Advice and resources : About our Request for Help process

Our referral process

Putting support in place quickly, and in the right way, can help a child or young person.

We can do this without diagnosis, assessment, or referral. 

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: made jointly by those that know the child or young person the most, such as families, early years settings, schools, or another professional 
• Support in place: as a plan which has been followed 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: to make sure you have worked through the criteria before deciding if a referral is needed

• Request for Help process guidance for professionals

Improving our process

Current challenges

ADHD and Autism Assessment referrals for children and young people are exceptionally high across the UK.  

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

However, we must keep in mind that there are difficulties. 

• No plans in place: some children and young people attend assessments with little or no evidence that they have a support plan in place to meet their needs
• Lack of guidance for schools: some schools have told us they were waiting for an assessment/diagnosis, before putting support in place for a child or young person
• Unaware of options: some families come for an assessment because they believe this is the only way they can access support
• Choice: some young people and families attend assessments when it is not what they would have chosen to do themselves
• Incomplete picture: 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 catch up
• Support still needed: some children and young people may not receive a diagnosis after being assessed, but will still need support
• Waiting to be seen, and heard: adding children and young people to a long waiting list does not meet their needs, and they should not have to rely on referral/assessment/diagnosis to get support

We know that a diagnosis often does not provide all the benefits that people expect.

People should not have to wait for a diagnosis to find out what to do next.

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.

• The SEND code of practice

Why we're making these changes

We're updating our referral process for our Children and Young People's Autism and ADHD services.

We're doing this by following:

• NHS and trust strategy
• Guidance from our Integrated Care Boards (ICBs), who commission our local autism and ADHD assessment services
• Feedback from patients and families

Our aim is to meet the needs of children and young people at the earliest opportunity, within a robust, needs-led approach.

This should happen whether there is a formal diagnosis or not.

Four key reasons for change

1. To make sure children and young people have support as soon as possible, instead of no support while they're on the waiting list
2. To get the right information from those who know the child or young person best
3. To have faster assessments, as these changes will mean shorter waiting times for an assessment when it is clear one is needed
4. To support choice, by making sure every child and young person does not feel they have to attend an assessment for their needs to be met

We know that dome children and young people are already faced with waiting many years for assessment.

Without changes, we risk delays to accessing early help. 

What matters most is ensuring that the right support is provided, at the right time, in the right place.

What’s changing?

We're 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 on a shared understanding, by those who know the child or young person best.

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 will give us all the information we need to help us offer the right help, and make effective triage decisions.  

When they refer

The right time to decide whether a referral is needed is after a robust support plan has been used and evaluated.

The support plan must have been fully implemented and reviewed for at least six months/two terms for example, 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.

You said, we did

Thank you to everyone who has provided feedback, using the online survey and direct contact.

We have used this feedback to gradually update our referral process in phases. We have done this by:

• Providing detailed guidance on the referral process for families and for professionals
• Adding Frequently Asked Questions (FAQs) for families and for professionals
• Reformatting word documents to provide a better experience
• Simplifying wording at different touchpoints 
• Introducing additional documents for autism and ADHD as well as the combined document
• Reducing duplication across the additional information document and the online referral form
• Simplifying forms and removing some of the questions, making documents shorter, such as reducing the additional information form for autism and ADHD from 14 pages to 10 pages
• Creating instructions on how to fill the the additional information document and the online referral form correctly

• Make a referral
• Parents and carers - how to request help

Waiting times

It's very difficult to accurately predict the wait for an individual child or young person, as appointments can depend on factors like staff vacancies, and the type of appointment the child or young person is waiting for.

Current waiting times

• Autism Assessment Service: approximately 28 to 36 months
• ADHD Service: approximately 30 to 40 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 autism.

• Getting help now: ADHD
• Getting help now: Autism