Advice and resources : About our Request for Help process

The most important thing for a child or young person is to put support in place straight away – this can happen without diagnosis, assessment or referral. This means that needs-based support can be put in place as early as possible, regardless of diagnosis.

The information we are asking for now is all the information we will ask for at the triage stage. Our process is to make sure we have:

Partnership referrals: Referrals are made jointly by families, early years settings, schools, or another professional with direct knowledge of the child or young person, making sure that those who know the child or young person best provide the information that we need. This means completing an additional information document together.
Support in place: We ask that a support plan has been in place for at least six months before making a decision about referring for both autism and ADHD assessment, or a request to consider starting ADHD medication.
Checked off the pre-referral checklist: We ask you to make sure you have worked through everything on the pre referral checklist on this page before deciding if a referral is needed.

Read more detail about our referral process

We have recently introduced some changes to our referral process for our Children and Young People's Autism and ADHD services. We have been working closely with our Integrated Care Boards who commission our local autism and ADHD assessment services. We agree that we need to identify and meet the needs of children and young people at the earliest opportunity, within a robust, needs-led system approach.

We are implementing changes to ensure that individualised needs-led support is provided as early as possible, regardless of whether there is a formal diagnosis. Over time, we also aim to reduce the waiting time for assessments when it is evident that a child or young person requires one to address their needs.

A child or young person’s needs are the same before an assessment as they are after a diagnosis. What matters most is ensuring that the right support is provided, at the right time, in the right place.

Current challenges

Referrals for children and young people's ADHD and autism assessments are exceptionally high nationally, leading to unsustainable waiting times across the UK.

The SEND Code of Practice emphasises a needs-led, flexible approach which doesn’t rely on a formal diagnosis. However:

Some children and young people attend for an assessment with little or no evidence that they have a support plan in place to meet their needs.
Some schools have told us they were waiting for an assessment/diagnosis before putting support in place for a child or young person.
Some families come for an assessment because they believe this is the only way they can access support.
Some young people and families attend assessments when it is not what they would have chosen to do themselves.

In addition to this:

Referrals often do not give us the information we need to make prompt decisions about how best to help, which creates inefficiencies and delays while we try to obtain this information.
Some children and young people may not receive a diagnosis after being assessed but will still require support.
Adding children and young people to a long waiting list does not meet their needs, and they should not have to wait for or rely on referral/assessment/diagnosis to get support.

Finally, we know that a diagnosis often does not provide all the benefits that people expect. Having a diagnosis does not significantly change the situation for the child or young person, and it is not always necessary for understanding and addressing their needs.

What’s changing?

We are making changes to who refers, how they refer, at what point they refer, and what needs to have happened before a decision is made about whether a referral is needed.

Who refers: Referrals will now be made by families and the early years setting or school in partnership together. This means referrals are made by those who know the child or young person best, based on a shared understanding of their needs, with a focus on what support is or should be in place now.
How they refer: Families and early years settings or schools will complete an additional information document together and upload this with the online referral form. This means that we will have all the information we need from the right people to decide how we can best help and can make effective and prompt triage decisions.
When they refer: The right time to decide whether a referral is needed is after a robust support plan has been implemented and evaluated. The support plan must have been fully implemented and reviewed for at least six months/two terms (eg two Assess Plan Do Review cycles in school, following the SEND graduated response).
Helping where it is needed most: Specialist autism and ADHD assessments and ADHD medication will be focused on those who will benefit most from a formal diagnosis, Children and young people should be referred for specialist assessment when it is clear this is required to meet their needs. This means that over time the wait for this will reduce. Assessment and diagnosis remain in place when it is clear that this is important to meet the needs of the child or young person.

We will be offering the opportunity for families, early years settings or schools and other referrers to provide feedback with every referral so that we can refine the updated process.  

Why are we making these changes?

To make sure children and young people have support in place as early as possible which is more beneficial than being added to a long waiting list.
To get the right information from those who know the child or young person best: the process will enhance everyone’s understanding of the child or young person’s needs and promote necessary support that should be in place now.
To ensure faster assessments: Over time, these changes will mean shorter waiting times for an assessment when it is clear one is needed.
To support choice: We want to make sure that children/young people and families do not feel they have to attend an assessment for their needs to be met.

Without these changes, we risk delays to accessing early help. Waits for assessment will become longer.

We know that, in some areas, children and young people are already faced with waiting many years for assessment and we do not want this for our families. These changes are designed to help make sure timely support is in place, tailored to the individual needs of each child or young person. Needs should be met in inclusive environments with no delay in receiving support.

We believe this approach is crucial in providing the early help and support that can make a significant difference in the child or young person’s development and wellbeing – and this is what matters most.

You said, we did

We have been introducing updates to the referral process in a phased implementation extending from 1 November to 6 January. This has allowed us time to listen to and reflect on feedback from individuals and groups.

We understand that changes like these can raise questions and concerns, and your feedback, insights and suggestions are very important to us as we implement these updates. Thank you so much to everyone who has completed the online survey or has got in touch with feedback about the updates to the referral process. We have listened to all your feedback and are very grateful for the time and thought you have generously put in to provide us with your views and feedback about your experiences.

We have used your feedback to make some changes to the additional information documents found here.
We have provided detailed guidance on the referral process for families and for professionals.
We have also used your feedback to add to our Frequently Asked Questions (FAQs) for families and for professionals.
We have reviewed every single comment and suggestion regarding the updated process and whenever possible have made changes to reflect your feedback. Below are some of the changes we have made.
Word documents have been reformatted to provide a better experience.
Some of the wording has been changed.
We have introduced separate additional information documents for autism and ADHD as well as the combined document.
We have worked hard to address duplication across the additional information document and the online referral form.
We have streamlined the forms and removed some of the questions. As a result the documents are now shorter. For example, we have reduced the additional information form for autism and ADHD from 14 pages to 10 pages.
We have created some advice for filling in the additional information document and the online referral form.

Waiting times

It's very difficult to accurately predict the wait for an individual child or young person, as waits can go up and down depending on a number of factors (including staff vacancies) and what type of appointment the child or young person is waiting for.

Currently the waits to be seen are:

Autism Assessment Service: approximately 30-40 months
ADHD Service: approximately 28-36 months

We are sorry for the long waiting times. We understand this can be very difficult and are working as hard as we can to reduce these.

Much of the same support available after a diagnosis is available before an assessment. Find out about the support available for possible ADHD and possible autism.