this initial support, the professional can advise and support parents/carers on the next steps.
• To access support from SIASS who are the parent / carer advocacy service. They have drop in sessions that you can turn up to. Information is available on their Salford Information Advice Support Service Facebook page.

GP requests

A GP is not the best placed professional to make a request. All referrals need a certain level of information to be included so that a decision can be made at triage on whether there is a need for a neurodevelopmental assessment. GPs, due to their infrequent contact with children and young people, are unlikely to be able to describe all of the areas of strengths and needs.

GPs in Salford have been advised to direct parents and carers to their child’s setting in the first instance to discuss their concerns. This ensures that the required information is available at the point of a request for the triage team to consider, reducing any future delays.   

What age can a child be referred to the Neurodevelopmental Assessment Pathway?

Where it has been agreed with parents and carers that it is in the best interests of the child or the young person to assess their skills further, some specific criteria is in place.

For children under two years six months of age (2.06 years) with social interaction difficulties an initial period of interventions should take place prior to making a referral. This is in line with the national recommended guidelines.

For children and young people showing signs of difficulties with concentration referrals for a neurodevelopmental assessment are considered from six years of age.

What additional criteria does the Neurodevelopmental Assessment Pathway have? 

The online referral form has a range of mandatory fields linked to areas of strength and needs. Referrals cannot be submitted without the information being included. Please take the time to consider the questions it asks you. If you are unable to answer a question please consider whether you need to take an action such as speak to parents/carers or implement support before you make the referral for a neurodevelopmental assessment.   

Yes. Children and young people should have accessed some initial support prior to a referral being made. This supports an referral as it provides information on what the need may be, how the child/young person is responding to interventions and what helps on a day-to-day basis. These are important considerations when considering whether there is a need for a neurodevelopmental assessment.

Requests should indicate:

• What support parents/carers have accessed to support their child at home. For example support from services such as Early Help, Parenting Support, Health Services or whether they have accessed a workshop or course linked to the specific area of need.
• Evidence the child/young person has accessed interventions in settings and how the child/young person has responded to this support over a period of time in line with a SEND Graduated Response
• Evidence that a specialist support service such as Learning Support Service, Educational Psychology, Speech and Language Therapy or CAMHs have provided advice and support depending on the area and level of need where this is appropriate.

Yes you can. We do ask referrers to carefully consider the reasons for making the request and whether a pathway the child/young person is currently accessing is meeting their needs. For example, pathways such as EHCP and Child in Need pathways will mean a range of professionals are currently involved. Consideration should be given to why there is a need for a neurodevelopmental assessment and the level of evidence the referrer or multi-professional team has indicating there is a need for a further assessment.  

The triage team consider each case on an individual basis. In some instances, referrers may be signposted to another pathway if this seems more appropriate at that point in time. This does not mean future referrals will not be accepted, it may be another process needs to be completed prior to a request for a neurodevelopmental assessment. This is so a clear understanding of the circumstances, what a child/young person may need and why the professionals feel a neurodevelopmental assessment is required is obtained.    

There is criteria and guidance to follow on this website and this should be considered before an assessment request is made. Assessment requests are made at the request of the parent/carer and the young person when they are able to make this decision. When a parent/carer is not seeking a diagnosis support should be accessed and maintained in the expected ways.

Please see the sections above for further information.

What happens once a neurodevelopmental assessment request is made?

When a request to the Neurodevelopmental Assessment Pathway is made the referrer will receive an acknowledgment email. This means the request has been successfully submitted and it will be considered by the triage team. At this point the request has not been accepted to the Neurodevelopmental Assessment Pathway.

Who are the triage team?

All requests for a neurodevelopmental assessment are considered by a multi-agency team. The team includes a Community Paediatrician, a Clinical Psychologist, a Speech and Language Therapist and an Early Help Locality Manager. There is also administration support during the triage meeting.

Triage takes place once a week and all requests to the Neurodevelopmental Assessment Pathway are considered by the team.

What do the triage team look for?

All requests are considered on an individual basis alongside the criteria. The key pieces of information that are considered include:

• The needs of the child or young person
• The complexity and persistence of any difficulties
• What support has been put in place
• How any difficulties impact on a child or young persons’ day to day functioning across all of their environments

It is important that all of this information is clearly described in the request.   

What decisions are made at triage?

At triage one of the following decisions is made:

• The request is accepted to the Neurodevelopmental Assessment Pathway. The child/young person will be listed for an appointment with either our CAMHs Team or Community Paediatricians depending on what the child/young person’s needs are.
• The request is accepted but we may need to do some further exploration work to understand the nature of the difficulties. These requests will be directed to our Neurodevelopmental Keyworkers. Once they have gathered some information they will share this information with the neurodevelopmental triage team. A decision will then be made as to whether there is a need for a neurodevelopmental assessment and which service will be best placed to complete this. It may also be that there is not a need for an assessment at this point in time. We will advise you of the next steps and any recommendations in this situation.
• There is a need for an Early Help response in the first instance. The request will be directed to one of our Early Help teams.
• There is not enough information included in the request or key information is missing. The request will be returned to the referrer advising them of this and what is needed. The referrer will need to make a new request with the relevant information included.
• The information does not indicate a need for a specific neurodevelopmental assessment at this time. Some steps may need to be taken before an assessment is considered. The referrer will be given advice on what the recommended next step should be.

What happens once my child has been accepted onto the Neurodevelopmental Assessment pathway?

Every child and young person is different. Each has a different set of strengths and needs. The triage team decide which service is best suited to understand your child’s needs in more detail and complete an assessment.

As part of the outcome email you receive you will be given information on a workshop we offer called ‘Understanding the Assessment Process’. This workshop will give you important information on what happens during the assessment process, what the professionals are looking for and what evidence they are gathering. It is helpful for parents/carers to attend this session so that you know what to expect during the assessment process.

First appointment

• Review of history/your child's development
• Assessment, for example medical assessment
• Information gathering

Onward referrals for assessment linked to needs

• Speech, language and communication
• Medical investigations, for example bloods
• Assessment of concentration
• Observations in setting
• Learning skills
• Mental health/trauma

Diagnostic Panel - reviews the evidence using specific criteria

• Enough evidence to meet clinical thresholds – Diagnosis given
• Not enough evidence to meet clinical thresholds – No diagnosis given
• Inconclusive/conflicting evidence – Re-referral at a later point 

The two services responsible for an assessment of a neurodevelopmental need in Salford are:

• CAMHs: CAMHs is made up of a range of professionals including Psychiatrists, Clinical Psychologists and Mental Health Practitioners. They work with children and young people to understand their neurodevelopmental, emotional, behavioural and mental health needs.
• Community Paediatricians: Community Paediatricians are children and young people’s doctors who specialise in childhood neurodevelopmental disorders, childhood disability and complex medical conditions. Their role in the team is to find out about your child’s medical needs.

Once it has been decided which team is best suited to understand a child or young person’s needs that service will send an appointment to you once your child reaches the top of the waiting list.

These teams may also need to involve some other services as part of the assessment process if they have not already seen your child. These services include:

• Speech and Language Therapy: Speech and Language Therapists work with children and young people to identify why they may have speech, language or communication difficulties in different settings. Their role in the team is to understand and support speech, language and communication skills.
• Educational Psychology:  Educational Psychologists alongside teachers assess children and young people to identify strengths and difficulties in educational settings. Their role in the team is to focus on strengths, challenges and solutions for a child or young person linked to their learning.
• Occupational Therapy: Children’s Occupational Therapists assess and advise children and families on how they can participate in daily activities to enable them to become as independent as possible. This includes general self-care, school, work and play/leisure (dependent on the age of the child or young person). Occupational Therapists may also investigate sensory processing difficulties.

It is important that any appointment you are offered you do attend. This is so we have all of the information that is needed to understand your child’s strengths and needs thoroughly.

Your first appointment: What might I be asked?

As a parent/carer the professionals want to understand what you have noticed in your child’s development. They will usually ask you questions such as what your child finds easier and what you may have needed help with. They will ask you about their early development as well as the impact any difficulties are having day to day on your child.  

They may ask your child to do some individual activities as well as observe them playing, interacting and learning. The assessment process can take a while. The assessment team will need to ensure they have all the information to understand your child’s strengths and needs. It is also important to see how your child develops and responds to support over time. 

It may be useful for you to make a note of questions you have or things you have observed to share these with professionals.

What happens following this first appointment?

The lead professional, who may be a Paediatrician, Psychiatrist or Clinical Psychologist, will consider what information they already have and what they may need in the future. They will explain to you what the next steps will be. This may be a further appointment, an observation completed of your child or a period of seeing how they develop. For each person this will be different depending on what the need is.

Once all the required information has been gathered by the team, you will be offered an appointment to finalise and share the outcome of the assessment.

Sometimes this outcome is clear. This may include a specific diagnosis being given.

Sometimes the assessments may have indicated that your child does not need a specific diagnosis. This will be discussed with you alongside any reasons for this decision. You may be signposted to suitable support depending on what the assessments have indicated.

What should I do if I have further questions?

The professionals you have been working with continue to be a point of contact for you. Once your child has been accepted onto the Neurodevelopmental Assessment Pathway you can also ask the professionals involved in your child’s care. This may be the Paediatrician, Psychologist, Psychiatrist or Neurodevelopmental Keyworker.   

How do I get support?

Support is offered according to needs. Professionals working with you will discuss this and what support you would like. Sometimes where more specific support may be needed the Neurodevelopmental Pathway team can signpost to this support if it is not already in place.

Our website has further information that you can access as well as tips, advice and strategies that you may find useful.