Quick reference:
Referral guide to York Teaching Hospitals
Children’s Therapy Services:
Quick reference: Referral guide to Children’s Therapy Services: Speech and Language
Speech and Language Therapy Referral
Is the child under 5 years Old ? Yes Is the Child over 5 years Old? No Either route below:
Direct referal form Direct referal form Parent self referral form Professional via Professional or can be be completed by Integrated Therapy Parent via parent and sent to: Referral Form Integrated Therapy Referral Form
Scarbrough Whitby and Ryedale Complete additional Parents: information SLT form and if there are also feeding York and Selby Parents: Children's Therapy Team, Beck House, West Parade Road, York Hospital, Wigginton Road, York, YO318HE and swallowing Scarbrough , YO12 5ED difficulties complete the feeding additional form
Send to: [email protected] Or by post: (Please see Children’s AHP Therapy Service Access Routes for York Selby, Scarborough Whitby, Ryedale Flow Chart in the Quick reference section.
Further information: • For Scarborough, Whitby and Ryedale Speech and Language Therapy call 01723 342472 • For York and Selby Speech and Language Therapy call 01904 726599
Quick reference: When to refer to Speech and Language and when to watch and wait Refer at any age if the child has : unintelligible speech speech skills that seem significantly delayed (see the chart below) verbal comprehension and/or expressive language impairments that are noticeably outside the expected range and affecting access to the curriculum a stammer lost communication abilities ‘nasal‘ sounding speech and/or over uses ‘m’, ‘n’ or ‘uh’ sounds a croaky or husky voice not attributable to a cold a very varied speaking profile (parent/carer reports child talks easily at home but is silent in the EY or school setting) By 18 months • A vocabulary of first • Child has a few • Poor attention e.g. words is emerging words (10-20) unable to sit with adult (around 50 words or • Possibly using jargon for short period more) or nonsense • Does not make eye • Child understands language for the contact or show what others say in main part interest in adults or familiar situations • Looks with interest other children • Understands more when hears language • Not saying any words words and phrases but no attempts to • Not using words for than they can say copy words communication (e.g. • Child copies words • Only understands may just say words for and possibly some very familiar words no apparent reason) short familiar phrases in known situations • Doesn’t look to people e.g. “what that?” e.g. “You want or objects when • Parents understand juice?” named the child’s speech • Looks with interest • Does not seem to more than unfamiliar when hears language understand what is listeners but no attempts to said much at all. • Words may be made copy words • Doesn’t turn to look of small range of • Words are not used where sounds are sounds, often used in for a few coming from (hearing?) babbling e.g. b, d and communication • Has lost social or m (and vowels). functions language skills • Words are short e.g. “beh” for ‘bread’
DO NOT refer Do not refer. Review at 23 Refer to Speech and months (if not improved Language Therapy then refer to Speech and Language therapy) Also see advice sheet/s; See SLT advice sheet; ‘Gesture’ ‘Advice for Early Years- delayed language’ sheets
BY 2 YEARS • Vocabulary increasing, • 20-50 single words • Little pretend play possibly hard to list all • Some simple • Poor attention and/or words said. pretend play. can’t share attention • Still mostly single • Able to concentrate e.g. looking at a book words, but some 2 for short spells with an adult word phrases may be • Possibly jargon • 0-20 single words heard. (nonsense speech) • No apparent • Speech intelligible to used with one or comprehension skills close family two words • Or, can only • Understands some interspersed understand stressed words out of context • Responds to familiar single words in familiar • Can understand some instructions and contexts short phrases without language only • Not responding to clues their name • Child using language • Has lost speech or in more ways e.g. not language skills just to ask for things • Not sharing attention or comment by pointing to or following point to things of interest • Attempts at words are unintelligible • Words used repetitively e.g. just to name items • Speech sounds ‘nasal’ and child may use ‘uh’, ‘m’ and ‘n’ a great deal DO NOT refer Monitor in home/setting Refer to Speech and
Language Therapy See SLT advice sheet;
‘Advice for Early years- Also see advice sheet/s; delayed language’ ‘Gesture’ BY 2½ YEARS • Using some two word • Has an increasing • Poor comprehension of phrases e.g. “Daddy vocabulary of single language shoe” words, but no signs • Few or no words used • Understands some yet of linking these. although other skills
questions e.g. “What?” • Comprehension of appear better (e.g. (‘is it’ and ‘doing’) language seems play, attention and • Understands basic good, but there are problem solving) instructions when concerns regarding • Vocabulary is not clues are absent e.g. number of single increasing or when “Put the bear on the words used new words are added chair” expressively others are lost. • Short ‘telegrammatic’ • Loss of language skills phrases used previously there. • Still most intelligible • Memorised speech to family and others used rather than 1 to 2 familiar with the child. word level phrases • Child can keep on a ‘made up’ by the child subject for a little • The child ‘echoes’ what while is said a great deal • Speech unintelligible to most, even close family • If the child is stammering • Child has varied speaking profile e.g. uses words to ‘chat’ at home, but is silent in early years setting
• Speech sounds ‘nasal’ and child may use ‘uh’, ‘m’ and ‘n’ a great deal DO NOT Refer Monitor in home/setting Refer to Speech and
Language Therapy
See SLT advice sheets ‘Advice for Early years- Also see advice sheet/s; delayed language’ ‘Dysfluency in the Early Years’ ‘Situational fear of talking’
‘Gesture’ By 3 YEARS • Producing two to • Little sign of/only a • Poor comprehension of three word phrases, few words linked, language e.g. “me want juice” but child appears to • Only saying single • Understands basic have better words, (or learnt position words such as development in phrases) although ‘on’, ‘in’ and ‘under’ other areas e.g. play other skills are good • Welcomes and or attention • Limited pretend play responds to adult • Not understanding • Cannot attend for suggestions most of more than basic longer than a few the time ‘what’ questions e.g. minutes • Child using language “where?” • Child is stammering to accompany play • Frequently • Child has varied • Some speech can be unintelligible to speaking profile e.g. difficult to understand, other people than uses words to ‘chat’ at but child is mostly close family home, but is silent in intelligible early years setting • Language used repetitively • Speech very unintelligible DO NOT Refer Monitor in home/setting Refer to Speech and
Language Therapy
See SLT advice sheets; ‘Advice for Early years- Also see advice sheet/s; delayed language’ ‘Dysfluency in the Early Years’ ‘Children who have unclear ‘Situational fear of talking’ speech- speech delay’ ‘Gesture By 4 YEARS • Utterances are • Child finding it • Noticeable difficulties developing to be at difficult to with comprehension of least 5-6 words long understand language and used questions • No evidence of 5-6 appropriately • Child has short word utterances • Child is developing phrases of up to 4 (although other skills knowledge of words good) concepts of size and • Child’s phrases are • Odd phrases; words shape developing but seem muddled • Child is intelligible to sound ‘young’ for • Unintelligible even to
most people the child’s age family most of the • In speech, ‘fricative’ • Child’s speech time. sounds, f v s z are sounds ‘young’ (may • Shows an unusual used but may be be accompanied by speech pattern, e.g. missed in blends e.g. immature language omits all initial ‘pider’ (spider) development). consonants, vowel
• The child may still • Child’s social skills abnormalities, over use have difficulty with sh, seem immature and of one consonant zh, ch and j sounds in line with general sound or mixes up • The sounds t and d developmental level sounds in words can be used for k and • Child uses odd or g (e.g. tar for car), up ‘sing-song’ intonation until around 3 ½ years pattern • ‘l’ may only be • Child has heightened developing by the end vocabulary in area of of this time frame too interest but poor • Child developing vocabulary in other ability to reason and areas report outside the • Child is not using ‘here and now’ about language for basic e.g. past events conversation • Child uses language repetitively • Child uses odd or ‘sing-song’ intonation pattern • Child is stammering • Child has varied speaking profile e.g. uses words to ‘chat’ at home, but is silent in early years/school setting • Child has significantly gruff or husky voice that does not change over time (gain referral to ENT prior to referral) DO NOT Refer Monitor in home/setting Refer to Speech and
Language Therapy
See SLT advice sheets; ‘Language comprehension’, Also see advice sheet/s; ‘Expressive language’ ‘Dysfluency in the Early Years’ ‘Children who have unclear ‘Situational fear of talking and speech- speech delay’ Selective Mutism’ ‘social communication skills for pre-school children’ BY 5 YEARS • Utterances are long • Child has intelligible • Severely unintelligible and appropriate but but has immature even in context. some grammatical sounding speech; • Significant features may still be sounds like a comprehension and /or incorrect younger child expressive language • Child links phrases • Child may have difficulties with ’and’ and later, immature expressive • Child seems to ‘because’ language and does understand very well, • Child may still have not understand as but has marked difficulty with sh zh ch well as others of difficulties with j but these should his/her age, but this expressive skills have developed by the seems part of the • Difficulties end of this age range child’s general level understanding • Blends with 3 of development instructions containing consonants will • Child may find more several key words or continue to be difficult complex position understanding for the child e.g. words difficult to question words, e.g., “splash” understand e.g. who/where/when/why • Child may have a lisp ‘behind’ • Child is mixing or slushy speech • Child has immature pronouns e.g. ‘he’ for • Child still uses ‘’w’ or a social skills and this ‘she’ or ‘you’ when similar sound for ‘r’ appears to relate to s/he means ‘me’ • Child uses ‘f’ or ‘th’ or the child’s • Child is not interacting ‘v’ for voiced (noisy) developmental level with peers ‘th’ • Child may talk repetitively and not be developing the usual two-way conversational abilities • Child is stammering • Child has varied
speaking profile e.g. uses words to ‘chat’ at home, but is silent in early years/school setting • Child has significantly gruff or husky voice that does not change over time (gain referral to ENT prior to referral) DO NOT Refer Monitor in home/setting Refer to Speech and
Language Therapy
See SLT advice sheets; ‘Language comprehension’, Also see advice sheet/s; ‘Expressive language’ ‘Dysfluency- school age’ ‘Children who have unclear ‘Selective Mutism’ speech- speech delay’ ‘Speech disorder’ ‘Social communication Skills ‘Articulation disorder’ for Primary School Aged Children BY 6-7 YEARS • Child is known to have developmental • Child has continued difficulties with delay and speech and language are producing intelligible speech or seems characteristic of the child’s to be stuck in a ‘young’ speech developmental age/level. pattern e.g. still uses ‘t’ for ‘k’ and ‘d’ • The child’s speech, language or for ‘g’ (see chart below) communication need can be targeted • Child unable to pronounce ‘r’ and ‘th’ through strategies, interventions and by age 6½ to 7 supportive practice within school e.g. • Child has unusual speech, may sound For immaturities in the child’s speech ‘slushy’ or ‘lispy’ (air escapes down and language that need the usual side of tongue or tongue slips out e.g. reminders e.g. ‘felled’ for ‘fell or for ‘s’) ‘catched’ for ‘caught’ • Child has nasal sounding speech For immature speech patterns • Child’s speech is unintelligible and/or For immature social skills, social children monitored by school at 4½-5 comprehension and inferential skills years who have not improved (when this is in line with the child’s • There are significant comprehension developmental level) and/or expressive language difficulties affecting access to the curriculum and
• For difficulties with 3 consonant the SLT’s assessment will be helpful blends or difficulties with ‘r’ or ‘th’ (please state if you feel the child’s before the ages detailed below skills in other areas are more • For Literacy difficulties e.g. reading advanced than in verbal language comprehension areas) • Child finds it very difficult to get his/her message across, possibly struggling to think of the words needed • Child does not have friendships or relate to peers as might be expected • May find it hard to make social judgments in communicative situations • Child may mis-read non literal language and implied meaning (can’t ‘read between the lines’) • Child is stammering • Child is silent or mostly silent in school, when parents/carers report a very different child at home • Child has gruff or husky voice not attributable to a cold
DO NOT refer or seek further information Refer to Speech and Language Therapy from SLTSee SLT advice sheets; ‘Speech delay’ Also see advice sheets; ‘Language comprehension’ ‘Speech disorder’ ‘Expressive language’ ‘Articulation disorder’ ‘Social communication, pre-school, school ‘Dysfluency- school age’ age and secondary school age’ ‘Selective Mutism’ ‘Higher level language difficulties’ ‘Word finding and vocabulary’
Average Speech and Language Development Sound Age sounds Examples of Sound substitutions in developing are usually sound in speech achieved by child’s (90%) speech p, b, m, w 3yrs 5mths Pop, baby, p may sound like b to begin with eg more, where peebee t, d, n 3yrs 5mths Two, daddy, t may sound like d to begin with eg to no do ng 3yrs 5mths sing Child may use /n/ e.g. sing sin up to the age of 5 k/c, g 3yrs 5mths Car, walk, go, Child may use /t/ /d/ instead until 3:11 bag eg cartar bag bad h 3yrs 5mths home /h/ may be left off initially eg home ome f ,v 3yrs 5mths fork, coffee, child may use p,b,t or,d until 3:06 eg off forkbork van, river, move s, z 3yrs 5mths Seesaw, bus, Child may use /t/or /d/ until 3:06+ zebra nose y 3yrs 5mths Yogurt, buying l 3yrs 11mths Light, balloon child may use ‘w’ or ‘y’ until 4yrs eg likewike Consonant 3yrs 11 months Spider, Child will reduce the consonant blend of blends eg flower, nest 2 sounds to 1 eg spider – pider or sider sp, fl, st basket sh, zh 4 yrs 11 mths Sheep, wash May use as /t/ or /d/ until 3:0 measure May use /s/ /z/after this until 5 yrs eg sheepseep ch, j/dg 4yrs 11 mths chip, watch May use as /t/ or /d/ until 4:0 jump, badge May use as /ts//dz/ until 5 yrs eg watchwats Consonant 5yrs 11 months split Consonant blends of 2 or 3 sounds blends of 3 including r e.g. , bread, spring may not consonants develop till age 6:05+ eg spl--- r 6 yrs 5 mths rabbit, carry Gliding: may present as /w/ or /y/ until 6:06 Eg rabbitwabbit th (θ) 7yrs+ thumb May use b then f/v until 7yrs e.g. th (ð) there thumbfum May use d until 4+ then v Quick reference: Referral guide to Children’s Therapy Services Paediatric Dietetics and Nutrition
Paediatric Dietetics and Nutrition Referral
Direct referal form Professional via Integrated Therapy Referral Form
Send to: [email protected] Or by post:
(Please see Children’s AHP Therapy Service Access Routes for York Selby, Scarborough Whitby, Ryedale Flow Chart in the Quick reference section.
Further information:
• For Scarborough, Whitby and Ryedale Dieticians Administrators call 01723 342415 • For York and Selby Dietician Administrators call 01904 725269 Quick reference: Referral guide to Children’s Therapy Services: Physiotherapy and Occupational Therapy
Physiotherapy and Occupational Therapy Referral
Professional Completes Integrated Referral Form
Does the child/ young person require a sensory profiling assessment ?
YES YOU MUST COMPLETE THE NO ADDITIONAL OCCUPATIONAL ASSESSMENT FORM
Send to: Send to: [email protected] [email protected] Or by post: Or by post: (Please see Children’s AHP Therapy Service Access (Please see Children’s AHP Therapy Service Access Routes for York Selby, Scarborough Whitby, Ryedale Routes for York Selby, Scarborough Whitby, Ryedale Flow Chart in the Quick reference section Flow Chart in the Quick reference section
Further information:
• For Scarborough, Whitby and Ryedale Occupational Therapy and Physiotherapy call 01723 342357 • For York and Selby Occupational Therapy and Physiotherapy call 01904 726599 From 1st June 2016 Scarborough/ Whitby Complete referral form and email to: yhs- OT/PT office no: Referral Access Routes Ryedale [email protected] 01723 342357 Childrens Therapy Therapy - Or send completed form to: Children’s Therapy Department, Physio /OT Scarborough General Hospital, Woodlands Drive, Scarborough, Teams York Teaching YO12 6QL Hospitals NHS
Foundation Trust York Scarborough Complete referral form and email to yhs- Office No York:
Whitby Ryedale [email protected] 01904 725269 Paediatric Or send to: Dietetics Department York Teaching Hospital NHS Office no Scarborough Dietetics Foundation Trust, Wigginton Road, York, YO318HE. 01723 342415 Acceptable Referral source:
GP Complete referral form and email to: yhs- Scarborough/ Whitby SLT office no: Paediatrician [email protected] Ryedale Other Healthcare Or send to: Beck House, 3 West Parade Road, Scarborough, Professional 01723 342472 Speech and Language YO125ED. Social Care Therapy colleagues
Education (SLT only) Complete referral form and email to yhs- York Selby Speech SLT office No: and Language [email protected] 01904 724366 Parental /self- Therapy Or send to Children’s Therapy Team, Child Development Centre referral is only York Teaching Hospital NHS Foundation Trust, Wigginton Road,
accepted for York, YO318HE. children under 5 for referrals to speech York and Complete referral form and email to yhs- Therapy Office No: Selby and language [email protected] 01904 726753 Or send to: Children’s Therapy Team, Child Development Centre Physio /OT York Teaching Hospital NHS Foundation Trust, Wigginton Road,
York, YO318HE.
Completed parental referral send form to: York SLT office Under 5’s 01904 724366 parental / Scarborough Whitby Ryedale parents send to: Beck House, 3 West Parade Scarborough Office self-referral Road, Scarborough, YO125ED 01723 342472 SLT only