Accessing specialist support from Children's Integrated Therapy Service

Speech sounds – School Years

For school years aged children, we ask that school complete two terms of Speech Link® intervention, or similar, sending evidence and outcomes when referring to us.

Speech sounds – Early Years

Referrals from three years. By the time a child reaches their third birthday they should be mostly intelligible although they will still have several speech immaturities. If a child is still very difficult to understand after the age of three, a referral should be considered. This is for children who present with moderate to severe speech sound disorders, including Childhood Apraxia of Speech (CAS).

Moderate needs present as multiple articulation errors with the child being understood by familiar care givers, however unintelligible to unfamiliar listeners. The errors are consistent, and the child has a repertoire of sounds containing both consonants and vowels.

Severe needs present as multiple articulation errors with the speech being unintelligible to even familiar listeners. Errors are usually extensive substitutions and/or omissions and consonants and vowels are affected.

Voice

Referrals from birth. These are for children and young people with moderate or severe voice needs, as outlined below. These both include the voice difference being of concern to the child or young person, parent/carer(s), teacher(s), and/or other professional(s).

Moderate needs are a persistent and noticeable difference in voice production quality (for example, tension, resonance, pitch, intensity or rate).

Severe needs include a consistent and noticeable extreme difference in voice production quality (for example, tension, resonance, pitch, intensity or rate). This includes where the voice is distinctly atypical for the age and gender of the child or young person.

Stammering

Dysfluency (also known as stammering or stuttering). Referrals from three years. Many children experience non-fluency when they start to talk in phrases and sentences between two to three years of age. Usually, this non-fluency subsides within three to six months. When this non-fluency happens, it is helpful for parent/carer(s) and professionals to understand dysfluency so that they can provide a child who is stammering with reassuring messages about themselves as a communicator and support a child to feel good about their talking. Please find information and resources on our website to support this (Stammering (dysfluency) | East Sussex).

We advise a referral after three months if any of the following are in evidence:

• the child has shown frustration or upset about their talking
• parents are concerned or worried
• there is a history of stammering in the family.

Parent/carer(s), education settings and other professionals known to the child can refer at any point via the website if a school aged child is stammering.

Selective Mutism.

Referrals from three years. Selective Mutism is a condition where individuals can speak but consistently fail to do so in specific social situations, despite speaking freely in others. It's not a choice, but rather a form of anxiety that can manifest as a "freeze" response from the child when faced with speaking in certain settings. For example, they may stop talking at home if someone outside the immediate family unit joins them. The inability to speak interferes with children’s ability to function in that setting, and is not usually better explained by another behavioural, mental health, or communication disorder. We would always advise a referral to Speech and Language Therapy where selective mutism is a concern as outcomes are much better with early intervention.

Please note that some children also present with Reactive Mutism (RM). This has a similar presentation to Selective Mutism however, has a different cause that is usually related to a trauma in the child’s life. If it is identified as part of our triage or assessment process that the child is presenting with RM, the child will be discharged with recommendations on other services best suited to meet the child’s needs.

Cleft palate

Referrals from birth. Children with cleft palate sometimes experience eating and drinking and/or speech sound problems. Please refer directly to these descriptors (for example, eating and drinking and speech) for children who will be seen.

Alternative and Augmentative Communication (AAC)

From birth

This refers to methods used to support or replace speech for individuals with communication difficulties. These methods can range from simple tools like picture boards to more complex electronic devices. AAC aims to enhance or provide a means of communication for those who have trouble speaking or understanding language. AAC is used classed in to the following two groups:

• Powered AAC: For example an iPad with a communication App (for example, GridPlayer, Proloquo2Go)
• Non powered AAC: Communication boards and books, Makaton, Objects of Reference.

AAC is used for children with speech sound disorders, including CAS, language disorders and DLD, and voice disorders.

CITES will provide non-powered AAC, as required. For powered AAC, assessment and provision are commissioned by the Chailey Communication Aid Service (CCAS).

Acquired brain disorders

Referrals from birth

Usually referrals come to our Speech and Language Therapy service from the hospital via our Therapy One Point (TOP).  If the hospital has not referred, parent/carer(s) and/or other professionals known to the child are invited to refer via our TOP.

Deafness

Referrals from birth. Children with hearing impairment are usually referred through Audiology or Ear Nose and Throat (ENT) or other specialist tertiary centres (for example, paediatrics). If you think a referral may be needed, please contact the service on 0300 123 2650 for advice.

Language – Early Years

Language disorder and Developmental Language Disorder (DLD). Referrals from the child’s preschool year. Children under three years of age and not yet in their pre-school year, can access advice and support through:

• Early Communication Support Workers (ECSW) who work in local children’s centres
• Family Hubs accessed through Health Visiting
• Special Educational Needs and Disabilities (SEND) Early Years Service (EYS), supports children from zero to five years with SEND.

The EYS and CITES Speech and Language Therapy have worked together to develop a joint pathway for early years children who have not yet developed a functional communication system and meet our respective services referral requirements. 

Children who are not yet three or in their preschool year and are without a functional communication system will start their communication journey with SEND EYS. The SEND EYS will support the child’s early years settings to use graduated therapy programmes co-produced with our Speech and Language Therapy (SLT) service. These programmes are aimed to develop the child’s joint attention, early interaction, and introduction of signs and symbols to support intentional communication.

When the child transitions into their preschool year, SEND EYS will share children’s details with the SLT service and the child will be placed on the SLT caseload. Our SLT service will then provide a pre-school package of care including transition support. This package of care will include one-to-one sessions, information meetings, workshops co-delivered with SEND EYS, and telephone support through Therapy One Point (TOP) as and when required. 

Language – School Years

For a school aged child, we ask that schools complete two terms of Language Link® intervention, or similar, and then send evidence and outcomes when referring to us. Children who have mild to moderate language needs will have their needs met under the Communication Language and Autism Support Service (CLASS) and CITES universal and targeted offer (for example, school consultations, Makaton training).

Please see further information for distinction between mild, moderate and severe language needs:

Mild language needs are those children whose language needs have a minimal interference on their communication skills and whose scores on standardised assessments are as follows: 

• 1 to <1.5 standard deviations below the mean standard score
• 7-15th percentile.

Moderate language needs are those with children whose language deficit usually interferes with communication and whose scores on standardised assessments are as follows: 

• 1.5 to 2 standard deviations below the mean standard score
• 2-6th percentile.

Severe language needs are those with children has limited functional language skills and/or communication is an effort. Also, the child may be non or pre-verbal and whose scores on standardised assessments are as follows: 

• More than 2 standard deviations below the mean standard score
• 2nd percentile or below. 

Please note for children who are non-verbal that they need to have communicative intent to access intervention.  

For school years aged children, we ask that school complete two terms of Speech Link® intervention, or similar, sending evidence and outcomes when referring to us.

Severe Developmental Delay

Referrals from birth. A referral should be considered for early years children with severe developmental delay and/or neurodevelopmental disorders. You are welcome to contact our Speech and Language Therapy service via our Therapy One Point (TOP) to discuss a referral. If a child is already known to SEND EYS please discuss the child with this service prior to referring.

Children and young people can access specialist support from zero to 18 years old (or up to 19 if in full-time education).

This specialist area of support is appropriate for children with motor development difficulties where the primary need relates to gross or fine motor skills impacting daily function.

Our referral criteria includes:

• Delayed motor milestones (for example, head control, sitting, walking)
• Higher-level balance and coordination difficulties (for example, jumping, stairs, running) impacting function
• Developmental Coordination Disorder (DCD), subject to pathway criteria
• Atypical gait patterns impacting function or development
• Hypermobility significantly impacting gross motor function or daily living activities
• Chronic fatigue and/or pain conditions or Functional Neurological Disorder, where function is significantly impacted and child is or has engaged with the Child and Adolescent Mental Health Service (CAMHS) or Primary Mental Health Services.

Before referral

• Parent/carer(s) and/or school must provide evidence of strategies trialled using videos and resources (Moderate physical disability and development | East Sussex) over at least 12 weeks.
• Jump Ahead and/or Sensory Circuits programme must be completed a minimum of three times a week for four academic terms. Evidence of this must be uploaded as part of the referral process.
• If considering a referral, please contact our Therapy One Point (TOP) on 0300 123 2650 to discuss the child before proceeding.

Please note

• Children with Musculoskeletal (MSK) conditions should be referred to MSK Physiotherapy Services.
• Referrals will not be accepted for children whose primary difficulties relate to sensory processing, emotional regulation, or handwriting difficulties where either of these occur in isolation.
• Typical gait variants (for example, symmetrical in-toeing, flat feet) and general health or fitness concerns (for example, obesity, fatigue) are out of scope.

 

For full details of what is in and out of scope please see the 'Physiotherapy referral guidance details' and 'Occupational therapy guidance details'  in further information section below -  or phone our Therapy One Point service on 0300 123 2650.

 

Children and young people can access this specialist support from zero to 18 years old (or up to 19 if in full-time education).

This specialist area of support is appropriate where the primary area of need includes:

• complex health needs
• multiple specialist interventions
• Cerebral Palsy (Gross Motor Function Classification System levels 4–5)
• eating and drinking difficulties (dysphagia)
• profound and multiple learning disabilities
• neuro-muscular conditions (acute deterioration or new complex presentation)
• susceptibility to respiratory compromise, including that associated with eating and drinking difficulties.

Eating and drinking referrals may be considered for children showing signs such as:

Some babies and children need specialist support from a Speech and Language Therapist to support their swallow safety and functional eating and drinking skills. The medical term for difficulty or an inability to swallow is ‘dysphagia’.

Please consider a referral for a child when you see the following: 

• A baby has difficulty establishing or maintaining a sucking action alongside any coughing, choking, colour change, or nasal regurgitation.
• A baby is distressed when feeding or straight afterwards. They may also vomit a lot, draw their legs up in pain, are unable to suck on a teat, and/or display weight loss. It will be best to visit your GP or Health Visitor in the first instance who will then be able to refer on as required.
• A child is unable to chew a range of textures or manage family meals. They may become distressed, cough, choke at mealtimes or vomit. The child may also be experiencing weight loss.
• Eating and drinking difficulties because of a degenerative condition.

It is important to consider that children may present with behavioural feeding difficulties such as gagging on specific textures, rigidity around times of eating, aversive behaviours around the temperature of foods, the colour of foods, texture of food and smell of food. Please note that children who are displaying these type of sensory and behavioural difficulties in relation to eating and drinking would not usually be accepted. Advice may be offered on sensory strategies.

If you are unsure about whether to refer, please contact the service for further telephone advice. 

Please note

• All babies with Down Syndrome/Trisomy 21 should be referred by their Health Visitor in their first year of life for a therapeutic advice and input. If children are not referred for eating and drinking concerns at birth, we recommend babies with Down Syndrome/ Trisomy 21 are referred by their Health Visitor in their first year of life for early language advice including how to create a communication friendly environment. Intervention will be based on clinical need and presentation of the child and consider our other pathway criteria (for example, language, speech sound, eating and drinking).
• For pupils in Special Educational Needs (SEN) schools, please discuss concerns with the therapists who regularly visit the school.

Musculoskeletal problems

• Children with Musculoskeletal (MSK) conditions should be referred to the appropriate MSK Physiotherapy Service.
• We accept referrals for babies with:
  • congenital foot abnormalities (for example, talipes)
  • preferential head turning (Torticollis)
  • hip dysplasia (DDH)
  • shoulder dystocia with neuromuscular signs (Erb’s Palsy).

For full details of what is in and out of scope please see further information section below - or phone our Therapy One Point service on 0300 123 2650.

Children and young people can access this Pathway from preschool age to 19 years old.

Please visit our adaptations page for further information.