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A referral form for the Social Communication Pathway (SCP) in Manchester, UK. It is intended for parents and guardians of children who have concerns about their social communication development. The form asks for detailed information about the child, including their background, medical history, and social and communication difficulties. The SCP is a multidisciplinary team made up of professionals from Child and Adolescent Mental Health Services, Speech and Language Therapy, Occupational Therapy, Community Paediatrics, and Community Child Health and Educational Psychology. The team uses the information provided in the form to decide whether the child would benefit from a social communication assessment or if further assessment in another area is required.
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` SOCIAL COMMUNICATION PATHWAY (SCP) PARENT INFORMATION TO REQUEST ASSESSMENT Please return this form to the Carol Kendrick Centre, Stratus House, Southmoor Rd, Wythenshawe, Manchester M23 9XD The Social Communication Pathway is primarily for children with significant social communication needs, particularly those who might have autism. Children can have Social Communication difficulties for different reasons. For example, children might struggle with social communication if they have a learning disability or a language disorder, have experienced some trauma or fit criteria for a diagnosis such as ADHD or Developmental Co-ordination Disorder, This form helps us decide whether your child’s social communication difficulties might need an autism assessment. The Social Communication Pathway is a virtual team made up of practitioners from Child and Adolescent Mental Health Services; Speech and Language Therapy; Occupational Therapy; Community Paediatrics and Community Child Health and Educational Psychology. By filling in this form, you are helping this team decide if the Social Communication Pathway is the right pathway for your child. Try to fill in all sections of this form and give examples wherever possible. The information you provide is really helpful to us. If you need any help with filling in this form, please ask someone who knows your child well to help you to complete it. (E.g. your health visitor, teacher) Once your form and the one from school are received, the Social Communication Pathway team will consider all the information and let you know if they think the pathway is the right assessment for your child, or if something else is required (e.g. their learning needs or their language need more assessment first)
Child/Young Person’s Name : Date of Birth : Ethnicity: Address: School/Nursery/Child Minder : Year Group: Your Name: Address: Relationship to child: GP Name: Address: Does this child have English as an additional language? YES/NO If yes, what is their first language? If yes, please comment on their level of English acquisition
Frequently Asked Questions
1. Does a referral to this team mean that my child has autism? No, it does not necessarily mean your child has autism. Children can have Social Communication difficulties for different reasons e.g. developmental trauma, ADHD, learning disabilities or global developmental delay; language or co-ordination disorders. This assessment will help you to find out why you child might be slower to develop their social communication skills than other children their age. The pathway is for children where there is a question mark about whether their difficulties fit the criteria for an autism diagnosis but referral here does not mean that they have this diagnosis. 2. Where do I send the forms to? You send the forms to the SCP, Carol Kendrick Centre, Stratus House, Southmoor Rd, Wythenshawe, Manchester, M23 9XD 3. What happens after I send in the forms? Once your information and the information from school or nursery is received, the multiagency Social Communication Pathway team will review this information. They will also look at any reports on your child’s health record (e.g. those from Community Paediatricians, Speech and Language Therapists, Occupational Therapists etc) or reports that have been completed by One Education (but only if you have signed this form to say we have permission to look at these). The team decides if the information it has does suggest that your child would benefit from a social communication assessment or if this does not seem a good fit. If it sounds as if your child has another condition not assessed by this team, we may refer your child to the service that can help them. Someone from the team will inform you by phone or in a letter what the outcome of this meeting is. The team meet every week.
Has your child or young person had any support from any of the following professionals? (tick as appropriate) Please tell us the name of any professional you know who sees your child. Please send any reports from professionals with this referral form. Professional Name Contact details Educational Psychology Children’s Services (Children Families and Social Care) Child and Adolescent Mental Health Services (CAMHS) Children and Parents Service CAPS Paediatrician Rodney House Outreach Service (RHOSEY) Health Visitor or School Nurse Occupational Therapy Physiotherapy Speech and Language Therapy Other Does your child receive any additional help in school/nursery? YES/NO If YES, please give any details ………………………………………………………………………………………………………………… …………………………………………………………………………………………………
SOCIAL INTERACTION (Getting on with children and adults) Give a description of any difficulties your Child or young person has with getting on with other children or with adults.
COMMUNICATION (Talking/understanding/use of gestures/listening) Please give a description of any difficulties your Child and young person might have with communication If English is your child’s second language, please comment on communication in their first language
How does your child manage unexpected changes in routine?
Please give a brief description if your child or young person has any differences in sensory processing. (hearing, touch, smell, taste, vision, movement) Have you noticed any repetitive movements? E.g. Rocking, tapping or making noises?
When did you first notice that your child had difficulties? Was there anything else important happening at school or home at this time?
What does your child or young person like? What has helped to support your Child and young person? What has not worked well to help your child and young person?