Speech and language therapy for children

Please read this information carefully before making a referral:

What can we help with?

We can help with:

• Speech, language or communication needs that school/nursery have not been able to meet via the Graduated Response (see below for more details of this).
• Stammering (also known as stuttering), including in very young children. Please see this website for more information while waiting for assessment: www.stamma.org.
• Assessment of speech, language and communication needs as part of wider multi-professional Autism assessment.

We cannot help with:

• English as an Additional Language: If the difficulties only affect English, and the child can communicate as expected in their home language, please ask the school SENCo or Local Authority for help. You may also find this leaflet helpful: Supporting bilingual children
• Selective Mutism (SM): This is managed via a virtual multi-professional team under the Graduated Response. Please see the Derby and Derbyshire Selective Mutism Pathway and Toolkit here for more information and support: Derbyshire Selective Mutism & Derby City Council Selective Mutism. We can only accept referrals if there is evidence of an underlying speech, language or social communication need. This may include a stammer, speech disorder or social communication disorder.

Before you refer:

Where children are in an education setting, the first point of support for speech, language and communication is from the setting, via the Graduated Response.

Speech, language and communication needs (SLCN) fall under the Communication and Interaction strand of SEND (Special Educational Needs and Disability).

The Graduated Response is a national statutory framework for supporting SEND. It helps education settings to deliver the right support at the right time. The links below give more detail:

• Derbyshire Graduated Response
• Derby City Graduated Response

Universal level support: Settings should put support in place for all children in the class / setting.

Targeted level support: Settings should give additional support (smaller group or individual) for some children who have additional needs

Specialist level support: Settings should monitor the impact of targeted support. If the child / young person continues to make no or little progress despite evidence-based targeted support, settings can refer to specialist services (such as the SLT Service).

Who can refer?

Anyone can refer a child/young person to the service, including parents / guardians.

We are independent of the local authority. Referrals do not need to go through them.

The only exception to this is referrals as part of a multi-professional assessment for autism. Only Consultant Paediatricians or Clinical Psychologists may refer to us for this reason.

Parents:

Adults can often effectively support children with speech, language and communication needs at home and/or at school/nursery. Children do not always need a referral to the specialist speech and language therapy service.

Please discuss any concerns about speech, language and communication with your health visitor or school SENCo in the first instance. They should be able to give advice and support straight away. They will also decide what to do next and will contact us if they need more specialist advice.

If you are still very concerned after this, you can ring us on 0115 9512433 or email us at DCHST.SLTCentralReg@nhs.net to discuss your concerns with us. Please include your child’s full name, DOB, address and setting (if they attend) when contacting us.

Education professionals:

Communication and Interaction Graduated Response Toolkit:

We have developed a toolkit to help settings provide support for Communication and Interaction under the Graduated Response. This gives detailed advice about support for settings and families to provide in the first instance. We will check at referral that settings have followed this advice.

Families can also follow a lot of the advice in the toolkit, even if the child is not in an education setting.

The toolkit also explains when to consider referral to the specialist SLT service.

There is a separate version for each education phase. Please follow the advice in the relevant toolkit/s for your setting:

• Early Years
• Primary
• Secondary

Non-education professionals:

Please encourage parents to discuss any concerns with the setting SENCo in the first instance. They will know what to do.

If the child is not in a setting, please follow the process below to discuss the concerns with us.

The Graduated Response toolkits above also contain lots of advice that families can follow at home. You may wish to signpost parents/carers to the advice that is relevant for their child.

When you are ready to refer:

Parent consent

If you are not the parent or legal guardian, you need parental consent to refer a child to SLT. You must ensure the parent agrees with all the information you are giving us. You will be asked to confirm on the form that you have parental consent.

Discuss your concerns

Please contact your local SLT to discuss your concerns. If you don't know who this is, ring us on 0115 951 2433. We will ask the right SLT to ring you back.

We can only accept referrals without a discussion for:

• Stammering (stuttering)
  • You can ring us if you wish. Or you can fill in the referral form. Make sure you answer the stammering questions at the end.
• Multi-agency autism assessment.

  • Only Paediatrician/Clinical Psychologist can refer for this.

  • Please refer via Single Point of Access. Or fill in the referral form and tick the Autism multi-professional assessment box.

If we agree that a referral is needed, we will give you a unique reference number and ask you to fill in the children's SLT service referral form. You must quote the reference number on the form.

Email your completed form to dchst.sltcentralreg@nhs.net.

If you are a parent and you cannot access the internet, we can take a referral over the phone. Professionals must use the referral form.

Anyone can refer a child/young person to the service, including parents / guardians. We are independent of the local authority and referrals do not need to go through them.

We can help with:

We can help with eating, drinking or swallowing difficulties with a physical or medical cause. This includes difficulties chewing or coughing during or after meals.

For example, children with a physical disability like cerebral palsy may have trouble chewing and swallowing. Children with a respiratory condition may have trouble coordinating breathing and feeding/swallowing (even though they can chew).

We cannot help with:

Behavioural eating and drinking difficulties: 

If the main concern is food refusal or limited variety in the diet, please talk to the health visitor or school nurse. This includes aversion related to sensory preferences, such as not tolerating certain tastes or textures (for example liking purees but not liking lumpy foods).

If the main concern relates to a baby with gastro-oesophageal reflux (GOR) and/or a cow’s milk protein intolerance, please talk to the GP or paediatrician.

A note about coughing, gagging and choking.

These are often mistaken for each other which can cause unnecessary worry. They are each very different processes.

Coughing is noisy. It is a reflex using air to push food or fluid out of the airway. If the child is coughing they are breathing. Frequent coughing during or after meals or drinks may indicate a swallowing difficulty. Please contact us to discuss.

Choking is silent. The airway is completely blocked and no air (or noise) can get through. This can result in the skin going blue. Please see this page for advice: How to stop a child from choking - NHS (www.nhs.uk). If a child often chokes while eating solid foods, this may indicate a swallowing difficulty. Please contact us to discuss.

Gagging is usually noisy. It is a normal reflex as children learn to chew and swallow solid foods. They may make retching sounds. This page describes what gagging looks like and has a useful video. Choking and gagging on food - Start for Life - NHS (www.nhs.uk). Gagging is not harmful and is not a reason for referral to the SLT service.

This page has a useful description of gagging vs choking – scroll down to the section called Gagging and Choking How to introduce your baby to solid foods (derbyshirefamilyhealthservice.nhs.uk)

This page has lots of useful advice and information about helping children to wean:

Toddler nutrition (derbyshirefamilyhealthservice.nhs.uk)

To make a referral:

Parent consent

If you are not the parent or legal guardian, you need parental consent to refer a child to SLT. You must ensure the parent agrees with all the information you are giving us. You will be asked to confirm on the form that you have parental consent.

Making a referral

You can  refer for eating, drinking and swallowing assessment in any of the following ways:

• Complete and return the Eating and drinking before you refer sheet. Please fill in ALL boxes or we may need to return it to you.
• Ring 0115 9512433 – either an SLT will ring you back or we may send you a  prompt sheet to complete.
• Paediatricians may send a clinic / referral letter which includes specific details of the concerns and the specific SLT support needed. Please task us via SystmOne or email it to us at dchst.sltcentralreg@nhs.net.

When we have received the referral and added it to our system, we add the child to their local waiting list. A therapist will be in touch as soon as possible to collect further information  and/or arrange a visit.

At the first appointment:

If the child cannot attend

Please telephone us on 0115 951 2433 at least 2 weeks before the appointment.

Where will we see the child

We may see the child at school/nursery (if they attend), at home or in clinic. In some cases, we may use a video call - we will agree with parents or school/nursery whether this is suitable.

What will happen at the visit

We need a quiet, private space to assess the child and talk to parents and/or school staff about their concerns.

What we will assess

Depending on your concerns, we may assess the child’s:

• Speech (how they pronounce sounds and how clear their speech is)
• Language (the words and sentences they use and/or understand)
• Communication, incluiding social communication (how they use speech and language and/or other means to communicate with others).
• Eating, drinking and swalllowing skills 

How we will assess

Depending on the child’s needs and age, we may:

• watch them around the home, school/nursery or clinic room,
• talk to them,
• play with them,
• do a formal, paper-based assessment.
• watch them eat a meal or snack, and/or have a drink (for eating/drinking concerns)

We do formal assessments under ‘test conditions’, so please do not help the child (unless the SLT is trying out support techniques).

How long it will take

The visit may last between 30 and 90 minutes. This depends on what we need to assess and the child’s attention span. We may need to do another visit to get more information, or to see the child in a different setting.

What will happen next

We will agree the next steps with you, including any further support we need to give. We will send a short written report with details of what we found and what we agreed.

How we give support

This depends on the child’s needs. We may give:

• Advice to key adults* to help them support the child’s needs at home or school. Most children learn to communicate best when the adults around them every day use specific support strategies during everyday routines.
• A programme of therapeutic activities. Some children also need to do therapeutic activities to help them learn certain skills (like speech sounds, grammar or using electronic communication systems). They need an adult* to help them do these activities in short practice sessions regularly throughout the week.
• If needed, a speech and language therapy assistant (SLTA) or practitioner (SLP) can provide a small number of sessions to show key adult/s how to use support strategies or how to carry out therapeutic activities. The SLTA/SLP will agree with you how many sessions you need. It is very important for the key adult/s* to attend every session. If a key adult is not available, we will not be able to go ahead with the session.
• Direct therapy. A very small number of children with specific needs may need direct therapy from specialist SLT staff to help them learn very technical skills related to specific types of speech sound disorder. The number and frequency of sessions will depend on the child’s needs. The child will still need to practice with a key adult between direct therapy sessions, so a key adult must attend every therapy session.

*Key adults may be a class teacher, teaching assistant, nursery practitioner, SENCo, parent or carer.

What happens after that?

After giving advice, a programme or therapy, the next step may be:

Discharge 

This happens when we have given all the support we can at this time, and can give no new advice. This may be because:

• the child’s skills are as expected for their age or developmental stage,
• we expect the child's skills to keep developing with support from the adults around them,
• the child’s needs are being adequately supported and managed at home and/or at school,
• the child can communicate successfully for their needs in daily activities (with support if needed), or
• the necessary support from parents/other professionals is not available.

Once discharged, we can quickly re-open the child’s case if new concerns arise. Please ring us if this is the case.

Patient initiated follow up 

We ask parents or school/nursery staff to ring us if new advice or support is needed. We do this if we predict that the child's needs will not change in the short-term (within 3 months) and so new advice or targets will not be needed. If you do not ring us within 3 months, we will close the case.

Planned follow-up

We arrange specific time to review the child when we expect their needs to change quite quickly (within 3 months), meaning we will need to give new advice or targets quite soon. At the follow-up, we will agree the next steps after that (e.g. more advice, more input or discharge).

We try to agree any support and follow up with parents. However, the speech and language therapist will make the final decision, based on the clinical needs of the child.

What if my child attends a Special School?

This leaflet explains how we work with Special Schools.

How do I get in touch if I need to?

Ring 01773 525079 and leave a message with your child’s name and date of birth. The therapist will get back to you as soon as they can.

Information for schools

This site www.wholeschoolsend.org.uk/page/online-cpd-units offers free online training modules for school staff about all aspects of SEND, including several modules about speech, language and communication and how to get the most out of speech and language therapy.
 

General advice to help speech, language and communication development

• Activities to support language development in babies, toddlers and children - BBC Tiny Happy People
• Early language
• Language
• Speech sounds
• Speech sounds - typical development
• Speech - understanding what your child says
• Stammering
• Social communication - older children and young people
   

Autism and neurodevelopmental needs

Neuro-developmental pathway assessments (including autism and ADHD) - information about how to access neurodevelopmental assessments for children in Derby and southern Derbyshire.

Supporting older children and young people to manage social communication differences - a toolkit for older children and young people with social communication needs, their families and other professionals. The toolkit offers a wide range of information, advice and resources to support social communication needs (both in children and young people with autism and those without).

Derby & Derbyshire - Emotional Health & Wellbeing - support for wider needs related to neurodiversity. Click on the Neurodiversity tab.

Derbyshire Sensory Processing Toolkit  - the multi-agency toolkit for supporting sensory processing needs in Derbyshire, which guides settings to support children’s sensory processing needs day to day.

Building Communication in Children with Autism (hanen.org) -  specific advice and training for professionals and parents around managing communication needs for children in the early years.

National Autistic Society (autism.org.uk) - the UK's leading charity for people on the autism spectrum and their families, providing support, guidance and advice, as well as campaigning for improved rights, services and opportunities to help create a society that works for autistic people.

How to talk about autism - the service works with the Autistic community, parents/carers, providers and partners about the language we use and the services we provide. As part of this, we are sharing this link from the National Autistic Society about how to talk about autism as we know it can be confusing to know what language to use. It is always best to ask the person what they prefer. However, generally we aim to use positive language talking about ‘identity’ first - e.g. 'Autistic person' rather than 'person with Autism'. The latter can sound as though Autism is an illness or something you carry around. We won’t always get it right, but developing awareness is the first step to making changes.

Developmental Language Disorder

Developmental Language Disorder (DLD) is a hidden lifelong disability affecting around 2 children in every classroom. Children with DLD have significant difficulties understanding and/or using language, in every language they use. There is no single known cause of DLD. It is not caused by other conditions such as Autism or hearing loss, though children with these difficulties may also have a language disorder.

Children with DLD might:

• Use language in a way that sounds immature for their age
• Find it difficult to express themselves verbally and not talk as much as others
• Struggle to find the words they want to use in their sentences, or use lots of general words like ‘thingy’
• Have difficulty understanding what others say and following instructions
• Have trouble saying words in the right order, engaging in conversations and telling a story
• Have difficulty with reading, writing and discriminating between sounds in words
• Have difficulties with attention and listening

Useful links for information and advice about DLD

RADLD | Raising Awareness of Developmental Language Disorder – resources that explain what DLD is, the impact it can have, how to get help and how to raise awareness.

Speech and Language UK: Changing young lives - a charity whose mission is that no child should be left out or left behind because of a difficulty speaking or understanding. Their vision is a world where all children have the communication skills they need to fulfil their potential

Afasic - Afasic supports and provides information for families with children and young adults who have Speech Language and Communication Needs (SLCN) with a focus on Developmental Language Disorder (DLD).

DLD and me – an organisation aiming to raise awareness about developmental language disorder (DLD) and to offer support and resources for parents, teachers and individuals impacted by DLD.

The Hanen Centre | Speech and Language Development for Children - company offering advice and traing for parents and professionals around communicaiton development in the early years.

Hearing Impairment

Does my child need a speech and language therapist - a guide for parents of children with hearing difficulties

RNID - National hearing loss charity for the 12 million people in the UK who are deaf, have hearing loss or tinnitus.​​​​

National Deaf Children's Society  - the leading charity for deaf children no matter what their level or type of deafness or how they communicate

Stammering and dysfluency

We work in a ‘social model’ where we value children’s voices whilst supporting them with any communication needs they have. As part of this we want everyone to understand that stammered voices are valued, and that children can communicate effectively whether they stammer or not. Our approach includes:

•  ​​​​support for parents to feel comfortable and confident in their knowledge about stammering
•  how adults can influence your child’s environment to help them communicate effectively
•  helping children communicate confidently whether they are stammering or not

STAMMA (British Stammering Association) - STAMMA, the British Stammering Association, is dedicated to creating a world where people who stammer are able to fulfil their potential and enjoy respect and consideration

Bilingual children

Supporting bilingual children - advice to support parents and others to support children learning more than one language.

Charities and support organisations

The links below take you to websites that may give more information about your child’s individual needs.

Afasic - a charity helping children and young people with speech and language difficulties and their families.

Child brain injury trust

Cleft Lip & Palate Association - working to support, connect and empower everyone affected by cleft in the United Kingdom

Communication Trust  -  a campaigning voice for children with speech, language and communication needs.

Down's Syndrome Association (DSA) - information and support on all aspects of living with Down’s Syndrome for all who need it

Elklan - information and resources to support children’s speech and language development

Electronic Assistive Teachnology Service (EATS) - an NHS service supporting children with alternative and audmentative communication

Hanen Centre including information about More Than Words - a website for parents and educators of pre-school children

Headway - the brain injury association.

Nuffield Dyspraxia Foundation - information about verbal dyspraxia

Makaton - information on Makaton signing, resources and training.

Speech and Language UK -  a charity supporting children with speech and language difficulties.

Speech Link - information about the Speech Link and Language Link computer packages for screening and supporting children in school

Talking Point - information and resources for parents of children with communication difficulties and professionals working with them

Words for life (Talk to your baby)

SEND Support

The Local Authority Local Offer sites summarise help, advice and information about the services available for children and young people, from birth to 25 years, with a Special Educational Need or Disability (SEND):

Derby City Local Offer

Derbyshire Local Offer

SEND Information, Advice and Support Services provide independent information, advice and support to children and young people with special educational needs and disabilities (SEND), as well as their parents and carers.

Derby SEND Information & Advice Support Service (SENDIASS)

Derbyshire Information, Advice and Support Service for SEND

Parent Carer forums are led by parents/carers of children with SEND. They support parents/carers of children with SEND and help parents/carers have a voice about local SEND provision.

Derby City: Parent Carers Together C.I.C | Facebook

Derbyshire: Parent Carer Voice

Contact - for families with disabled children, is a charity supporting families of disabled children. Their freephone helpline is: 0808 808 3555

Special Schools and SLT

This leaflet explains how we work with Special Schools.

Specific support and therapy approaches

The sites and documents below give further information about specific support and therapy approaches that your SLT may recommend.

The information on these sites is not intended to be instructional – if you need help with using the approaches, please ask your therapist.

Please only use these approaches if your SLT has specifically advised you to do so.  Using non-recommended approaches may cause harm.

• Attention Autism
• Comic Strip Conversations
• Intensive Interaction
• Intensive Interaction factsheet
• Lego™ Therapy
• Objects of reference
• Social Stories^TM
• Supporting older children and young people to manage social communication difficulties 
• Stammering information and advice - STAMMA
• Stammering information and advice - Action for Stammering Children