Speech and language therapy referral guidelines - 4 years to 4 years, 11 months

Refer to SLT if… 

• Referrer has accessed and implemented the following targeted support for 3 months and there has been no/minimal progress: 
  • FOLLOW - Top Tips for Talking Webinar and FOLLOW postcard
  • if child is school age, setting to have implemented activities and strategies to support specific language needs through ‘Assess, Plan, Do, Review’ process 
  • if child is school age, setting to have accessed and implemented targeted language groups or other structured language interventions such as NELI (Nuffield Early Language Intervention) or Wellcomm.  
• AND child has difficulty with  more than one of the following:
  • understanding instructions containing 3 key words, for example, ‘give Jack the big ball', ‘give Sophie the little car’, ‘point to the black cat’s tail’, ‘make teddy jump on the bed’ or ‘make spider walk on the table’, when you are not looking or pointing at the same time 
  • understanding a range of words e.g. action words, body parts, animals, food, clothes and transport  
  • understanding ‘what’, ‘where’ and ‘who’ questions in conversation and play, for example, ‘what shall we eat?’ ‘what is he doing?’ ‘where do we sleep?’ or ‘who is hiding?’  
  • understanding concepts: size (for example, ‘long,’ ‘tall’), space, (for example, ‘front’, ‘next to’), comparison, (for example, ‘same’)     
  • understanding language that has an impact at home or in nursery or school. 

Refer to Speech and Language Therapy, if: 

• Referrer has accessed and implemented the following targeted support for 3 months and there has been no/minimal progress: 
  • FOLLOW - Top Tips for Talking Webinar and FOLLOW postcard
  • If child is school age, setting to have implemented activities and strategies to support specific language needs through ‘Assess, Plan, Do, Review’ process 
  • If child is school age, setting to have accessed and implemented targeted language groups or other structured language interventions such as NELI (Nuffield Early Language Intervention) or Wellcomm
• AND the child has difficulty with more than one of the following:
  • putting words together to make a full sentence, for example, ‘Mummy go shop’ instead of ‘Mummy is going shopping’, or with correct word order ‘whistle man’ instead of ‘the man is blowing a whistle’
  • limited use of verbs and overuse of empty verbs such as ‘do’, ‘get’, e.g. ‘girl do football,’ (instead of girl kicking football) ‘Daddy get flowers’ (instead of Daddy buying flowers)
  • does not copy and learn new words or cannot remember the words they want to say 
  • telling you about something that has happened to them
  • re-telling a simple story, for example, while looking through a familiar book
  • not being able to make themselves understood due to difficulties with selecting words and forming sentences to express their needs and ideas leading to frustration

Refer to SLT if… 

• Referrer has accessed and implemented the following targeted support for 3 months and there has been no/minimal progress: 
  • JOIN Webinar and JOIN postcard 
  • Say, Show, Wait Webinar
• AND the child has any of the following:
  • minimal interactions with familiar adults e.g. not seeking them out, not initiating or responding to them during an interactive game such as peek a boo
  • is not using a communication system (in other words, spoken words/phrases, sign, pictures or symbols) with a key adult 
  • is not communicating for a variety of reasons (for example rejecting, requesting, responding, commenting, self advocate)  
  • is not having conversations about topics of interest to them.

Refer to SLT if… 

• Referrer has accessed and implemented advice from the Speech Sound webinar and postcard for 3 months and there has been no/minimal progress.   
• Referrer has completed the speech screen (either the word document or PDF version).
• Adults find it difficult to understand what the child/young person is saying.
• AND the child is having any of the difficulties below:
  • misses out or swaps sounds with other sounds, for example, on speech screen they may say “dun” for “sun” / “ta” for “tap” 
  • behaviour/confidence/participation due to impact of speech sound difficulties
  • says the same word in a different way every time. For example, fish may be said as “fis”, “pish”, “bi”. E.g. baby may be said as “gaygee”, “bay-ee”, “baydee”
  • only using one or two consonants e.g. if trying to say “teddy fall over” they say “deddy dall oder”
  • vowel errors, for example, says “taddy" for "teddy” or “mer” for “more” (not due to any accent differences)
  • Only using vowels, for example, “ar” for “car” “eh” for “bed”, “uh-ee” for “mummy”, “uh-er” for “jumper”.
• OR the child has cleft related speech concerns and referral is from a specialist cleft centre or other relevant professionals or the child has cleft related speech errors or nasal speech in the absence of identified cleft palate (speech sound webinar/postcard and speech screen do not apply for cleft related referrals).