Early Identification Pathway for Additional Needs

Health visiting pre-school pathway  

Checking a child's milestones in their early years is important as it helps identify any areas where support and intervention may be necessary.  

If concerns regarding development needs are raised by parents, carers or professionals, your family health visitor should arrange a meeting with you.

Your health visitor will aim to meet with you and your child within 14 days.  

They will talk through any concerns that have been highlighted and may: 

• Ask you to complete an Ages and Stages Questionnaire (ASQ) about your child 
• Use the Schedule of Growing Skills tool to explore further your child's development 

Your health visitor may find that your child has no additional health or development needs.  

If this is the case you will discuss this with you and your child may be monitored through the Healthy Child Programme.  

In order for your child and your family to get the right support, it is important to have all needs identified.  

The best way to identify need is through an Early Help assessment, this may be led by your health visitor or another professional.

Early Help assessment  

Early Help assessments look at your whole families strengths and areas of needs, this includes education, health and care needs.  

It may identify further assessments that may be necessary from other services / professionals to support your child and family.

When the Early Help assessment is completed, it may be beneficial for your family to have an Early Help plan.  

The Early Help plan will be co-ordinated by a lead professional. This may be your family health visitor or someone else who knows your child and family well. 

Early Help plans make sure that all the support you need is available at the right time and make sure this is well communicated between all services.  

The Early Help plan will continue as long needed, making sure the plan is suitable for you and your family. 

Further identification  

Where children are presenting with delayed / disordered development or specific needs such as social communication, your health visitor may take further steps to explore this. 

Social Communication Clinic Pathway  

The Social Communication Clinic Pathway is the process that is used to assess your child's ability to use their language and communication skills appropriately in social situations, across different settings with different people.  

• It is used to identify social communication difficulties  
• Identify support and interventions needed for the child 
• Formal diagnosis of Autism Spectrum Disorder (ASD) for children under 5 years 

Identification and referral 

If social communication needs are identified by you, your health visitor or other professional, a discussion on next steps will be discussed with you.  

It is important that your child and your family are provided with the support that you need from the earliest point. 

You may have an active Early Help plan in place.

If you don't have an Early Help plan, an assessment may be carried out to identify your child and family's needs and an Early Help plan may be put in place.  

A lead professional will be identified to support coordination of the plan, and this will be discussed with you.  

They will be your main point of contact while the Early Help plan is in place. 

As part of the social communication assessment, your child may have been referred to Speech and Language Therapy and Pre-School and Portage. 

Speech and Language Therapy may advise attending the Little Explorers Group as part of the assessment pathway.  

Speech and Language (Little Explorers) 

Speech and Language Therapy will provide information and support in relation to your child's communication and language and contribute to the wider assessment process with your agreement. 

Your child will be seen for direct observation and assessment within clinic and / or their nursery / school setting. 

This is to gain the information required for assessment and to provide you with communication strategies to use with your child to help their development.  

We will also gather further information from you and other relevant professionals with your consent, through telephone or video calls, questionnaires and attendance at relevant multi-disciplinary meetings.  

A summary report will be completed and shared with you and other professionals involved, including information about your child's strengths and needs.  

Not all children will need further support from a Speech and Language Therapist. You may be provided with recommendations in relation to his / her communication development and activities that can be carried out with your child by people that support them. 

Support during assessment 

You should have an Early Help plan in place which will have identified support that your child and family needs. 

You can contact your lead professional at any point if you need any further assistance.

The Autism Hub offers support to families with autistic children and young people before assessment, during assessment and after formal diagnosis.

Education support is available based on the needs of your child; a diagnosis is not necessary for them to receive support through their current school/setting, this may include support from Pre-School and Portage or Ashley Child Development Centre.  

Decision-making 

Throughout your child's assessment, there will be Multi Agency Assessment Team (MAAT) who regularly meet to discuss your child's progress on the pathway.    

The meeting is led by a paediatrician and includes professionals from education and health services including:  

• Pre-School and Portage Service
• Speech and Language
• Clinical Lead for Children with Additional Needs

The multi-agency assessment team are responsible for decision-making, alongside parents and carers.  

You will be invited to meet with the Paediatrician on a regular basis, usually every 6 months, to make sure you are included in the decision-making process and kept up to date.

To make a decision, the multi-agency assessment team review all reports from assessments that have been carried out and any other relevant information.

They follow NICE guidelines to decide if a child meets the criteria for a diagnosis. 

Whatever the outcome of the MAAT meeting, you will meet with the Paediatrician to discuss the outcome with you, this may include: 

• The team may feel that further assessment gathering is required from professionals. If this is the case, you will be invited to another appointment, usually in 6 months' time, to discuss next steps. This is known as 'Watchful Waiting'.  
• Your child may receive formal diagnosis of Autism Spectrum Disorder (ASD).  
• No diagnosis - where this is the case, you will receive continued support through your Early Help Plan. 
• An onward referral to the Lifecycle service may be made if the multi-agency team feel ongoing assessment is needed for identified needs outside of the social communication pathway 

Post clinic support 

We understand that a formal diagnosis is important for children and families, to help understand the reason behind certain traits and behaviours.  

However, the diagnosis should not impact upon the support you receive, an Early Help plan should address all of your needs, regardless of the outcome.

If your child does not receive a diagnosis or further assessments or watchful waiting is required, you will still be able to access support. 

This process is focused on partnership working, decisions are made with all involved with the child at the centre.  

If for any reason you were not confident in the decision made you would discuss this and plan together what the next steps are.  

If your child is diagnosed with ASD your health visitor and the Clinical Lead for Children with Additional Needs or Health Visitor Champion will aim to visit you, usually within 4 weeks to:

• discuss the diagnosis 
• answer questions  
• let you know about support available locally, regionally and nationally.  
• Your Early Help Plan will continue for as long as you need 

The lead paediatrician will notify SEND Services of your child's diagnosis.  

Occasionally the paediatrician may request a developmental screening blood test. 

This is a blood test that looks at your specific parts of your child's DNA to find out if there are any missing or duplicated genes.  

Sometimes if there are differences in your child's DNA it gives greater understanding of your child's condition, especially if there is a similar history in other family members.   

It is not a diagnostic test and usually comes back with no evidence of any differences.  

If there are any differences found the Clinical Genetic Team will talk to you about the results.