1. 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

2. To work together to ensure successful implementation of this pathway
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
Aim of this session

3. A review of Children’s Services in 2016 established:
This prompted the re-design of the ASD Pathway for Children and Young People
Increase in the number of children being referred to the Community Paediatric Service resulting in long waiting times of over 12 months
Increase in identification of SEND relating to autism, above national benchmarks
Increasing demand for services
No additional funding
Background
Swindon population aged 0 to 18 years will increase from 54,222 to 58,273 by 2031.
150% over national benchmarks
In 2018/19, 1,108 referrals were made to the Community Paediatric Service. 739 referrals were accepted during this period.
As of June 2019, they are seeing patients who have been waiting since January 2018.

4. What we did Mapped the existing and new pathways
Formed a multi-agency 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

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

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

7. Misconception: Children can only get support if they have a diagnosis
ASD is often the default assumption for children with speech and language delay or challenging behaviour
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
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
Misconception: Children can only get support if they have a diagnosis
The main challenges
challenges

8. Quick Quiz Question 1: Question 2:
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%
Quick Quiz
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

9. 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
The New Pathway

12. 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
The Referral Process What we need from referrers

13. The Referral Process For GPs via ERS
For all other referrals, including schools, by post to:
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
The Referral Process

14. Any questions?