Children’s Social Communication and Autism Assessment Service (SCAAS) and CAMHS Neurodiversity Team

Below are just some questions you might find beneficial in talking through with families/ carers prior to deciding whether a referral is needed to explore social communication. Most of these will likely have already been discussed in your visits over time and having accurate answers to some of the below questions will help decide whether a referral is required or whether another route of support would be more beneficial.

• Was there a loss of language?
• Was there a general loss of skills?
• What is their current level of language?
• How do they currently communicate?
• Are they engaging with others? If so, how?
• Is there any ritualistic verbalisation or behaviours?
• Are they using gestures?
• Do they play imaginatively? If so, do they do this independently or with others?
• Are there any unusual sensory interests?
• How does the child cope with changes in their routine or environment?

If families/ carers have not raised concerns with you but you have observed or have clear evidence that their child would benefit from social communication assessment then it is helpful to discuss through their understanding of what social communication means to them. Do they agree with the current concerns that you’re observing? What are their thoughts about these concerns? Have they had discussions with any other professionals such as school? If so, have school raised concerns too?

It is important to reassure them that a referral to SCAAS does not necessarily mean their child is going to receive a diagnosis however, exploration of their child’s social communication needs and what avenue of ongoing support will be most beneficial for their child.

If you feel that a referral to SCAAS is clinically indicated please follow the process outlined in the making a referral section of this webpage.

We require 4 pieces of information in order for a referral to be opened and accepted to be screened by our clinicians:

• SCAAS Neurodiversity Referral Form: Completed by a professional – this could be GP, school, family support worker, counsellor. We cannot accept referrals completed by parents/carers. 
• Family Information Form: this is an opportunity for the family to tell us about their young person; their behaviour/routines in the home setting. If the young person would like to tell us themselves as well, please encourage them to do so, either in a different colour ink or on a separate sheet.
• School Information Form: having information from School or College will help us to understand how your young person gets on in different environments. It is best to liaise with a teacher who knows them really well or school SENDCo. This is not to be completed by parents/carers.
• MyPlan/MyPlan+, My Assessment or EHCP (or equivalent): We would expect all children to be on the Graduated Pathway prior to referral. This should have been discussed during a professionals’ meeting held before the referral is made. If a child is not on the graduated pathway we would need to see a plan of support around the child, to ensure that they can get their needs met, whilst awaiting a diagnostic assessment. This may be a holistic plan, thinking more about school or about home or a combination but prior to considering a lifelong diagnosis ensuring support is in place is vital. These could include: My Plan/My Plan+/My Assessment/My Profile/Pupil Passport/Individual Learning Plan/EHCP/Family Plan/TAF meeting minutes.

If a diagnosis of Autism is given to a child it will be with them for the rest of their life, so careful consideration needs to be given as to whether seeking a diagnostic assessment is right for the young person. Many report that having a diagnosis helps them to understand themselves and to be understood, however there are concerns that it may also be a barrier to certain types of employment. A significant amount of work is being done to educate employers and ensure that equal opportunities are offered to neuro-diverse individuals but there is still work to be done around this.

An assessment does not necessarily lead to a diagnosis of Autism and there may be other reasons that a child has social communication differences. You may hear that the difficulties you are experiencing are not caused by Autism. Some of the reasons you might observe these differences are in the attached leaflet.

If you are unsure about whether a child would benefit from a referral or not the best next step is to discuss this in your clinical supervision. If it is recommended to complete a referral then please follow the referral process for assessment with the SCAAS team. If you and your supervisor would like further advice then please feel free to email us on SCAAS.Team@ghc.nhs.uk and ask to book in a consultation slot with a member of the SCAAS team. 

A discussion with the family around their concerns and thoughts about referral to SCAAS is the first step of the referral process. Consideration for other causes that may be contributing to concerns is important such as previous or current change in circumstances that may be distressing for the family or child. As there will be a long wait for the diagnostic assessment it is important that there is a plan to support the child or young person whilst they are on our waiting list. This could be through the graduated pathway in the form of a MyPlan, a MyPlan+ or an Education Health and Care Plan (EHCP), or it could be a more informal pastoral support plan or My profile document. If a child does not need additional support or adaptions it is important to consider whether considering a life long diagnosis is the right next step at this time.

This is your decision, however we would encourage you to think carefully about talking to your child about the referral and what it might mean, especially if they are 10 or older. If your child is old enough and capable of understanding, they should be fully involved in making the decision to establish a diagnosis as there is a legal obligation to consider their wishes.

Children under the age of 16 can consent to their own assessment or treatment, if it is believed that they have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being “Gillick competent” – http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Childrenunder-16.aspxPros

If accepted for assessment, your child will be asked for their views. It is, therefore, very important that you have discussed this with them thoroughly before they meet our assessment team.

Getting good quality information allows us to make an informed decision about your young person to ensure we are appropriately considering a life long diagnosis. We will not meet every young person who is referred to the service, some will be signposted as the information provided suggests another service could more effectively meet the young person’s needs. As a service we are working hard to ensure that families meet with the right professionals from our team and that we offer a thorough assessment that is as timely as possible and makes best use of resources.

When we get good quality information about your person and their family, it allows our team to choose the right assessment approach for the young person, ensuring they have the right number of appointments. For example, when we have a lot of very clear information from school or nursery we may not need to plan a meeting with school or nursery as part of the assessment process.

Referred received with all required paperwork and opened

You should receive a referral acknowledgement letter confirming we have received your referral

Referral is screened by clinicians and next steps communicated to you, GP and referrer (if not GP). This could be a waiting list confirmation letter (accepted for assessment), request for further information (in order for us to make the best informed decision) or referral signposting letter (based on the information we have received we feel another service is best placed to meet your young person’s needs)

If accepted for an assessment, you will be placed on a waiting list and when you reach the top, we will be contact you to offer an appointment.

If all of the required referral paperwork is not received all together, then the referral will be declined, as the clinicians cannot screen the referral. A referral decline letter will be sent to you, GP and referrer, explaining what paperwork is missing and that until we receive it, your young person does not have an open referral to our service.

It usually takes around 3-6 months to let families know the outcome of the referral screening.

Currently this is approx. 2 – 2 ½ years from the date that the referral is received by our team.

No, there is support available through the graduated pathway which is strengths and needs based and is not reliant on a diagnosis. Glosfamilies Directory | Using the Graduated Pathway of Early Help and SEND Support

Due to the number of young people waiting for an assessment we are not able to predict waiting times for individual young people. If you are unsure if you young person is waiting for assessment or not we are happy to tell you, please contact us via email.

There are a number of reasons why waiting times are long; some national and some local.

Nationally:

• Demand for Autism and ADHD assessment has increased by between 200-300%
• COVID resulted in a period of time where it was not possible for assessments to be completed
• There is a delay between the increase in demand and increasing funding and staffing.

Locally:

• There were big differences between the assessment processes and waiting times for different ages of children in Gloucestershire. We have focussed on bringing pathways together to increase efficiency and offer a fair service across age ranges. This means waiting times for older children have reduced from around 4 years, whilst waiting times for younger children have increased.
• The service is receiving over 200 new referrals a month, which reflects the increased demand seen nationally. The service is growing to support assessment for those children where it is appropriate for an assessment to be offered, however not all referrals being received are appropriate for us at the current time. Further support through the graduated pathway can be accessed regardless of whether a child meets criteria for further assessment through our service. We have changed the referral process to ensure that families no not have to wait many years for other services, such as Educational Psychology, before being referred to our service.

In Gloucestershire we are working hard to reduce waiting times as we know waiting for an assessment to better understand your child can be stressful and frustrating. We have been taking a range of actions over the last few months to both reduce the wait and support families better:

• Recruiting to all new roles to increase assessment capacity
• Working with a NICE compliant external provider to complete waiting list initiatives. These assessments are being offered to families when appropriate as they reach the top of our waiting list.
• Developing a website to give families information and advice whilst they are waiting
• Bringing in a Multi-Agency Forum Coordinator to help link up the systems across Gloucestershire to enable us to make helpful recommendations both to the families that are signposted and families whilst they are waiting for assessment. This will prevent us giving recommendations that families have already done.

It is your decision if you want to seek a private assessment. The quality and structure of private assessments vary significantly, with some completed by experienced multi-disciplinary teams, and others completed by a single, sometimes unqualified, individual. For this reason, and to give you peace of mind that the assessment will be accepted by statutory services, we recommend that you look for a service that offers a NICE Compliant assessment process if you decide to seek a private assessment. This is the only way to guarantee that the diagnostic outcome will be supported by the NHS and the Local Education Authority.  Overview | Autism spectrum disorder in under 19s: recognition, referral and diagnosis | Guidance | NICE

If you choose to seek a private ADHD assessment and are prescribed medication, the NHS is not able to continue this medication without offering our own assessment. This means that the young person will need to wait on the NHS waiting list until a reassessment can be offered. These referrals will not be given priority. This is due to the nature of medications used for ADHD.

It is your right to choose who your assessment provider is. Please speak to your GP or search Right to Choose for further information. As stated above our service is not able to continue medication prescribed through a Right to Choose assessment.

• For queries please email: SCAAS.Team@ghc.nhs.uk
• For new referrals please email: SCAASNeuroReferrals@ghc.nhs.uk