Referral guidelines

Who can refer

We have an open referral system. This means anyone can refer to Newcastle Speech and Language Therapy for children and young people, as long as they have consent from a parent (or person or agency with parental responsibility such as Children’s Social Care).

The child or young person must have a Newcastle GP and/or attend a school or setting in Newcastle.

When to refer

Using the Newcastle Graduated Response to meeting special educational needs, schools and settings should first implement support strategies from the Universally Available Provision document on the Newcastle Support Directory.

If the impact on individual progress/outcomes is limited, you may then wish to refer to our service, showing evidence of what support is already in place and the impact of this. Referrals which do not show this evidence may be returned.

How to refer

Please use this document to decide if you should refer to Newcastle Speech and Language Therapy for children and young people.  

We only accept referrals which meet these criteria and are made on a referral form which has been fully completed.

For referring schools and settings, please use the referral form to tell us what you have already put in place from the Universally Available Provision to support speech, language and communication.

Minimum referral age:

• We accept referrals from birth for children with difficulties in swallowing or feeding safely, or for children with significant and complex medical needs such as cerebral palsy or Down syndrome.
  
• We accept referrals from 18 months of age for children where there are significant and clear concerns about autism, which have been discussed with the parent.
  
• We accept referrals from 2 years where there are concerns around development of speaking or understanding.
  
• We accept referrals from 3 years where there are concerns around speech production (pronunciation) as long as the child meets the criteria set out in this guide and a speech screen is included with the referral.

Across all ages, the key indicators for referral are:

• If there are significant concerns about a child’s use of spoken language.
• If there are significant concerns about a child’s understanding of spoken language.
• If there are concerns about the child’s ability to chew and swallow safely.
• If the child is stammering and the child or their carers are concerned about this. Stammering in itself is not a reason for referral unless it is having a negative impact on the child’s well-being and/or participation.
• If the child has an unusual voice quality e.g. hoarseness or a nasal sounding voice, which is not linked to a current illness such as a cold or tonsillitis.
• If you are concerned about a pre-school child who may be autistic. School-age autism assessments are carried out by CYPS.
• If a pre-school child had started to use words then has ‘lost’ this skill.
• If a school-aged child has a diagnosis of autism and you are concerned about their speech, language and communication.
• You have used strategies and interventions from the Universally Available Guidance and the child has not made progress.

For any child with a significant communication problem a referral to audiology for a hearing assessment should be considered, this can be done by asking parents to discuss with their GP, health visitor, or school health advisor.

We do not accept referrals for:

• Children who are selective talkers.

This means there are only concerns about the spoken language a child uses in one context, but not in another, such as a child who talks freely and age appropriately at home but not in nursery. This is known as selective mutism/selective talking.

If you are concerned about selective mutism then there are resources you can access or the book ‘Supporting Shy and Quiet Children’ – Maggie Johnson and Michael Jones.

• Children who are of reception age or higher, who do not have a diagnosis of autism, where the main concern is around social communication and interaction skills or possible autism.

Please note: English as an additional language (EAL)

If a child has English as an additional language, we will only accept a referral if there are also concerns about their home language.

Consider a referral if your child is only using single words in their home language if they are older than 2 years.

You do not need to refer if your child is using their home language well but are only saying a few English words. 

If you are concerned about other aspects of their speech, language or communication please follow the guidelines below as usual.

Age-related checklist

For all referrals, you must fully complete a referral form and age-related checklist. Only refer if the child meets the criteria in the red section.

Concerns for children over 7 years

Refer to speech and language therapy if…

• The child finds it difficult to learn and understand words
• The child finds long and complicated instructions hard to understand
• The child is only using short, simple phrases with limited vocabulary
• The child finds it difficult to tell stories, to tell what has happened and to give explanations

You will find some information on typical speech and language development over the next few pages. Please use the screening tools and age-related checklists to help identify any areas of difficulty.

Screening tools

Understanding

If you are making a referral for understanding, you can use the screening tool below to help identify what key word level the child is working at and to monitor their progress while you await assessment.

Key words carry meaning and are the essential words needed to understand a sentence or follow an instruction correctly. For a key word to be valid there must be a contrast item.

When giving a child an instruction there are often words which the child doesn’t need to understand in order to correctly follow the instruction. For example at break time a teacher says to a child, ‘put your coat on’, and points to the child’s coat whilst all the other children are getting ready to go outside. This sentence has 4 words but the child is not required to understand any of these words as he can follow what the other children are doing. It has 0 key words.

The child has to understand 1 word in a phrase to follow an instruction “pass me the cup” when there is a choice of cup, plate and spoon.

The child needs to understand 2 words to follow the instruction “where is pig and cow?”, when a selection of different animals are on the table.

Speech sound development (pronunciation)

If your child is using lots of words and joining these together into sentences but you have noticed that their pronunciation or some speech sounds are not clear or not always used correctly then you may want to check this speech sound development chart to see if the errors that your child is making are typical for their age.

If you are concerned about a child’s speech sound development, you must download and complete the speech screen below and include this with your referral. This will give you an idea of how your child is pronouncing words and any mistakes they are making.

If you wish, you can also use the assessment of speech impact tool which helps describe how worried you are about the child’s speech and the impact their difficulty is having on them.

 You can refer if:

• The child is aged 3 years or older.
• If there are significant concerns about the clarity of a child’s speech.
• It is indicated by the chart above.
• They have extra puffs of air or ‘snort’ sounds through the nose when talking.
• They are 5 or older and cannot make specific sounds. For example, they cannot say a clear ‘k’ or ‘sh’ sound. A child may have difficulties producing a sound for physical reasons, e.g. missing teeth, or because they have not learnt how to make the sound.
• Refer if this is having a significant impact on their communication or the child themselves is concerned and wants to learn how to make the sound.